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Prevalence of cognitive impairment in older adults with heart failure
Tanya R Gure1, Caroline S Blaum, Bruno Giordani
1Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA. tanruff@umich.edu
Insights
Cognitive impairment, including dementia, is common in older adults with heart failure (HF). Individuals with HF have a higher risk of dementia, suggesting routine cognitive assessments are needed in HF care.
Area of Science:
- Gerontology
- Cardiology
- Neurology
Background:
- Heart failure (HF) is a prevalent condition in older adults.
- Cognitive impairment is a growing concern in aging populations.
- The relationship between HF and cognitive decline requires further investigation.
Purpose of the Study:
- To determine the prevalence of cognitive impairment in older adults diagnosed with heart failure (HF).
- To assess the association between heart failure and the risk of dementia in the elderly population.
Main Methods:
- Cross-sectional analysis using the Health and Retirement Study and Medicare claims data (2002-2004).
- Inclusion of 6,189 individuals aged 67 and older.
- Development of an algorithm to categorize HF likelihood and assessment of cognitive function using screening tools or proxy ratings.
Main Results:
- The prevalence of dementia was 15% and mild cognitive impairment was 24% in older adults with HF.
- Individuals with HF showed significantly higher odds of dementia (OR=1.52, 95% CI=1.14-2.02) after adjusting for covariates.
- Cognitive impairment is independently associated with an increased risk of dementia in this population.
Conclusions:
- Cognitive impairment is a common comorbidity in older adults with heart failure.
- Heart failure is an independent risk factor for dementia.
- Routine cognitive assessment should be integrated into heart failure management protocols.
Objectives:
To determine the prevalence of cognitive impairment in older adults with heart failure (HF).
Design:
Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims.
Setting:
United States, community.
Participants:
Six thousand one hundred eighty-nine individuals aged 67 and older.
Measurements:
An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups.
Results:
The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02).
Conclusion:
Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.
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