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Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure
G Zuccalà1, C Cattel, E Manes-Gravina
1Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.
Insights
Cognitive impairment is common in older adults with heart failure, linked to reduced left ventricular ejection fraction. Early detection and treatment of systolic dysfunction may help prevent dementia.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Cognitive impairment is increasingly recognized in patients with heart failure.
- Previous studies have focused on middle-aged patients with end-stage disease.
Purpose of the Study:
- To assess the prevalence and determinants of cognitive dysfunction in older adults with mild to moderate heart failure.
- To identify factors associated with cognitive impairment in this population.
Main Methods:
- A cross-sectional study of 57 older patients with chronic heart failure.
- Evaluations included physical examination, laboratory tests, echocardiography, and cognitive assessments (MMSE, mental deterioration battery, etc.).
Main Results:
- 53% of participants had Mini-Mental State Examination (MMSE) scores below 24, indicating cognitive impairment.
- Lower left ventricular ejection fraction (LVEF) was significantly associated with poorer cognitive performance.
- Age and LVEF were independent predictors of MMSE scores in multivariate analysis.
Conclusions:
- Cognitive impairment is prevalent in older patients with heart failure and independently associated with reduced LVEF.
- Early detection and management of cognitive dysfunction and systolic dysfunction are crucial in older heart failure patients.
- Intervention may prevent or delay dementia in this vulnerable population.
Objectives:
Cognitive impairment has been reported in middle aged patients with end stage heart failure. This cross sectional study assessed the prevalence and determinants of cognitive dysfunction in older patients with mild to moderate heart failure.
Methods:
57 consecutive patients (mean age 76.7 years) with chronic heart failure underwent physical examination, blood chemistry, urinalysis, chest radiography ECG, Doppler echocardiography, and the mini mental state examination (MMSE), mental deterioration battery, depression scale of the Center for Epidemiological Studies (CES-D), Katz activities of daily living, and instrumental activities of daily living 24 hours before hospital discharge.
Results:
MMSE scores <24 were found in 53% of participants. The MMSE score was associated with left ventricular ejection fraction according to a non-linear correlation, so that cognitive performance was significantly lower in subjects with left ventricular ejection fraction < or =30%. The same pattern of correlation was evidenced between left ventricular ejection fraction and both the attention sub-item of MMSE and the Raven test score. In a multivariate linear regression model, after adjusting for age, sex, and a series of clinical data and objective tests, both age (beta=-0.30; P=0.038) and the natural log of left ventricular ejection fraction (beta=0.58; P=0.001) were associated with the MMSE score.
Conclusion:
Cognitive impairment in older patients with chronic heart failure is common, and independently associated with lower left ventricular ejection fraction. Given the overwhelming incidence and prevalence of heart failure in older populations, early detection of cognitive impairment in these subjects with prompt, intensive treatment of left ventricular systolic dysfunction may prevent or delay a remarkable proportion of dementia in advanced age.