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Park DY, Jamil Y, Babapour G, Kim J, Campbell G, Akman Z, Kochar A, Sen S, Samsky MD, Sikand NV, Frampton J, Damluji AA, Nanna MG. Association of cardiovascular diseases with cognitive performance in older adults. Am Heart J 2024; 273:10-20. [PMID: 38575050 PMCID: PMC11162917 DOI: 10.1016/j.ahj.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 03/30/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Cognitive function and cardiovascular disease (CVD) have a bidirectional relationship, but studies on the impact of CVD subtypes and aging spectrum have been scarce. METHODS We assessed older adults aged ≥60 years from the 2011 to 2012 and 2013 to 2014 cycles of the National Health and Nutrition Examination Survey who had coronary heart disease, angina, prior myocardial infarction, congestive heart failure, or prior stroke. We compared CERAD-IR, CERAD-DR, Animal Fluency test, and DSST scores to assess cognitive performance in older adults with and without CVD. RESULTS We included 3,131 older adults, representing 55,479,673 older adults at the national level. Older adults with CVD had lower CERAD-IR (mean difference 1.8, 95% CI 1.4-2.1, P < .001), CERAD-DR (mean difference 0.8, 95% CI 0.6-1.0, P < .001), Animal Fluency test (mean difference 2.1, 95% CI 1.6-2.6, P < .001), and DSST (mean difference 9.5, 95% CI 8.0-10.9, P < .001) scores compared with those without CVD. After adjustment, no difference in CERAD-IR, CERAD-DR, and Animal Fluency test scores was observed, but DSST scores were lower in older adults with CVD (adjusted mean difference 2.9, 95% CI 1.1-4.7, P = .001). Across CVD subtypes, individuals with congestive heart failure had lower performance on the DSST score. The oldest-old cohort of patients ≥80 years old with CVD had lower performance than those without CVD on both the DSST and Animal Fluency test. CONCLUSION Older adults with CVD had lower cognitive performance as measured than those free of CVD, driven by pronounced differences among those with CHF and those ≥80 years old with CVD.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL
| | - Yasser Jamil
- Department of Medicine, Yale New Haven Program, Waterbury, CT
| | - Golsa Babapour
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Junglee Kim
- Department of Medicine, Cook County Health, Chicago, IL
| | - Greta Campbell
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Zafer Akman
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Ajar Kochar
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Marc D Samsky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Nikhil V Sikand
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Abdulla Al Damluji
- Inova Center of Outcomes Research, Falls Church, VA; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
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2
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Pedersini P, Picciolini S, Di Salvo F, Toccafondi A, Novembre G, Gualerzi A, Cusmano I, Garascia A, Tavanelli M, Verde A, Masciocco G, Ricci C, Mannini A, Bedoni M, Morici N. The Exercise aNd hEArt transplant (ENEA) trial - a registry-based randomized controlled trial evaluating the safety and efficacy of cardiac telerehabilitation after heart transplant. Contemp Clin Trials 2024; 136:107415. [PMID: 38114046 DOI: 10.1016/j.cct.2023.107415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Heart transplant (HTx) is gold-standard therapy for patients with end-stage heart failure. Cardiac rehabilitation (CR) is a multidisciplinary intervention shown to improve cardiovascular prognosis and quality of life. The aim in this randomized controlled trial is to explore the safety and efficacy of cardiac telerehabilitation after HTx. In addition, biomarkers of rehabilitation outcomes will be identified, as data that will enable treatment to be tailored to patient phenotype. METHODS Patients after HTx will be recruited at IRCCS S. Maria Nascente - Fondazione Don Gnocchi, Milan, Italy (n = 40). Consenting participants will be randomly allocated to either of two groups (1:1): an intervention group who will receive on-site CR followed by 12 weeks of telerehabilitation, or a control group who will receive on-site CR followed by standard homecare and exercise programme. Recruitment began on 20th May 2023 and is expected to continue until 20th May 2025. Socio-demographic characteristics, lifestyle, health status, cardiovascular events, cognitive function, anxiety and depression symptoms, and quality of life will be assessed, as well as exercise capacity and muscular endurance. Participants will be evaluated before the intervention, post-CR and after 6 months. In addition, analysis of circulating extracellular vesicles using Surface Plasmon Resonance imaging (SPRi), based on a rehabilomic approach, will be applied to both groups pre- and post-CR. CONCLUSION This study will explore the safety and efficacy of cardiac telerehabilitation after HTx. In addition, a rehabilomic approach will be used to investigate biomolecular phenotypization in HTx patients. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT05824364.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrea Garascia
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Alessandro Verde
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriella Masciocco
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristian Ricci
- Africa Unit for transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
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Koons B, Anderson MR, Smith PJ, Greenland JR, Singer JP. The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care. CURRENT TRANSPLANTATION REPORTS 2022; 9:149-159. [PMID: 36341000 PMCID: PMC9632682 DOI: 10.1007/s40472-022-00365-2] [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] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Purpose Older adults (age ≥ 65 years) are the fastest growing age group undergoing lung transplantation. Further, international consensus document for the selection of lung transplant candidates no longer suggest a fixed upper age limit. Although carefully selected older adults can derive great benefit, understanding which older adults will do well after transplant with improved survival and health-related qualiy of life is key to informed decision-making. Herein, we review the epidemiology of aging in lung transplantation and its impact on outcomes, highlight selected physiological measures that may be informative when evaluating and managing older lung transplant patients, and identify directions for future research. Recent Findings In general, listing and transplanting older, sicker patients has contributed to worse clinical outcomes and greater healthcare use. Emerging evidence suggest that measures of physiological age, such as frailty, body composition, and neurocognitive and psychosocial function, may better identify risk for poor transplant outcomes than chronlogical age. Summary The evidence base to inform transplant decision-making and improvements in care for older adults is small but growing. Multipronged efforts at the intersection of aging and lung transplantation are needed to improve the clinical and patient centered outcomes for this large and growing cohort of patients. Future research should focus on identifying novel and ideally modifiable risk factors for poor outcomes specific to older adults, better approaches to measuring physiological aging (e.g., frailty, body composition, neurocognitive and psychosocial function), and the underlying mechanisms of physiological aging. Finally, interventions that can improve clinical and patient centered outcomes for older adults are needed.
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Affiliation(s)
- Brittany Koons
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall Room 350, Villanova, PA 19085, USA
| | - Michaela R. Anderson
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Neurosciences, Duke University Medical Center, Durham, NC, USA
| | - John R. Greenland
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jonathan P. Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, UC San Francisco, San Francisco, CA, USA
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4
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Rathgeber SL, Hutchison SM, De Souza AM, Lester R, Blydt-Hansen T, Human DG, Guttman O, Oberlander TF, Armstrong KR. A text messaging intervention and quality of life in adolescents with solid organ transplants. Pediatr Transplant 2022; 26:e14219. [PMID: 35142005 DOI: 10.1111/petr.14219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/02/2021] [Accepted: 12/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Facilitating communication between adolescents and HCP outside of appointments may enhance patient experience and outcomes. The purpose of this study was to determine whether SMS enhances the healthcare experience, QoL, and medication adherence in adolescent SOT patients. METHODS This was a prospective observational study of an SMS platform (WelTel Inc) for SOT patients aged 12-19 years. QoL was assessed before and after using the PedsQL™ Transplant Module. Medication adherence was assessed with the frequency of therapeutic tacrolimus levels and variation based on control chart analysis. Patient experience and engagement was evaluated with surveys, response rate to messages, and number of clinical conversations (>2 messages). RESULTS Twenty-three patients were included (median age 15.7 years (IQR 13.6-17.1)). Median intervention duration was 13.5 months (range 4.0-16.7 months). There was a 68% response rate (742/1095) with 375 clinical conversations. The majority of patients reported the intervention provided a positive outlook on their health (17/23), was useful (18/23), and improved their connection to HCPs (17/23). Following the intervention, there was no significant difference in the median scaled QoL scores (pre-intervention: 81 (IQR 76.5-93.3), post-intervention: 78 (IQR 76-93); p = .37), mean percentage of therapeutic tacrolimus levels (pre-intervention: 52 ± 25%, post-intervention: 65 ± 17%; p = .07), or variation on control chart analysis of tacrolimus levels. CONCLUSIONS The WelTel messaging platform provided supplemental clinical care for a group of adolescent SOT patients that enhanced their healthcare experience. Patient QoL and adherence were unchanged following the intervention and remained at a high level.
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Affiliation(s)
- Steven L Rathgeber
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah M Hutchison
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Astrid-Marie De Souza
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Blydt-Hansen
- Division of Nephrology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek G Human
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Orlee Guttman
- Division of Gastroenterology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn R Armstrong
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Cardiorespiratory Fitness Mediates Cognitive Performance in Chronic Heart Failure Patients and Heart Transplant Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228591. [PMID: 33228046 PMCID: PMC7699401 DOI: 10.3390/ijerph17228591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
Abstract
We compared cognitive profiles in chronic heart failure patients (HF), heart transplant recipients (HT) and healthy controls (HC) and examined the relationship between cardiorespiratory fitness (V˙O2peak), peak cardiac output (COpeak) and cognitive performance. Stable HT patients (n = 11), HF patients (n = 11) and HC (n = 13) (61.5 ± 8.5 years) were recruited. Four cognitive composite scores targeting different cognitive functions were computed from neuropsychological tests: working memory, processing speed, executive functions and verbal memory. Processing speed and executive function scores were higher, which indicates lower performances in HF and HT compared to HC (p < 0.05). V˙O2peak and first ventilatory threshold (VT1) were lower in HF and HT vs. HC (p < 0.01). COpeak was lower in HF vs. HT and HC (p < 0.01). Processing speed, executive function and verbal memory performances were correlated with V˙O2peak, VT1 and peak cardiac hemodynamics (p < 0.05). Mediation analyses showed that V˙O2peak and VT1 mediated the relationship between group and processing speed and executive function performances in HF and HT. COpeak fully mediated executive function and processing speed performances in HF only. V˙O2peak and COpeak were related to cognitive performance in the entire sample. In addition, V˙O2peak and VT1 fully mediated the relationship between group and executive function and processing speed performances.
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6
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Abstract
The view that chronic heart failure was exclusively a disease of the heart dominated the cardiovascular literature until relatively recently. However, over the last 40 years it has increasingly come to be seen as a multisystem disease. Aside from changes in the sympathetic and parasympathetic nervous systems and the renin-angiotensin-aldosterone system, adaptations to the lungs, muscles and gastrointestinal tract have been clearly documented. It is clear that the brain and CNS are also affected in patients with heart failure, although this is often under recognized. The purpose of this review is to summarize the changes in the structure and biochemical function of the CNS in patients with chronic heart failure and to discuss their potential importance.
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Affiliation(s)
- Mark Dayer
- Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - David H MacIver
- Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK.,Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, M13 9PL, UK
| | - Stuart D Rosen
- Ealing & Royal Brompton Hospitals, Uxbridge Rd, Southall, UB1 3HW, UK.,Imperial College London, South Kensington, London, SW7 2BU, UK
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7
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Hutchison SM, Rathgeber SL, De Souza AM, Blydt-Hansen T, Mâsse LC, Armstrong KR, Oberlander TF. Adolescents with solid organ transplant: Using the BRIEF2 parent-report and self-report to measure parent-child agreement and everyday executive function. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:260-269. [PMID: 32758025 DOI: 10.1080/21622965.2020.1800468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Agreement between parent and adolescent ratings of executive function (EF) is not known in adolescents with solid organ transplant (SOT), even though pressing concerns about EF deficits are being raised in this population. The current study investigated EF in adolescents with SOT using parent and self report. Twenty-five adolescents (M = 15.51 years) with SOT and their parent completed a behavior rating scale assessing EF within everyday context using the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2). Parents and their adolescents demonstrated moderate to excellent agreement across the BRIEF2 clinical and index scores, higher than previous research with a typical sample. Adolescent males had higher agreement with their parents than female adolescents. Both parents and adolescents reported significantly higher mean T scores on various BRIEF2 indices and domains, in addition to higher rates of clinically elevated executive dysfunction than their peers. Assessment of EF and targeting specific EF domains for intervention may be useful in this population.
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Affiliation(s)
- Sarah M Hutchison
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Steven L Rathgeber
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Canada Children's Heart Centre BC Children's Hospital, Vancouver, BC, Canada
| | - Astrid M De Souza
- Canada Children's Heart Centre BC Children's Hospital, Vancouver, BC, Canada
| | - Tom Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Canada Children's Heart Centre BC Children's Hospital, Vancouver, BC, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kathryn R Armstrong
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Canada Children's Heart Centre BC Children's Hospital, Vancouver, BC, Canada
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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8
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Ciacciarelli A, Sette G, Giubilei F, Orzi F. Chronic cerebral hypoperfusion: An undefined, relevant entity. J Clin Neurosci 2020; 73:8-12. [PMID: 31948882 DOI: 10.1016/j.jocn.2020.01.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/06/2020] [Indexed: 01/11/2023]
Abstract
Despite the large body of data available, chronic cerebral hypoperfusion lacks an operative definition. In a tautological way, the term hypoperfusion is being referred to conditions of "inadequate blood flow", "defects of perfusion" or "dysfunction of autoregulation". The chronicity refers to sustained conditions or wavering states characterized by repeated phases of inefficient functional hyperemia. The phenomenon may affect the whole brain or defined areas. A few defined clinical disorders, including heart failure, hypotension, atherosclerosis of large or small vessels and carotid stenosis are thought to cause progressive brain disorders due to chronic hypoperfusion. The clinical relevance manifests mostly as neurocognitive disorders associated with neuroimaging changes.The available data support a conceptual framework that considerschronic cerebral hypoperfusiona likely, relevant pathogenic mechanism for the neurodegeneration-like progression of the neurocognitive disorders. The relationship between neuropathology, cerebral perfusion, and symptoms progression is, however, elusive for several aspects. Typical microangiopathy findings, such as MRI white matter hyperintensities, may appear in individuals without any cerebrovascular risk or vascular lesions. Pathology features of the MRI changes, such as demyelination and gliosis, may result from dysfunction of the neuro-vascular unit not directly associated withvascular mechanisms. In this review, we aim to overview the most common clinical conditions thought to reflect chronic hypoperfusion.
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Affiliation(s)
- Antonio Ciacciarelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy.
| | - Giuliano Sette
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy
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9
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Bui QM, Allen LA, LeMond L, Brambatti M, Adler E. Psychosocial Evaluation of Candidates for Heart Transplant and Ventricular Assist Devices: Beyond the Current Consensus. Circ Heart Fail 2019; 12:e006058. [DOI: 10.1161/circheartfailure.119.006058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools—including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale—were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.
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Affiliation(s)
- Quan M. Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Larry A. Allen
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (L.A.A.)
| | - Lisa LeMond
- Department of Cardiology, Mayo Clinic Arizona, Phoenix (L.L.)
| | - Michela Brambatti
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
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10
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Ryan L, Hay M, Huentelman MJ, Duarte A, Rundek T, Levin B, Soldan A, Pettigrew C, Mehl MR, Barnes CA. Precision Aging: Applying Precision Medicine to the Field of Cognitive Aging. Front Aging Neurosci 2019; 11:128. [PMID: 31231204 PMCID: PMC6568195 DOI: 10.3389/fnagi.2019.00128] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022] Open
Abstract
The current "one size fits all" approach to our cognitive aging population is not adequate to close the gap between cognitive health span and lifespan. In this review article, we present a novel model for understanding, preventing, and treating age-related cognitive impairment (ARCI) based on concepts borrowed from precision medicine. We will discuss how multiple risk factors can be classified into risk categories because of their interrelatedness in real life, the genetic variants that increase sensitivity to, or ameliorate, risk for ARCI, and the brain drivers or common mechanisms mediating brain aging. Rather than providing a definitive model of risk for ARCI and cognitive decline, the Precision Aging model is meant as a starting point to guide future research. To that end, after briefly discussing key risk categories, genetic risks, and brain drivers, we conclude with a discussion of steps that must be taken to move the field forward.
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Affiliation(s)
- Lee Ryan
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Meredith Hay
- Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Matt J. Huentelman
- Neurobehavioral Research Unit, Division of Neurological Disorders, Translational Genomics Research Institute (TGen), Phoenix, AZ, United States
| | - Audrey Duarte
- Center for Advanced Brain Imaging, School of Psychology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Tatjana Rundek
- Clinical and Translational Research Division, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Bonnie Levin
- Neuropsychology Division, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Anja Soldan
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Corinne Pettigrew
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Matthias R. Mehl
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Carol A. Barnes
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
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11
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Terhoeven V, Nikendei C, Cranz A, Weisbrod M, Geis N, Raake PW, Katus HA, Herzog W, Friederich HC, Schultz JH, Pleger ST. Effects of MitraClip on cognitive and psychological function in heart failure patients: the sicker the better. Eur J Med Res 2019; 24:14. [PMID: 30791961 PMCID: PMC6385405 DOI: 10.1186/s40001-019-0371-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/04/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Cognitive impairment and reduced quality of life is a common condition in patients with heart failure (HF). Percutaneous mitral valve repair using (PMVR) MitraClip (MC) has emerged as a promising interventional tool, reducing all-cause mortality and hospitalization as well as increasing cognitive functioning and quality of life. However, the benefit of HF patients with severely depressed cognitive functioning remains unknown. Methods We assessed cognitive functioning (figural memory—FGT, executive function—TOL, TMT B), psychosocial functioning (depression—PHQ-9, quality of life—SF36), and clinical parameters (echocardiography, 6-min walk test distance, and cardiac biomarkers) 1 day before (t0) and 6 weeks after (t1) MC intervention in HF patients (n = 40). First, paired sample t tests were conducted to uncover improvements in cognitive functioning post-MC intervention. Second, the COGBAT Norm-sample, a representative age-matched healthy sample, was used to compare participants’ individual scores. Third, bivariate linear regressions were calculated for all key predictors of the detected improvements in cognitive functioning post-MC intervention (t1–t0). Results Following the MC intervention, we found significant improvements in figural memory, executive functioning, and psychosocial functioning. Most of the patients with depressed executive functioning before the MC intervention showed post-intervention test scores within the normal range (> 50th percentile; t0 22.5% vs. t1 60%) as compared to the normative COGBAT sample. Regression analyses revealed that lower baseline scores in planning ability before the MC intervention (t0) were associated with greater planning ability (TOL; B = − 0.78, 95% CI − 1.04 to − 0.53), figural memory (FGT; B = − 0.26, 95% CI − 0.44 to − 0.07), and cognitive flexibility (TMT B; B = − 0.36, 95% CI − 0.50 to − 0.23) improvement post-MC intervention (t1–t0). Psychosocial functioning and age were not associated with these improvements. Conclusions Patients with depressed executive functioning showed the greatest benefit from the MC intervention regarding cognitive functioning. Age and psychological functioning seem less important for cognitive performance improvements post-MC intervention. Hence, severely depressed cognitive functioning in patients is not a contraindication for PMVR using MitraClip.
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Affiliation(s)
- Valentin Terhoeven
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstrasse 4, 69115, Heidelberg, Germany
| | - Christoph Nikendei
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstrasse 4, 69115, Heidelberg, Germany.
| | - Anna Cranz
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstrasse 4, 69115, Heidelberg, Germany
| | - Matthias Weisbrod
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.,Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstrasse 1, 76307, Karlsbad-Langensteinbach, Germany
| | - Nicolas Geis
- Department of Cardiology, Angiology, Pneumology, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip W Raake
- Department of Cardiology, Angiology, Pneumology, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, Pneumology, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Wolfgang Herzog
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstrasse 4, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstrasse 4, 69115, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstrasse 4, 69115, Heidelberg, Germany
| | - Sven T Pleger
- Department of Cardiology, Angiology, Pneumology, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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12
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Salisbury D, Meredith K. Neuropsychological functioning following cardiac transplant in Danon disease. Dev Neurorehabil 2019; 22:67-70. [PMID: 28594253 DOI: 10.1080/17518423.2017.1326184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To present a unique case involving a 31-year-old male with Danon disease (diagnosed at 14) who received cardiac transplant and subsequent cardiac re-transplant. RESEARCH DESIGN Brief report/case study. METHODS Serial neuropsychological assessment across a 23-year span along with a review of school records and prior psychoeducational assessment. RESULTS A consistent pattern of higher level cognitive impairment from childhood through adulthood was found. This pattern is interpreted in light of the sparse literature regarding cognitive and adaptive functioning related to Danon disease. CONCLUSIONS The noteworthy aspects of this case include the preservation of some academic abilities and an unexpected level of functional independence given cognitive concerns. This case study further explores the nature of the deficits related to Danon disease and highlights the benefits of neuropsychological evaluation to guide functional interventions and maximize level of independence across the life span.
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Affiliation(s)
- David Salisbury
- a Department of Neuropsychology , Baylor Institute for Rehabilitation , Dallas , TX , USA
| | - Katherine Meredith
- a Department of Neuropsychology , Baylor Institute for Rehabilitation , Dallas , TX , USA
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13
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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14
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Pierobon A, Ranzini L, Torlaschi V, Sini Bottelli E, Giardini A, Bruschi C, Maestri R, Callegari S, Raccanelli R, Sommaruga M. Screening for neuropsychological impairment in COPD patients undergoing rehabilitation. PLoS One 2018; 13:e0199736. [PMID: 30067787 PMCID: PMC6070177 DOI: 10.1371/journal.pone.0199736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/13/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a complex multi-component disorder characterized by progressive irreversible respiratory symptoms and extrapulmonary comorbidities, including anxiety-depression and mild cognitive impairment (MCI). However, the prevalence of these impairments is still uncertain, due to non-optimal screening methods. This observational cross-sectional multicentre study aimed to evaluate the prevalence of anxiety-depressive symptoms and MCI in COPD patients, identify the most appropriate cognitive tests to screen MCI, and investigate specific cognitive deficits in these patients and possible predictive factors. Materials and methods Sixty-five stable COPD inpatients (n = 65, aged 69.9±7.6 years, mainly stage III–IV GOLD) underwent the following assessments: Hospital Anxiety and Depression Scale (HADS), Geriatric Depression Scale (GDS) or Beck Depression Inventory-II (BDI-II), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a complete neuropsychological battery (ENB-2) including different cognitive domains (attention, memory, executive functions, and perceptive and praxis abilities). Results Moderate-severe anxiety was present in 18.5% of patients and depressive symptoms in 30.7%. The prevalence of MCI varied according to the test: 6.2% (MMSE), 18.5% (MoCA) and 50.8% (ENB-2). In ENB-2, patients performed significantly worse compared to Italian normative data on digit span (5.11±0.9 vs. 5.52±1.0, p = 0.0004), trail making test-B (TMT-B) (176.31±99.5 vs. 135.93±58.0, p = 0.004), overlapping pictures (26.03±8.9 vs. 28.75±8.2, p = 0.018) and copy drawing (1.370.6 vs. 1.61±0.5, p = 0.002). At logistic regression analysis, only COPD severity (p = 0.012, odds ratio, OR, 4.4 [95% CI: 1.4–14.0]) and anxiety symptoms (p = 0.026, OR 4.6 [1.2–17.7]) were significant and independent predictors of the deficit in copy drawing, which assesses visuospatial and praxis skills. Conclusion Given the prevalence of neuropsychological impairments in COPD patients, the routine adoption in rehabilitation of screening tools for mood and cognitive function, including digit span, TMT-B and copy drawing, may be useful to detect psychosocial comorbidities and personalize the rehabilitative program.
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Affiliation(s)
- Antonia Pierobon
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
- * E-mail:
| | - Laura Ranzini
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Valeria Torlaschi
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Elisa Sini Bottelli
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Anna Giardini
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Claudio Bruschi
- Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Simona Callegari
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Montescano (PV), Italy
| | - Rita Raccanelli
- Cardiorespiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Camaldoli (MI), Italy
| | - Marinella Sommaruga
- Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Camaldoli (MI), Italy
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15
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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Abstract
BACKGROUND Cognitive impairment is prevalent in heart failure (HF) with severe consequences, including increased risk of mortality and reduced ability to self-manage HF symptoms. Identifying cognitive impairment through screening would assist clinicians in managing HF and comorbid cognitive impairment. However, the accuracy of cognitive screening instruments for HF has not been adequately determined. OBJECTIVE The aim of this study was to determine the diagnostic accuracy of cognitive screening instruments in screening for mild cognitive impairment (MCI) in HF patients. METHODS A systematic review of major electronic bibliographic databases was searched from January 1999 to June 2013. Inclusion criteria were as follows: primary studies examining cognitive impairment in HF, administration of a cognitive screening instrument and neuropsychological test battery, and cognitive impairment indicated by performance on neuropsychological tests 1.5 SDs less than that of normative data. Methodological rigor of included publications was evaluated using 2 bias risk instruments: QUality Assessment of Diagnostic Accuracy Studies and STAndards for the Reporting of Diagnostic accuracy studies. The precision, accuracy, and receiver operating characteristic curves of the Mini Mental State Examination were computed. RESULTS From 593 citations identified, 8 publications met inclusion criteria. Risk of bias included selective HF patient samples, and no study examined the diagnostic test accuracy of the cognitive screening instruments. The Mini Mental State Examination had low sensitivity (26%) and high specificity (95%) with a score of 28 or less as the optimal threshold for MCI screening. CONCLUSIONS Screening for cognitive impairment in HF is recommended; however, future studies need to establish the diagnostic accuracy of screening instruments of MCI in this population.
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17
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Neurological Sequelae and Clinical Outcomes After Lung Transplantation. Transplant Direct 2018; 4:e353. [PMID: 29707624 PMCID: PMC5908456 DOI: 10.1097/txd.0000000000000766] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background Neurological complications are common after lung transplantation. However, no large cohort studies have examined the incidence, predictors, and clinical significance of neurological events sustained by lung transplant recipients. Methods We conducted a retrospective cohort analysis of a consecutive series of lung transplant recipients, transplanted at Duke University Medical Center between May 2014 and February 2017 (n = 276). Early neurological complications (ie, occurring during the first week after transplant) were documented by transplant mental health specialists and included delirium, ischemic injury, and posterior reversible encephalopathy syndrome. Analyses accounted for age, native disease, sex, type of transplant, lung allocation score, and primary graft dysfunction. The objectives of the study were to characterize the prevalence and predictors of early neurological sequelae (NSE), occurring during the first week posttransplant, and the association between NSE and subsequent clinical outcomes, including length of stay and mortality. Results Neurological sequelae were common, occurring in 123 (45%) patients. Fifty-seven patients died over a follow-up interval of 2.1 years. The most common NSE were postoperative delirium (n = 110 [40%]) and posterior reversible encephalopathy syndrome (n = 12 [4%]), followed by stroke/transient ischemic attack and neurotoxicity. Higher lung allocation score was the strongest predictor of delirium. The presence of a NSE was associated with longer length of hospital stay (32 days vs 17 days, P < 0.001) and greater mortality (hazard ratio, 1.90; 95% confidence interval, 1.09-3.32], P = 0.024), with the greatest mortality risk occurring approximately 2 years after transplantation. Conclusions Neurological events are relatively common after lung transplantation and associated with adverse clinical outcomes.
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18
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Abstract
PURPOSE OF THE REVIEW The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care. RECENT FINDINGS Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.
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19
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Bürker BS, Gude E, Gullestad L, Grov I, Relbo Authen A, Andreassen AK, Havik OE, Dew MA, Fiane AE, Haraldsen IR, Malt UF, Andersson S. Cognitive function among long-term survivors of heart transplantation. Clin Transplant 2017; 31. [PMID: 29055147 DOI: 10.1111/ctr.13143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cognitive impairment is documented early after heart transplantation (HTx), but we lack data on cognitive function beyond the fourth year post-transplant. Against the background of good long-term survival, this knowledge is necessary to improve clinical care throughout the entire post-transplant period. METHODS We assessed cognitive function with a neuropsychological test battery in a sample of HTx recipients ≥16 years post-transplant. To improve clinical utility, we also applied adapted consensus criteria for Mild Cognitive Impairment (MCI). Furthermore, we explored sociodemographic and clinical characteristics possibly related to cognitive function. RESULTS Thirty-seven subjects were included 20.3 (±3.8) years after HTx. Mean age was 57.5 (±14.2) years, and 18.9% were women. Up to 38.9% exhibited impaired test performance (ie, performance at least 1.5 standard deviations below the normative mean) on several individual cognitive measures, especially on measures of processing speed, executive functions, memory, and language functions. One subject was diagnosed with dementia, and 30.1% qualified for MCI. Those with MCI had lower hemoglobin than those without. CONCLUSIONS A substantial proportion of long-term survivors of HTx might be cognitively impaired. The level of impairment appears comparable to what is defined as MCI in the literature. Modifiable factors related to cognitive impairment might exist.
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Affiliation(s)
- Britta S Bürker
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry of Old Age, Oslo University Hospital - Ullevål, Oslo, Norway.,Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Odd E Havik
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arnt E Fiane
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ira R Haraldsen
- Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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20
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Bürker BS, Gullestad L, Gude E, Relbo Authen A, Grov I, Hol PK, Andreassen AK, Arora S, Dew MA, Fiane AE, Haraldsen IR, Malt UF, Andersson S. Cognitive function after heart transplantation: Comparing everolimus-based and calcineurin inhibitor-based regimens. Clin Transplant 2017; 31. [PMID: 28185318 DOI: 10.1111/ctr.12927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies have shown conflicting results concerning the occurrence of cognitive impairment after successful heart transplantation (HTx). Another unresolved issue is the possible differential impact of immunosuppressants on cognitive function. In this study, we describe cognitive function in a cohort of HTx recipients and subsequently compare cognitive function between subjects on either everolimus- or calcineurin inhibitor (CNI)-based immunosuppression. METHODS Cognitive function, covering attention, processing speed, executive functions, memory, and language functions, was assessed with a neuropsychological test battery. Thirty-seven subjects were included (everolimus group: n=20; CNI group: n=17). The extent of cerebrovascular pathology was assessed with magnetic resonance imaging. RESULTS About 40% of subjects had cognitive impairment, defined as performance at least 1.5 standard deviations below normative mean in one or several cognitive domains. Cerebrovascular pathology was present in 33.3%. There were no statistically significant differences between treatment groups across cognitive domains. CONCLUSIONS Given the high prevalence of cognitive impairment in the sample, plus the known negative impact of cognitive impairment on clinical outcome, our results indicate that cognitive assessment should be an integrated part of routine clinical follow-up after HTx. However, everolimus- and CNI-based immunosuppressive regimens did not show differential impacts on cognitive function.
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Affiliation(s)
- Britta S Bürker
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Per K Hol
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Satish Arora
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arnt E Fiane
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ira R Haraldsen
- Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Jesse MT, Rubinstein E, Eshelman A, Wee C, Tankasala M, Li J, Abouljoud M. Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model. Perm J 2016; 20:15-207. [PMID: 27455056 DOI: 10.7812/tpp/15-207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients pursuing organ transplantation have complex medical needs, undergo comprehensive evaluation for possible listing, and require extensive education. However, transplant patients and their supports frequently report the need for more lifestyle and self-management strategies for living with organ transplantation. OBJECTIVES First, to explore feasibility of a successful, patient-run transplant lifestyle educational group (Transplant Living Community), designed to complement medical care and integrated into the clinical setting; and second, to report the major themes of patients' and supports' qualitative and quantitative feedback regarding the group. METHODS Informal programmatic review and patient satisfaction surveys. RESULTS A total of 1862 patient satisfaction surveys were disseminated and 823 were returned (response rate, 44.2%). Patients and their supports reported positive feedback regarding the group, including appreciation that the volunteer was a transplant recipient and gratitude for the lifestyle information. Five areas were associated with the success of Transplant Living Community: 1) a "champion" dedicated to the program and its successful integration into a multidisciplinary team; 2) a health care environment receptive to integration of a patient-led group with ongoing community development; 3) a high level of visibility to physicians and staff, patients, and supports; 4) a clearly presented and manageable lifestyle plan ("Play Your ACES"(a) [Attitude, Compliance, Exercise, and Support]), and 5) a strong volunteer structure with thoughtful training with the ultimate objective of volunteers taking ownership of the program. CONCLUSION It is feasible to integrate a sustainable patient-led lifestyle and self-management educational group into a busy tertiary care clinic for patients with complex chronic illnesses.
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Affiliation(s)
- Michelle T Jesse
- Bioscientist for the Transplant Institute and Senior Staff Psychologist in the Behavioral Health Department at the Henry Ford Health System in Detroit, MI.
| | - Elizabeth Rubinstein
- Patient Advocate for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Anne Eshelman
- Senior Staff Psychologist for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Corinne Wee
- Research Assistant for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Mrunalini Tankasala
- Research Assistant for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Jia Li
- Assistant Scientist in Public Health Sciences at the Henry Ford Health System in Detroit, MI.
| | - Marwan Abouljoud
- Director of the Transplant Institute and Hepatobiliary Surgery for the Henry Ford Health System in Detroit, MI.
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The Effects of Mitral Valve Repair on Memory Performance, Executive Function, and Psychological Measures in Patients With Heart Failure. Psychosom Med 2016; 78:432-42. [PMID: 26705072 DOI: 10.1097/psy.0000000000000284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Heart failure (HF) is a prevalent disease that remains costly and associated with a high mortality rate. HF is also associated with poor neurocognitive functioning. For the treatment for HF patients with severe mitral regurgitation, the MitraClip device has emerged as a promising interventional tool that reduces the mitral valve leakage and thus increases cardiac output. Currently, there is only limited knowledge on changes in cognitive and psychosocial functioning before and after the MitraClip intervention. METHODS Cognitive function (memory and executive function) and psychosocial measures (depression, anxiety, and quality of life) were assessed before and after the MitraClip intervention in 24 HF patients and 23 healthy participants (comparison group). RESULTS MitraClip intervention in HF patients was followed by improvements in figural long-term memory (p = .003) and executive function (planning ability, p < .001) relative to the comparison group. In addition, the intervention resulted in a significant improvement in depression (p = .002), anxiety (p = .003) and quality of life scores (physical p = .017, mental p = .013) as well as improved 6-minute walk test results over time (p = .002). CONCLUSIONS The presented data provide evidence of a significant improvement in memory and executive function as well as in depression, anxiety, and quality of life scores in patients with chronic HF after MitraClip intervention. Further research is needed to shed light on the long-term development of cognitive function, psychosocial well-being, and clinical parameters after MitraClip intervention and how these factors depend on one another.
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Čelutkienė J, Vaitkevičius A, Jakštienė S, Jatužis D. Expert Opinion-Cognitive Decline in Heart Failure: More Attention is Needed. Card Fail Rev 2016; 2:106-109. [PMID: 28785462 DOI: 10.15420/cfr.2016:19:2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cognitive decline is a prevalent condition and independent prognostic marker of unfavourable outcomes in patients with heart failure. The highest prevalence, up to 80 %, is reported in patients hospitalised due to acute decompensation. Numerous factors contribute to cognitive dysfunction in heart failure patients, with hypertension, atrial fibrillation, stroke and impaired haemodynamics being the most relevant. Cerebral hypoperfusion, disruption of blood-brain barrier, oxidative damage and brain-derived cytokines are pathogenic links between heart failure and alteration of cognitive functioning. White matter hyperintensities, lacunar infarcts and generalised volume loss are common features revealed by neuroimaging. Typically affected cognitive domains are presented. Assessment of cognitive functioning, even by simple screening tests, should be part of routine clinical examination of heart failure patients.
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Affiliation(s)
- Jelena Čelutkienė
- Department of Cardiovascular Diseases, Vilnius University, Vilnius, Lithuania
| | - Arūnas Vaitkevičius
- Department of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania
| | - Silvija Jakštienė
- Department of Radiology, Lithuanian University of Health Sciences, Vilnius, Lithuania
| | - Dalius Jatužis
- Department of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania
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24
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Reduced regional brain cortical thickness in patients with heart failure. PLoS One 2015; 10:e0126595. [PMID: 25962164 PMCID: PMC4427362 DOI: 10.1371/journal.pone.0126595] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/06/2015] [Indexed: 11/19/2022] Open
Abstract
AIMS Autonomic, cognitive, and neuropsychologic deficits appear in heart failure (HF) subjects, and these compromised functions depend on cerebral cortex integrity in addition to that of subcortical and brainstem sites. Impaired autoregulation, low cardiac output, sleep-disordered-breathing, hypertension, and diabetic conditions in HF offer considerable potential to affect cortical areas by loss of neurons and glia, which would be expressed as reduced cortical thicknesses. However, except for gross descriptions of cortical volume loss/injury, regional cortical thickness integrity in HF is unknown. Our goal was to assess regional cortical thicknesses across the brain in HF, compared to control subjects. METHODS AND RESULTS We examined localized cortical thicknesses in 35 HF and 61 control subjects with high-resolution T1-weighted images (3.0-Tesla MRI) using FreeSurfer software, and assessed group differences with analysis-of-covariance (covariates; age, gender; p<0.05; FDR). Significantly-reduced cortical thicknesses appeared in HF over controls in multiple areas, including the frontal, parietal, temporal, and occipital lobes, more markedly on the left side, within areas that control autonomic, cognitive, affective, language, and visual functions. CONCLUSION Heart failure subjects show reduced regional cortical thicknesses in sites that control autonomic, cognitive, affective, language, and visual functions that are deficient in the condition. The findings suggest chronic tissue alterations, with regional changes reflecting loss of neurons and glia, and presumably are related to earlier-described axonal changes. The pathological mechanisms contributing to reduced cortical thicknesses likely include hypoxia/ischemia, accompanying impaired cerebral perfusion from reduced cardiac output and sleep-disordered-breathing and other comorbidities in HF.
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Mapelli D, Cavazzana A, Cavalli C, Bottio T, Tarzia V, Gerosa G, Volpe BR. Clinical psychological and neuropsychological issues with left ventricular assist devices (LVADs). Ann Cardiothorac Surg 2014; 3:480-9. [PMID: 25452908 DOI: 10.3978/j.issn.2225-319x.2014.08.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/16/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are increasingly being used to treat patients in end-stage heart failure (HF) as bridge-to-transplantation, lifetime support or destination therapy. However, the importance of this newer technique for chronic cardiac support compared to heart transplantation is still open to discussion. To date, there are few studies that extensively explore the psychological and cognitive profiles of patient with ventricular assist devices (VADs). METHODS We studied the psychological aspects, quality of life (QOL) and cognitive profiles of 19 patients with HF before VAD implantation and then at two, five and 16 months post-implantation. RESULTS Our results showed that after VAD implantation, patients did not show any psychopathological problems such as anxiety and/or depression. More interestingly, despite the constant risk of neurological events determined by the continuous-blood-flow pump (CBFP), patients' cognitive functioning did not worsen. In fact, significant enhancements were observed over time. CONCLUSIONS Psychological and cognitive deficits are common in advanced HF and often worsen over time. Appropriately designed and randomized studies are needed to demonstrate whether earlier VAD implantation is warranted to arrest cognitive decline and encourage better post-implantation adaptation.
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Affiliation(s)
- Daniela Mapelli
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Annachiara Cavazzana
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Chiara Cavalli
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Tomaso Bottio
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gino Gerosa
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Bianca Rosa Volpe
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Jurgens CY, Faulkner KM, Lee CS. Phenotypic profiling of cognitive impairment risk among patients with heart failure: a literature review of the usefulness of cardiac-related variables. Eur J Cardiovasc Nurs 2013; 12:109-31. [PMID: 23303768 DOI: 10.1177/1474515112470046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mild cognitive impairment among patients with heart failure can be subtle. Heart failure-related variables such as ejection fraction, low systolic blood pressure and functional status are reportedly associated with cognitive impairment among heart failure patients. The purpose of this literature review was to examine the value of cardiac variables commonly assessed during heart failure-related hospitalizations for a phenotypic profile of the risk of cognitive impairment. METHOD A literature review of primary research studies was conducted. Electronic databases (PubMed and CINAHL) were searched using the keywords heart failure, blood pressure, ejection fraction, functional status, and B-type natriuretic peptide (BNP) in combination with the terms cognition, cognitive function, cognitive dysfunction, and cognitive impairment. RESULTS Thirty-seven studies met the inclusion criteria. Evidence supports the potential utility of lower ejection fraction, lower blood pressure and functional status and elevated B-type natriuretic peptide as a phenotypic profile for an increased risk of cognitive impairment. IMPLICATIONS If the risk for cognitive impairment is suspected, specific evaluations of cognition can be performed. For community-dwelling heart failure patients with mild cognitive impairment, more intense interventions to support self-care, increased family involvement and more frequent follow up may be necessary.
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Affiliation(s)
- Corrine Y Jurgens
- Stony Brook University, School of Nursing, HSC L2- 246, Stony Brook, NY 11794-8240, USA.
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Dardiotis E, Giamouzis G, Mastrogiannis D, Vogiatzi C, Skoularigis J, Triposkiadis F, Hadjigeorgiou GM. Cognitive impairment in heart failure. Cardiol Res Pract 2012; 2012:595821. [PMID: 22720185 PMCID: PMC3375144 DOI: 10.1155/2012/595821] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 03/31/2012] [Indexed: 01/06/2023] Open
Abstract
Cognitive impairment (CI) is increasingly recognized as a common adverse consequence of heart failure (HF). Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients' decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches.
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Affiliation(s)
- Efthimios Dardiotis
- Department of Neurology, University of Thessaly, University Hospital of Larissa, P.O. Box 1400, Larissa, Greece
| | - Gregory Giamouzis
- Department of Cardiology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | | | - Christina Vogiatzi
- Department of Neurology, University of Thessaly, University Hospital of Larissa, P.O. Box 1400, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Georgios M. Hadjigeorgiou
- Department of Neurology, University of Thessaly, University Hospital of Larissa, P.O. Box 1400, Larissa, Greece
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