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Minerva Psichiatrica 2010 March;51(1):53-71


language: English

Cognitive impairment in heart failure: a review of the literature and an analysis of a community sample of elders aged 70 and older

Turvey C. L. 1, 2, Johnson F. 1, Beglinger L. J. 1, Schultz S. K. 1, Scovel P. 3, Smith L. 3, Stewart T. 3

1 Department of Psychiatry, University of Iowa, Iowa City, IA, USA 2 Center for Research in the Implementation of Innovative Strategies in Practice, VA Iowa City, VA Health Care System Iowa City, IA, USA 3 University of Iowa Heart Failure Treatment Center, Iowa City, IA, USA


Heart failure (HF) is one of the most debilitating chronic illnesses in late-life. Though the relation between HF and kidney and liver function has been well-examined, the relation between cognitive impairment (CI) and HF has received less attention. This study reviews some of the major studies examining this relationship. It then provides data on the relation between CI and HF in a large community-based study of elders aged 70 and older. A descriptive topical review of prior studies of CI and HF is provided. Data is presented from the Asset and Health Dynamics among the Oldest Old (AHEAD) study, a community-based study in the United States (N=7023). Participants provided information on demographic, health, and functional variables. They also completed a brief battery of cognitive function based on the Mini-Mental State Exam and the Telephone Interview for Cognitive Status. Participants too frail to participate could designate a proxy interviewee to complete all assessments except assessment of mood and cognitive performance measures. However they did provide global estimates of the participants’ cognitive function. There was a strong and graded association between cognitive function and cardiac condition where those with HF performed worse than those in with other cardiac conditions and those with no cardiac conditions. In a full multivariate model, the association between cardiac condition and Total Cognitive Score on the performance measures was no longer statistically significant, yet the association remained robust when report of activities of daily living and instrumental activities of daily living were the main outcomes. Proxy reporters indicated that HF participants demonstrated more impairment in organization than the other two study groups, yet they did not report differences in memory function. There is an association between cognitive function and HF, but the association may not be evident when controlling for key covariates and the sample includes people with mild heart failure. More severe heart failure patients may not be able to complete cognitive performance measures which suggest that prior studies have underestimated severity of impairment in later stages of HF. CI in HF appears to affect domains broader than what is seen in dementias commonly described as cortical, such as in Alzheimer’s disease.

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