2006 Heart-Brain summit proceedings
Cognitive impairment in chronic heart failure
ARTICLE INTRODUCTION
Advances in the treatment of ischemic heart disease have resulted in the survival of an increasingly elderly population with chronic heart failure (CHF). Approximately 5 million Americans suffer from CHF, and an additional 20 million are presymptomatic with a reduced ejection fraction. As the heart fails, so do other organs; renal failure and the profound weight loss of cardiac cachexia are significant determinants of mortality. However, it is the decline in cognitive functioning that can significantly reduce patients’ quality of life at a time when physical abilities are limited. This article reviews patient characteristics associated with cognitive impairment in CHF as well as conditions that may contribute to it.
CITATIONS
- Pullicino PM, Halperin J, Thompson J.
Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000; 54:288–298.
http://www.ncbi.nlm.nih.gov/pubmed/10668685 - Almeida OP, Flicker L.
The mind of a failing heart: a systematic review of the association between cognitive functioning. Intern Med J 2001; 31:290–295.
http://www.ncbi.nlm.nih.gov/pubmed/11512600 - Sabatini R, Barbisoni P, Rozzini R, Trabucchi M, Zuccalà G.
Hypotension and cognitive impairment: selective association in patients with heart failure. Neurology 2002; 59:651.
http://www.ncbi.nlm.nih.gov/pubmed/12196680 - Zuccalà G, Onder G, Pedrone C, et al on behalf of the GIFA (SIGG-ONLUS) Investigators.
Cognitive dysfunction as a major determinant of disability in patients with heart failure: results of a multicentre survey. J Neurol Neurosurg Psychiatry 2001; 70:109–112.
http://www.ncbi.nlm.nih.gov/pubmed/11118258 - Zuccalà G, Cattel C, Manes-Gravina E, Di Niro MG, Cocchi A,
Bernabei R.
Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry 1997; 63:509–512.
http://www.ncbi.nlm.nih.gov/pubmed/9343133 - Bornstein RA, Starling RC, Myerowitz P, Haas GJ.
Neuropsychological function in patients with end-stage heart failure before and after cardiac transplantation. Acta Neurol Scand 1995; 91:260–265.
http://www.ncbi.nlm.nih.gov/pubmed/7625151 - Putzke J, Williams MA, Rayburn BK, Kirklin JK, Boll TJ.
The relationship between cardiac function and neuropsychological status among heart transplant candidates. Card Fail 1998; 4:295–303.
http://www.ncbi.nlm.nih.gov/pubmed/9924851 - Schall RR, Petrucci RJ, Brozena SC, Cavarocchi NC, Jessup M.
Cognitive function in patients with symptomatic heart dilated cardiomyopathy before and after cardiac transplantation. J Am Coll Cardiol 1989; 14:1666–1672.
http://www.ncbi.nlm.nih.gov/pubmed/2584554 - Evangelista LS, Dracup K.
A closer look at compliance research in heart failure patients in the last decade. Prog Cardiovasc Nurs 2000; 15:97–103.
http://www.ncbi.nlm.nih.gov/pubmed/10951951 - Gregory D, Kimmelstiel C, Perry K, Parikh A, Konstam V, Konstam MA.
Hospital cost effect of a heart failure disease management program: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) Trial. Am Heart J 2006; 151:1013–1018.
http://www.ncbi.nlm.nih.gov/pubmed/16644325 - Hays AG, Sacco RL, Rundek T, et al.
Left ventricular systolic dysfunction and the risk of stroke in a multiethnic population. Stroke 2006; 37:1715–1719.
http://www.ncbi.nlm.nih.gov/pubmed/16741172 - Siachos J, Vanbakel A, Feldman DS, Uber W, Simpson KN, Pereira NL.
Silent strokes in patients with heart failure. Card Fail 2005; 11:485–489.
http://www.ncbi.nlm.nih.gov/pubmed/16198241 - Loh E, Sutton MS, Wun CC, et al.
Ventricular dysfunction and the risk of stroke after myocardial dysfunction. N Engl J Med 1997; 336:251–257.
http://www.ncbi.nlm.nih.gov/pubmed/8995087 - Dries DL, Rosenberg YD, Waclawiw MA, Domanske MJ.
Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm. J Am Coll Cardiol 1997; 29:1074–1080.
http://www.ncbi.nlm.nih.gov/pubmed/9120162 - Kalaria VG, Passannante MR, Shah T, Modi K, Weisse AB.
Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy. Am Heart J 1998; 135:215–220.
http://www.ncbi.nlm.nih.gov/pubmed/9489967 - Nadareishvili ZG, Choudary Z, Joyner C, Brodie D, Norris JW.
Cerebral microembolism in acute myocardial infarction. Stroke 1999; 30:2679–2682.
http://www.ncbi.nlm.nih.gov/pubmed/10582996 - Sila CA.
Cardiac catheterization, angiography and surgery. In: Noseworthy J, ed. Neurological Therapeutics: Neurologic Complications of Systemic Illness. London, UK: Martin Dunitz; 2006:1383–1388. - Massie BM, Krol WF, Ammon SE, et al.
The Warfarin and Antiplatelet Therapy in Heart Failure trial (WATCH): rationale, design, and baseline patient characteristics. J Card Fail 2004; 10:101–112.
http://www.ncbi.nlm.nih.gov/pubmed/15101020 - Pullicino P, Thompson JL, Ammon SE, et al.
Warfarin Aspirin in Reduced Cardiac Ejection Fraction (WARCEF): rationale, objectives, and design. J Card Fail 2006; 12:39–46.
http://www.ncbi.nlm.nih.gov/pubmed/16500579 - Pullicino PM, Hart J.
Cognitive impairment in congestive heart failure? Embolism vs hypoperfusion. Neurology 2001; 57:1945–1946.
http://www.ncbi.nlm.nih.gov/pubmed/11739807 - Gruhn N, Larsen FS, Borsgaard S, et al.
Cerebral blood flow in patients with chronic heart failure before and after heart transplantation. Stroke 2001; 32:2530–2533.
http://www.ncbi.nlm.nih.gov/pubmed/11692012 - Massaro AR, Dutra AP, Almeida DR, Diniz RV, Malheiros SM.
Transcranial Doppler assessment of cerebral blood flow: effect of cardiac transplantation. Neurology 2006; 66:124–126.
http://www.ncbi.nlm.nih.gov/pubmed/16401862 - Ackerman RH.
Cerebral blood flow and neurological changes in chronic heart failure. Stroke 2001; 32:2462–2464.
http://www.ncbi.nlm.nih.gov/pubmed/11692001 - Georgiadis D, Sievert M, Cencetti S, et al.
Cerebrovascular reactivity is impaired in patients with cardiac failure. Eur Heart J 2000; 21:407–413.
http://www.ncbi.nlm.nih.gov/pubmed/10666355 - Schmidt R, Fazekas F, Offenbacher H, Dusleag J, Lechner H.
Brain magnetic resonance imaging and neuropsychologic evaluation of patients with idiopathic dilated cardiomyopathy. Stroke 1991; 22:195–199.
http://www.ncbi.nlm.nih.gov/pubmed/2003283 - Steinborn W, Anker SD.
Cardiac cachexia: pathophysiology and clinical implications. Basic Appl Myol 2003; 13:191–201. - Caplan LR.
Cardiac encephalopathy and congestive heart failure. Neurology 2006; 66:99–101.
http://www.ncbi.nlm.nih.gov/pubmed/16401854 - Woo MA, Macey PM, Fonarow GC, Hamilton MA, Harper RM.
Regional brain gray matter loss in heart failure. J Appl Physiol 2003; 95:677–684.
http://www.ncbi.nlm.nih.gov/pubmed/12716866 - Woo MA, Macey PM, Keens PT, et al.
Functional abnormalities in brain areas that mediate autonomic nervous system control in advance heart failure. J Card Fail 2005; 11:437–446.
http://www.ncbi.nlm.nih.gov/pubmed/16105635 - Lee CW, Lee JH, Lim TH, et al.
Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure. Circulation 2001; 103:2784–2787.
http://www.ncbi.nlm.nih.gov/pubmed/11401932 - Javaheri S, Parker TJ, Wexler L, et al.
Occult sleep-disordered breathing in stable congestive heart failure. Ann Intern Med 1995; 122:487–492.
http://www.ncbi.nlm.nih.gov/pubmed/7872582 - Cormican LJ, Williams A.
Sleep disordered breathing and its treatment in congestive heart failure. Heart 2005; 91:1265–1270.
http://www.ncbi.nlm.nih.gov/pubmed/16162610 - Xie A, Skatrud JB, Dempsey JA, Morgan B, Russell D.
Cerebrovascular response to carbon dioxide in patients with congestive heart failure. Am J Respir Crit Care Med 2005; 172: 371–378.
http://www.ncbi.nlm.nih.gov/pubmed/15901613 - Westlake C, Dracup K, Fonarow G, et al.
Depression in patients with heart failure. J Card Fail 2005; 11:30–35.
http://www.ncbi.nlm.nih.gov/pubmed/15704061