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Cognitive impairment measured by Mini-Cog provides additive prognostic information in elderly patients with heart

Hiroshi Saito1, Masashi Yamashita2, Yoshiko Endo3

  • 1Department of Rehabilitation, Kameda Medical Center, Chiba, Japan; Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Journal of Cardiology
|July 7, 2020
PubMed

Insights

Cognitive impairment (CI) in elderly heart failure patients provides additional prognostic information. The Mini-Cog test is a better tool than the Mini-Mental State Examination (MMSE) for predicting outcomes in these patients.

Area of Science:

  • Gerontology
  • Cardiology
  • Neurology

Background:

  • Heart failure is a growing concern in elderly populations.
  • Prognostic factors in heart failure are well-established, but the role of cognitive impairment is less understood.
  • Existing prognostic models may not fully capture the risk in elderly heart failure patients.

Purpose of the Study:

  • To determine if cognitive impairment (CI) offers additional prognostic value in elderly heart failure patients.
  • To compare the efficacy of two cognitive assessment tools, the Mini-Mental State Examination (MMSE) and Mini-Cog, in predicting prognosis.
  • To evaluate if CI assessment improves existing risk prediction models.

Main Methods:

  • A multicenter retrospective study of 352 heart failure patients aged 75 years and older.
  • Cognitive function assessed using the Mini-Mental State Examination (MMSE) and Mini-Cog.
  • The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was used as a baseline prognostic model.
  • All-cause mortality was the primary outcome, analyzed using multivariate Cox regression and receiver operating characteristic (ROC) curves.

Main Results:

  • Nearly half of the elderly heart failure patients exhibited cognitive impairment (47.4% by MMSE, 45.2% by Mini-Cog).
  • Cognitive impairment, assessed by both MMSE and Mini-Cog, was independently associated with a worse prognosis (HR: 2.05 and 2.57, respectively).
  • The Mini-Cog test demonstrated a significant improvement in risk reclassification when added to the MAGGIC score, outperforming the MMSE.

Conclusions:

  • Cognitive impairment is a critical, independent prognostic factor in elderly patients with heart failure.
  • The Mini-Cog test is a more effective tool than the MMSE for identifying patients at higher risk of mortality.
  • Incorporating cognitive assessment, particularly with the Mini-Cog, can enhance prognostic accuracy in this vulnerable population.
Abstract

Keywords:
Cognitive impairmentElderlyHeart failure

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