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Kim J, Shin MS, Hwang SY, Park E, Lim YH, Shim JL, Kim SH, Kim YH, An M. Memory loss and decreased executive function are associated with limited functional capacity in patients with heart failure compared to patients with other medical conditions. Heart Lung 2018; 47:61-67. [DOI: 10.1016/j.hrtlng.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/28/2022]
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Abstract
PURPOSE OF THE REVIEW The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care. RECENT FINDINGS Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.
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Shin MS, An M, Kim S, Shim JL, Park JK, Kim J. Concomitant diastolic dysfunction further interferes with cognitive performance in moderate to severe systolic heart failure. PLoS One 2017; 12:e0184981. [PMID: 28977012 PMCID: PMC5627914 DOI: 10.1371/journal.pone.0184981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/04/2017] [Indexed: 01/07/2023] Open
Abstract
Background Studies of the relevance of cardiac functional markers to cognitive performance in heart failure (HF) have primarily focused on systolic markers. In this study, we examine whether concomitant diastolic dysfunction further interferes with cognitive performance in memory, attention, and executive function in patients with HF. Methods and results In this cross-sectional correlational study, 82 patients completed face-to-face interviews for neuropsychological testing for cognitive evaluation. Echocardiographic data were obtained from a review of medical records. Mild to moderate (ejection fraction [EF] ≥ 30%) and severe (EF < 30%) systolic dysfunction were present in 55 (67.1%) and 27 (32.9%) patients, respectively, while 21 (26.3%) had diastolic dysfunction (E/e′ > 15). Those patients who had severe systolic dysfunction had significantly lower attention scores (Digit Span Test [DST] backward, t = 2.62, p = 0.011), while those with concomitant severe diastolic dysfunction had significantly lower verbal fluency (t = 2.84, p = 0.006) and executive function (Korean-Trail Making Test Part B) (t = -2.14, p = 0.036) scores than those without severe diastolic dysfunction. After controlling for age and education, systolic patients with HF with concomitant severe diastolic dysfunction had worse cognitive performance in verbal fluency than those without severe diastolic dysfunction (F = 4.33, p = 0.041, partial eta = 0.057). Concomitant moderate to severe systolic and severe diastolic dysfunction further reduced verbal fluency (F = 8.42, p = 0.005, partial eta = 0.106). Conclusions Cognitive performance, particularly executive function, was worse in patients with HF with systolic dysfunction when diastolic dysfunction was concomitantly present. Routine monitoring of and surveillance for diastolic dysfunction and cognitive screening are warranted in the management of patients with HF.
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Affiliation(s)
- Mi-Seung Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwang-ju, Korea
| | - Sunhwa Kim
- Department of Nursing, Doowon Technical University, Seoul, Korea
| | - Jae Lan Shim
- Department of Nursing, Doowon Technical University, Seoul, Korea
| | - Jin-Kyu Park
- Department of Internal Medicine Hanyang University Medical Center, Seoul, Korea
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, Korea
- * E-mail:
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Randomized Crossover Study of the Natural Restorative Environment Intervention to Improve Attention and Mood in Heart Failure. J Cardiovasc Nurs 2017; 32:464-479. [DOI: 10.1097/jcn.0000000000000368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Roy B, Woo MA, Wang DJJ, Fonarow GC, Harper RM, Kumar R. Reduced regional cerebral blood flow in patients with heart failure. Eur J Heart Fail 2017; 19:1294-1302. [PMID: 28560737 DOI: 10.1002/ejhf.874] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/13/2017] [Accepted: 04/04/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS Heart failure (HF) patients show significant lateralized neural injury, accompanied by autonomic, mood and cognitive deficits. Both gray and white matter damage occurs and probably develops from altered cerebral blood flow (CBF), a consequence of impaired cardiac output. However, the distribution of regional CBF changes in HF patients is unknown, but is an issue in determining mechanisms of neural injury. Our aim was to compare regional CBF changes in HF with CBF in control subjects using non-invasive pseudo-continuous arterial spin labelling (ASL) procedures. METHODS AND RESULTS We collected pseudo-continuous ASL data from 19 HF patients [mean age 55.5 ± 9.1 years; mean body mass index 27.7 ± 5.3 kg/m2 ; 13 male) and 29 control subjects (mean age 51.4 ± 5.3 years; mean body mass index 25.7 ± 3.6 kg/m2 ; 18 male), using a 3.0-Tesla magnetic resonance imaging (MRI) scanner. Whole-brain CBF maps were calculated, normalized to a common space, smoothed and compared between groups using ANCOVA (covariates; age, gender and gray matter volume). Reduced CBF appeared in multiple sites in HF patients in comparison with controls, with principally lateralized lower flow in temporal, parietal and occipital regions. Areas with decreased CBF included the bilateral prefrontal, frontal, temporal and occipital cortex, thalamus, cerebellum, corona radiate, corpus callosum, hippocampus and amygdala. CONCLUSIONS Heart failure patients showed lower, and largely lateralized, CBF in multiple autonomic, mood and cognitive regulatory sites. The reduced CBF is likely to contribute to the lateralized brain injury, leading to the autonomic and neuropsychological deficits found in the condition.
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Affiliation(s)
- Bhaswati Roy
- School of Nursing, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mary A Woo
- School of Nursing, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Danny J J Wang
- Departments of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ronald M Harper
- Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Rajesh Kumar
- Brain Research Institute, UCLA, Los Angeles, CA, USA.,Anaesthesiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Radiological Sciences and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Bioengineering, and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 2016; 22:1-11. [DOI: 10.1007/s10741-016-9587-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pressler SJ, Harrison JM, Titler M, Koelling TM, Jung M, Dorsey SG, Bakoyannis G, Riley PL, Hoyland-Domenico L, Giordani B. APOE ε4 and Memory Among Patients With Heart Failure. West J Nurs Res 2016; 39:455-472. [DOI: 10.1177/0193945916670145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Twenty-three percent to 50% of heart failure (HF) patients have memory loss. Objectives were to (a) characterize major allelic frequency of 2 variants in apolipoprotein ( APOE) gene in HF patients, (b) evaluate differences in memory and serum brain-derived neurotrophic factor (BDNF) levels based on APOE ε4 allele(s), and (c) estimate effect sizes (ESs) and confidence intervals (CIs). In this pilot, 29 HF patients were enrolled and 26 completed. Recall and delayed recall memory were measured at baseline and 12 weeks. Serum was collected at baseline and 8 weeks. Seven (24.1%) patients had APOE ε4 allele. No significant differences were found in recall and delayed recall memory or serum BDNF levels based on APOE ε4 allele. ESs were small to medium; CIs indicated ES precision was small. Future studies are needed to fully understand how genotypic and neuropsychological phenotypic variables influence response to computerized cognitive training.
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Affiliation(s)
| | | | - Marita Titler
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Todd M. Koelling
- University of Michigan School of Medicine, Division of Internal Medicine, Cardiology, Ann Arbor, MI, USA
| | - Miyeon Jung
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Susan G. Dorsey
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Giorgos Bakoyannis
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Penny L. Riley
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Lisa Hoyland-Domenico
- University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA
| | - Bruno Giordani
- University of Michigan School of Medicine, Neuropsychology Section, Department of Psychiatry, Neurology, and Psychology, Ann Arbor, MI, USA
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Pulignano G, Del Sindaco D, Tinti MD, Di Lenarda A, Alunni G, Senni M, Tarantini L, Cioffi G, Barbati G, Minardi G, Murrone A, Ciurluini P, Uguccioni M. Atrial fibrillation, cognitive impairment, frailty and disability in older heart failure patients. J Cardiovasc Med (Hagerstown) 2016; 17:616-23. [DOI: 10.2459/jcm.0000000000000366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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59
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Yang H, Niu W, Zang X, Lin M, Zhao Y. The association between atrial fibrillation and cognitive function in patients with heart failure. Eur J Cardiovasc Nurs 2016; 16:104-112. [PMID: 27036954 DOI: 10.1177/1474515116641299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with cognitive impairment in heart failure (HF). AIMS The purpose of this study was to examine whether AF independently predicted cognitive function in HF patients after controlling for more demographic, medical and psychological characteristics, and whether the timing of AF onset in relation to HF diagnosis independently contributed to cognitive function in HF patients with AF. METHODS A total of 188 hospitalized HF patients (62.8% male, age 66.3±10.6 years) completed cognitive function assessment with the Montreal Cognitive Assessment (MoCA). A history of AF, along with other medical characteristics, was ascertained through a review of participants' medical charts. The timing of AF onset in relation to HF diagnosis was categorized into AF occurring prior to HF diagnosis (i.e. prior AF) and AF developing after HF diagnosis (i.e. incident AF). RESULTS Altogether 72 participants had a positive diagnostic history of AF. Specifically, 41 had prior AF, and 31 developed AF subsequently. In HF patients, AF was associated with poorer performance on cognitive function after controlling for more confounders (β=-0.112, ΔR2=0.010, p=0.046). Among HF patients with AF, incident AF independently predicted poorer cognitive function (β=-0.238, ΔR2=0.027, p=0.047). CONCLUSION AF independently contributes to cognitive function in HF patients after adjusting for more confounding variables. The timing of AF onset in relation to HF diagnosis independently predicts cognitive function in HF patients with AF. Prospective studies are needed to elucidate possible mechanisms for the association between AF and cognitive function in HF populations.
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Affiliation(s)
- Huifeng Yang
- 1 School of Nursing, Tianjin Medical University, China
| | - Weihua Niu
- 2 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, China
| | - Xiaoying Zang
- 1 School of Nursing, Tianjin Medical University, China
| | - Mei Lin
- 3 Department of Nursing, General Hospital of Tianjin Medical University, China
| | - Yue Zhao
- 1 School of Nursing, Tianjin Medical University, China
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Shen BJ, Xu Y, Eisenberg S. Psychosocial and Physiological Predictors of Mortality in Patients of Heart Failure: Independent Effects of Marital Status and C-Reactive Protein. Int J Behav Med 2016; 24:83-91. [DOI: 10.1007/s12529-016-9579-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Park B, Roy B, Woo MA, Palomares JA, Fonarow GC, Harper RM, Kumar R. Lateralized Resting-State Functional Brain Network Organization Changes in Heart Failure. PLoS One 2016; 11:e0155894. [PMID: 27203600 PMCID: PMC4874547 DOI: 10.1371/journal.pone.0155894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/05/2016] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) patients show brain injury in autonomic, affective, and cognitive sites, which can change resting-state functional connectivity (FC), potentially altering overall functional brain network organization. However, the status of such connectivity or functional organization is unknown in HF. Determination of that status was the aim here, and we examined region-to-region FC and brain network topological properties across the whole-brain in 27 HF patients compared to 53 controls with resting-state functional MRI procedures. Decreased FC in HF appeared between the caudate and cerebellar regions, olfactory and cerebellar sites, vermis and medial frontal regions, and precentral gyri and cerebellar areas. However, increased FC emerged between the middle frontal gyrus and sensorimotor areas, superior parietal gyrus and orbito/medial frontal regions, inferior temporal gyrus and lingual gyrus/cerebellar lobe/pallidum, fusiform gyrus and superior orbitofrontal gyrus and cerebellar sites, and within vermis and cerebellar areas; these connections were largely in the right hemisphere (p<0.005; 10,000 permutations). The topology of functional integration and specialized characteristics in HF are significantly changed in regions showing altered FC, an outcome which would interfere with brain network organization (p<0.05; 10,000 permutations). Brain dysfunction in HF extends to resting conditions, and autonomic, cognitive, and affective deficits may stem from altered FC and brain network organization that may contribute to higher morbidity and mortality in the condition. Our findings likely result from the prominent axonal and nuclear structural changes reported earlier in HF; protecting neural tissue may improve FC integrity, and thus, increase quality of life and reduce morbidity and mortality.
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Affiliation(s)
- Bumhee Park
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Bhaswati Roy
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Mary A. Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jose A. Palomares
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Gregg C. Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ronald M. Harper
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Neurobiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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62
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Hwang SY, Kim J. An examination of the association of cognitive functioning, adherence to sodium restriction and Na/K ratios in Korean heart failure patients. J Clin Nurs 2016; 25:1766-76. [DOI: 10.1111/jocn.13198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
Affiliation(s)
| | - JinShil Kim
- College of Nursing; Gachon University; Incheon South Korea
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63
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Cameron JD, Gallagher R, Pressler SJ, McLennan SN, Ski CF, Tofler G, Thompson DR. Sensitivity and Specificity of a Five-Minute Cognitive Screening Test in Patients With Heart Failure. J Card Fail 2016; 22:99-107. [DOI: 10.1016/j.cardfail.2015.08.343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 11/16/2022]
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Coma M, González-Moneo MJ, Enjuanes C, Velázquez PP, Espargaró DB, Pérez BA, Tajes M, Garcia-Elias A, Farré N, Sánchez-Benavides G, Martí-Almor J, Comin-Colet J, Benito B. Effect of Permanent Atrial Fibrillation on Cognitive Function in Patients With Chronic Heart Failure. Am J Cardiol 2016; 117:233-9. [PMID: 26686573 DOI: 10.1016/j.amjcard.2015.10.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 12/31/2022]
Abstract
In patients with chronic heart failure (HF), cognitive impairment (CI) is associated with poorer treatment adherence and higher readmission and mortality rates. Previous studies suggest that atrial fibrillation (AF) could impair cognitive function. This study sought to assess the association between permanent AF (permAF) and CI in patients with HF. We evaluated cognitive function in 881 patients with stable HF (73 ± 11 years, 44% women, 48% with preserved ejection fraction) using the Mini-Mental State Examination test (n = 876) and the Pfeiffer's Short Portable Mental Status Questionnaire (n = 848). CI was defined as a Mini-Mental State Examination score <24 or Short Portable Mental Status Questionnaire (errors) >2. The independent association between permAF and CI was assessed by binary logistic regression analysis. A total of 295 patients (33.5%) had CI, in 5.1% of cases moderate/severe. Patients with permAF had more frequently any degree of CI (43% vs 31%), and moderate/severe CI (8% vs 5%). In the multivariate analysis, CI was associated with permAF (odds ratio 1.54, 95% C.I. 1.05 to 2.28), an older age, female gender, diabetes mellitus, chronic kidney disease, previous stroke, New York Heart Association class III/IV, and lower systolic blood pressure. No interaction was found for AF and CI between patients with reduced and preserved ejection fraction. In conclusion, the presence of permAF is independently associated with CI in patients with HF, both with reduced and preserved ejection fraction. Given the clinical impact of CI in the HF population, active assessment of cognitive function is particularly warranted in patients with HF with permAF.
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Affiliation(s)
- Maria Coma
- School of Medicine, Department of Medicine, Universitat Pompeu Fabra/Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Cristina Enjuanes
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | | | - Deva Bas Espargaró
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - Marta Tajes
- Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Anna Garcia-Elias
- Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Núria Farré
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Group of Neurofunctionality of Brain and Language, Neuroscience Research Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Julio Martí-Almor
- School of Medicine, Department of Medicine, Universitat Pompeu Fabra/Universitat Autònoma de Barcelona, Barcelona, Spain; Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Josep Comin-Colet
- School of Medicine, Department of Medicine, Universitat Pompeu Fabra/Universitat Autònoma de Barcelona, Barcelona, Spain; Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Begoña Benito
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Inflammatory and Cardiovascular Disorders Program, Hospital del Mar Medical Research Insititute (IMIM), Parc de Salut Mar, Barcelona, Spain.
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Galioto R, Fedor AF, Gunstad J. Possible neurocognitive benefits of exercise in persons with heart failure. Eur Rev Aging Phys Act 2015; 12:6. [PMID: 26865870 PMCID: PMC4745145 DOI: 10.1186/s11556-015-0151-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/30/2015] [Indexed: 01/08/2023] Open
Abstract
More than 6 million Americans have heart failure (HF) and more than 500,000 are diagnosed each year. In addition to its many adverse medical consequences, HF is also a significant risk factor for neurological disorders like Alzheimer's disease and associated with cognitive impairment long prior to the onset of these conditions. Converging bodies of literature suggest cognitive dysfunction in HF may be at least partially modifiable. One key mechanism for cognitive improvement is improved cerebral blood flow, which may be possible with exercise in patients with HF. This brief review provides a model for the likely neurocognitive benefits of exercise in HF and encourages further work in this area.
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Affiliation(s)
- Rachel Galioto
- Department of Psychology Sciences, Kent State University, Kent, OH 44242 USA
| | - Andrew F Fedor
- Department of Psychology Sciences, Kent State University, Kent, OH 44242 USA
| | - John Gunstad
- Department of Psychology Sciences, Kent State University, Kent, OH 44242 USA
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66
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Executive function moderates the relationship between depressive symptoms and resting heart rate variability in heart failure. J Behav Med 2015; 39:192-200. [DOI: 10.1007/s10865-015-9684-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/11/2015] [Indexed: 12/18/2022]
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67
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Chou CC, Pressler SJ, Giordani B, Fetzer SJ. Validation of the Chinese version of the CogState computerised cognitive assessment battery in Taiwanese patients with heart failure. J Clin Nurs 2015; 24:3147-54. [DOI: 10.1111/jocn.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Cheng-Chen Chou
- Department of Nursing; College of Medicine; National Cheng Kung University; Tainan Taiwan
| | | | - Bruno Giordani
- School of Medicine; Neuropsychology Section; Department of Psychiatry; University of Michigan; Ann Arbor MI USA
- Department of Neurology; University of Michigan; Ann Arbor MI USA
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Kim JS, Hwang SY, Shim JL, Jeong MH. Cognitive Function and Self-Care in Patients with Chronic Heart Failure. Korean Circ J 2015; 45:310-6. [PMID: 26240585 PMCID: PMC4521109 DOI: 10.4070/kcj.2015.45.4.310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/12/2015] [Accepted: 03/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives This study examined the association of cognitive function with self-care and major adverse cardiac events (MACE) among heart failure (HF) patients. Subjects and Methods In this prospective study, 86 outpatients with HF completed face-to-face interviews including neuropsychological testing to evaluate cognitive function and the use of the Self-Care of Heart Failure Index to measure self-care. Functional status was assessed with the New York Heart Association (NYHA) classification. Follow-up data on MACE were obtained at 24 months after enrollment. Results Compared with the Korean norm values, more than half of the HF patients had cognitive deficits in global function (33.0%), immediate recall (65.1%), delayed recall memory (65.1%), and executive function (60.5%). Patients with symptomatic HF (≥NYHA class II) had the higher risk for substantially poor cognitive function in all areas of cognitive function than asymptomatic HF patients (NYHA class I, p<0.05). Most patients demonstrated poor self-care adequacy in maintenance (84.9%), management of symptoms (100%), and confidence (86.0%). After adjustment for age and gender, memory function was significantly associated with self-care confidence (odds ratio 1.41, 95% confidence interval 1.03-1.92, p=0.033). No relationship was found between cognition and self-care maintenance. There were 19 MACE's during the 24-month follow-up. Patients without MACE had a significantly higher global cognitive function (p=0.024), while no cognitive domains were significant predictors of MACE when adjusted for age and gender. Conclusion HF patients with memory loss have poorer self-care confidence. Studies are warranted to examine the functional implication of cognitive deficits and adverse outcomes in a larger sample.
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Affiliation(s)
- Jin Shil Kim
- College of Nursing, Gachon University, Incheon, Korea
| | | | - Jae Lan Shim
- College of Nursing, Hanyang University, Seoul, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University, Gwangju, Korea
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Nurse-Enhanced Computerized Cognitive Training Increases Serum Brain-Derived Neurotropic Factor Levels and Improves Working Memory in Heart Failure. J Card Fail 2015; 21:630-41. [PMID: 25982826 DOI: 10.1016/j.cardfail.2015.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/27/2015] [Accepted: 05/07/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Memory loss is common in heart failure (HF) patients, but few interventions have been tested to treat it. The objective of this study was to evaluate efficacy of a cognitive training intervention, Brain Fitness, to improve memory, serum brain-derived neurotropic factor (BDNF) levels, working memory, processing speed, executive function, instrumental activities of daily living, mobility, depressive symptoms, and health-related quality of life. METHODS AND RESULTS Twenty-seven HF patients were randomly assigned to Brain Fitness and health education active control interventions. Data were collected at baseline and 8 and 12 weeks. Linear mixed models analyses were completed. Patients in the Brain Fitness group were older with lower ejection fraction. At 12 weeks, a group by time interaction effect was found for serum BDNF levels (P = .011): serum BDNF levels increased among patients who completed Brain Fitness and decreased among patients who completed health education. No differences were found in memory, but a group by time interaction (P = .046) effect was found for working memory. CONCLUSIONS Findings support efficacy of Brain Fitness in improving working memory and serum BDNF levels as a biomarker of intervention response. A randomized controlled study is needed among a larger more diverse group of HF patients.
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Abstract
Patients with heart failure (HF) exhibit a wide range of symptoms, including dyspnea, sleep-disordered breathing, autonomic abnormalities, cognitive dysfunction, and neuropsychological disturbances. These symptoms, which affect quality of life and morbidity and mortality in the condition, are largely related to structural and functional changes in the brain. There are increasing reports of brain abnormalities in HF, but often the linkages between brain injury and common HF clinical symptomatology are not clearly described. In this review, we will discuss the current evidence of brain injury and the associated clinical symptoms in HF, focusing on those brain regions that are commonly damaged in the condition. We will also provide a brief exploration of some potential mechanisms for brain injury in HF.
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Affiliation(s)
- Jennifer A Ogren
- UCLA School of Nursing, 700 Tiverton Ave., Los Angeles, CA, 90095-1702, USA,
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71
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Abstract
Patient education is an important element of care, but evidence with regard to education material is not always apparent, as it is intertwined with educational strategies as components of heart failure management programs. Difficulties have arisen in determining the effectiveness of particular education strategies, as multiple strategies are commonly bundled together and packaged within research protocols. To further complicate this issue, the bundles are diverse, lack precision in describing their components, and report different outcomes. Despite these difficulties, clinicians can utilise a number of proven commonalities to deliver effective education: assessment of learning needs and style, verbal interaction with a healthcare professional, and a selection of multimedia patient education materials.
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72
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Gallagher R, Sullivan A, Burke R, Hales S, Sharpe P, Tofler G. Quality of life, social support and cognitive impairment in heart failure patients without diagnosed dementia. Int J Nurs Pract 2015; 22:179-88. [PMID: 25943781 DOI: 10.1111/ijn.12402] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed.
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Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anne Sullivan
- Management of Cardiac Function (MACARF), Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rhonda Burke
- Management of Cardiac Function (MACARF), Manly and Mona Vale Hospitals, Sydney, New South Wales, Australia
| | - Susan Hales
- Management of Cardiac Function (MACARF), Ryde Hospital, Sydney, New South Wales, Australia
| | - Precilla Sharpe
- Management of Cardiac Function (MACARF), Hornsby Hospital, Sydney, New South Wales, Australia
| | - Geoffrey Tofler
- Management of Cardiac Function (MACARF), Royal North Shore Hospital, Sydney, New South Wales, Australia
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Cameron J, Rendell PG, Ski CF, Kure CE, McLennan SN, Rose NS, Prior DL, Thompson DR. PROspective MEmory Training to improve HEart failUre Self-care (PROMETHEUS): study protocol for a randomised controlled trial. Trials 2015; 16:196. [PMID: 25927718 PMCID: PMC4419391 DOI: 10.1186/s13063-015-0721-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/14/2015] [Indexed: 01/26/2023] Open
Abstract
Background Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients’ health outcomes. Prospective memory, which is defined as memory to carry out future intentions, is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients. The objective of this study is to examine the effects of prospective memory training on patients’ engagement in HF self-care and health outcomes, carer strain and quality of life. Methods/design The proposed study is a randomised, controlled trial in which 200 patients diagnosed with HF, and their carers will be recruited from 3 major hospitals across Melbourne. Eligible patients with HF will be randomised to receive either: 1) The Virtual Week Training Program - a computerised prospective memory (PM) training program (intervention) or 2) non-adaptive computer-based word puzzles (active control). HF patients’ baseline cognitive function will be compared to a healthy control group (n = 60) living independently in the community. Patients will undergo a comprehensive assessment of PM, neuropsychological functioning, self-care, physical, and emotional functioning. Assessments will take place at baseline, 4 weeks and 12 months following intervention. Carers will complete measures assessing quality of life, strain, perceived control in the management of the patients’ HF symptoms, and ratings of the patients’ level of engagement in HF self-care behaviours. Discussion If the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs. Trial registration Australian New Zealand Clinical Trials Registry #366376; 27 May 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366376&isClinicalTrial=False.
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Affiliation(s)
- Jan Cameron
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Peter G Rendell
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, 115 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Chantal F Ski
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Christina E Kure
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Skye N McLennan
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, 115 Victoria Parade, Melbourne, VIC, 3065, Australia.
| | - Nathan S Rose
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, 115 Victoria Parade, Melbourne, VIC, 3065, Australia. .,Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI, 53179, USA.
| | - David L Prior
- Department of Cardiology, St Vincent's Hospital, Princess Street, Melbourne, VIC, 3065, Australia.
| | - David R Thompson
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
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Alosco ML, Spitznagel MB, Gunstad J. Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure. Heart Fail Rev 2015; 19:403-11. [PMID: 23743688 DOI: 10.1007/s10741-013-9399-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80% of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, 340 Kent Hall, Kent, OH, 44224, USA,
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75
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Abstract
It has recently been proposed that heart failure is a risk factor for Alzheimer's disease. Decreased cerebral blood flow and neurohormonal activation due to heart failure may contribute to the dysfunction of the neurovascular unit and cause an energy crisis in neurons. This leads to the impaired clearance of amyloid beta and hyperphosphorylation of tau protein, resulting in the formation of amyloid beta plaques and neurofibrillary tangles. In this article, we will summarize the current understanding of the relationship between heart failure and Alzheimer's disease based on epidemiological studies, brain imaging research, pathological findings and the use of animal models. The importance of atherosclerosis, myocardial infarction, atrial fibrillation, blood pressure and valve disease as well as the effect of relevant medications will be discussed.
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Affiliation(s)
- P Cermakova
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetHuddinge, Sweden
- International Clinical Research Center and St. Anne's University HospitalBrno, Czech Republic
| | - M Eriksdotter
- Department of Geriatric Medicine, Karolinska University HospitalStockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetStockholm, Sweden
| | - L H Lund
- Department of Cardiology, Karolinska University HospitalStockholm, Sweden
- Unit of Cardiology, Department of Medicine, Karolinska InstitutetStockholm, Sweden
| | - B Winblad
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetHuddinge, Sweden
- Department of Geriatric Medicine, Karolinska University HospitalStockholm, Sweden
| | - P Religa
- Department of Medicine, Center for Molecular Medicine, Karolinska InstitutetStockholm, Sweden
| | - D Religa
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetHuddinge, Sweden
- Department of Geriatric Medicine, Karolinska University HospitalStockholm, Sweden
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Le Corvoisier P, Bastuji-Garin S, Renaud B, Mahé I, Bergmann JF, Perchet H, Paillaud E, Mottier D, Montagne O. Functional status and co-morbidities are associated with in-hospital mortality among older patients with acute decompensated heart failure: a multicentre prospective cohort study. Age Ageing 2015; 44:225-31. [PMID: 25313242 DOI: 10.1093/ageing/afu144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Among patients admitted for acute decompensated heart failure (ADHF), half are aged 75 years or over. The high prevalence of co-morbidities and functional impairments in this age group may affect patient outcomes. OBJECTIVE To assess the association between co-morbidities, functional status and in-hospital mortality in patients with ADHF aged ≥75 years. DESIGN A prospective, multicentre cohort study. SETTING Five French hospitals. SUBJECTS Five hundred and fifty-five patients aged ≥75 years admitted to the emergency department with ADHF. METHODS Baseline clinical data and co-morbidities were recorded at admission. Functional status and cognition were assessed using the Katz index and Mini-Mental Status Examination score, respectively. The primary outcome was in-hospital mortality. RESULTS We found high prevalences of co-morbidities and functional impairments including hypertension (74.0%), atrial fibrillation (40.2%), prior acute coronary syndrome (32.3%) and diabetes (18.2%). The average creatinine clearance was 56.3 ml/min/1.73 m(2) (interquartile range, 39.2-77.0). In-hospital mortality was 67/555 (12.1%; 95% confidence interval, 9.4-14.8). In multivariate analysis, in-hospital mortality showed a statistically positive association with prior loss of self-sufficiency (Odds ratio [OR]: 5.85 [2.25-12.19]), hyperglycaemia (OR: 1.80 [1.26-2.54] per 1 SD increase), prior cerebral ischaemic event (OR: 3.56 [1.51-8.44]) and troponin I elevation above upper limit of normal (OR: 2.81 [1.37-5.77]). In addition, systolic blood pressure (OR: 0.98 [0.97-0.99] per 1 mmHg increase) and creatinine clearance (OR: 0.72 [0.51-1.00] per 1 SD increase) were negatively associated with in-hospital mortality. CONCLUSION Co-morbidities and functional impairments are associated with a worse short-term prognosis in patients aged ≥75 years admitted for ADHF. Assessing these parameters at admission may improve patient management.
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Affiliation(s)
- Philippe Le Corvoisier
- Inserm, Clinical Investigation Centre 1430, APHP, Henri Mondor Hospital, F-94010 Creteil, France
| | - Sylvie Bastuji-Garin
- Paris Est University (UPE), LIC EA4393 and APHP, Henri Mondor hospital, Clinical Research Unit (URC Mondor), F-94010 Créteil, France
| | - Bertrand Renaud
- APHP, Cochin Hospital, Emergency Department, F-75014 Paris, France
| | - Isabelle Mahé
- APHP, Louis Mourier Hospital, Department of Internal Medicine and Paris 7 University, EA REMES Paris Diderot University, Sorbonne Paris Cité, F-92700 Colombes, France
| | - Jean-François Bergmann
- APHP, Lariboisière-Fernand Vidal Hospital, Department of Internal Medicine, F-75010 Paris, France
| | - Herve Perchet
- Meaux Hospital, Department of Cardiology, F-77100 Meaux, France
| | - Elena Paillaud
- APHP, Henri Mondor Hospital, Department of Geriatry, F-94010 Creteil, France
| | - Dominique Mottier
- Cavale Blanche Hospital, Department of Internal Medicine and Pneumology, EA 3878 (GETBO), F-29609 Brest, France
| | - Olivier Montagne
- Inserm, Clinical Investigation Centre 1430, APHP, Henri Mondor Hospital, F-94010 Creteil, France
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77
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Abstract
Although cognitive deficits are common in patients with chronic heart failure (CHF), no study to date has investigated whether these deficits extend to the capacity to execute delayed intentions (prospective memory, PM). This is a surprising omission given the critical role PM plays in correctly implementing many important CHF self-care behaviors. The present study aimed to provide the first empirical assessment of PM function in people with CHF. The key dependent measure was a laboratory measure of PM that closely simulates PM tasks in daily life - Virtual Week. A group comparison design was used, with 30 CHF patients compared to 30 demographically matched controls. Background measures assessing executive functions, working memory, and verbal memory were also administered. The CHF group exhibited significant PM impairment, with difficulties generalizing across different types of PM tasks (event, time, regular, irregular). The CHF group also had moderate deficits on several of the background cognitive measures. Given the level of impairment remained consistent even on tasks that imposed minimal demands on memory for task content, CHF-related difficulties most likely reflects problems with the prospective component. However, exploratory analyses suggest that difficulties with retrospective memory and global cognition (but not executive control), also contribute to the PM difficulties seen in this group. The implications of these data are discussed, and in particular, it is argued that problems with PM may help explain why patient engagement in CHF self-care behaviors is often poor.
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78
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Hjelm CM, Broström A, Riegel B, Årestedt K, Strömberg A. The association between cognitive function and self-care in patients with chronic heart failure. Heart Lung 2015; 44:113-9. [PMID: 25682390 DOI: 10.1016/j.hrtlng.2014.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression. METHODS This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses. RESULTS Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression. CONCLUSIONS Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.
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Affiliation(s)
- Carina M Hjelm
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; Department of Cardiothoracic Surgery, County Council of Östergötland, Sweden.
| | - Anders Broström
- Department of Clinical Neurophysiology, County Council of Östergötland, Sweden; Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | - Barbara Riegel
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Kristofer Årestedt
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; School of Health and Caring Sciences, Linnaeus University Kalmar, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; Department of Cardiology, County Council of Östergötland, Sweden
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79
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Cognitive impairment in heart failure patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 11:316-28. [PMID: 25593581 PMCID: PMC4294149 DOI: 10.11909/j.issn.1671-5411.2014.04.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/21/2022]
Abstract
Cognitive damage in heart failure (HF) involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, alterations of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mechanisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers available data pointing out assured information and discussing possible areas of research development.
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80
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Athilingam P, Edwards JD, Valdes EG, Ji M, Guglin M. Computerized auditory cognitive training to improve cognition and functional outcomes in patients with heart failure: Results of a pilot study. Heart Lung 2015; 44:120-8. [PMID: 25592205 DOI: 10.1016/j.hrtlng.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Feasibility and efficacy of computerized auditory cognitive training (ACT) was examined among patients with heart failure (HF). BACKGROUND Individuals with HF have four times increased risk of cognitive impairment, yet cognitive intervention studies are sparse. METHODS A pilot randomized controlled design was used. RESULTS The ACT group (n = 9) and control group (n = 8) had similar baseline characteristics. Seven participants (78%) completed ≥ 18 hours of ACT. Medium effect sizes were observed for improved cognition as indicated by auditory processing speed (d = 0.78), speech processing (d = 0.88), and working memory (d = 0.44-0.50). Small effect sizes were found for improved functional outcomes including HF selfcare (d = 0.34), Timed Instrumental Activities of Daily Living (d = 0.32), Six-Minute Walk Test (d = 0.38) and Short-Form-36 (d = 0.22) relative to controls. CONCLUSION Results indicated ACT is feasible among persons with HF. Despite a small sample size, ACT showed potential for improved speed of processing and working memory and improved functional outcomes, and warrants further exploration.
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Affiliation(s)
| | | | - Elise G Valdes
- School of Aging Studies, University of South Florida, USA
| | - Ming Ji
- College of Nursing, University of South Florida, USA
| | - Maya Guglin
- Cardiovascular Medicine, University of Kentucky, Lexington, USA
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81
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Butts B, Gary R. Coexisting Frailty, Cognitive Impairment, and Heart Failure: Implications for Clinical Care. JOURNAL OF CLINICAL OUTCOMES MANAGEMENT : JCOM 2015; 22:38-46. [PMID: 26594103 PMCID: PMC4650868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review some of the proposed pathways that increase frailty risk in older persons with heart failure and to discuss tools that may be used to assess for changes in physical and cognitive functioning in this population in order to assist with appropriate and timely intervention. METHODS Review of the literature. RESULTS Heart failure is the only cardiovascular disease that is increasing by epidemic proportions, largely due to an aging society and therapeutic advances in disease management. Because heart failure is largely a cardiogeriatric syndrome, age-related syndromes such as frailty and cognitive impairment are common in heart failure patients. Compared with age-matched counterparts, older adults with heart failure 4 to 6 times more likely to be frail or cognitively impaired. The reason for the high prevalence of frailty and cognitive impairment in this population is not well known but may likely reflect the synergistic effects of heart failure and aging, which may heighten vulnerability to stressors and accelerate loss of physiologic reserve. Despite the high prevalence of frailty and cognitive impairment in the heart failure population, these conditions are not routinely screened for in clinical practice settings and guidelines on optimal assessment strategies are lacking. CONCLUSION Persons with heart failure are at an increased risk for frailty, which may worsen symptoms, impair self-management, and lead to worse heart failure outcomes. Early detection of frailty and cognitive impairment may be an opportunity for intervention and a key strategy for improving clinical outcomes in older adults with heart failure.
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Affiliation(s)
- Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Fernandes S, Guthrie DM. A Comparison Between End-of-Life Home Care Clients With Cancer and Heart Failure in Ontario. Home Health Care Serv Q 2014; 34:14-29. [DOI: 10.1080/01621424.2014.995257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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83
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Cognitive status in patients hospitalized with acute decompensated heart failure. Am Heart J 2014; 168:917-23. [PMID: 25458656 DOI: 10.1016/j.ahj.2014.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/16/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cognitive impairment is highly prevalent in patients with heart failure and is associated with adverse outcomes. However, whether specific cognitive abilities (eg, memory vs executive function) are impaired in heart failure has not been fully examined. We investigated the prevalence of impairment in 3 cognitive domains in patients hospitalized with acute decompensated heart failure (ADHF) and the associations of impairment with demographic and clinical characteristics. METHODS The sample included 744 patients hospitalized with ADHF (mean age 72 years, 46% female) at 5 medical centers. Impairment was assessed in 3 cognitive domains (memory, processing speed, executive function) using standardized measures. Demographic and clinical characteristics were obtained from a structured interview and medical record review. RESULTS A total of 593 (80%) of 744 patients were impaired in at least 1 cognitive domain; 32%, 31%, and 17% of patients were impaired in 1, 2, or all 3 cognitive domains, respectively. Patients impaired in more than 1 cognitive domain were significantly older, had less formal education, and had more noncardiac comorbidities (all P values < .05). In multivariable adjusted analyses, patients with older age and lower education had higher odds of impairment in 2 or more cognitive domains. Depressed patients had twice the odds of being impaired in all 3 cognitive domains (odds ratio 1.98, 95% CI 1.08-3.64). CONCLUSION Impairments in executive function, processing speed, and memory are common among patients hospitalized for ADHF. Recognition of these prevalent cognitive deficits is critical for the clinical management of these high-risk patients.
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Arslanian-Engoren C, Giordani BJ, Algase D, Schuh A, Lee C, Moser DK. Cognitive Dysfunction in Older Adults Hospitalized for Acute Heart Failure. J Card Fail 2014; 20:669-78. [DOI: 10.1016/j.cardfail.2014.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/16/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
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Lowry J, Austin A, Al-Sayegh H, Yan F, Liu F, Zhang J. Impaired verbal memory is a significant predictor of early cerebral-cardiovascular death, an 18-year follow-up of a national cohort. Int J Geriatr Psychiatry 2014; 29:837-45. [PMID: 24677142 DOI: 10.1002/gps.4068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 12/11/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND The mortality pattern of individuals with impaired verbal memory (IVM) has not yet been well described. We sought to describe the risk of all-causes, as well as specific causes of death associated with IVM. METHOD We used the data of 4151 nationally representative adults ≥60 years old who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and completed one non-contextual (i.e., word list memory) and one contextual delayed-recall tests (i.e., short story recall). The participants were passively followed up through 31 December 2006. We determined the hazard ratio of death from all-causes and specific cause through Cox proportional hazard regression. RESULTS Severe and moderate IVM were present in 268 (6.5%) and 495 (11.9%) participants at baseline survey, and 2550 deaths occurred by the end of 18-year follow-up (median = 12 years). The medians of survival time adjusted for all-causes death were 6.17 (95% CI: 5.50, 6.92), 9.50 (8.92, 10.25), and 13.17 (12.75, 13.58) years, respectively for the individuals with severe, moderate, and no IVM. Severe IVM was significantly associated with death from cardio-cerebral vascular diseases [hazard ratio = 1.70, 95% CI = (1.36-2.12)], stroke [2.60 (1.69-3.99)], and Alzheimer's disease [3.50 (1.40-8.76)]. The shortened survival time of the participants with IVM was mainly driven by the deaths of cerebral-cardiovascular diseases, which accounted for almost half of all deaths. CONCLUSION The predictability of memory scores to early cerebral-cardiovascular deaths demonstrated that central challenge among individuals with cognitive impairment was cardiovascular diseases management.
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Affiliation(s)
- Joseph Lowry
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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Garcia S, Calvo D, Spitznagel MB, Sweet L, Josephson R, Hughes J, Gunstad J. Dairy intake is associated with memory and pulsatility index in heart failure. Int J Neurosci 2014; 125:247-52. [PMID: 24894048 DOI: 10.3109/00207454.2014.928290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/AIM Past work shows an inconsistent relationship between dairy intake and cognition in healthy older adults. A cross-sectional design was conducted to examine dairy consumption, cognitive dysfunction, and cerebral blood flow in a sample of older adults with heart failure (HF) to clarify their association in this population at high risk for adverse neurocognitive outcomes. MATERIALS AND METHODS A total of 86 older adults with HF (70.39 ± 9.51 years; 33.1% female) underwent neuropsychological testing, transcranial Doppler (TCD) sonography to quantify cerebral blood flow. Dairy intake was quantified using a brief self-report questionnaire. RESULTS Partial correlations between the dairy consumption questionnaire and neuropsychological tests were conducted adjusting for HF severity, age, and sex. Contrary to expectations, results showed greater dairy intake was associated with poorer memory (r = -0.21, p = 0.01) and higher pulsatility index in the medial cerebral artery (r = -0.17, p = 0.05). CONCLUSION Results suggest that greater dairy intake was associated with poorer memory performance in older adults with HF. Several possible explanations for these findings exist, including the contribution of high-fat dairy to underlying physiological processes that promote vascular cognitive impairment. Prospective studies employing objective measures specific to high and low fat dairy are needed to clarify this possibility.
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Predictors of memory performance among Taiwanese postmenopausal women with heart failure. J Card Fail 2014; 20:679-88. [PMID: 24954427 DOI: 10.1016/j.cardfail.2014.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are no studies describing the nature of memory deficits among women with heart failure (HF). OBJECTIVES The aims of this study were to examine memory performance among Taiwanese women with HF compared with age- and education-matched healthy women, and to evaluate factors that explain memory performance in women with HF. METHODS AND RESULTS Seventy-six women with HF and 64 healthy women were recruited in Taiwan. Women completed working, verbal, and visual memory tests; HF severity was collected from the medical records. Women with HF performed significantly worse than healthy women on tests of working memory and verbal memory. Among women with HF, older age explained poorer working memory, and older age, higher HF severity, more comorbidities, and systolic HF explained poorer verbal memory. Menopausal symptoms were not associated with memory performance. CONCLUSIONS Results of the study validate findings of memory loss in HF patients from the United States and Europe in a culturally different sample of women. Working memory and verbal memory were worse in Taiwanese women with HF compared with healthy participants. Studies are needed to determine mechanisms of memory deficits in these women and develop interventions to improve memory.
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Pulignano G, Del Sindaco D, Di Lenarda A, Tinti MD, Tarantini L, Cioffi G, Tolone S, Pero G, Minardi G. Chronic renal dysfunction and anaemia are associated with cognitive impairment in older patients with heart failure. J Cardiovasc Med (Hagerstown) 2014; 15:481-90. [DOI: 10.2459/jcm.0000000000000005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chung ML, Lennie TA, Mudd-Martin G, Dunbar SB, Pressler SJ, Moser DK. Depressive symptoms in patients with heart failure negatively affect family caregiver outcomes and quality of life. Eur J Cardiovasc Nurs 2014; 15:30-8. [PMID: 24829295 DOI: 10.1177/1474515114535329] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 04/22/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depressive symptoms in people with heart failure (HF) are highly prevalent. Caring for patients with both HF and depression may be more burdensome than caring for patients with HF alone. AIMS The purpose of this study was to examine differences in caregivers' outcomes (i.e. caregiving burden, difficulty and time spent on caregiving, perceptions of life change as a result of caregiving, and quality of life) between caregivers who take care of HF patients with depressive symptoms and without depressive symptoms. METHOD Patient-caregiver dyads at an outpatient clinic completed survey questionnaires. Patients' depression was assessed using the Beck Depression Inventory-II (BDI-II); primary caregivers completed caregiving outcome questionnaires. Differences in caregiving outcomes between patients with and without depressive symptoms (BDI-II≥14) were examined using t-tests, Chi-square, and Mann-Whitney U-test. RESULTS Of 102 patients (64% male, mean age 61, 41% NYHA Class III-IV, mean ejection fraction 35.8±13.9), 26.5% had clinically significant depressive symptoms. Of the primary caregivers (78% female; mean age 56.7), 42% reported severe burden (the Zarit Burden Interview (ZBI)≥17). Caregivers of patients with depressive symptoms had a higher level of burden (25±13 vs 13.5±12 on the ZBI; p<0.001), spent more time caregiving (37±12 vs 30±11 on the Oberst Caregiving Burden Scale; p=0.004), and reported worse mental quality of life (46±10 vs 51±10 on the SF-12v2; p=0.026) than those of patients without depressive symptoms. CONCLUSION Family members caring for HF patients with depressive symptoms had significantly higher levels of caregiving burden and worse quality of life compared to those caring for patients without depressive symptoms.
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Berg SK, Svanholm J, Lauberg A, Borregaard B, Herning M, Mygind A, Christensen AV, Christensen AI, Ekholm O, Juel K, Thrysøe L. Patient-reported outcomes at hospital discharge from Heart Centres, a national cross-sectional survey with a register-based follow-up: the DenHeart study protocol. BMJ Open 2014; 4:e004709. [PMID: 24793253 PMCID: PMC4025470 DOI: 10.1136/bmjopen-2013-004709] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patient reported health status, which includes symptom burden, functional status and quality of life, is an important measure of health. Differences in health status between diagnostic groups within cardiology have only been sparsely investigated. These outcomes may predict morbidity, mortality, labour market affiliation and healthcare utilisation in various diagnostic groups. A national survey aiming to include all cardiac diagnostic groups from a total Heart Centre population has been designed as the DenHeart survey. METHODS AND ANALYSIS DenHeart is designed as a cross-sectional survey with a register-based follow-up. All diagnostic groups at the five national Heart Centres are included during 1 year (15 April 2013 to 15 April 2014) and asked to fill out a questionnaire at hospital discharge. The total eligible population, both responders and non-responders, will be followed in national registers. The following instruments are used: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire (B-IPQ), HeartQoL and Edmonton Symptom Assessment Scale. The following variables are collected from national registers: action diagnosis, procedures, comorbidity, length of hospital stay, type of hospitalisation, visits to general practitioners and other agents in primary healthcare, dispensed prescription medication, vital status and cause of death. Labour market affiliation, sick leave, early retirement pension, educational degree and income will be collected from registers. Frequency distributions and multiple logistic regression analyses will be used to describe and assess differences in patient reported outcomes at hospital discharge between diagnostic groups and in-hospital predicting factors. Cox proportional hazards regression models with age as the time scale will be used to investigate associations between patient reported outcomes at baseline and morbidity/mortality, labour market affiliation and healthcare utilisation after 1 year. ETHICS AND DISSEMINATION The study complies with the Declaration of Helsinki. The study has been approved by the Danish Data Protection Agency: 2007-58-0015/30-0937 and registered at ClinicalTrials.gov (NCT01926145). Study findings will be disseminated widely through peer reviewed publications and conference presentations.
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Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Unit 2151, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Jette Svanholm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Astrid Lauberg
- Departments of Cardiology and Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Borregaard
- Department of Thoracic, Cardiac and Vascular Surgery, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Margrethe Herning
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Anna Mygind
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Smith PJ, Blumenthal JA, Carney RM, Freedland KE, O'Hayer CVF, Trulock EP, Martinu T, Schwartz TA, Hoffman BM, Koch GG, Davis RD, Palmer SM. Neurobehavioral functioning and survival following lung transplantation. Chest 2014; 145:604-611. [PMID: 24233282 DOI: 10.1378/chest.12-2127] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neurobehavioral functioning is widely recognized as being an important consideration in lung transplant candidates, but little is known about whether these factors are related to clinical outcomes. The present study examined the relationship of neurobehavioral functioning, including measures of executive function and memory, depression, and anxiety, to long-term survival among lung transplant recipients. METHODS The sample was drawn from 201 patients who underwent transplantation at Duke University and Washington University who participated in a dual-site clinical trial investigating medical and psychosocial outcomes in transplant candidates with end-stage lung disease. All patients completed the Beck Depression Inventory-II (BDI-II) and Spielberger State-Trait Anxiety Inventory at baseline and again after 12 weeks, while a subset of 86 patients from Duke University also completed neurocognitive testing. Patients were followed for survival up to 12 years after completing baseline assessments. RESULTS One hundred eleven patients died over a mean follow-up of 10.8 years (SD=0.8). Baseline depression, anxiety, and neurocognitive function were examined as predictors of posttransplant survival, controlling for age, 6-min walk distance, FEV, and native disease; education and cardiovascular risk factors were also included in the model for neurocognition. Lower executive function (hazard ratio [HR]=1.09, P=.012) and memory performance (HR=1.11, P=.030) were independently associated with greater mortality following lung transplant. Although pretransplant depression and anxiety were not predictive of mortality, patients who scored>13 on the BDI-II at baseline and after 3 months pretransplant had greater mortality (HR=1.85 [95% CI, 1.04, 3.28], P=.036). CONCLUSIONS Neurobehavioral functioning, including persistently elevated depressive symptoms and lower neurocognitive performance, was associated with reduced survival after lung transplantation. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00113139; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University Health System, Durham, NC.
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University Health System, Durham, NC
| | - Robert M Carney
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | - Elbert P Trulock
- Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Tereza Martinu
- Department of Medicine, Duke University Medical Center, Duke University Health System, Durham, NC
| | | | - Benson M Hoffman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University Health System, Durham, NC
| | - Gary G Koch
- College of Medicine, Drexel University, Philadelphia, PA
| | - R Duane Davis
- Department of Surgery, Duke University Medical Center, Duke University Health System, Durham, NC
| | - Scott M Palmer
- Department of Medicine, Duke University Medical Center, Duke University Health System, Durham, NC
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Park SK, Larson JL. Cognitive Function as Measured by Trail Making Test in Patients With COPD. West J Nurs Res 2014; 37:236-56. [DOI: 10.1177/0193945914530520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
People with chronic obstructive pulmonary disease (COPD) exhibit cognitive impairment in several subdomains, but little is known about factors associated with cognitive function and its relationship to health-related quality of life (HRQOL) in people with COPD. A data set from the National Emphysema Treatment Trial was used for this study. Data were obtained through questionnaires and clinical testing. Cognitive function in people with COPD was measured with the Trail Making Test. Descriptive and inferential statistics were used to analyze the data. Participants with COPD had slightly impaired processing speed and executive function. Test results revealed that age, gender, education, and income were significantly associated with cognitive function. Test scores also showed that cognitive function was significantly associated with HRQOL in people with COPD. This finding suggests that cognitive function should be screened in people with COPD.
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Mastenbroek MH, Versteeg H, Zijlstra WP, Meine M, Spertus JA, Pedersen SS. Disease-specific health status as a predictor of mortality in patients with heart failure: a systematic literature review and meta-analysis of prospective cohort studies. Eur J Heart Fail 2014; 16:384-93. [DOI: 10.1002/ejhf.55] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mirjam H. Mastenbroek
- C o RPS - Centre of Research on Psychology in Somatic diseases; Tilburg University; the Netherlands
- Department of Cardiology; University Medical Center; Utrecht the Netherlands
| | - Henneke Versteeg
- C o RPS - Centre of Research on Psychology in Somatic diseases; Tilburg University; the Netherlands
- Department of Cardiology; University Medical Center; Utrecht the Netherlands
| | - Wobbe P. Zijlstra
- C o RPS - Centre of Research on Psychology in Somatic diseases; Tilburg University; the Netherlands
| | - Mathias Meine
- Department of Cardiology; University Medical Center; Utrecht the Netherlands
| | - John A. Spertus
- Mid America Heart Institute of Saint Luke's Hospital; Kansas City Missouri USA
| | - Susanne S. Pedersen
- C o RPS - Centre of Research on Psychology in Somatic diseases; Tilburg University; the Netherlands
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam the Netherlands
- Department of Cardiology; Odense University Hospital
- Institute of Psychology; University of Southern Denmark; Odense Denmark
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Cameron J, Pressler SJ, Ski CF, Thompson DR. Cognitive impairment in heart failure: towards a consensus on screening. Eur J Heart Fail 2013; 16:235-7. [DOI: 10.1002/ejhf.12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jan Cameron
- Cardiovascular Research Centre; Australian Catholic University; Victoria Australia
| | | | - Chantal F. Ski
- Cardiovascular Research Centre; Australian Catholic University; Victoria Australia
| | - David R. Thompson
- Cardiovascular Research Centre; Australian Catholic University; Victoria Australia
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Pressler SJ, Martineau A, Grossi J, Giordani B, Koelling TM, Ronis DL, Riley PL, Chou CC, Sullivan BJ, Smith DG. Healthcare resource use among heart failure patients in a randomized pilot study of a cognitive training intervention. Heart Lung 2013; 42:332-8. [PMID: 23809197 PMCID: PMC3781586 DOI: 10.1016/j.hrtlng.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 05/02/2013] [Accepted: 05/05/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare healthcare resource use of patients with heart failure (HF) randomized to the cognitive training intervention and to the health education active control intervention in a randomized controlled pilot study. BACKGROUND Cognitive training interventions may be efficacious and improve patients' memory and abilities to perform instrumental activities of daily living and self-care behaviors that may, in turn, lower healthcare resource use, but the influence of these interventions on healthcare resource use is unknown. METHODS Thirty-four HF patients were randomized to the computerized plasticity-based cognitive training intervention called Brain Fitness and to the health education active control intervention and completed the study. The primary outcome variable for the study was memory (recall and delayed recall). The secondary purpose of the study that is the focus of this paper was to compare healthcare resource use between the two groups using the third-party payer perspective. Data were collected at baseline and at 8 and 12 weeks after baseline. Healthcare resources were priced at Medicare payment levels for services and average wholesale price for medications. RESULTS Average costs of visits, procedures, and medications were similar between groups. Average costs of hospitalizations and tests, and therefore total costs, were half as much in the Brain Fitness group as compared to the active control group, but this difference was not significantly different from zero (p = 0.24). CONCLUSIONS Larger randomized controlled trials are needed that include analyses of program costs and costs associated with medical and non-medical services in order to fully evaluate efficacy of this intervention.
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Affiliation(s)
- Susan J. Pressler
- Professor and Associate Dean for Graduate Studies, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 734-764-7188
| | | | - Judith Grossi
- Clinical Research Coordinator, University of Michigan School of Medicine, Division of Internal Medicine, Cardiology Cardiovascular Center, 1500 E. Medical Center Drive Ann Arbor, MI 48109, Phone 734-232-6367
| | - Bruno Giordani
- Associate Professor and Director, University of Michigan School of Medicine, Neuropsychology Section, Department of Psychiatry and Department of Neurology, 2101 Commonwealth, Suite C Ann Arbor, MI 48105, Phone 734-764-3169
| | - Todd M. Koelling
- Associate Professor and Medical Director, Heart Failure Program, University of Michigan School of Medicine, Division of Internal Medicine, Cardiology Cardiovascular Center, 1500 E. Medical Center Drive Ann Arbor, MI 48109, Phone 734-764-7440
| | - David L. Ronis
- Research Scientist and Director of Statistical Consulting Team, University of Michigan School of Nursing and Veterans Affairs Center for Clinical Management Research, Department of Veterans Affairs, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 734-647-0462
| | - Penny L. Riley
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 248-437-3201
| | - Cheng-Chen Chou
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone, 886-2-33225398
| | - Barbara J Sullivan
- Clinical Assistant Professor, University of Michigan School of Nursing and University of Michigan Depression Center, Department of Psychiatry, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 734-647-0179
| | - Dean G. Smith
- Professor and Director of Executive Education and Life-Long Learning, University of Michigan School of Public Health,1415 Washington Heights, Ann Arbor, Michigan 48109, Phone 734-647-6233
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Gallagher R, Sullivan A, Burke R, Hales S, Gillies G, Cameron J, Saliba B, Tofler G. Mild Cognitive Impairment, Screening, and Patient Perceptions in Heart Failure Patients. J Card Fail 2013; 19:641-6. [DOI: 10.1016/j.cardfail.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/25/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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Habota T, Cameron J, McLennan SN, Ski CF, Thompson DR, Rendell PG. Prospective memory and chronic heart failure. BMC Cardiovasc Disord 2013; 13:63. [PMID: 23984757 PMCID: PMC3766272 DOI: 10.1186/1471-2261-13-63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/15/2013] [Indexed: 01/11/2023] Open
Abstract
Background Patients with chronic heart failure (CHF) experience a number of debilitating symptoms, which impact on activities of daily living and result in poor quality of life. Prospective memory, which is defined as memory to carry out future intentions, has not been investigated in this group. However, emerging evidence suggests CHF patients have difficulties with cognitive processes related to prospective memory. Self-care, which partly relies on prospective memory, is essential in symptom management and preventing acute clinical deterioration. This study aims to measure prospective memory in CHF patients, and examine the relationship between prospective memory and CHF self-care. Methods/Design A comprehensive neuropsychological assessment will be conducted to assess a range of cognitive functions and psychopathology. The primary focus will be an assessment of prospective memory using a well-established behavioral measure; Virtual Week. Thirty CHF patients attending a nurse-led management program will be recruited from three hospital sites in Melbourne, Australia and their self-care behaviors will be assessed using the Self-care Chronic Heart Failure Index (SCHFI), a validated self-report tool. An additional 30 healthy controls, matched on age, gender, and IQ will be recruited from the general community. Discussion This is a group comparison study that will provide an evaluation of the prospective memory abilities of CHF patients. The findings of this research will provide insight into whether prospective memory may be hindering patients’ ability to perform adequate self-care.
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Affiliation(s)
- Tina Habota
- School of Psychology, Australian Catholic University, Melbourne, Australia.
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Cameron J, Ski CF, McLennan SN, Rendell PG, Whitbourn RJ, Thompson DR. Development of the Heart Failure Screening Tool (Heart-FaST) to measure barriers that impede engagement in self-care. Eur J Cardiovasc Nurs 2013; 13:408-17. [PMID: 23969781 DOI: 10.1177/1474515113502461] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Screening for self-care capacity is advocated before applying educational strategies. No screening tool has been specifically developed to assess barriers that impede engagement in self-care in people with heart failure. Earlier conceptual work (InCOGNITO) identified NYHA class, mild cognitive impairment and depressive symptoms as barriers that impede engagement in HF self-care. AIMS Study aims were: 1) to develop the Heart Failure Screening Tool (Heart-FaST) as a means of assessing three critical barriers to self-care; 2) to assess the content validity of the Heart-FaST; and 3) to test the feasibility of implementing the Heart-FaST in clinical practice. METHODS The Heart-FaST was developed from barriers identified in previous research (InCOGNITO) and from expert panel consensus. Content validity was assessed by examining the proportion of experts who scored each item as relevant. RESULTS The InCOGNITO study indicated that four cognitive tasks, seven emotional questions and NYHA functional class were significantly correlated with the self-care scales: maintenance, management and confidence. These factors were used to create the Heart-FaST items. Consensus on wording and items to be included in the Heart-FaST was reached after two rounds of panel discussion. All items had an item-level content validity index ≥ 0.78. High scores on each barrier (physical, cognitive and emotional functioning) suggest poor self-care and the need for more intensive disease management efforts. CONCLUSION The Heart-FaST measures three critical barriers that impede engagement in self-care. In clinical practice this tool may assist in individually tailoring educational and support strategies to promote effective heart failure self-care.
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Affiliation(s)
- Jan Cameron
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
| | - Chantal F Ski
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
| | - Skye N McLennan
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Peter G Rendell
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Robert J Whitbourn
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
| | - David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
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Alosco ML, Spitznagel MB, Cleveland MJ, Gunstad J. Cognitive deficits are associated with poorer simulated driving in older adults with heart failure. BMC Geriatr 2013; 13:58. [PMID: 24499466 PMCID: PMC3681599 DOI: 10.1186/1471-2318-13-58] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/31/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive impairment is prevalent in older adults with heart failure (HF) and associated with reduced functional independence. HF patients appear at risk for reduced driving ability, as past work in other medical samples has shown cognitive dysfunction to be an important contributor to driving performance. The current study examined whether cognitive dysfunction was independently associated with reduced driving simulation performance in a sample of HF patients. METHODS 18 persons with HF (67.72; SD = 8.56 year) completed echocardiogram and a brief neuropsychological test battery assessing global cognitive function, attention/executive function, memory and motor function. All participants then completed the Kent Multidimensional Assessment Driving Simulation (K-MADS), a driving simulator scenario with good psychometric properties. RESULTS The sample exhibited an average Mini Mental State Examination (MMSE) score of 27.83 (SD = 2.09). Independent sample t-tests showed that HF patients performed worse than healthy adults on the driving simulation scenario. Finally, partial correlations showed worse attention/executive and motor function were independently associated with poorer driving simulation performance across several indices reflective of driving ability (i.e., centerline crossings, number of collisions, % of time over the speed limit, among others). CONCLUSION The current findings showed that reduced cognitive function was associated with poor simulated driving performance in older adults with HF. If replicated using behind-the-wheel testing, HF patients may be at elevated risk for unsafe driving and routine driving evaluations in this population may be warranted.
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