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Wang W, Peng Y, He G, Li Y, Liu Y, Lei L, Li J, Pu B, Yu Y, Zhang L, Guo Y. Effects of Cumulative Cognitive Function Within 1 Year of Discharge on Subsequent Mortality Among Patients Hospitalized for Acute Heart Failure: A Nationwide Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad288. [PMID: 38170569 PMCID: PMC11157964 DOI: 10.1093/gerona/glad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To examine the association between cumulative cognitive function and subsequent mortality among patients hospitalized for acute heart failure (AHF). METHODS Based on a prospective cohort of patients hospitalized for AHF, cognitive function was measured using Mini-Cog test at admission, 1- and 12-month following discharge. Cumulative cognitive function was interpreted by cumulative Mini-Cog score and cumulative times of cognitive impairment. Outcomes included subsequent all-cause and cardiovascular mortality. RESULTS 1 454 patients hospitalized for AHF with median follow-up of 4.76 (interquartile range [IQR]: 4.18-5.07) years were included. Tertile 1 of cumulative Mini-Cog score had the highest risk of all-cause (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.14-2.03) and cardiovascular mortality (HR: 1.40, 95% CI: 1.02-1.93) compared with Tertile 3; patients with ≥2 times of cognitive impairment had the highest risk of all-cause (HR: 1.34, 95% CI: 1.03-1.73) and cardiovascular mortality (HR: 1.25, 95% CI: 0.93-1.67) compared with patients without any cognitive impairment. Cumulative Mini-Cog score provided the highest incremental prognostic ability in predicting all-cause (C-statistics: 0.64, 95% CI: 0.61-0.66) and cardiovascular mortality (C-statistics: 0.63, 95% CI: 0.60-0.67) risk on the basis of Get With The Guidelines-Heart Failure score. CONCLUSIONS Poor cumulative cognitive function was associated with increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with AHF. Longitudinal assessment and monitoring of cognitive function among patients with AHF would be of great importance in identifying patients at greater risk of self-care absence for optimizing personal disease management in clinical practice.
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Affiliation(s)
- Wei Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangda He
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanchen Liu
- National Clinical Research Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Lubi Lei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingkuo Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boxuan Pu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanwu Yu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanlin Guo
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Traub J, Homola G, Morbach C, Sell R, Göpfert D, Frantz S, Pham M, Stoll G, Störk S, Frey A. Long-term cognitive and brain morphologic changes in chronic heart failure: Results of the Cognition.Matters-HF study. ESC Heart Fail 2024. [PMID: 38873878 DOI: 10.1002/ehf2.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
AIMS Cognitive impairment (CI) is a common, yet frequently unrecognized co-morbidity in chronic heart failure (HF). We quantified trajectories of cognitive performance, brain volume, and related clinical outcome over a time course of 6 years. METHODS AND RESULTS The Cognition.Matters-HF cohort study recruited patients with stable HF of any aetiology and severity. Beyond cardiological assessment, the workup included cognitive testing and brain magnetic resonance imaging (MRI). Of 148 recruited patients, 70% exhibited CI at baseline. During the median follow-up time of 69 months (quartiles: 68, 70), indicators of HF severity remained essentially unaltered. CI was also stable, with the exception of intensity of attention, where age-adjusted t-scores decreased from 42 (38, 46) to 38 (34, 44; P < 0.001). Complete sets of four serial brain MRI scans were available in 47 patients (32% of total sample). Total brain volume shrank by 0.4% per year, from 1103 (1060, 1143) cm3 to 1078 (1027, 1117) cm3, which was within limits observed in non-diseased ageing individuals. During follow-up, 29 study participants (20%) died, and 26 (18%) were at least once hospitalized due to worsening HF. The presence of CI was not associated with overall (P = 0.290) or hospitalization-free (P = 0.450) survival. CONCLUSIONS In patients with stable HF patients receiving guideline-directed pharmacologic treatment and regular medical care, the presence of CI did not affect overall and hospitalization-free 6-year survival. The loss of brain parenchyma observed in patients with stable HF did not exceed that of normal ageing.
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Affiliation(s)
- Jan Traub
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - György Homola
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Roxanne Sell
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Dennis Göpfert
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Mirko Pham
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Guido Stoll
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Anna Frey
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
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Chen SM, Wu MK, Chen C, Wang LY, Guo NW, Wei CL, Zheng YC, Hsiao HY, Wu PJ, Chen YL, Chen CJ, Hang CL. Benefit of cardiac rehabilitation in acute heart failure patients with cognitive impairment. Heliyon 2024; 10:e30493. [PMID: 38726193 PMCID: PMC11079101 DOI: 10.1016/j.heliyon.2024.e30493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
Aims This study aimed to evaluate the prevalence of cognitive impairment among patients with acute heart failure (AHF), its prognosis, and the effects of cardiac rehabilitation (CR) on these patients' outcomes. Methods Overall, 247 consecutive AHF patients (median age, 60 years; males, 78.5 %) were evaluated from March 2015 to May 2021. Patients received an AHF disease management program coordinated by an HF specialist nurse and underwent a Luria-Nebraska Neuropsychological battery-screening test (LNNB-S) assessment during admission. Cognitive impairment was defined as an LNNB-S score ≥10. Patients who underwent at least one session of phase II CR and continued with the home-based exercise program were considered to have received CR. The primary endpoint was composite all-cause mortality or readmission after a 3.30-year follow-up (interquartile range, 1.69-5.09 years). Results Cognitive impairment occurred in 53.0 % and was associated with significantly higher composite endpoint, all-cause mortality, and readmission rates (p=<0.001, 0.001, and 0.015, respectively). In the total cohort, 40.9 % of patients experienced the composite endpoint. Multivariate analysis showed that the peak VO2 was a significant predictor of the composite endpoint. After adjustment, CR significantly decreased the event rate of the composite endpoint and the all-cause mortality in patients with cognitive impairment (log-rank p = 0.024 and 0.009, respectively). However, CR did not have a significant benefit on the composite endpoint and the all-cause mortality in patients without cognitive impairment (log-rank p = 0.682 and 0.701, respectively). Conclusion Cognitive impairment is common in AHF patients and can lead to poor outcomes. CR is a standard treatment to improve prognosis.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
- Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Ching Chen
- Clinical Psychologist, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Nai-Wen Guo
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Taiwan, Republic of China
| | - Chin-Ling Wei
- Department of Nursing, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - You-Cheng Zheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Hao-Yi Hsiao
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
- Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Chien-Jen Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
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Jung M, Smith AB, Giordani B, Clark DG, Gradus-Pizlo I, Wierenga KL, Lake KR, Pressler SJ. Computerized Cognitive Training and 24-Month Mortality in Heart Failure. J Cardiovasc Nurs 2024; 39:E51-E58. [PMID: 37494830 PMCID: PMC10808269 DOI: 10.1097/jcn.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Cognitive dysfunction predicts mortality in heart failure (HF). Computerized cognitive training (CCT) has shown preliminary efficacy in improving cognitive function. However, the relationship between CCT and mortality is unclear. Aims were to evaluate (1) long-term efficacy of CCT in reducing 24-month mortality and (2) age, HF severity, global cognition, memory, working memory, depressive symptoms, and health-related quality of life as predictors of 24-month mortality among patients with HF. METHODS In this prospective longitudinal study, 142 patients enrolled in a 3-arm randomized controlled trial were followed for 24 months. Logistic regression was used to achieve the aims. RESULTS Across 24 months, 16 patients died (CCT, 8.3%; control groups, 12.8%). Computerized cognitive training did not predict 24-month mortality (odds ratio [OR], 0.65). Older age (OR, 1.08), worse global cognition (OR, 0.73), memory (OR, 0.81), and depressive symptoms (OR, 1.10) at baseline predicted 24-month mortality. CONCLUSIONS Efficacious interventions are needed to improve global cognition, memory, and depressive symptoms and reduce mortality in HF.
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Affiliation(s)
- Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Asa B. Smith
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Bruno Giordani
- University of Michigan, School of Medicine Department of Psychiatry Michigan Alzheimer’s Disease Research Center, Suite C, 2101 Commonwealth Blvd. Ann Arbor MI 48105
| | - David G. Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA 92868-32988
| | - Kelly L. Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
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Forte G, Favieri F, Marotta A, Arcari L, Cacciotti L, Casagrande M. The Efficiency of Attentional Networks in Takostubo Syndrome: A Study With the Attentional Network Task for Interaction. J Atten Disord 2024; 28:469-479. [PMID: 38069477 DOI: 10.1177/10870547231215517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
INTRODUCTION The role of cardiovascular risk factors in the occurrence and progression of cognitive impairment is relevant in aging studies. In this condition, attention is one of the processes less studied, but preliminary evidence suggests an association between cardiometabolic alterations and attentional decline. Attention is not a unitary process but a set of independent systems (Alerting, Orienting, Executive), which can interact in certain conditions to ensure maximum behavioral efficiency. METHODS We investigated attentive networks and their interactions in patients with Takostubo syndrome (TTS). In all, 20 participants with TTS and 20 individuals without cardiovascular pathologies performed an Attention-Network Task for Interaction, which assesses attentional networks and their interactions. RESULTS Patients with TTS showed an atypical orienting effect when compared to the control group. Moreover, only the control group exhibited an interaction between orienting and alerting. CONCLUSION These findings establish the relevance of brain-heart interaction in identifying attentional impairment as a prodrome of progressively severe cognitive impairment in TTS.
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Affiliation(s)
- Giuseppe Forte
- Department of Dynamic and Clinical Psychology and Health Studies, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Favieri
- Department of Dynamic and Clinical Psychology and Health Studies, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Marotta
- Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Luca Arcari
- Cardiology Unit, M.G. Vannini Hospital, Rome, Italy
| | | | - Maria Casagrande
- Department of Dynamic and Clinical Psychology and Health Studies, "Sapienza" University of Rome, Rome, Italy
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Wang L, Lu Z, Teng Y, Pan W, Li Y, Su S, Chang J, Zhao M. Cognitive impairment is associated with BDNF-TrkB signaling mediating synaptic damage and reduction of amino acid neurotransmitters in heart failure. FASEB J 2024; 38:e23351. [PMID: 38085181 DOI: 10.1096/fj.202301699rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
Heart failure (HF) is often accompanied by cognitive impairment (CI). Brain-derived neurotrophic factor (BDNF) deficiency is closely associated with CI. However, the role and mechanism of BDNF in HF with CI is still not fully understood. Here, the case-control study was designed including 25 HF without CI patients (HF-NCI) and 50 HF with CI patients (HF-CI) to investigate the predictive value of BDNF in HF-CI while animal and cell experiments were used for mechanism research. Results found that BDNF levels in serum neuronal-derived exosomes were downregulated in HF-CI patients. There was no significant difference in serum BDNF levels among the two groups. HF rats showed obvious impairment in learning and memory; also, they had reduced thickness and length of postsynaptic density (PSD) and increased synaptic cleft width. Expression of BDNF, TrkB, PSD95, and VGLUT1 was significantly decreased in HF rats brain. In addition, compared with sham rats, amino acids were significantly reduced with no changes in the acetylcholine and monoamine neurotransmitters. Further examination showed that the number of synaptic bifurcations and the expression of BDNF, TrkB, PSD95, and VGLUT1 were all decreased in the neurons that interfered with BDNF-siRNA compared with those in the negative control neurons. Together, our results demonstrated that neuronal-derived exosomal BDNF act as effective biomarkers for prediction of HF-CI. The decrease of BDNF in the brain triggers synaptic structural damage and a decline in amino acid neurotransmitters via the BDNF-TrkB-PSD95/VGLUT1 pathway. This discovery unveils a novel pathological mechanism underlying cognitive impairment following heart failure.
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Affiliation(s)
- Lei Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ziwen Lu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Teng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Weibing Pan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sha Su
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mingjing Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Pressler SJ, Jung M, Giordani B, Titler MG, Gradus-Pizlo I, Lake KR, Wierenga KL, Clark DG, Perkins SM, Smith DG, Mocci E, Dorsey SG. Evaluating depressive symptoms, BDNF Val66Met, and APOE-ε4 as moderators of response to computerized cognitive training in heart failure. Heart Lung 2023; 59:146-156. [PMID: 36805256 PMCID: PMC10065971 DOI: 10.1016/j.hrtlng.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF). OBJECTIVES The purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL). METHODS 256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators. RESULTS As previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results. CONCLUSIONS Studies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.
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Affiliation(s)
- Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Bruno Giordani
- University of Michigan, Michigan Alzheimer's Disease Research Center and Department of Psychiatry, Suite C, 2101 Commonwealth Blvd., Ann Arbor, MI 48105, United States.
| | - Marita G Titler
- University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109-5482, United States.
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA 92868-32988, United States.
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States
| | - Kelly L Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - David G Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202, United States.
| | - Susan M Perkins
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202, United States.
| | - Dean G Smith
- Louisiana State University School of Public Health 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112.
| | - Evelina Mocci
- University of Maryland School of Nursing, Department of Pain and Translational Science, 655 West Lombard Street, Baltimore, MD 21201, United States.
| | - Susan G Dorsey
- University of Maryland School of Nursing, Department of Pain and Translational Science, 655 West Lombard Street, Baltimore, MD 21201, United States.
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Xiong T, Shi J, Zhang J, Sun Y, Wang Z, Wang Y, Wang G, Chen S, Dong N. The impact of postoperative cognitive impairment on mid-term survival after heart transplantation. Clin Transplant 2023; 37:e14870. [PMID: 36478609 DOI: 10.1111/ctr.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heart transplantation is the definitive therapy for patients with end-stage heart failure. Antecedent studies reported that a substantial proportion of heart transplant recipients developed postoperative cognitive impairment in the long term. However, no studies have explored the association between postoperative cognitive impairment and survival after heart transplantation. METHODS The data of 43 adult patients who underwent heart transplantation were consecutively enrolled and assessed using the MMSE and MoCA neuropsychological tests. Kaplan-Meier curves and Cox proportional hazards models were used for survival analyses. Primary component analysis was performed to integrate MoCA subtests into the "Attention factor," "Naming factor," and "Orientation factor." RESULTS About 30% of the patients were diagnosed with short-term postoperative cognitive impairment. The impairment group was older and had lower baseline cognitive performances, larger LV diameter, worse MMSE decline and higher ratio of significant MoCA decline. Postoperative cognitive impairment was significantly associated with worse survival (P = .028). Multivariate Cox analyses showed that higher postoperative MoCA score was significantly associated with lower mid-term post-transplant mortality (HR = .744 [.584, .949], P = .017), in which "Attention factor" contributed to this association most (HR = .345 [.123, .970], P = .044) rather than "Naming factor" or "Orientation factor." Notably, preoperative cognitive impairment was closely related with postoperative cognitive impairment and also indicated the worse post-transplant survival (P = .015). CONCLUSION Postoperative as well as preoperative cognitive impairments were associated with a worse mid-term survival after heart transplantation, indicating that neuropsychological assessments before and after heart transplantation should be routinely performed for heart transplant recipients for better risk stratification.
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Affiliation(s)
- Tixiusi Xiong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jing Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yongfeng Sun
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhiwen Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Jurgens CY, Lee CS, Aycock DM, Masterson Creber R, Denfeld QE, DeVon HA, Evers LR, Jung M, Pucciarelli G, Streur MM, Konstam MA. State of the Science: The Relevance of Symptoms in Cardiovascular Disease and Research: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e173-e184. [PMID: 35979825 DOI: 10.1161/cir.0000000000001089] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Symptoms of cardiovascular disease drive health care use and are a major contributor to quality of life. Symptoms are of fundamental significance not only to the diagnosis of cardiovascular disease and appraisal of response to medical therapy but also directly to patients' daily lives. The primary purpose of this scientific statement is to present the state of the science and relevance of symptoms associated with cardiovascular disease. Symptoms as patient-reported outcomes are reviewed in terms of the genesis, manifestation, and similarities or differences between diagnoses. Specifically, symptoms associated with acute coronary syndrome, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease are reviewed. Secondary aims include (1) describing symptom measurement methods in research and application in clinical practice and (2) describing the importance of cardiovascular disease symptoms in terms of clinical events and other patient-reported outcomes as applicable.
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10
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Niu Q, Liu W, Wang F, Tian L, Dong Y. The Utility of Cognitive Screening in Asian Patients With Heart Failure: A Systematic Review. Front Psychiatry 2022; 13:930121. [PMID: 35911251 PMCID: PMC9329604 DOI: 10.3389/fpsyt.2022.930121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of undiagnosed cognitive impairment in patients with heart failure is alarmingly high in Asia. There is still no consensus on cognitive screening tools to detect cognitive impairment in the Asian heart failure population. The clinical implications based on our systematic review may help to improve cognitive screening practice for patients with heart failure in Asia. Methods This review is registered in the PROSPERO (CRD42021264288). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, we searched PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Scopus, the Web of Science, PsycINFO, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data in English and Chinese literatures concerning heart failure and cognitive impairment. Results The search yielded 21 eligible studies. Only in five studies, cognitive brief tests, including the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Mini-Cog, were used as cognitive screening tools for Asian patients with heart failure. In the rest 16 studies, brief cognitive tests were used as screening tools for global cognition. Only one study validated screening tests against a gold standard formal neuropsychological assessment test battery. Among these studies, patients with heart failure tended to perform worse than patients without heart failure. The presence of cognitive impairment in patients with heart failure is associated with poorer self-care, quality of life, and hospital readmission. Conclusion Brief cognitive tests have been used in Asian patients with heart failure and these tests are frequently used as a measure of global cognitive function for cognitive screening. However, validating brief cognitive tests against a gold standard formal neuropsychological assessment in Asian patients with heart failure is lacking. Future studies need to address methodological issues to validate cognitive screening measures in a larger population of Asian patients with heart failure.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Qi Niu
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - WeiHua Liu
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | | | - LiYa Tian
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - YanHong Dong
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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11
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The Emerging Role of Combined Brain/Heart Magnetic Resonance Imaging for the Evaluation of Brain/Heart Interaction in Heart Failure. J Clin Med 2022; 11:jcm11144009. [PMID: 35887772 PMCID: PMC9322381 DOI: 10.3390/jcm11144009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) patients frequently develop brain deficits that lead to cognitive dysfunction (CD), which may ultimately also affect survival. There is an important interaction between brain and heart that becomes crucial for survival in patients with HF. Our aim was to review the brain/heart interactions in HF and discuss the emerging role of combined brain/heart magnetic resonance imaging (MRI) evaluation. A scoping review of published literature was conducted in the PubMed EMBASE (OVID), Web of Science, Scopus and PsycInfo databases. Keywords for searches included heart failure, brain lesion, brain, cognitive, cognitive dysfunction, magnetic resonance imaging cardiovascular magnetic resonance imaging electroencephalogram, positron emission tomography and echocardiography. CD testing, the most commonly used diagnostic approach, can identify neither subclinical cases nor the pathophysiologic background of CD. A combined brain/heart MRI has the capability of diagnosing brain/heart lesions at an early stage and potentially facilitates treatment. Additionally, valuable information about edema, fibrosis and cardiac remodeling, provided with the use of cardiovascular magnetic resonance, can improve HF risk stratification and treatment modification. However, availability, familiarity with this modality and cost should be taken under consideration before final conclusions can be drawn. Abnormal CD testing in HF patients is a strong motivating factor for applying a combined brain/heart MRI to identify early brain/heart lesions and modify risk stratification accordingly.
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12
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Perceived Facilitators and Barriers to Treatment Fidelity in Computerized Cognitive Training Interventions. J Cardiovasc Nurs 2022; 38:247-255. [PMID: 37027129 DOI: 10.1097/jcn.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Computerized cognitive training (CCT) interventions may have an important role in improving cognition among patients with heart failure. Ensuring treatment fidelity of CCT interventions is an essential part of testing their efficacy. OBJECTIVE The aim of this study was to describe facilitators of and barriers to treatment fidelity perceived by CCT intervenors while delivering the interventions to patients with heart failure. METHODS AND RESULTS A qualitative descriptive study was completed with 7 intervenors who delivered CCT interventions in 3 studies. Directed content analysis revealed 4 main themes of perceived facilitators: (1) training for intervention delivery, (2) supportive work environment, (3) prespecified implementation guide, and (4) confidence and awareness. Three main themes were identified as perceived barriers: (1) technical issues, (2) logistic barriers, and (3) sample characteristics. CONCLUSION This study is novel because it was one of the few studies focused on the intervenors' perceptions rather than the patients' perception of using CCT interventions. Beyond the treatment fidelity recommendations, this study found new components that might help the future investigators in designing and implementing CCT interventions with high treatment fidelity.
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13
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Iwatsu K, Adachi T, Kamisaka K, Kamiya K, Iida Y, Yamada S. Clinical benefit of combined assessment of physical and psychological frailty in patients with heart failure. J Am Geriatr Soc 2022; 70:2070-2079. [PMID: 35352819 DOI: 10.1111/jgs.17769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/06/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Physical frailty becomes a robust risk factor in patients with heart failure (HF) and coexistence of physical and psychological frailty is likely to be a prognostic indicator. This study aimed to analyze the prognosis of coexistence of these two factors in patients with HF. METHODS This study was a secondary analysis of a multicenter prospective cohort study (FLAGSHIP). We analyzed data from 2502 patients with HF from the FLAGSHIP study in Japan. We divided the patients into four physical frailty categories using a frailty score ranging from 0 to 14 (<4: I, 4-8: II, 9-12: III, and 14: IV, the score 13 does not exist in calculation). The higher category indicates more severe physical frailty. Psychological frailty was defined as the presence of cognitive decline and/or depressive symptoms. The study outcome was a 2-year composite outcome of rehospitalization for HF or all-cause mortality after hospital discharge. RESULTS During the 3734.7 person-year follow-up, 774 patients experienced the composite outcome. After adjusting for confounders, physical and psychological frailty were independently associated with adverse outcomes. Using physical frailty category I, without psychological frailty as the reference, adjusted hazard ratios for adverse outcomes were 1.29 [95% confidence interval (CI) 0.86-1.92] for category I with psychological frailty, 0.99 (95% CI 0.71-1.37) for category II without psychological frailty, 1.61 (95% CI 1.16-2.23) for category II with psychological frailty, 1.56 (95% CI 1.14-2.15) for category III without psychological frailty, 1.62 (95% CI 1.20-2.20) for category III with psychological frailty, 1.50 (95% CI 1.05-2.14) for category IV without psychological frailty, and 2.16 (95% CI 1.59-2.94) for category IV with psychological frailty, respectively. CONCLUSIONS Combined assessment of physical and psychological frailty leads to more detailed risk stratification of patients with HF.
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Affiliation(s)
- Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Takuji Adachi
- Department of Integrated Health Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Kitano Hospital, Osaka, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
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14
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Duan C, Shi J, Yuan G, Shou X, Chen T, Zhu X, Yang Y, Hu Y. Causal Association Between Heart Failure and Alzheimer's Disease: A Two-Sample Bidirectional Mendelian Randomization Study. Front Genet 2022; 12:772343. [PMID: 35087565 PMCID: PMC8787319 DOI: 10.3389/fgene.2021.772343] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Traditional observational studies have demonstrated an association between heart failure and Alzheimer's disease. The strengths of observational studies lie in their speed of implementation, cost, and applicability to rare diseases. However, observational studies have several limitations, such as uncontrollable confounders. Therefore, we employed Mendelian randomization of genetic variants to evaluate the causal relationships existing between AD and HF, which can avoid these limitations. Materials and Methods: A two-sample bidirectional MR analysis was employed. All datasets were results from the UK's Medical Research Council Integrative Epidemiology Unit genome-wide association study database, and we conducted a series of control steps to select the most suitable single-nucleotide polymorphisms for MR analysis, for which five primary methods are offered. We reversed the functions of exposure and outcomes to explore the causal direction of HF and AD. Sensitivity analysis was used to conduct several tests to avoid heterogeneity and pleiotropic bias in the MR results. Results: Our MR studies did not support a meaningful causal relationship between AD on HF (MR-Egger, p = 0.634 > 0.05; weighted median (WM), p = 0.337 > 0.05; inverse variance weighted (IVW), p = 0.471 > 0.05; simple mode, p = 0.454 > 0.05; weighted mode, p = 0.401 > 0.05). At the same time, we did not find a significant causal relationship between HF and AD with four of the methods (MR-Egger, p = 0.195 > 0.05; IVW, p = 0.0879 > 0.05; simple mode, p = 0.170 > 0.05; weighted mode, p = 0.110 > 0.05), but the WM method indicated a significant effect of HF on AD (p = 0.025 < 0.05). Because the statistical powers of IVW and MR-Egger are more than that of WM, we think that there is no causal effect of HF on AD. Sensitivity analysis and horizontal pleiotropy were not detected in the MR analysis. Conclusion: Our results did not provide significant evidence indicating any causal relationships between HF and AD in the European population. Therefore, more large-scale datasets or datasets related to similar factors are expected for further MR analysis.
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Affiliation(s)
- Chenglin Duan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Shi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guozhen Yuan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xintian Shou
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Ting Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Xueping Zhu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yihan Yang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Yuanhui Hu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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15
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Cognitive Impairment in Heart Failure—A Review. BIOLOGY 2022; 11:biology11020179. [PMID: 35205045 PMCID: PMC8869585 DOI: 10.3390/biology11020179] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/31/2022]
Abstract
Simple Summary Compared to the general population, patients with heart failure have reduced cognition and increased dementia risk. Brain changes have been observed in these individuals, including reduced brain volumes and abnormal areas suggestive of ischaemia (lack of blood and hence oxygen supply to tissues). Patients with heart failure who have cognitive impairment have poorer self-care and are at increased risk of rehospitalisation and death. Causes of cognitive impairment in heart failure have been suggested, including reduced blood supply to the brain, inflammatory processes, protein abnormalities and thromboembolic disease (formation of blood clots which may travel to the brain and impede blood flow). In this article, we discuss these potential causes linking heart failure and cognitive impairment, and discuss the recognition and management of cognitive impairment in patients with heart failure. Abstract Cognitive impairment (CI) is common in heart failure (HF). Patients with HF demonstrate reduced global cognition as well as deficits in multiple cognitive domains compared to controls. Degree of CI may be related to HF severity. HF has also been associated with an increased risk of dementia. Anatomical brain changes have been observed in patients with HF, including grey matter atrophy and increased white matter lesions. Patients with HF and CI have poorer functional independence and self-care, more frequent rehospitalisations as well as increased mortality. Pathophysiological pathways linking HF and CI have been proposed, including cerebral hypoperfusion and impaired cerebrovascular autoregulation, systemic inflammation, proteotoxicity and thromboembolic disease. However, these mechanisms are poorly understood. We conducted a search on MEDLINE, Embase and Scopus for original research exploring the connection between HF and CI. We then reviewed the relevant literature and discuss the associations between HF and CI, the patterns of brain injury in HF and their potential mechanisms, as well as the recognition and management of CI in patients with HF.
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16
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Cognitive decline and risk of dementia in individuals with heart failure: A systematic review and meta-analysis. J Card Fail 2021; 28:1337-1348. [PMID: 34971812 DOI: 10.1016/j.cardfail.2021.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
AIM To determine the association between heart failure (HF) and cognitive change and dementia. METHODS AND RESULTS Systematic search of three electronic databases was performed and 29 eligible studies involving approximately 3 million participants were identified. Twelve studies examined dementia and 20 cognitive change, but only a subset of studies could be included in the meta-analysis. These findings indicated that HF was not significantly associated with dementia (n=8, hazard ratio [HR] 1.18, 95% confidence interval [CI] [0.93, 1.50]), but increased the risk of cognitive impairment (n=3, HR 1.80, 95%CI [1.14,2.86]) . Additionally, HF was associated with poorer mean cognitive performance in global cognition (Hedges' g -0.73, 95%CI [-1.12, -0.35]), memory (Hedges' g -0.57, 95%CI [-0.72, -0.42]), executive function (Hedges' g -0.58, 95%CI [-0.72, -0.43]), attention/speed (Hedges' g -0.50, 95%CI [-0.63, -0.37]) and language (Hedges' g -0.61, 95%CI [-1.05, -0.17]). CONCLUSION Patients with HF perform worse on all cognitive tests, and have an increased risk of cognitive impairment. These findings highlight the need for clinicians to consider cognition as part of routine care for patients with HF.
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17
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Pressler SJ, Jung M, Gradus-Pizlo I, Titler M, Smith D, Gao S, Lake KR, Burney H, Clark D, Wierenga K, Dorsey SG, Giordani B. Randomized Controlled Trial of a Cognitive Intervention to Improve Memory in Heart Failure. J Card Fail 2021; 28:519-530. [PMID: 34763080 DOI: 10.1016/j.cardfail.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The objective of this 3-arm randomized controlled trial was to evaluate efficacy of computerized cognitive training (CCT) to improve primary outcomes of delayed recall memory and serum brain-derived neurotrophic factor (BDNF) levels and secondary outcomes of working memory, instrumental activities of daily living (IADL), and health-related quality of life (HRQL) among patients with heart failure (HF). METHODS AND RESULTS Patients (N = 256) were randomly assigned to 8 weeks of CCT using BrainHQ, computerized crossword puzzles active control intervention, and usual care. All patients received weekly nurse enhancement interventions. Data were collected at enrollment and baseline visits and at 10 weeks and 4 and 8 months. In mixed effects models, there were no statistically significant group or group by time differences in outcomes. There were statistically significant differences over time in all outcomes in all groups. Patients improved over time on measures of delayed recall memory, working memory, IADL, and HRQL and had decreased serum BDNF. CONCLUSIONS CCT did not improve outcomes compared with the active control intervention and usual care. Nurse enhancement interventions may have led to improved outcomes over time. Future studies are needed to test nurse enhancement interventions in combination with other cognitive interventions to improve memory in HF. LAYSUMMARY In 256 patients with heart failure, 8 weeks of computerized cognitive training, computerized crossword puzzles, or usual care were studied for effects on (1st) recall memory and serum brain-derived neurotrophic factor (BDNF) and (2nd) working memory, instrumental activities of daily living (IADL), and health-related quality of life (HRQL). Measurements were at baseline, 10 weeks, 4- and 8-months. Nurse enhancement interventions (e.g., support, assessment) were provided. Recall memory, working memory, IADL, and HRQL improved over time. There were no statistically significant differences among treatment groups over time. BDNF unexpectedly decreased. Nurse enhancement interventions may explain improved outcomes. Future studies are needed.
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Affiliation(s)
- Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202.
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA
| | - Marita Titler
- University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, Michigan 48109-5482
| | - Dean Smith
- Louisiana State University School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112
| | - Sujuan Gao
- Indiana University School of Medicine, Department of Biostatistics, 410 West 10(th) Street, Suite 3000, Indianapolis, IN 46202
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Heather Burney
- Indiana University School of Medicine, Department of Biostatistics, 410 West 10(th) Street, Suite 3000, Indianapolis, IN 46202
| | - David Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202
| | - Kelly Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Susan G Dorsey
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21201
| | - Bruno Giordani
- University of Michigan, Michigan Alzheimer's Disease Research Center, Suite C, 2101 Commonwealth Blvd. Ann Arbor MI 48105
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18
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Effect of atrial fibrillation on cognitive function in heart failure patients. J Geriatr Cardiol 2021; 18:585-590. [PMID: 34404994 PMCID: PMC8352770 DOI: 10.11909/j.issn.1671-5411.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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19
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Parent MB, Ferreira-Neto HC, Kruemmel AR, Althammer F, Patel AA, Keo S, Whitley KE, Cox DN, Stern JE. Heart failure impairs mood and memory in male rats and down-regulates the expression of numerous genes important for synaptic plasticity in related brain regions. Behav Brain Res 2021; 414:113452. [PMID: 34274373 DOI: 10.1016/j.bbr.2021.113452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/21/2021] [Accepted: 07/08/2021] [Indexed: 12/01/2022]
Abstract
Chronic heart failure (HF) is a serious disorder that afflicts more than 26 million patients worldwide. HF is comorbid with depression, anxiety and memory deficits that have serious implications for quality of life and self-care in patients who have HF. Still, there are few studies that have assessed the effects of severely reduced ejection fraction (≤40 %) on cognition in non-human animal models. Moreover, limited information is available regarding the effects of HF on genetic markers of synaptic plasticity in brain areas critical for memory and mood regulation. We induced HF in male rats and tested mood and anxiety (sucrose preference and elevated plus maze) and memory (spontaneous alternation and inhibitory avoidance) and measured the simultaneous expression of 84 synaptic plasticity-associated genes in dorsal (DH) and ventral hippocampus (VH), basolateral (BLA) and central amygdala (CeA) and prefrontal cortex (PFC). We also included the hypothalamic paraventricular nucleus (PVN), which is implicated in neurohumoral activation in HF. Our results show that rats with severely reduced ejection fraction recapitulate behavioral symptoms seen in patients with chronic HF including, increased anxiety and impaired memory in both tasks. HF also downregulated several synaptic-plasticity genes in PFC and PVN, moderate decreases in DH and CeA and minimal effects in BLA and VH. Collectively, these findings identify candidate brain areas and molecular mechanisms underlying HF-induced disturbances in mood and memory.
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Affiliation(s)
- Marise B Parent
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | | | | | | | - Atit A Patel
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Sreinick Keo
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | | | - Daniel N Cox
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Javier E Stern
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA.
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20
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Jung M, Apostolova LG, Gao S, Burney HN, Lai D, Foroud T, Saykin AJ, Pressler SJ. Testing influences of APOE and BDNF genes and heart failure on cognitive function. Heart Lung 2021; 50:51-58. [PMID: 32703621 PMCID: PMC8809626 DOI: 10.1016/j.hrtlng.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Apolipoprotein E (APOE) ε2, ε4 and brain-derived neurotrophic factor (BDNF) Val66Met alleles have been associated with cognition. Associations of these alleles with cognition in heart failure (HF) and influences of HF across the cognitive spectrum (i.e., cognitively normal to Alzheimer's dementia [AD]) remain unexplored. OBJECTIVES To investigate influences of APOE ε2, ε4, BDNF Met and HF on cognition among participants across the cognitive spectrum. METHODS Genetic association study using national databases (N = 7,166). RESULTS APOE ε2 frequencies were similar across the cognitive spectrum among participants with HF. APOE ε4 frequency was lower among participants with HF and AD than non-HF participants with AD. BDNF Met frequencies did not differ across the spectrum. HF was associated with worse attention and language. In the HF subsample, ε4 was associated with worse memory. CONCLUSION Associations between APOE and cognition may differ in HF but need to be tested in a larger sample.
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Affiliation(s)
- Miyeon Jung
- Assistant Professor, Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Liana G Apostolova
- Professor, Indiana University School of Medicine, Neurology, Radiology, Medical and Molecular Genetics, 355 West 16th Street, Indianapolis, IN 46202, USA.
| | - Sujuan Gao
- Professor, Indiana University School of Medicine, Department of Biostatistics, 410 West 10th Street, Indianapolis, IN 46202, USA.
| | - Heather N Burney
- Biostatistician, Indiana University School of Medicine, Department of Biostatistics, 410 West 10th Street, Indianapolis, IN 46202, USA.
| | - Dongbing Lai
- Assistant Research Professor, Indiana University School of Medicine, Medical and Molecular Genetics, 410 West 10th Street, Indianapolis, IN 46202, USA.
| | - Tatiana Foroud
- Professor, Indiana University School of Medicine, Medical and Molecular Genetics, 410 West 10th Street, Indianapolis, IN 46202, USA.
| | - Andrew J Saykin
- Professor, Indiana University School of Medicine, Department of Radiology and Imaging Sciences, 355 West 16th street, Indianapolis, IN 46202, USA.
| | - Susan J Pressler
- Professor, Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, USA.
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21
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García Bruñén JM, Povar Echeverria M, Díez-Manglano J, Manzano L, Trullàs JC, Romero Requena JM, Salamanca Bautista MP, González Franco Á, Cepeda Rodrigo JM, Montero-Pérez-Barquero M. Cognitive impairment in patients hospitalized for congestive heart failure: data from the RICA Registry. Intern Emerg Med 2021; 16:141-148. [PMID: 32557090 DOI: 10.1007/s11739-020-02400-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
The objective of this study is to determine the prevalence of cognitive impairment (CogI) in patients hospitalized for congestive heart failure, and the influence of CogI on mortality and hospital readmission. This is a multicenter cohort study of patients hospitalized for congestive heart failure enrolled in the RICA registry. The patients were divided into 3 groups according to their Short Portable Mental Status Questionnaire score: 0-3 errors (no CogI or mild CogI), 4-7 (moderate CogI) and 8-10 (severe CogI). A total of 3845 patients with a mean (SD) age of 79 (8.6) years were included; 2038 (53%) were women. A total of 550 (14%) patients had moderate CogI and 76 (2%) had severe CogI. Factors independently associated with severe CogI were age (OR 1.09, 95% CI 1.05-1.14 p < 0.001), male sex (OR 0.57, 95% CI 0.34-0.95, p = 0.031), heart rate (OR 1.01, 95% CI 1.00-1.02, p = 0.004), Charlson index (OR 1.16, 95% CI 1.06-1.27, p = 0.002), and history of stroke (OR 2.67, 95% CI 1.60-4.44, p < 0.001). Severe CogI was associated with higher mortality after one year (HR 3.05, 95% CI 2.25-4.14, p < 0.001). The composite variable of death/hospital readmission was higher in patients with CogI (log rank p < 0.001). Patients with heart failure and severe CogI are older and have a higher comorbidity burden, lower survival, and a higher rate of death or readmission at 1 year, compared to patients with no CogI.
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Affiliation(s)
| | | | - Jesús Díez-Manglano
- Department of Internal Medicine, Hospital Royo Villanova, Avda San Gregorio nº 30, 50015, Saragossa, Spain.
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute, Saragossa, Spain.
| | - Luis Manzano
- Department of Internal Medicine, University Hospital Ramón y Cajal, University of Alcalá (IRYCIS), Madrid, Spain
| | - Joan Carles Trullàs
- Department of Internal Medicine, Hospital d'Olot i comarcal de la Garrotxa, Olot, Girona, Spain
- Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain
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A Pilot Study to Evaluate a Computer-Based Intervention to Improve Self-care in Patients With Heart Failure. J Cardiovasc Nurs 2020; 36:157-164. [PMID: 33369990 DOI: 10.1097/jcn.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive dysfunction contributes to poor learning and impaired self-care (SC) for patients with heart failure. OBJECTIVES The aims of this study were to (1) evaluate the feasibility and acceptability of a nurse-led, virtual home-based cognitive training and SC education intervention to support SC and (2) evaluate the relationship between improvements in SC and cognitive change and examine 30-day readmission rates. METHODS In this 2-phase pilot study, we used a prospective, exploratory design. In phase 1, recruitment criteria and retention issues threatened feasibility and acceptance. Significant modifications were made and evaluated in phase 2. RESULTS In phase 2, 12 participants were recruited (7 women and 5 men). Feasibility was supported. All participants and the study nurse positively evaluated acceptability of the intervention. Median SC scores improved over time. Thirty-day hospital readmission rates were 25%. CONCLUSION Phase 1 indicates the intervention as originally designed was not feasible or acceptable. Phase 2 supports the feasibility and acceptability of the modified intervention. Further testing is warranted.
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Pressler SJ, Jung M, Haedtke C. Interventions Transformed Through Technology to Improve Cognitive Function in Heart Failure. J Cardiovasc Nurs 2020; 34:430-432. [PMID: 31609279 PMCID: PMC6812552 DOI: 10.1097/jcn.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Drive NU E409, Indianapolis, IN 46202
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive NU E411, Indianapolis, IN 46202
| | - Christine Haedtke
- Indiana University School of Nursing, 600 Barnhill Drive NU W431, Indianapolis, IN 46202
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Moriarty TA, Bourbeau K, Mermier C, Kravitz L, Gibson A, Beltz N, Negrete O, Zuhl M. Exercise-Based Cardiac Rehabilitation Improves Cognitive Function Among Patients With Cardiovascular Disease. J Cardiopulm Rehabil Prev 2020; 40:407-413. [PMID: 32947322 DOI: 10.1097/hcr.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the effects of cardiac rehabilitation (CR) exercise training on cognitive performance and whether the changes are associated with alterations in prefrontal cortex (PFC) oxygenation among patients with cardiovascular disease. METHODS Twenty (men: n = 15; women: n = 5) participants from an outpatient CR program were enrolled in the study. Each participant completed a cognitive performance test battery and a submaximal graded treadmill evaluation on separate occasions prior to and again upon completion of 18 individualized CR sessions. A functional near-infrared spectroscopy (fNIRS) device was used to measure left and right prefrontal cortex (LPFC and RPFC) oxygenation parameters (oxyhemoglobin [O2Hb], deoxyhemoglobin [HHb], total hemoglobin [tHb], and oxyhemoglobin difference [Hbdiff]) during the cognitive test battery. RESULTS Patients showed improvements in cardiorespiratory fitness (+1.4 metabolic equivalents [METs]) and various cognitive constructs. A significant increase in PFC oxygenation, primarily in the LPFC region, occurred at post-CR testing. Negative associations between changes in cognition (executive function [LPFC O2Hb: r = -0.45, P = .049; LPFC tHb: r = -0.49, P = .030] and fluid composite score [RPFC Hbdiff: r = -0.47, P = .038; LPFC Hbdiff: r = -0.45, P = .048]) and PFC changes were detected. The change in cardiorespiratory fitness was positively associated with the change in working memory score (r = 0.55, P = .016). CONCLUSION Cardiovascular disease patients enrolled in CR showed significant improvements in multiple cognitive domains along with increased cortical activation. The negative associations between cognitive functioning and PFC oxygenation suggest an improved neural efficiency.
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Affiliation(s)
- Terence A Moriarty
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque (Drs Moriarty, Mermier, Kravitz, Gibson, and Zuhl and Ms Bourbeau); Department of Kinesiology, University of Northern Iowa, Cedar Falls (Dr Moriarty); Department of Kinesiology, University of Wisconsin-Eau Claire (Dr Beltz); New Heart Center for Wellness, Fitness and Cardiac Rehabilitation, Albuquerque, New Mexico (Mr Negrete); and School of Health Sciences, Central Michigan University, Mount Pleasant (Dr Zuhl)
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25
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Pressler SJ, Jung M, Lee CS, Arkins TP, O'Donnell D, Cook R, Bakoyannis G, Newhouse R, Gradus-Pizlo I, Pang PS. Predictors of emergency medical services use by adults with heart failure; 2009–2017. Heart Lung 2020; 49:475-480. [DOI: 10.1016/j.hrtlng.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 01/14/2023]
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Niu W, Yang H, Lu C. The relationship between serum uric acid and cognitive function in patients with chronic heart failure. BMC Cardiovasc Disord 2020; 20:381. [PMID: 32819289 PMCID: PMC7441639 DOI: 10.1186/s12872-020-01666-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence has shown that serum uric acid (UA) is associated with cognitive function, but this finding remains debatable. Serum UA is commonly elevated in patients with chronic heart failure (CHF), especially in men. However, the relationship between serum UA and cognitive function in CHF populations and stratified by sex are unclear. We aimed to examine whether serum UA was independently associated with cognitive function in CHF populations after controlling for demographic, medical and psychological variables and whether there was a sex difference in the association between serum UA and cognitive function among male and female CHF patients. METHODS One hundred ninety-two hospitalized patients with CHF underwent an assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) and the determination of serum UA. Hyperuricemia was defined as serum UA ≥7 mg/dl in men and ≥ 6 mg/dl in women. Multiple linear hierarchical regression analyses were conducted to examine the independent association between serum UA and cognitive function in CHF populations and stratified by sex. RESULTS The mean serum UA concentration of participants was 7.3 ± 2.6 mg/dL. The prevalence of hyperuricemia was 54.7% (105 of 192) in CHF patients, 52.9% (64 of 121) in men, and 57.7% (41 of 71) in women. In the total sample, higher serum UA was associated with poorer cognitive function independent of demographic, medical and psychological variables (β = - 0.130, ΔR2 = 0.014, p = 0.015). In sex-stratified groups, elevated serum UA was independently associated with worse cognitive function in men (β = - 0.247, ΔR2 = 0.049, p = 0.001) but not in women (β = - 0.005, ΔR2 = 0.000, p = 0.955). CONCLUSIONS Higher serum UA is independently associated with poorer cognitive function in CHF populations after adjusting for confounding variables. Furthermore, elevated serum UA is independently related to worse performance on cognitive function in men but not in women. More longitudinal studies are needed to examine the association between serum UA and cognitive function in CHF populations and stratified by sex.
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Affiliation(s)
- Weihua Niu
- First Center Clinic College of Tianjin Medical University, Tianjin First Central Hospital, No 24 Fukang Road, Nankai District, Tianjin, 300192, China.,Department of Cardiology, Tianjin First Central Hospital, No 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Huifeng Yang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, No 10 Panyang Road, West District, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Central Hospital, No 24 Fukang Road, Nankai District, Tianjin, 300192, China.
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Granata N, Nissanova E, Torlaschi V, Ferrari M, Vigorè M, Sommaruga M, Angelino E, Rizza C, Caprino A, Pierobon A. Psychosocial Cardiological Schedule-Revised (PCS-R) in a Cardiac Rehabilitation Unit: Reflections Upon Data Collection (2010-2017) and New Challenges. Front Psychol 2020; 11:1720. [PMID: 32765382 PMCID: PMC7381208 DOI: 10.3389/fpsyg.2020.01720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction The Psychosocial Cardiological Schedule (PCS) was developed as a screening tool for patients undergoing cardiac rehabilitation (CR) to detect clinically relevant psychosocial/cognitive problems requiring psychological assessment/intervention. Filled out by a trained nurse, it classifies patients according to their need or not for a psychological interview and intervention provided by the psychologist (PCS-Yes vs. PCS-No). Aims The main aim was to compare PCS data collected, respectively, in 2010 and 2017, regarding patients’ socio-demographic characteristics, clinical variables, and the inclusion criteria for psychological counseling. Subsequently, the original Italian PCS was revised and an English version of the schedule was provided [PCS-Revised (PCS-R)]. Results 28 patients (aged 53.5 + 12.6 years, M = 20) of the 87 recruited in 2010 vs. 35 (aged 64.9 + 12.7 years, M = 28) of the 83 recruited in 2017 met the criteria for PCS-Yes: age < 55 years, social problems (living alone, no social support), manifest psychological/behavioral problems, suspected neuropsychological disorders, low prescription adherence, inadequate disease awareness. Comparing the two samples (2010 vs. 2017), clinical variables were similar, and the need for a psychological interview did not differ substantially (32.2 vs. 42.2%), but age increased significantly (PCS-Yes: 53.5 ± 12.6 vs. 64.9 ± 12.7 years, p = 0.001; PCS-No: 68.3 ± 8.0 vs. 75.0 ± 7.7 years, p = 0.0001). A significant increase was observed in the recommendation for neuropsychological assessment (3.6 vs. 25.7%, p = 0.02) to confirm eventual cognitive deficits. These results, the clinical experience, and the recent evidences from literature led to the PCS-R, incorporating a psychosocial screening, a psychological/neuropsychological deeper assessment, and a recommendation for a specific intervention to be carried out either during rehabilitation or in outpatient services. Conclusion The data comparison highlight changes in the cardiac population, which is aging and more frequently requires neuropsychological assessment. The PCS-R could be considered in clinical practice as a useful screening tool to implement a timely coordinated interdisciplinary intervention, comprehensive of specific and tailored psychotherapeutic techniques.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Ekaterina Nissanova
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Valeria Torlaschi
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marina Ferrari
- Department of Cardiac Rehabilitation, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Martina Vigorè
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marinella Sommaruga
- Psychology Unit, Istituto di Camaldoli, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Elisabetta Angelino
- Psychology Unit, Istituto di Torino, Istituti Clinici Scientifici Maugeri IRCCS, Turin, Italy
| | | | - Alessandra Caprino
- Department of Cardiac Rehabilitation, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonia Pierobon
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Kotwal AA, Lee SJ, Dale W, Boscardin WJ, Waite LJ, Smith AK. Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5-Year Mortality Prediction. J Am Geriatr Soc 2020; 68:1796-1802. [PMID: 32356919 PMCID: PMC8189656 DOI: 10.1111/jgs.16451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index. DESIGN, SETTING, AND PARTICIPANTS The National Social Life Health and Aging Project Wave 2, a nationally representative, cross-sectional, in-home survey conducted in 2010 to 2011 on 3,199 community-dwelling adults aged 60 to 99 years. MEASUREMENTS Cognition was measured using a Survey-Adapted Montreal Cognitive Assessment (MoCA-SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18-23 points), and screen positive for dementia (<18 points). Single-item cognitive measures included clock-draw and five-word delayed recall. We constructed a modified Lee Prognostic Index (range = 0-18 points) based on age, behavior, function, and comorbidities shown to predict long-term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5-year mortality prediction. RESULTS The sample was 54% female and had a mean age of 72 years, MoCA-SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA-SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4-7 points or 8-12 points), the absolute mortality rate difference was 15% by cognitive status. The clock-draw and delayed-recall items added similar value to mortality predictions as the longer MoCA-SA. Cognition had the third highest fraction of new information of all 13 Lee index items. CONCLUSION Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5-year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk. J Am Geriatr Soc 68:1796-1802, 2020.
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Affiliation(s)
- Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - William Dale
- Department of Supportive Care Medicine, City of Hope National Medical Center
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
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Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation. PLoS One 2020; 15:e0235570. [PMID: 32614895 PMCID: PMC7332048 DOI: 10.1371/journal.pone.0235570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023] Open
Abstract
Background The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population. Purpose To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients’ functional status. Methods This study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke’s Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE). Results 100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT. Conclusions Psychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.
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Pan D, Pellicori P, Walklett C, Green A, Masse AR, Wood J, Purdy J, Clark AL. Driving Habits and Reaction Times on a Driving Simulation in Older Drivers With Chronic Heart Failure. J Card Fail 2020; 26:555-563. [DOI: 10.1016/j.cardfail.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/16/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022]
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31
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Kim J, Choi J, Shin MS, Park JK, An M, Kim SH, Choi N, Lee MO, Heo S. Effect of physical and psychocognitive function and perceived health status on 12-month adverse cardiac events among implantable cardioverter-defibrillator recipients. Heart Lung 2020; 49:530-536. [PMID: 32434703 DOI: 10.1016/j.hrtlng.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-implant recovery in patients with implantable cardioverter-defibrillators (ICDs) is often compromised because of reduced physical and psycho-cognitive function and poor health perception, leading to short event-free survival. OBJECTIVES To examine the effects of psychocognitive function, health perception, and ICD-related factors on 12-month cardiac events among ICD patients. METHODS Using a prospective study design, ICD patients underwent baseline assessment and were followed for 12 months to assess cardiac events. RESULTS Cardiac events occurred in 14 patients (18.9%) (N = 74: age, 58 years; primary ICDs, 45.9%). Time after ICD implant (odds ratio [OR] = 1.002; p = .028) and executive function (OR = 1.021; p = .027) were significant predictors of 12-month cardiac events, while other physical and psychological indices were not. CONCLUSIONS Reduced executive function and longer time after implant predicted the events. Healthcare professionals need to assess executive function and provide treatment and support to improve executive function.
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Affiliation(s)
- JinShil Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, College of Medicine, Incheon, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Minjeong An
- Chonnam National University, College of Nursing, Gwangju, South Korea
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, Seoul, South Korea.
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Mee Ok Lee
- Gachon University Gil Medical Center, Incheon, South Korea
| | - Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, Atlanta, USA
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Ely AV, Alio C, Bygrave D, Burke M, Walker E. Relationship Between Psychological Distress and Cognitive Function Differs as a Function of Obesity Status in Inpatient Heart Failure. Front Psychol 2020; 11:162. [PMID: 32116957 PMCID: PMC7033423 DOI: 10.3389/fpsyg.2020.00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/21/2020] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a chronic medical condition rapidly growing in prevalence. Evidence links HF to cognitive decline, obesity, and psychological distress. The current study examined the association between cognitive function and ejection fraction (EF%), anxiety, depression, and obesity in inpatient HF. Patients completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7), Patient Health Questionnaire 9-Item Scale (PHQ-9), and Mini-Cog while hospitalized for HF. Additional demographic and medical information was gathered via chart review. All models controlled for age. Of 117 patients assessed (49% male), 55% (n = 64) were obese. ANCOVA analyses were conducted comparing those with obesity and without on cognitive function: model A included EF%, model B included depression, and model C included anxiety. All three models were significantly related to cognitive function. There was a significant interaction effect of EF% and obesity and of anxiety and obesity to predict Mini-Cog scores. Post hoc partial correlational analyses revealed that anxiety was negatively associated with Mini-Cog scores among only patients without obesity. Depression was not significantly related to cognitive function in either group. However, patients with obesity demonstrated higher depression and anxiety than patients without. Results suggest that at lower EF%, and with higher anxiety, patients without obesity may be at greater risk of cognitive dysfunction than those with obesity. Cognitive dysfunction among HF patients with obesity may be independent of psychological distress. These findings may reflect the “obesity paradox” observed among HF patients, in that patients with obesity may have a different biopsychosocial presentation, which may lead to unexpected clinical outcomes. Further research is necessary to articulate the relationship of obesity and cognitive function in HF.
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Affiliation(s)
- Alice V Ely
- Department of Psychiatry, Christiana Care, Newark, DE, United States.,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Courtney Alio
- Department of Psychiatry, Christiana Care, Newark, DE, United States
| | - Desiree Bygrave
- Department of Psychiatry, Christiana Care, Newark, DE, United States.,School of Nursing, University of Delaware, Newark, DE, United States
| | - Marykate Burke
- Department of Psychiatry, Christiana Care, Newark, DE, United States
| | - Earl Walker
- Department of Psychiatry, Christiana Care, Newark, DE, United States
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Lu Z, Yang T, Wang L, Qiu Q, Zhao Y, Wu A, Li T, Cheng W, Wang B, Li Y, Yang J, Zhao M. Comparison of different protocols of Morris water maze in cognitive impairment with heart failure. Brain Behav 2020; 10:e01519. [PMID: 31944619 PMCID: PMC7010571 DOI: 10.1002/brb3.1519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022] Open
Abstract
AIM This study aimed to find a more sensitive and systematic behavioral evaluation protocol to evaluate the cognitive impairment in rats with heart failure (HF). METHODS AND RESULTS An HF rat model was built by ligating the left anterior descending coronary artery. The cardiac function and structure were detected using echocardiography. Myocardial histopathological changes were observed by nitro blue tetrazolium and hematoxylin-eosin staining. The cognitive functions were evaluated using the acquisition task, probe trial, reversal test, and matching-to-sample test of the Morris water maze. In the probe trial, the number of times the rats in the model group crossed the platform site significantly decreased compared with that in the sham group. In the reversal test, the average latency was significantly longer in the sham group compared with the model group in the first trial but was shorter in the second and third trials. In the matching-to-sample test, the average latency of Trial1 increased significantly in the model group compared with the sham group, while no obvious difference was observed in Trial2. Therefore, the difference in the average latency between Trial1 and Trial2 of the model group was significantly larger. CONCLUSIONS The cognitive impairment in rats with HF mainly reflected in the long-term and working memory, spatial learning, and reversal learning ability. The probe trial and reversal test in the water maze may be more sensitive and preferred to evaluate cognitive function after HF. These findings would provide a brief evaluation protocol for further studies on the relationship between cognitive function and HF.
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Affiliation(s)
- Ziwen Lu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tao Yang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Qiu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yizhou Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Aiming Wu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tong Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenkun Cheng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Baofu Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Yang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mingjing Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Pressler SJ, Giordani B, Titler M, Gradus-Pizlo I, Smith D, Dorsey SG, Gao S, Jung M. Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study. J Cardiovasc Nurs 2019; 33:344-355. [PMID: 29601367 PMCID: PMC5995611 DOI: 10.1097/jcn.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure.
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Affiliation(s)
- Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202,
| | - Bruno Giordani
- University of Michigan School of Medicine, Neuropsychology Program, Department of Psychiatry, 2101 Commonwealth Dr., Ste. C, Ann Arbor, MI 48104,
| | - Marita Titler
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109,
| | - Irmina Gradus-Pizlo
- University of California, Irvine, Division of Cardiology, 101 City Drive South, City Tower 400, Orange, CA 92868,
| | - Dean Smith
- Louisiana State University Health Sciences Center School of Public Health, 2020 Gravier St., New Orleans, LA 70112,
| | - Susan G. Dorsey
- University of Maryland School of Nursing Department of Pain and Transitional Symptom Science, Room 727, 655 West Lombard St., Baltimore, MD 21201,
| | - Sujuan Gao
- Indiana University School of Medicine, Department of Biostatistics, 410 W. 10 St., Suite 3000,
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202,
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Harris KM, Schiele SE, Emery CF. Pilot randomized trial of brief behavioral treatment for insomnia in patients with heart failure. Heart Lung 2019; 48:373-380. [DOI: 10.1016/j.hrtlng.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 01/07/2023]
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Toledo C, Lucero C, Andrade DC, Díaz HS, Schwarz KG, Pereyra KV, Arce-Álvarez A, López NA, Martinez M, Inestrosa NC, Del Rio R. Cognitive impairment in heart failure is associated with altered Wnt signaling in the hippocampus. Aging (Albany NY) 2019; 11:5924-5942. [PMID: 31447429 PMCID: PMC6738419 DOI: 10.18632/aging.102150] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022]
Abstract
Age represents the highest risk factor for death due to cardiovascular disease. Heart failure (HF) is the most common cardiovascular disease in elder population and it is associated with cognitive impairment (CI), diminishing learning and memory process affecting life quality and mortality in these patients. In HF, CI has been associated with inadequate O2 supply to the brain; however, an important subset of HF patients displays CI with almost no alteration in cerebral blood flow. Importantly, nothing is known about the pathophysiological mechanisms underpinning CI in HF with no change in brain tissue perfusion. Here, we aimed to study memory performance and learning function in a rodent model of HF that shows no change in blood flow going to the brain. We found that HF rats presented learning impairments and memory loss. In addition, HF rats displayed a decreased level of Wnt/β-catenin signaling downstream elements in the hippocampus, one pathway implicated largely in aging diseases. Taken together, our results suggest that in HF rats CI is associated with dysfunction of the Wnt/β-catenin signaling pathway. The mechanisms involved in the alterations of Wnt/β-catenin signaling in HF and its contribution to the development/maintenance of CI deserves future investigations.
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Affiliation(s)
- Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Claudia Lucero
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Universidad Mayor, Santiago, Chile
| | - Hugo S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis Arce-Álvarez
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás A López
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milka Martinez
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nibaldo C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
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Gary RA, Paul S, Corwin E, Butts B, Miller AH, Hepburn K, Williams B, Waldrop-Valverde D. Exercise and Cognitive Training as a Strategy to Improve Neurocognitive Outcomes in Heart Failure: A Pilot Study. Am J Geriatr Psychiatry 2019; 27:809-819. [PMID: 30910420 PMCID: PMC6646088 DOI: 10.1016/j.jagp.2019.01.211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Mild cognitive impairment, especially memory loss, is prevalent in patients with heart failure (HF) and contributes to poor clinical outcomes and higher mortality. METHODS This study evaluated a combined aerobic exercise and cognitive training (EX/CT) program on memory, executive function, attention, processing speed and reaction time compared to exercise only or a usual care attention control (UCAC) stretching and flexibility program. Participants completed a standardized neurocognitive battery at baseline, 3 months, and 6 months along with demographic, clinical, and functional capacity (6-minute walk test). A linear mixed model analysis was used with comorbidity as a covariate. RESULTS Sixty-nine participants were enrolled, the mean age was 61 ± 10 years, 54% were women, 55% were African American, and the mean left ventricular ejection fraction percentage was 35 ± 15. A significant group by time interaction for verbal memory was found at 3 months (F [2, 53] = 4.3, p = 0.018) but was not sustained at 6 months in the EX/CT group. Processing speed/attention differed across treatment groups between baseline and 6 months, but improvement occurred among UCAC participants. There were also significant group differences in the 6MWT distance occurring at 3 months (F [2, 52] = 3.5, p = 0.036); however, significant improvement was observed within the EX/CT group only. There were no significant differences in 6MWT in the other groups at 3 or 6 months. CONCLUSION An EX/CT intervention was associated with improved memory in persons with HF and warrants further investigation in a larger trial. The relationship between functional capacity and cognitive function also needs further study.
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Affiliation(s)
- Rebecca A Gary
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta.
| | - Sudeshna Paul
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta
| | - Elizabeth Corwin
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta
| | - Brittany Butts
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta
| | - Andrew H Miller
- Emory University School of Medicine (AHM), Winship Cancer Institute, Atlanta
| | - Kenneth Hepburn
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta
| | - Bryan Williams
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta
| | - Drenna Waldrop-Valverde
- Emory University Nell Hodgson Woodruff School of Nursing (RAG, SP, EC, BB, KH, BW, DWV), Atlanta
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Gathright EC, Dolansky MA, Gunstad J, Josephson RA, Moore SM, Hughes JW. Examination of attention, executive function, and memory as predictors of mortality risk in adults with systolic heart failure. Eur J Cardiovasc Nurs 2019; 18:729-735. [PMID: 31342781 DOI: 10.1177/1474515119863182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence and impact of cognitive impairment in heart failure is increasingly recognized. Converging evidence points to global cognitive function as predictive of prognosis in adults with heart failure when assessed with screening tools. Additional work is needed to understand which domains of cognitive function are most relevant for prognosis. AIMS The present study sought to examine associations between domains of cognitive function and mortality risk in adults with heart failure. METHODS In the present prospective, observational cohort study, global cognitive function, attention, executive function, and memory were assessed by means of a comprehensive neuropsychogical battery in adults with systolic heart failure. Mortality data were obtained from the National Death Index (median follow-up 2.95 years). Relationships among each cognitive domain and mortality were assessed with Cox regression. Covariates included age, sex, heart failure severity, comorbidity and depressive symptoms. RESULTS Participants were 325 patients with systolic heart failure with a mean age of 68.6 years (59% men, 73% Caucasian). Following covariate adjustment, better global cognitive function, attention, and executive function were related to decreased mortality risk. CONCLUSIONS Future research is needed to clarify the underlying mechanisms of the association between cognitive impairment and mortality.
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Affiliation(s)
- Emily C Gathright
- Department of Psychological Sciences, Kent State University, USA.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, USA
| | - Richard A Josephson
- School of Medicine, Case Western Reserve University, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, USA
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Toledo C, Andrade DC, Díaz HS, Inestrosa NC, Del Rio R. Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment. Mol Neurobiol 2019; 56:8035-8051. [PMID: 31165973 DOI: 10.1007/s12035-019-01655-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.
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Affiliation(s)
- C Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de investigación en fisiología del ejercicio, Universidad Mayor, Santiago, Chile
| | - H S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - N C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - R Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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Lovell J, Pham T, Noaman SQ, Davis MC, Johnson M, Ibrahim JE. Self-management of heart failure in dementia and cognitive impairment: a systematic review. BMC Cardiovasc Disord 2019; 19:99. [PMID: 31035921 PMCID: PMC6489234 DOI: 10.1186/s12872-019-1077-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/11/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The cornerstone of effective management in heart failure (HF) is the ability to self-care. Aims include i) To determine factors influencing self-care in HF patients with cognitive impairment (CI) and ii) to determine the influence of cognitive domains on self-care in patients with HF and CI. METHODS MEDLINE, CINAHL, EMBASE, EBSCOHost, PsychINFO, ProQuest Research Library, Health Technology Assessment Database, The Cochrane Library, Web of Science and Scopus databases were systematically searched. Original research describing the relationship between cognition and HF self-care in community-dwelling older persons with dementia/CI in English, published in a peer-reviewed journal from 1stJanuary(2000)-22ndMarch(2016) was identified. Study and population characteristics, data sources, self-care processes, methods of cognitive assessment, cognitive domains affected, study outcomes, impact of impairment, and other risk factors of self-care impairment were abstracted by two reviewers. RESULTS Of 10,688 studies identified, 14 met the inclusion criteria. Patients with HF and CI ranged from 14 to 73%. Where reported, self-care maintenance adequacy ranged from 50 to 61%; self-care management adequacy ranged from 14 to 36% and self-care confidence adequacy ranged from 0 to 44% on the Self-care of Heart Failure Index (SCHFI). All but one study predicted poor self-care ability according to poor outcome on cognitive testing. Additionally, specific cognitive domain deficits impaired self-care. Subjects with lower cognitive scores were less likely to seek assistance while subjects with depression had poor self-care abilities. CONCLUSIONS Clinicians must consider the type and severity of impairments in cognitive domains to tailor management. Awareness of depression, self-confidence and support access may modulate self-care ability.
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Affiliation(s)
- Janaka Lovell
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Tony Pham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Samer Q Noaman
- Department of Cardiology, Alfred Health, Victoria, 3004, Australia
| | | | - Marilyn Johnson
- Institute of Transport Studies, Monash University, Victoria, 3800, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Kim J, Hwang SY, Heo S, Shin MS, Kim SH. Predicted relationships between cognitive function, depressive symptoms, self-care adequacy, and health-related quality of life and major events among patients with heart failure. Eur J Cardiovasc Nurs 2019; 18:418-426. [PMID: 30919663 DOI: 10.1177/1474515119840877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive decline, which often occurs in heart failure, is likely to decrease health-related quality of life and increase morbidity and mortality (major events), but it has been scantly addressed. AIMS To examine whether baseline cognitive domains of global cognition, memory and executive function predict baseline health-related quality of life and 15-month major events among patients with heart failure. METHODS This prospective study included 117 patients (mean age 65.5 ± 9.42 years; men 58.1%; New York Heart Association class III/IV 25.6%), who completed questionnaires, including neuropsychological testing for cognitive evaluation, depressive symptoms, self-care and health-related quality of life measures. Their 15-month major events were extracted from medical record reviews. RESULTS Approximately one-third of the sample had cognitive impairment. Forty-one patients (35.0%) experienced major events. Patients with major events had significantly worse memory (immediate recall memory 13.9 vs. 11.5, P=0.030; delayed recall memory 4.3 vs. 3.1, P=0.014) and reduced executive function (trail-making test A 28.1 vs. 38.0 seconds, P=0.031). After controlling for age, sex, heart failure severity and comorbidity, memory loss with depressive symptoms was associated with worse health-related quality of life, and odds ratios of experiencing major events increased only with reduced cognitive function in global cognition and executive function. CONCLUSION Cognitive function is an important factor for health-related quality of life and major events, and memory loss - worsened health-related quality of life and poor executive function was more likely to increase the risk of major events. Future studies should consider both cognitive function and depressive symptoms when designing heart failure interventions to improve patient outcomes.
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Affiliation(s)
- JinShil Kim
- 1 College of Nursing, Gachon University, South Korea
| | | | - Seongkum Heo
- 3 College of Nursing, University of Arkansas for Medical Sciences, USA
| | - Mi-Seung Shin
- 4 Department of Internal Medicine, Gachon University Gil Medical Center, South Korea
| | - Sun Hwa Kim
- 5 Stroke Unit, Hanyang University Medical Center, South Korea
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Lan H, Hawkins LA, Kashner M, Perez E, Firek CJ, Silvet H. Cognitive impairment predicts mortality in outpatient veterans with heart failure. Heart Lung 2018; 47:546-552. [PMID: 30143364 DOI: 10.1016/j.hrtlng.2018.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND In our prior study of 250 outpatient veterans with heart failure (HF), 58% had unrecognized cognitive impairment (CI) which was linked to worsened medication adherence. Literature suggests HF patients with CI have poorer clinical outcomes including higher mortality. OBJECTIVE The study is to examine mortality rates in outpatients with HF and undiagnosed CI compared to their cognitively intact peers. METHODS This is a retrospective study for all-cause mortality. RESULTS During the 3-year follow up, 64/250 (25.6%) patients died: 20/106 (18.9%) with no CI, 29/104 (27.9%) with mild CI, and 15/40 (37.5%) with severe CI. Patients with CI were at increased risk for mortality (hazard ratio 1.82, p = 0.038). Those with severe CI had the worst outcome (hazard ratio 2.710, p = 0.011). CONCLUSIONS CI was an independent risk factor for mortality in patients with heart failure when controlling for age and markers of disease severity. Cognitive screening should be performed routinely to identify patients at greater risk for adverse outcomes.
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Affiliation(s)
- Howard Lan
- Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA; VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Lee Ann Hawkins
- Indiana Wesleyan University, 4201 S Washington St, Marion, IN 46953, USA.
| | - Michael Kashner
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Elena Perez
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Christopher J Firek
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Helme Silvet
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
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Frey A, Sell R, Homola GA, Malsch C, Kraft P, Gunreben I, Morbach C, Alkonyi B, Schmid E, Colonna I, Hofer E, Müllges W, Ertl G, Heuschmann P, Solymosi L, Schmidt R, Störk S, Stoll G. Cognitive Deficits and Related Brain Lesions in Patients With Chronic Heart Failure. JACC-HEART FAILURE 2018; 6:583-592. [DOI: 10.1016/j.jchf.2018.03.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
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Chronic Heart Failure With Memory and Attention Dysfunction: Old Problem, Thinking Anew. JACC. HEART FAILURE 2018; 6:593-595. [PMID: 29885956 DOI: 10.1016/j.jchf.2018.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/29/2018] [Indexed: 10/14/2022]
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Lambert K, Mullan J, Mansfield K, Lonergan M. Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross-sectional study from Australia. Nephrology (Carlton) 2018; 22:899-906. [PMID: 27505310 DOI: 10.1111/nep.12892] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/21/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023]
Abstract
AIM The aim of this study was to compare the extent of cogntive impairment and the types of cognitive deficits in an Australian cohort of four patient groups with end stage kidney disease. Characteristics predicting the presence of cognitive impairment were also evaluated. METHODS Observational cross-sectional study of 155 patients with end stage kidney disease are recruited from a regional Australian renal unit. Eligible participants included those whose estimated Glomerular Filtration Rate was < 30 ml/min per 1.73 m2 , were undertaking peritoneal or haemodialysis, or had received a kidney transplant. The Montreal Cognitive Assessment tool was used to screen the study participants for cognitive impairment and evaluate cognitive deficits. Cognitive impairment was defined as a total Montreal Cognitive Assessment tool score ≤24/30. RESULTS The extent of cognitive impairment varied between the four groups with end stage kidney disease. Factors predicting the presence of cognitive impairment included undertaking dialysis, age ≥65, male gender and the presence of diabetes or cerebrovascular disease. Deficits in executive function, attention, language, visuospatial skills, memory and orientation were common among the study participants, and the extent of these deficits varied between groups. Limitations to the study included the cross-sectional design, and that the presence of confounders like depression were not recorded. CONCLUSION The impact of disparities in the cognitive capabilities identified in this study are likely to be far reaching. Tailoring of education and self-management programmes to the cognitive deficits of individuals is required.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Judy Mullan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- Service Director Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Profile and Determinants of Neurocognitive Dysfunction in a Sample of Adult Nigerians With Heart Failure. J Cardiovasc Nurs 2018; 31:535-544. [PMID: 26422634 DOI: 10.1097/jcn.0000000000000289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) in Africans is peculiar because subjects are younger than whites and have lower socioeconomic and educational level in addition to the high prevalence of hypertension-related etiology and increased mortality. Whereas cognitive dysfunction have been demonstrated among whites with HF, the prevalence and pattern of cognitive dysfunction among sub-Saharan African patients with HF have not been evaluated against this background. OBJECTIVES The aim of this study is to determine the 1-year prevalence and the factors contributing to cognitive dysfunction in a cohort of Nigerian patients with HF. MATERIALS AND METHODS In this cross-sectional case-control study, cognitive performance was evaluated in 111 consecutive individuals (60 HF patients and 51 controls matched for age, gender, and level of education) using the Community Screening Interview for Dementia, Word List Learning Delayed Recall, Boston Naming Test, and Modified Token Test. Other clinical and disease-specific variables were collated and correlated with cognitive performance. RESULTS The mean total Community Screening Interview for Dementia, Word List Learning Delayed Recall, Boston Naming Test, and Modified Token Test scores were significantly lower among HF patients (P = < .001). The prevalence of global cognitive dysfunction was 90.0% in HF and 5.9% among controls (odds ratio, 15.3; 95% confidence interval, 5.08-46.01). Elevated systolic blood pressure, increased comorbidity index, and wide pulse pressure were significantly associated with poorer performance on at least 1 neuropsychological test. Using a multivariate linear regression analysis, pulse pressure retained its significance (P = .029; 95% confidence interval, -0.117 to -0.007) as the most important predictor of cognitive dysfunction in the cohort of HF patients. CONCLUSION Cognitive dysfunction is prevalent among this sample of Nigerians with HF. Regular cognitive screening is therefore advocated among this high-risk group. Controlling comorbidities as well as blood pressure may improve cognitive performance among patients with HF.
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Berg SK, Thorup CB, Borregaard B, Christensen AV, Thrysoee L, Rasmussen TB, Ekholm O, Juel K, Vamosi M. Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey. Eur J Prev Cardiol 2018; 26:624-637. [DOI: 10.1177/2047487318769766] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52–2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81–2.90), poor quality of life (HR 0.46, 95% CI 0.39–0.54) and severe symptom distress (HR 2.47, 95% CI 1.92–3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65–0.77) and severe symptom distress (HR 1.58, 95% CI 1.35–1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.
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Affiliation(s)
- Selina K Berg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Charlotte B Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Anne V Christensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
| | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Marianne Vamosi
- Aarhus University, Institute of Public Health, Section of Nursing Science. Department of Cardiology, Aarhus University Hospital, Denmark
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Smith PJ, Blumenthal JA, Hoffman BM, Davis RD, Palmer SM. Postoperative cognitive dysfunction and mortality following lung transplantation. Am J Transplant 2018; 18:696-703. [PMID: 29087035 PMCID: PMC5820215 DOI: 10.1111/ajt.14570] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 01/25/2023]
Abstract
Preliminary evidence suggests that postoperative cognitive dysfunction (POCD) is common after lung transplantation. The impact of POCD on clinical outcomes has yet to be studied. The association between POCD and longer-term survival was therefore examined in a pilot study of posttransplantation survivors. Forty-nine participants from a prior randomized clinical trial underwent a neurocognitive assessment battery pretransplantation and 6 months posttransplantation, including assessments of the domains of Executive Function (Trail Making Test, Stroop, Digit Span), Processing Speed (Ruff 2 and 7 Test, Digit Symbol Substitution Test), and Verbal Memory (Verbal Paired Associates, Logical Memory, Animal Naming, and Controlled Oral Word Association Test). During a 13-year follow-up, 33 (67%) participants died. Greater neurocognition was associated with longer survival (hazard ratio [HR] = 0.49 [0.25-0.96], P = .039), and this association was strongest on tests assessing Processing Speed (HR = 0.58 [0.36-0.95], P = .03) and Executive Function (HR = 0.52 [0.28-0.97], P = .040). In addition, unadjusted analyses suggested an association between greater Memory performance and lower risk of CLAD (HR = 0.54 [0.29-1.00], P = .050). Declines in Executive Function tended to be predictive of worse survival. These preliminary findings suggest that postoperative neurocognition is predictive of subsequent mortality among lung transplant recipients. Further research is needed to confirm these findings in a larger sample and to examine mechanisms responsible for this relationship.
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Affiliation(s)
- PJ Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - JA Blumenthal
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - BM Hoffman
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | | | - SM Palmer
- Duke University Medical Center, Department of Medicine
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Kresge HA, Khan OA, Wagener MA, Liu D, Terry JG, Nair S, Cambronero FE, Gifford KA, Osborn KE, Hohman TJ, Pechman KR, Bell SP, Wang TJ, Carr JJ, Jefferson AL. Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults. J Am Heart Assoc 2018; 7:JAHA.117.007562. [PMID: 29440034 PMCID: PMC5850190 DOI: 10.1161/jaha.117.007562] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Global longitudinal strain (GLS), reflecting total shortening of the myocardium during the cardiac cycle, has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). Longitudinal strain may be selectively affected in subclinical heart disease, even in the presence of normal LVEF. This study examines subclinical cardiac dysfunction, assessed by GLS and LVEF, and cognition among older adults. METHODS AND RESULTS Vanderbilt Memory and Aging Project participants who were free of clinical dementia, stroke, and heart failure (n=318, 73±7 years, 58% male) completed neuropsychological assessment and cardiac magnetic resonance to quantify GLS and LVEF. Linear regression models related GLS and LVEF to neuropsychological performances, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and APOE*ε4 status. Models were repeated with a cardiac×cognitive diagnosis interaction term. Compromised GLS (reflected by higher values) related to worse naming (β=-0.07, P=0.04), visuospatial immediate recall (β=-0.83, P=0.03), visuospatial delayed recall (β=-0.22, P=0.03), and verbal delayed recall (β=-0.11, P=0.007). LVEF did not relate to worse performance on any measure (P>0.18). No diagnostic interactions were observed. CONCLUSIONS Our study results are among the first to suggest that compromised GLS relates to worse episodic memory and language performance among older adults who are free of clinical dementia, stroke, and heart failure. Subclinical cardiac dysfunction may correlate with cognitive health in late life, even when LVEF remains normal. The results add to growing evidence that GLS may be a more sensitive and preferred method for quantifying subclinical changes in cardiac function.
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Affiliation(s)
- Hailey A Kresge
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Omair A Khan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Madison A Wagener
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - James G Terry
- Radiology& Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sangeeta Nair
- Radiology& Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Francis E Cambronero
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Katherine A Gifford
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Katie E Osborn
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Timothy J Hohman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Kimberly R Pechman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Susan P Bell
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of General Internal Medicine, Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John Jeffrey Carr
- Radiology& Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Angela L Jefferson
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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de la Torre JC. Cerebral Perfusion Enhancing Interventions: A New Strategy for the Prevention of Alzheimer Dementia. Brain Pathol 2018; 26:618-31. [PMID: 27324946 DOI: 10.1111/bpa.12405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular and cerebrovascular diseases are major risk factors in the development of cognitive impairment and Alzheimer's disease (AD). These cardio-cerebral disorders promote a variety of vascular risk factors which in the presence of advancing age are prone to markedly reduce cerebral perfusion and create a neuronal energy crisis. Long-term hypoperfusion of the brain evolves mainly from cardiac structural pathology and brain vascular insufficiency. Brain hypoperfusion in the elderly is strongly associated with the development of mild cognitive impairment (MCI) and both conditions are presumed to be precursors of Alzheimer dementia. A therapeutic target to prevent or treat MCI and consequently reduce the incidence of AD aims to elevate cerebral perfusion using novel pharmacological agents. As reviewed here, the experimental pharmaca include the use of Rho kinase inhibitors, neurometabolic energy boosters, sirtuins and vascular growth factors. In addition, a compelling new technique in laser medicine called photobiomodulation is reviewed. Photobiomodulation is based on the use of low level laser therapy to stimulate mitochondrial energy production non-invasively in nerve cells. The use of novel pharmaca and photobiomodulation may become important tools in the treatment or prevention of cognitive decline that can lead to dementia.
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