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Shimoda T, Suzuki S, Mizukoshi D, Saori W, Yokoshima E, Terai T. Examination of the proportion and characteristics of cognitive function changes during hospitalization in patients with cardiovascular diseases. PLoS One 2024; 19:e0309306. [PMID: 39172903 PMCID: PMC11340958 DOI: 10.1371/journal.pone.0309306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 08/08/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVE Cognitive function decline is influenced by cardiovascular diseases and associated risk factors. However, changes in the cognitive function of patients with cardiovascular diseases during hospitalization and the factors influencing these changes remain unclear. This study elucidated the proportion and characteristics of changes in cognitive function during hospitalization in patients with cardiovascular diseases. METHODS We conducted cognitive function assessments at admission and discharge for patients with cardiovascular diseases. Using the Mini-Mental State Examination (MMSE) and the Japanese version of the Montreal Cognitive Assessment (MoCA-J), we categorized the patients into cognitive impairment, mild cognitive impairment (MCI), and non-cognitive impairment. Changes in MMSE or MoCA-J scores of ≥2 points at discharge were classified as improvement or decline, and all others as maintenance. RESULTS The cognitive impairment, MCI, and non-cognitive impairment categories comprised 215 (41.3%), 224 (40.2%), and 103 (18.5%) patients, respectively. The results of the cognitive function assessment at the time of discharge classified 90 patients (35.9%) into the maintenance group, 117 (46.6%) into the improvement group, and 44 (17.5%) into the decline group based on changes during hospitalization. There was a statistically significant difference among the three groups only in cognitive function at admission (P = 0.026). In multivariate analysis, those with MCI or cognitive impairment at admission and younger patients were associated with improved cognitive function during hospitalization. No factors were extracted that showed statistically significant associations with cognitive decline. CONCLUSION Approximately half of the patients with cardiovascular disease experienced improvements in cognitive function during hospitalization, while approximately 20% showed a decline in cognitive function during the same period. These findings demonstrate the importance of assessing cognitive changes in hospitalized patients with cardiovascular disease. Future studies are needed to identify factors associated with changes in cognitive function.
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Affiliation(s)
- Takahiro Shimoda
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Shinzi Suzuki
- Department of Rehabilitation, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Daisuke Mizukoshi
- Department of Rehabilitation, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Wada Saori
- Department of Rehabilitation, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Erina Yokoshima
- Department of Rehabilitation, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Tomoko Terai
- Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
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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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Nijskens CM, Thomas EG, Rhodius‐Meester HFM, Daemen MJAP, Biessels GJ, Handoko ML, Muller M. Is it time for Heart-Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure. Clin Cardiol 2024; 47:e24200. [PMID: 38183320 PMCID: PMC10785189 DOI: 10.1002/clc.24200] [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] [Received: 09/29/2023] [Accepted: 11/20/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Cognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, practical guidance is lacking. In this study, we explore cardiologists' perspective on screening and care for cognitive impairment in patients with HF. We give an example of a multidisciplinary Heart-Brain care pathway that facilitates screening for cognitive impairment in patients with HF. METHODS We distributed an online survey to cardiologists from the Dutch working groups on Geriatric Cardiology and Heart Failure. It covered questions about current clinical practice, impact of cognitive impairment on clinical decision-making, and their knowledge and skills to recognize cognitive impairment. RESULTS Thirty-six out of 55 invited cardiologists responded. Only 3% performed structured cognitive screening, while 83% stated that not enough attention is paid to cognitive impairment. More than half of the cardiologists desired more training in recognizing cognitive impairment and three-quarters indicated that knowing about cognitive impairment would change their treatment plan. Eighty percent agreed that systematic cognitive screening would benefit their patients and 74% wished to implement a Heart-Brain clinic. Time and expertise were addressed as the major barriers to screening for cognitive impairment. CONCLUSION Although cardiologists are aware of the clinical relevance of screening for cognitive impairment in cardiology patients, such clinical conduct is not yet commonly practiced due to lack of time and expertise. The Heart-Brain care pathway could facilitate this screening, thus improving personalized care in cardiology.
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Affiliation(s)
- Charlotte M. Nijskens
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
| | - Elias G. Thomas
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
| | - Hanneke F. M. Rhodius‐Meester
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Neurology, Alzheimer Center AmsterdamAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Amsterdam NeuroscienceAmsterdam UMCAmsterdamThe Netherlands
| | - Mat J. A. P. Daemen
- Department of PathologyAmsterdam UMC Location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain CenterUniversity Medical CenterUtrechtThe Netherlands
| | - M. Louis Handoko
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
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Morris K, Takegami M, Teramoto K, Murata S, Nakatsuka K, Ogata S, Nishimura K. Cognitive transitions based on functional status in older adults with heart failure: a population-based study. ESC Heart Fail 2023; 10:3454-3462. [PMID: 37706364 PMCID: PMC10682903 DOI: 10.1002/ehf2.14512] [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: 02/24/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS Cognitive impairment and functional status are both important determinants of poor outcomes in heart failure (HF). However, little is known about how functional status impacts the changes in cognitive status during the disease course. This study aimed to describe the cognitive transitions in patients with HF and assess the relationship of these transitions to functional status, which was assessed by the dependency of activities of daily living (ADL). METHODS AND RESULTS This retrospective cohort study included 1764 patients with an International Classification of Diseases-10 code of HF (≥65 years, mean age 82.3 ± 7.9 years, 39% male) from a long-term care and medical insurance database from Nobeoka city, a rural city of south-western Japan. Cognitive status at baseline and 6, 12, 18, and 24 month time points was collected, and participants were stratified based on ADL status at baseline. Generalized estimating equations and multi-state modelling were used to examine associations between ADL dependency and cognitive changes/mortality. Transition probabilities were estimated using multi-state modelling. At baseline, there were 1279 (73%) and 485 (27%) patients with independent and dependent ADL, respectively. In overall patients, 1656 (93.9%) patients had normal/mild cognitive status and 108 (6%) patients had a moderate/severe cognitive status at baseline. The majority [104 (96%) patients] of patients with moderate/severe cognitive status at baseline had dependent ADL. In patients with moderate/severe cognitive status, the number of patients with dependent ADL always outnumbered that of the independent ADL throughout the follow-up. Multi-state modelling estimated that patients with dependent ADL and normal/mild cognitive status at baseline had 47% probability of maintaining the same cognitive status at 24 months, while the probability of maintaining the same cognitive status was 86% for those with independent ADL. Patients with normal/mild cognitive status in the dependent ADL group at baseline had a higher risk of experiencing a transition to moderate/severe cognitive status at any time point during 24 months compared with those with independent ADL [hazard ratio 5.24 (95% confidence interval 3.47-7.90)]. CONCLUSIONS In older patients with HF, the prevalence of cognitive impairment was always higher for those with reduced functional status. Despite having a normal/mild cognitive status at baseline, patients with dependent ADL are at high risk of experiencing cognitive decline over 24 months with substantially less chance of maintaining their cognitive status. ADL dependency was an important risk factor of cognitive decline in patients with HF.
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Affiliation(s)
- Kensuke Morris
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Misa Takegami
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health and Health Policy, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kanako Teramoto
- Department of BiostatisticsNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Shunsuke Murata
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health, Graduate School of Health SciencesKobe UniversityKobeJapan
- Japan Society for the Promotion of ScienceTokyoJapan
| | - Kiyomasa Nakatsuka
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health, Graduate School of Health SciencesKobe UniversityKobeJapan
| | - Soshiro Ogata
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
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Goh FQ, Kong WKF, Wong RCC, Chong YF, Chew NWS, Yeo TC, Sharma VK, Poh KK, Sia CH. Cognitive Impairment in Heart Failure-A Review. BIOLOGY 2022; 11:179. [PMID: 35205045 PMCID: PMC8869585 DOI: 10.3390/biology11020179] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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
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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Affiliation(s)
- Fang Qin Goh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Raymond C. C. Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Yao Feng Chong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Vijay Kumar Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (F.Q.G.); (W.K.F.K.); (R.C.C.W.); (N.W.S.C.); (T.-C.Y.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
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Kazukauskiene N, Fineberg NA, Bunevicius A, Narvaez Linares NF, Poitras M, Plamondon H, Pranckeviciene A, Gecaite-Stonciene J, Brozaitiene J, Varoneckas G, Mickuviene N, Burkauskas J. Predictive value of baseline cognitive functioning on health-related quality of life in individuals with coronary artery disease: a 5-year longitudinal study. Eur J Cardiovasc Nurs 2021; 21:473-482. [PMID: 34894138 DOI: 10.1093/eurjcn/zvab116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/29/2022]
Abstract
AIMS Emerging studies suggest an association exists between coronary artery disease (CAD) and the development of neurodegenerative diseases, with CAD acting as a precursor. Our study aimed to investigate the relationship between baseline measures of cognitive functioning and long-term health-related quality of life (HRQoL) in individuals with CAD with specification to Type D personality traits and sex. METHODS AND RESULTS This prospective observational cohort study consisted of 864 participants (mean age 58 SD = 9 years, 74.0% men) with CAD after acute coronary syndrome. Baseline characteristics included comprehensive cognitive testing, measures of sociodemographic and clinical factors, and psychological assessment scales, such as Type D personality scale and the Hospital Anxiety and Depression scale. The Minnesota Living with Heart Failure Questionnaire assessed participants' HRQoL, conducted through phone interviews at baseline, every 6 months for up to 2 years, and after 5 years. Cognitive functioning correlated with HRQoL at all time intervals over the 5-year follow-up. Regarding sex and Type D personality, significant differences emerged in associations between impaired cognitive functioning at baseline and HRQoL measured over the period of 5 years. Men participants with characteristics of Type D personality were especially vulnerable to impaired cognitive functioning affecting the 5-year quality of life. CONCLUSION Men with CAD who obtained scores indicating characteristics of Type D personality were significantly more likely to have lower baseline cognitive functions and long-term HRQoL outcomes. This information could inform healthcare practitioners to screen for personality characteristics and closely follow-up those at a greater risk.
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Affiliation(s)
- Nijole Kazukauskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | - Naomi A Fineberg
- University of Hertfordshire College Lane, Hatfield Hertfordshire AL10 9AB, UK
| | - Adomas Bunevicius
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | | | - Marilou Poitras
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5 Canada
| | - Helene Plamondon
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5 Canada
| | - Aiste Pranckeviciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | - Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | - Julija Brozaitiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | - Giedrius Varoneckas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135 Palanga, Lithuania
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Tanaka S, Yamashita M, Saito H, Kamiya K, Maeda D, Konishi M, Matsue Y. Multidomain Frailty in Heart Failure: Current Status and Future Perspectives. Curr Heart Fail Rep 2021; 18:107-120. [PMID: 33835397 DOI: 10.1007/s11897-021-00513-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW With a worldwide aging population, frailty and heart failure (HF) have become issues that need to be addressed urgently in cardiovascular clinical practice. In this review, we outline the clinical implications of frailty in HF patients and the potential therapeutic strategies to improve the clinical outcomes of frail patients with HF. RECENT FINDINGS Frailty has physical, psychological, and social domains, each of which is a prognostic determinant for patients with HF, and each domain overlaps with the other, although there are no standardized criteria for diagnosing frailty. Frailty can be targeted for treatment with various interventions, and recent studies have suggested that multidisciplinary intervention could be a promising option for frail patients with HF. However, currently, there is limited data, and further research is needed before its clinical implementation. Frailty and HF share a common background and are strongly associated with each other. More comprehensive assessment and therapeutic interventions for frailty need to be developed to further improve the prognosis and quality of life of frail patients with HF.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Hiroshi Saito
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Daichi Maeda
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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8
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A decline in activities of daily living due to acute heart failure is an independent risk factor of hospitalization for heart failure and mortality. J Cardiol 2019; 73:522-529. [DOI: 10.1016/j.jjcc.2018.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/24/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
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Grant JS, Graven LJ. High Priority Problems Experienced by Informal Caregivers of Individuals With Heart Failure. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318800296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to identify high priority problems experienced by informal caregivers when providing care for individuals with heart failure in the home. This secondary analysis was part of a cross-sectional, descriptive study using online self-report instruments (N = 530), including one researcher-developed item identifying top priority problems for heart failure caregivers. Content and quantitative data analyses were conducted. Performing multifaceted activities and roles that evolve around daily heart failure demands (n = 463) and maintaining caregiver physical, emotional, social, and financial well-being (n = 138) were the two most common themes experienced by caregivers of individuals with heart failure. Each of these two problems had several dimensions. Another theme was providing unending care (n = 40), with two dimensions.
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Abstract
Cognitive impairment (CI) is common in older adults with heart failure (HF). The prevalence of CI is higher among patients with HF than in those without. The spectrum of CI in HF is similar to that observed in the general population and may range from delirium to isolated memory or non-memory-related deficits to dementia. Both HF with reduced ejection fraction and HF with preserved ejection fraction have been associated with defects in different domains of cognition. Numerous risk factors have been shown to contribute to CI in HF. Additionally, various pathophysiological mechanisms related to HF can contribute to cognitive decline. These conditions are not routinely screened for in clinical practice settings with HF populations, and guidelines on optimal assessment strategies are lacking. Validated tools and criteria should be used to differentiate acute cognitive decline (delirium) from chronic cognitive decline such as mild cognitive impairment and dementia. CI in HF has been associated with higher rates of disability and impairment in self-care activities that may in turn increase healthcare cost, hospital readmission and mortality. Early detection of CI may improve clinical outcomes in older adults with HF. Appropriate HF management strategies may also help to reduce CI in patients with HF, and future research is needed to develop and test newer and more effective interventions to improve outcomes in patients with HF and CI.
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Wennogle LP, Hoxie H, Peng Y, Hendrick JP. Phosphodiesterase 1: A Unique Drug Target for Degenerative Diseases and Cognitive Dysfunction. ADVANCES IN NEUROBIOLOGY 2018; 17:349-384. [PMID: 28956339 DOI: 10.1007/978-3-319-58811-7_13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The focus of this chapter is on the cyclic nucleotide phosphodiesterase 1 (PDE1) family. PDE1 is one member of the 11 PDE families (PDE 1-11). It is the only phosphodiesterase family that is calcium/calmodulin activated. As a result, whereas other families of PDEs 2-11 play a dominant role controlling basal levels of cyclic nucleotides, PDE1 is involved when intra-cellular calcium levels are elevated and, thus, has an "on demand" or activity-dependent involvement in the control of cyclic nucleotides in excitatory cells including neurons, cardiomyocytes and smooth muscle. As a Class 1 phosphodiesterase, PDE1 hydrolyzes the 3' bond of 3'-5'-cyclic nucleotides, cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Here, we review evidence for this family of enzymes as drug targets for development of therapies aimed to address disorders of the central nervous system (CNS) and of degenerative diseases. The chapter includes sections on the potential for cognitive enhancement in mental disorders, as well as a review of PDE1 enzyme structure, enzymology, tissue distribution, genomics, inhibitors, pharmacology, clinical trials, and therapeutic indications. Information is taken from public databases. A number of excellent reviews of the phosphodiesterase family have been written as well as reviews of the PDE1 family. References cited here are not comprehensive, rather pointing to major reviews and key publications.
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Affiliation(s)
- Lawrence P Wennogle
- Alexandria Center for Life Science, Intra-Cellular Therapies, Inc., New York, 10016, NY, USA.
| | - Helen Hoxie
- Alexandria Center for Life Science, Intra-Cellular Therapies, Inc., New York, 10016, NY, USA
| | - Youyi Peng
- Rutgers University, 7 College Ave, New Brunswick, NJ, 08901, USA
| | - Joseph P Hendrick
- Alexandria Center for Life Science, Intra-Cellular Therapies, Inc., New York, 10016, NY, USA
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Sako H, Miyazaki M, Suematsu Y, Koyoshi R, Shiga Y, Kuwano T, Kitajima K, Iwata A, Yorinaga K, Fujimi K, Miura SI. A Case of Multifaceted Assessment in an Elderly Patient With Acute Decompensated Heart Failure. Cardiol Res 2017; 8:339-343. [PMID: 29317979 PMCID: PMC5755668 DOI: 10.14740/cr640w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a common health problem worldwide, including in Japan. Unfortunately, patient outcomes remain poor, with a 5-year survival rate of approximately 50%. Therefore, we need to assess the precise conditions, including cardiac function, in patients with HF, particularly in the elderly. We performed a multifaceted assessment in an elderly patient with HF on admission and at discharge using eight different evaluations (the mean life expectancy using the Seattle Heart Failure Model (SHFM), the severity of dementia, nutrition, medication adherence, biomarker (the level of brain natriuretic peptide in blood), sociality, performance and comorbidity). Each parameter was scored on a 5-point scale (excellent = 5 points; good = 4 points; fair (average) = 3 points; poor = 2 points; failure = 1 point; maximum total points of 40) (Fukuoka University Heart Failure Scoring System, FUFS). An 86-year-old male patient who complained of dyspnea and lower-leg edema was admitted to our university hospital due to acute decompensated HF. After treatment, his symptoms improved, as did his cardiothoracic ratio, plural effusion and pulmonary congestion, and he exhibited compensated HF. His total score improved from 28 to 32 points, and his mean life expectancy using SHFM increased from 4.9 to 5.4 years. We evaluated the precise conditions using a multifaceted assessment strategy in an elderly patient with HF. The strategy was useful for evaluate the patient's condition in this case.
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Affiliation(s)
- Hideto Sako
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Midori Miyazaki
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Koyoshi
- Division of Medical Safety Management, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Katsura Yorinaga
- Division of Nursing, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Division of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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13
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Fausto BA, Badana ANS, Valdes OM, Athilingam P, Edwards JD. Examination of Heart Failure as a Predictor of Driving Cessation. JOURNAL OF TRANSPORT & HEALTH 2017; 7:202-208. [PMID: 29552488 PMCID: PMC5851464 DOI: 10.1016/j.jth.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cognitive dysfunction is a predictor of driving cessation in older adults and a common sequela of heart failure (HF). Although HF has been associated with an increased risk of driving cessation, the independent relationship between HF and driving cessation after cognitive function is considered remains to be established. The objective of these analyses is to examine HF as an independent predictor of driving cessation across three years among a cohort of older drivers in the United States. Analyses included 850 older adults who completed sensory, cognitive, and physical measures at baseline and mobility and health measures at a three-year follow-up. Cox regression was used to examine the effects of HF, stroke, vision, cognition, and physical function as predictors of incident driving cessation over three years. Participants with HF were over three times more likely to cease driving, HR = 3.19, 95% CI [1.27, 8.02], p = .014. However, HF was no longer a significant predictor of driving cessation when cognitive performance was considered, HR = 1.70, 95% CI [0.67, 4.30], p = .262. These findings suggest that the risk of driving cessation may be a consequence of the cognitive dysfunction associated with HF, rather than from HF itself. Cognitive training should be investigated among persons with HF to potentially prolong driving mobility.
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Affiliation(s)
- Bernadette A Fausto
- School of Aging Studies, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States
| | - Adrian N S Badana
- School of Aging Studies, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States
| | - Olivia M Valdes
- Department of Psychology, Florida Atlantic University, 3200 College Avenue, Fort Lauderdale, FL 33314, United States
| | - Ponrathi Athilingam
- College of Nursing, University of South Florida, 12901 Bruce B Downs Blvd, MDC 22, Tampa, FL 33612, United States
| | - Jerri D Edwards
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave., MDC 14, Tampa, FL 33613
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Cannon JA, Moffitt P, Perez-Moreno AC, Walters MR, Broomfield NM, McMurray JJ, Quinn TJ. Cognitive Impairment and Heart Failure: Systematic Review and Meta-Analysis. J Card Fail 2017; 23:464-475. [DOI: 10.1016/j.cardfail.2017.04.007] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Hill E, Taylor J. Chronic Heart Failure Care Planning: Considerations in Older Patients. Card Fail Rev 2017; 3:46-51. [PMID: 28785475 PMCID: PMC5494157 DOI: 10.15420/cfr.2016:15:2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/18/2016] [Indexed: 01/27/2023] Open
Abstract
In developed countries, it is estimated that more than 10 % of adults aged over 70 years have heart failure (HF). Despite therapeutic advances, it remains a condition associated with significant morbidity and mortality. It is one of the commonest causes of unscheduled hospital admissions in older adults and data consistently show a lower uptake of evidence-based investigations and therapies as well as higher rates of HF hospitalisations and mortality than in younger adults. These rates are highest amongst patients discharged to 'skilled nursing facilities', where comorbidities, frailty and cognitive impairment are common and have a significant impact on outcomes. In this review, we examine current guidance and its limitations and offer a pragmatic approach to management of HF in this elderly population.
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Affiliation(s)
- Eilidh Hill
- Department of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Jackie Taylor
- Department of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
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Reduced Gray Matter Volume Is Associated With Poorer Instrumental Activities of Daily Living Performance in Heart Failure. J Cardiovasc Nurs 2016; 31:31-41. [PMID: 25419946 DOI: 10.1097/jcn.0000000000000218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure patients require assistance with instrumental activities of daily living in part because of the high rates of cognitive impairment in this population. Structural brain insult (eg, reduced gray matter volume) is theorized to underlie cognitive dysfunction in heart failure, although no study has examined the association among gray matter, cognition, and instrumental activities of daily living in heart failure. OBJECTIVES The aim of this study was to investigate the associations among gray matter volume, cognitive function, and functional ability in heart failure. METHODS A total of 81 heart failure patients completed a cognitive test battery and the Lawton-Brody self-report questionnaire to assess instrumental activities of daily living. Participants underwent magnetic resonance imaging to quantify total gray matter and subcortical gray matter volume. RESULTS Impairments in instrumental activities of daily living were common in this sample of HF patients. Regression analyses controlling for demographic and medical confounders showed that smaller total gray matter volume predicted decreased scores on the instrumental activities of daily living composite, with specific associations noted for medication management and independence in driving. Interaction analyses showed that reduced total gray matter volume interacted with worse attention/executive function and memory to negatively impact instrumental activities of daily living. CONCLUSIONS Smaller gray matter volume is associated with greater impairment in instrumental activities of daily living in persons with heart failure, possibly via cognitive dysfunction. Prospective studies are needed to clarify the utility of clinical correlates of gray matter volume (eg, cognitive dysfunction) in identifying heart failure patients at risk for functional decline and determine whether interventions that target improved brain and cognitive function can preserve functional independence in this high-risk population.
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Negarandeh R, Delkhosh M, Janani L, Samiei N, Ghasemi E. The Relationship between Perceived Life Changes and Mental Health in Family Caregivers of Patients with Heart Failure who Referred to Rajaei Cardiovascular Medical and Research Center, Tehran. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2015; 3:283-91. [PMID: 26448955 PMCID: PMC4591572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/05/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Caring for a patient with heart failure can be a challenging and stressful situation. However, researchers have paid less attention to caregiving outcomes in heart failure caregivers. This study was conducted to investigate the relationship between perceived life changes and mental health of family caregivers of heart failure patients. METHODS Through a correlational design, a convenience sample of 90 Iranian family caregivers of patients with heart failure was selected. Data were collected using demographic-clinical characteristics form, Bakas Caregiving Outcomes Scale and General Health Questionnaire-28. Data were analyzed in SPSS using independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression analysis. RESULTS Half of the caregivers reported that their lives had changed for the worse and nearly three fourths were suspected cases of mental disorders. There was a strong negative correlation between perceived life changes and mental health (r=-0.607, P<0.001). This finding remained consistent (B=-0.522, P<0.001) even when potential confounding factors including caregiver's age (B=-0.222, P=0.016), caregiver's marital status (B=-6.085, P=0.025), and patient's age (B=-0.153, P=0.030) were controlled. Being younger, unmarried caregiver and caring of younger patients were identified as other correlated factors of poor caregivers' mental health. CONCLUSION The strong negative correlation between perceived life changes and mental health in caregivers of patients with heart failure suggests that the heart failure caregivers with poor mental health may benefit from nursing interventions that improve appropriate coping with life changes related to caregiving.
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Affiliation(s)
- Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Delkhosh
- Department of Public Health in Disaster, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Health Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Ghasemi
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Cannon JA, McMurray JJ, Quinn TJ. 'Hearts and minds': association, causation and implication of cognitive impairment in heart failure. ALZHEIMERS RESEARCH & THERAPY 2015; 7:22. [PMID: 25722749 PMCID: PMC4342092 DOI: 10.1186/s13195-015-0106-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The clinical syndrome of heart failure is one of the leading causes of hospitalisation and mortality in older adults. An association between cognitive impairment and heart failure is well described but our understanding of the relationship between the two conditions remains limited. In this review we provide a synthesis of available evidence, focussing on epidemiology, the potential pathogenesis, and treatment implications of cognitive decline in heart failure. Most evidence available relates to heart failure with reduced ejection fraction and the syndromes of chronic cognitive decline or dementia. These conditions are only part of a complex heart failure-cognition paradigm. Associations between cognition and heart failure with preserved ejection fraction and between acute delirium and heart failure also seem evident and where data are available we will discuss these syndromes. Many questions remain unanswered regarding heart failure and cognition. Much of the observational evidence on the association is confounded by study design, comorbidity and insensitive cognitive assessment tools. If a causal link exists, there are several potential pathophysiological explanations. Plausible underlying mechanisms relating to cerebral hypoperfusion or occult cerebrovascular disease have been described and it seems likely that these may coexist and exert synergistic effects. Despite the prevalence of the two conditions, when cognitive impairment coexists with heart failure there is no specific guidance on treatment. Institution of evidence-based heart failure therapies that reduce mortality and hospitalisations seems intuitive and there is no signal that these interventions have an adverse effect on cognition. However, cognitive impairment will present a further barrier to the often complex medication self-management that is required in contemporary heart failure treatment.
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Affiliation(s)
- Jane A Cannon
- British Heart Foundation Glasgow, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Avenue, Glasgow, G12 8TA UK
| | - John Jv McMurray
- British Heart Foundation Glasgow, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Avenue, Glasgow, G12 8TA UK
| | - Terry J Quinn
- Department of Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK G4 0SF UK
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