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The interactive effects of cerebral perfusion and depression on cognitive function in older adults with heart failure
Michael L Alosco1, Mary Beth Spitznagel, Naftali Raz
1Department of Psychology, Kent State University, Kent, OH 44242, USA. Malosco@kent.edu
Insights
Depression and reduced cerebral blood flow worsen cognitive function in heart failure patients. Specifically, attention and executive functions are most affected by this interaction.
Area of Science:
- Cardiology
- Neurology
- Psychiatry
Background:
- Heart failure (HF) is frequently accompanied by depression, which is linked to cognitive impairment.
- The underlying mechanisms connecting depression and cognitive decline in HF patients remain unclear.
Purpose of the Study:
- To investigate whether cerebral perfusion influences the relationship between depressive symptoms and cognitive impairment in individuals with HF.
- To examine the moderating role of cerebral blood flow on cognitive function in HF patients experiencing depression.
Main Methods:
- Eighty-nine HF patients underwent neuropsychological testing and impedance cardiography.
- Depressive symptoms were measured using the Beck Depression Inventory II (BDI-II).
- Cerebral perfusion was quantified using transcranial Doppler (TCD).
Main Results:
- Depression correlated with poorer performance in attention/executive function, language, and motor function.
- Global cerebral blood flow velocity positively correlated with memory performance.
- A significant interaction indicated that greater depressive symptoms combined with decreased cerebral blood flow velocity exacerbated attention/executive function deficits (β = .32, p = .003).
Conclusions:
- Depressive symptoms and reduced cerebral perfusion interact to negatively impact cognitive performance in older adults with HF.
- Further longitudinal research is necessary to understand the long-term effects and neuropathology of this interaction.
Objective:
Depression is common among persons with heart failure (HF) and has been linked to cognitive impairment in this population. The mechanisms of this relationship are unclear, and the current study examined whether cerebral perfusion moderates the association between depressive symptoms and cognitive impairment in patients with HF.
Methods:
Persons with HF (n = 89; mean [standard deviation] age = 67.61 [11.78] years) completed neuropsychological testing and impedance cardiography. Depressive symptoms were assessed using the Beck Depression Inventory II, and transcranial Doppler was used to quantify cerebral perfusion.
Results:
Depression was associated with reduced performance on tasks assessing attention/executive function (r = -0.28), language (r = -0.0.30), and motor function (r = -0.28) in unadjusted models (p values <.05). Global cerebral blood flow was correlated with memory performance (r = 0.22, p = .040) but not with other tasks. A moderation analysis was performed using hierarchical regression models for attention/executive function, memory, language, and motor function. For each model, medical and demographic characteristics were entered into the initial blocks, and the final block consisted of an interaction term between global cerebral blood flow velocity and the Beck Depression Inventory II. The interaction between greater depressive symptoms and decreased global cerebral blood flow velocity was associated with greater deficits in attention/executive function (β = .32, ΔR(2) = 0.08, p = .003).
Conclusions:
Depressive symptoms and cerebral hypoperfusion interact to adversely affect cognitive performance in older adults with HF. Longitudinal studies are needed to clarify this relationship and elucidate subsequent neuropathology.
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