Heart over head: cognitive problems in patients with chronic heart failure

Heart failure and cognitive decline – is there a link? This is the question that researchers from the University of California Davis Medical Center wanted to answer.

It may not be evident but heart health and brain health are closely linked. The UC Davis  study was conducted by comparing 50 heart failure patients with 50 controls (participants without heart failure). The demographics of the two groups (age, gender and estimated intelligence quotient) were very similar. The total of 100 participants were then assessed using 19 neurophysiological tests that asses the following:

• orientation
• attention
• memory
• executive function
• motor speed
• reaction times

The tests have been showed to be effective in measuring specific cognitive functions. The results of the assessments show that heart failure patients performed poorly compared to the control group in the majority of the tests. Other key results are:

• Heart failure patients had lower scores in 14 out of 19 test measures.
• 23% of heart failure patients had shown “mild to severe deficits in one or more aspects of memory, learning, attention, and/or reaction times.”
• Heart failure patients have a more than 4-fold risk for cognitive impairment than the controls

The severity of these cognitive deficits in this sample of HF patients was associated with several factors, namely depressed learning and previous heart attacks but not to the left ventricular ejection fraction (LVEF), depression, anxiety, or physical functioning, duration or the classification heart failure according to the New York Heart Association( NYHA) classification system.

Data on the link between heart functioning and brain function are very limited and the effects of chronic heart failure on cognitive functions are not fully understood. This study adds valuable data to this rather “underrecognized and underappreciated” issue. The results have some wide-encompassing clinical implications. According to lead author Dr Mary Jane Sauvé

“What it means in clinical practice is that when you give these patients verbal instructions, you also need to provide written materials because of patient difficulties with information requiring attention, learning, and memory functions; that you include the family in the discussion whenever possible; and that patients and families need to have a direct line to call if they are getting into trouble or become confused about the instructions. There is nothing more frustrating than a phone tree, even for people without [cognitive impairment].”

It is a fact that although screening for depression in cardiac patients is highly recommended, screening for cognitive deficits is not routine performed. However, cognitive problems can lead to non-compliance with therapy and medication regimen. Thus, this review paper recommends that

“…future research needs to focus on identifying a simple screening tool that nurses can use to screen for subtle changes in cognition including forgetfulness and delayed recall. Early identification of subtle cognitive changes has the potential to guide healthcare providers to formulate feasible strategies to understand and/or prevent a low cardiac output state before major cognitive impairment becomes evident.”

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