Heart Failure and Cognitive Impairment: Breaking It Down

Higher estimated levels of premorbid intelligence suggest that cognitive reserve could play a key role in moderating the adverse effects of heart failure.


Patients with heart failure (HF) often have cognitive impairment, but not all cognitive impairment in patients with HF is the same, say researchers from Case Western Reserve University and University Hospitals, both in Cleveland, Kent State University, and Akron City Hospital, all in Ohio. Patients tend to fall into 1of 3 distinct groups: (1) globally intact; (2) impaired; and (3) memory impaired. Those profiles, the researchers say, may reflect unique mechanistic pathways as well as different cognitive outcomes.

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The largest proportion (37.4%) were patients who were globally impaired across attention, executive functioning, and memory abilities. The researchers say that broadly fits with the pattern seen in patients with vascular disease. In contrast, 29.5% of patients exhibited intact performance in attention and executive functioning but deficits on memory tasks. The final 33.1% of patients demonstrated relatively intact functioning, but the researchers note that this group may have been assessed earlier in the HF disease process and “will likely demonstrate greater cognitive impairments over time.”

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Those classified as belonging to each profile did not differ in overall medical comorbidity, vascular or pulmonary disease, depression, or anxiety symptoms. Women were more likely than were men to exhibit intact cognitive function, which could relate to protective factors that grant women better prognoses and survival in HF. Patients with HF with intact cognition also had higher estimated levels of premorbid intelligence, which could suggest that cognitive reserve plays a key role in moderating the adverse effects of HF.

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The researchers argue for better screening to help target patients who might otherwise be overlooked. In particular, they’re concerned about patients with memory impairment who have a higher risk of conditions such as Alzheimer disease, because they tend to be older than the patients in the other 2 profiles.

Hawkins MAW, Schaefer JT, Gunstad J, et al. Appl Nurs Res. 2015;28(2):186-191.
doi: 10.1016/j.apnr.2014.10.005.

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