Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure

Zuccalà, Giuseppe; Onder, Graziano; Marzetti, Emanuele; Monaco, Maria Rita Lo; Cesari, Matteo; Cocchi, A; Carbonin, Pierugo; Bernabei, Roberto

doi:10.1093/eurheartj/ehi058

Cited by 116 publications

(83 citation statements)

References 40 publications

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“…27 The beneficial influence of HF treatment on cognition processes including angiotensin-converting enzyme inhibitors, diuretics, digoxin, cardiac resynchronisation therapy and heart transplantation were reported. [28][29][30][31] Clinical trials 32 Non-pharmacological measures, such as physical activity, are also important and have been identified to have beneficial effects on cognition as well as protective benefits on brain plasticity in vascular CI and related conditions. 33,34 The main task for physicians is to identify patients with early stages of CI in order to start corrective measures as soon as possible and also manage patients at risk of CI.…”

Section: Importance Of Cognitive Decline For Prognosis and Self-carementioning

confidence: 99%

Cognitive Decline in Heart Failure: More Attention is Needed

Čelutkienė

Vaitkevičius

Jakštienė

et al. 2016

Cardiac Failure Review

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To ensure performance of everyday tasks, adherence to treatment regiments, appointments, and following dietary requirements, cognition is crucial.1 Cognitive impairment (CI) is a broad and inclusive term used to describe dysfunction of processes in various cognitive domains, such as attention, memory, judgment, reasoning, decision-making and problem solving, comprehension and production of language. Prevalence and Pathogenic MechanismsEvidence is mounting that impaired cardiac function may precipitate early-onset CI. Reported prevalence 2-8 of cognitive dysfunction in the heart failure (HF) population parallels the severity of HF, being the highest in the acute decompensation settings (see Table 1).Multiple factors contributing to cognitive decline in HF are presented in Figure 1. Hypertension is found to be independently associated with CI 9,10 through compromise in auto-regulation of cerebral blood flow and cerebral ischaemia (see Figure 2). Neuroimaging has revealed structural brain abnormalities (see Cognitive Domains and Assessment ToolsThe severity of CI may range from mild symptoms to advanced dementia. Mild CI is a commonly used definition for a clinical syndrome in which a patient has subjective complaints as well as objective symptoms of cognitive decline (measured by neuropsychological tests), though daily functioning of the patient is mostly intact.11 It is established that patients with mild cognitive impairment have an increased risk of progression to dementia. 12,13 Dementia is characterised by a progressive impairment in more than one cognitive domain, and compromised daily functioning is evident.Most of the HF patients suffer from mild impairment in cognition, but some of them may have moderate-to-severe CI.13 Heart failure adversely affects various cognitive domains, including attention, learning ability and working memory, executive functions, and information processing speed (see Figure 4). [13][14][15] Cognitive impairment in HF patients usually fulfils the criteria of vascular CI or vascular dementia. 16Being one of the most important cognitive functions, episodic memory of specific personal events and experiences was demonstrated to slowly decline in HF patients. 5,13,14,17 Furthermore, deficits in initial learning as well as delayed information recall were reported in the literature. 17 This suggests that CI in HF patients and CI in patients with vascular dementia could share pathophysiological mechanisms.18 Deficits in executive functioning (problem solving, planning, reasoning and flexibility) have a AbstractCognitive decline is a prevalent condition and independent prognostic marker of unfavourable outcomes in patients with heart failure. The highest prevalence, up to 80 %, is reported in patients hospitalised due to acute decompensation. Numerous factors contribute to cognitive dysfunction in heart failure patients, with hypertension, atrial fibrillation, stroke and impaired haemodynamics being the most relevant. Cerebral hypoperfusion, disruption of blood-brain barrier, oxidative da...

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Section: Importance Of Cognitive Decline For Prognosis and Self-carementioning

confidence: 99%

Cognitive Decline in Heart Failure: More Attention is Needed

Čelutkienė

Vaitkevičius

Jakštienė

et al. 2016

Cardiac Failure Review

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show abstract

“…Observational data suggest that ACE inhibitor use in elderly heart failure patients may preserve cognition, slow functional decline, and reduce hospitalizations and perhaps even mortality, even in patients with relative contraindications, such as mild to moderate renal impairment (137)(138)(139). The beta-blocker nebivolol has been studied in 2128 patients 70 years of age or older with clinical evidence of heart failure regardless of ejection fraction (140).…”

Section: Recommendationsmentioning

confidence: 99%

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

Arnold¹,

Liu²,

Demers³

et al. 2006

Canadian Journal of Cardiology

363

256

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“…8 Researchers in HF have focused on understanding the etiology of cognitive dysfunction, 7,10 describing domains of cognitive impairment 1,6,7 and measuring improvements in cognition after interventions such as heart transplantation, [11][12][13] heart assist device implantation, 14 and medications such as angiotensin-converting enzyme inhibitors in persons with endstage HF. 15 Vogels et al suggested increased awareness of the prevalence of cognitive impairment in its early stages. 3 They advocated early screening to help preserve and improve quality of life for persons with HF.…”

mentioning

confidence: 99%

Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failure

et al. 2011

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Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure

Abstract: Treatment with ACE-inhibitors might selectively improve cognitive performance in patients with heart failure. However, up-titration of these agents might be required to yield the greatest benefit.

Cited by 116 publications

References 40 publications

Cognitive Decline in Heart Failure: More Attention is Needed

Cognitive Decline in Heart Failure: More Attention is Needed

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failure

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