Usefulness of Cognitive Dysfunction in Heart Failure to Predict Cardiovascular Risk at 180 Days

Gelow, Jill M.; Mudd, James O.; Chien, Christopher; Lee, Christopher S.

doi:10.1016/j.amjcard.2014.12.040

Cited by 25 publications

(20 citation statements)

References 29 publications

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“…However, younger HF patients are at risk for cognitive impairment. Cognitive impairment has been associated with poor outcomes in HF patients [6,10,36]. In addition, cognitive impairment in HF patients may limit a patient’s ability to actively manage their heart failure (i.e., self-care) [37,38].…”

Section: Discussionmentioning

confidence: 99%

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Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population

et al. 2016

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BackgroundThe association of hyponatremia with cognitive impairment and mobility in heart failure (HF) patients is unknown. The purpose of this study was to determine if hyponatremia is associated with cognitive and mobility impairment as measured by simple, validated, and time-sensitive tests.Material/MethodsThis was a prospective study in patients with reduced and preserved ejection fraction (HFrEF, HFpEF) seen in outpatient HF clinics. Hyponatremia was defined as sodium level ≤136 mEq/L. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) tool, and mobility was measured with the Timed Up and Go test (TUG-t).ResultsA total of 121 patients were evaluated; 30% were hyponatremic (134±1.9 mEq/l, range 128–136 mEq/l). Overall, 92% of hyponatremic patients had cognitive impairment (MoCA <26) compared to 76% of the non-hyponatremic patients [relative risk 1.2 (confidence interval: 1.02–1.4, p=0.02)]. In regard to mobility, 72% of hyponatremic patients and 62% of non-hyponatremic patients (p=0.4) had TUG-t times that were considered to be worse than average. A total of 84% (N=76) of HFrEF and 71% (N=22) of HFpEF patients had cognitive impairment (p=0.86). HFrEF patients had significantly lower overall MoCA scores (21.2±3.7 vs. 23.3±3.6, p=0.006) and similar TUG-t times compared to HFpEF patients.ConclusionsMost heart failure patients (HFrEF and HFpEF) seen in an ambulatory setting had impairment of cognitive function and mobility, with a higher prevalence among those with hyponatremia. Screening can be done using tests that can be administered in a clinical setting.

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Section: Discussionmentioning

confidence: 99%

“…Hyponatremia is also a frequent finding in patients with HF, with prevalence rates ranging from 8% to 28%, depending on HF severity, and is a marker for poor outcomes [7–10]. Most commonly, hyponatremia observed in HF patients is chronic in nature and mild-to-moderate in severity.…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population

et al. 2016

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“…For this reason, cognitive impairment in HF can negatively affect symptom relief, adherence to therapeutic regimens, quality of life, and clinical outcomes [1,8]. Despite its high prevalence and negative consequences, cognitive impairment in HF patients is usually underestimated by patients and healthcare professionals [9,10].…”

Section: Introductionmentioning

confidence: 99%

Combined Influence of Depression and Physical Frailty on Cognitive Impairment in Patients with Heart Failure

Lee

Won

Son

2018

IJERPH

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Cognitive impairment is a prevalent condition and important barrier to self-care behaviors in patients with heart failure (HF). HF patients with depression or physical frailty are more likely to have reduced cognitive function. However, it remains unclear if combined depression and physical frailty increased the risk of cognitive impairments among HF populations. This study aimed to identify the influence of combined depression and physical frailty on cognitive impairments in HF. This cross-sectional study was included 289 patients with HF in outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained patients’ characteristics including depression, physical frailty, and cognitive function with Korean validated tools using a face-to-face interview. The prevalence rate of cognitive impairment was approximately 27.3% in HF outpatients. We found that the combined influence of depression and physical frailty increased the risk of cognitive impairments in both unadjusted (odds ratio (OR) 4.360; 95% confidence interval (CI) (2.113, 8.994)) and adjusted models (OR 3.545; 95% CI (1.448, 8.681)). Our findings highlight that healthcare professionals need to be more aware of the vulnerable population who suffer from both depression and physical frailty at the same time. Future prospective studies should examine the causal relationships among depression, physical frailty and cognitive impairment during the HF illness trajectories.

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“…The Montreal Cognitive Assessment (MoCA) is commonly used in research as a multicategorical measure of cognitive function and is more sensitive than other measures such as the Mini-Mental State Examination [7]. Among HF patients, research suggests that reduced scores on the MoCA are an independent predictor of cardiovascular event risk at 6 months, even after adjusting for HF severity and comorbidity (hazard ratio 1.7) [8]. …”

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confidence: 99%

Differential Peripheral Inflammatory Factors Associated with Cognitive Function in Patients with Heart Failure

Redwine

Pung

Wilson

et al. 2018

Neuroimmunomodulation

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Objective: Cognitive deficits are common in patients with heart failure (HF), and can negatively affect self-care, predict rehospitalizations, and increase mortality rates 5-fold. Inflammation can produce vascular pathology, reducing cerebral blood flow to brain regions necessary for optimal cognitive function. The purpose of the investigation was to identify a pattern of peripheral blood inflammation-related biomarkers associated with cognitive impairment in patients with HF. Methods: Forty-five outpatients (median age = 67 years, SD = 9.9) were recruited from University of California, San Diego (UCSD) and Veterans Affairs San Diego Healthcare Systems (VASDHS), diagnosed with New York Heart Association Stages I–III HF. Participants were administered the Montreal Cognitive Assessment (MoCA) as a measure of global cognitive impairment, and blood was analyzed for plasma biomarkers, interferon-γ, tumor necrosis factor-α (TNFα), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), brain-derived neurotrophic factor (BDNF), interleukin-8 (IL-8), matrix metallopeptidase-9 (MMP-9), IL-6, C-reactive protein (CRP), and serum amyloid-A (SAA). Results: Almost half the patients scored below the threshold on the MoCA, indicating at least mild cognitive impairment. A factor analysis produced three biomarker factors: vascular inflammatory factor-1: TNFα, sICAM1, sVCAM1; neuroinflammatory factor-2: BDNF, MMP-9, IL-8; peripheral inflammatory factor-3: IL-6, CRP, SAA. Only vascular inflammatory factor-1 was significantly associated with cognitive function (MoCA) (ΔR² = 0.214, beta = –0.468, p = 0.008). Conclusions: In this cohort with HF, vascular inflammation appears related to poorer cognitive function. This could indicate targets for treatment to reduce cognitive deficits in HF. However, this is a preliminary study, and further research is needed.

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Usefulness of Cognitive Dysfunction in Heart Failure to Predict Cardiovascular Risk at 180 Days

Cited by 25 publications

References 29 publications

Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population

Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population

Combined Influence of Depression and Physical Frailty on Cognitive Impairment in Patients with Heart Failure

Differential Peripheral Inflammatory Factors Associated with Cognitive Function in Patients with Heart Failure

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