Depression is associated with cognitive dysfunction in older adults with heart failure

Trajectories of depression predict patterns of resilience following loss and potentially traumatic events

A key conceptual issue in the resilience literature centers on whether the presence of resilience in one domain corresponds to positive adaptation in other areas. The present studies investigated whether an individual's likelihood of demonstrating resilience in their trajectory of depressive symptoms would be associated with positive adjustment in psychological, functional, and health-related domains following exposure to spinal cord injury, bereavement, and heart attack. In each study, we utilized growth mixture and robust linear mixed-effects modeling to examine the associations between depression-based trajectories and multiple domains of positive adjustment. Results from all three studies indicated that, on average, individuals who exhibited trajectories of resilience in relation to depressive symptoms concurrently experienced better quality of life, perceived manageability, self-esteem, cognition, and body mass index (BMI). Further, a higher probability of belonging to the resilient trajectory class was linked to higher quality of life, B = 33.78, 95% CI [24.31, 42.91]; perceived manageability, B = 3.44, 95% CI [1.54, 5.21]; cognitive functioning, B = 2.30, 95% CI [1.32, 3.27]; and healthier BMI, B = -1.02, 95% CI [-1.89, -0.17]. Together, these findings illustrate that it is possible to utilize symptoms of depression to predict patterns of resilience across several clinically meaningful domains.

Association of cardiovascular diseases with cognitive performance in older adults

BACKGROUND

Cognitive function and cardiovascular disease (CVD) have a bidirectional relationship, but studies on the impact of CVD subtypes and aging spectrum have been scarce.

METHODS

We assessed older adults aged ≥60 years from the 2011 to 2012 and 2013 to 2014 cycles of the National Health and Nutrition Examination Survey who had coronary heart disease, angina, prior myocardial infarction, congestive heart failure, or prior stroke. We compared CERAD-IR, CERAD-DR, Animal Fluency test, and DSST scores to assess cognitive performance in older adults with and without CVD.

RESULTS

We included 3,131 older adults, representing 55,479,673 older adults at the national level. Older adults with CVD had lower CERAD-IR (mean difference 1.8, 95% CI 1.4-2.1, P < .001), CERAD-DR (mean difference 0.8, 95% CI 0.6-1.0, P < .001), Animal Fluency test (mean difference 2.1, 95% CI 1.6-2.6, P < .001), and DSST (mean difference 9.5, 95% CI 8.0-10.9, P < .001) scores compared with those without CVD. After adjustment, no difference in CERAD-IR, CERAD-DR, and Animal Fluency test scores was observed, but DSST scores were lower in older adults with CVD (adjusted mean difference 2.9, 95% CI 1.1-4.7, P = .001). Across CVD subtypes, individuals with congestive heart failure had lower performance on the DSST score. The oldest-old cohort of patients ≥80 years old with CVD had lower performance than those without CVD on both the DSST and Animal Fluency test.

CONCLUSION

Older adults with CVD had lower cognitive performance as measured than those free of CVD, driven by pronounced differences among those with CHF and those ≥80 years old with CVD.

Brain Imaging Changes and Related Risk Factors of Cognitive Impairment in Patients With Heart Failure

Background/Aims

To explore the imaging changes and related risk factors of heart failure (HF) patients with cognitive impairment (CI).

Methods

A literature search was systematically carried out in PubMed, Web of Science, Embase, and Cochrane Library. In this systematic review, important relevant information was extracted according to the inclusion and exclusion criteria. The methodological quality was assessed by three scales according to the different study types.

Results

Finally, 66 studies were included, involving 33,579 patients. In the imaging changes, the severity of medial temporal lobe atrophy (MTA) and the decrease of gray Matter (GM) volume were closely related to the cognitive decline. The reduction of cerebral blood flow (CBF) may be correlated with CI. However, the change of white matter (WM) volume was possibly independent of CI in HF patients. Specific risk factors were analyzed, and the data indicated that the increased levels of B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the comorbidities of HF, including atrial fibrillation (AF), diabetes mellitus (DM) and anemia were definitely correlated with CI in patients with HF, respectively. Certain studies had also obtained independent correlation results. Body mass index (BMI), depression and sleep disorder exhibited a tendency to be associated with CI. Low ejection fraction (EF) value (<30%) was inclined to be associated with the decline in cognitive function. However, no significant differences were noted between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in cognitive scores.

Conclusion

BNP/NT-proBNP and the comorbidities of HF including AF, DM and anemia were inextricably correlated with CI in patients with HF, respectively. These parameters were independent factors. The severity of MTA, GM volume, BMI index, depression, sleep disorder, and low EF value (<30%) have a disposition to associated with CI. The reduction in the CBF volume may be related to CI, whereas the WM volume may not be associated with CI in HF patients. The present systematic review provides an important basis for the prevention and treatment of CI following HF.

Impaired intestinal function is associated with lower muscle and cognitive health and well-being in patients with congestive heart failure

BACKGROUND

Small- and large-intestinal perturbations have been described as prevalent extracardiac systemic manifestations in congestive heart failure (CHF), but alterations in protein digestion and absorption and plasma short-chain fatty acid (SCFA) concentrations and the potential link with other systemic effects (muscle and cognitive health) have not been investigated in CHF.

METHODS

We analyzed protein digestion and absorption with dual stable tracer method in 14 clinically stable, noncachectic CHF outpatients (mean left ventricular ejection fraction: 35.5% [95% CI, 30.9%-40.1%]) and 15 controls. Small-intestinal non-carrier-mediated permeability and active carrier-mediated glucose transport were quantified by sugar permeability test. Plasma SCFA (acetate, propionate, butyrate, isovalerate, valerate) concentrations were measured as intestinal microbial metabolites. Muscle function was assessed by isokinetic dynamometry, cognition by a battery of tests, and well-being by questionnaire.

RESULTS

Protein digestion and absorption were impaired by 29.2% (P = .001) and active glucose transport by 38.4% (P = .010) in CHF. Non-carrier-mediated permeability was not altered. Whereas plasma propionate, butyrate, and isovalerate concentrations were lower in CHF (P < .05), acetate and valerate concentrations did not differ. Overall, intestinal dysfunction was associated with impaired leg muscle quality, emotional distress, and cognitive dysfunction (P < .05).

CONCLUSIONS

We identified impaired protein digestion and absorption and altered SCFA concentrations as additional intestinal dysfunctions in CHF that are linked to reduced muscle and cognitive health and well-being. More research is needed to implement strategies to improve intestinal function in CHF and to investigate the mechanisms underlying its link with other systemic manifestations.

Cognitive performance is associated with worse prognosis in patients with heart failure with reduced ejection fraction

AIMS

Heart failure (HF) is a complex clinical syndrome with multiple comorbidities. Cognitive impairment, stress, anxiety, depression, and lower quality of life are prevalent in HF. Herein, we explore the interplay between these parameters and study their value to predict major adverse cardiovascular events (MACEs) and health-related quality of life (HrQoL) in patients with HF with reduced ejection fraction using guideline recommended assessment tools.

METHODS AND RESULTS

We conducted a longitudinal study using a sample of 65 patients from two hospitals. A battery of tests was applied to assess cognition [Montreal Cognitive Assessment (MoCA)], stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) at baseline. MACEs were registered using clinical records. HrQoL was estimated using the Kansas City Cardiomyopathy Questionnaire (KCCQ). A descriptive statistical analysis was conducted, and multiple linear and Cox regression models conducted to determine the predictive value of neurocognitive parameters and HrQoL in MACE. Both MoCA [hazard ratio = 0.906 (0.829-0.990); P = 0.029] and KCCQ scores were predictors of MACE, but not of overall mortality. Anxiety, depression, and stress scores did not predict MACE. However, anxiety (β = -0.326; P = 0.012) and depression levels (β = -0.309; P = 0.014) were independent predictors of the KCCQ score.

CONCLUSIONS

The MoCA score and HrQoL were predictors of MACE-free survival. Anxiety and depression were good predictors of HrQoL, but not of MACE-free survival.

Relationship Between Psychological Distress and Cognitive Function Differs as a Function of Obesity Status in Inpatient Heart Failure

Heart failure (HF) is a chronic medical condition rapidly growing in prevalence. Evidence links HF to cognitive decline, obesity, and psychological distress. The current study examined the association between cognitive function and ejection fraction (EF%), anxiety, depression, and obesity in inpatient HF. Patients completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7), Patient Health Questionnaire 9-Item Scale (PHQ-9), and Mini-Cog while hospitalized for HF. Additional demographic and medical information was gathered via chart review. All models controlled for age. Of 117 patients assessed (49% male), 55% (n = 64) were obese. ANCOVA analyses were conducted comparing those with obesity and without on cognitive function: model A included EF%, model B included depression, and model C included anxiety. All three models were significantly related to cognitive function. There was a significant interaction effect of EF% and obesity and of anxiety and obesity to predict Mini-Cog scores. Post hoc partial correlational analyses revealed that anxiety was negatively associated with Mini-Cog scores among only patients without obesity. Depression was not significantly related to cognitive function in either group. However, patients with obesity demonstrated higher depression and anxiety than patients without. Results suggest that at lower EF%, and with higher anxiety, patients without obesity may be at greater risk of cognitive dysfunction than those with obesity. Cognitive dysfunction among HF patients with obesity may be independent of psychological distress. These findings may reflect the “obesity paradox” observed among HF patients, in that patients with obesity may have a different biopsychosocial presentation, which may lead to unexpected clinical outcomes. Further research is necessary to articulate the relationship of obesity and cognitive function in HF.

Combined Influence of Depression and Physical Frailty on Cognitive Impairment in Patients with Heart Failure

Cognitive impairment is a prevalent condition and important barrier to self-care behaviors in patients with heart failure (HF). HF patients with depression or physical frailty are more likely to have reduced cognitive function. However, it remains unclear if combined depression and physical frailty increased the risk of cognitive impairments among HF populations. This study aimed to identify the influence of combined depression and physical frailty on cognitive impairments in HF. This cross-sectional study was included 289 patients with HF in outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained patients’ characteristics including depression, physical frailty, and cognitive function with Korean validated tools using a face-to-face interview. The prevalence rate of cognitive impairment was approximately 27.3% in HF outpatients. We found that the combined influence of depression and physical frailty increased the risk of cognitive impairments in both unadjusted (odds ratio (OR) 4.360; 95% confidence interval (CI) (2.113, 8.994)) and adjusted models (OR 3.545; 95% CI (1.448, 8.681)). Our findings highlight that healthcare professionals need to be more aware of the vulnerable population who suffer from both depression and physical frailty at the same time. Future prospective studies should examine the causal relationships among depression, physical frailty and cognitive impairment during the HF illness trajectories.

Gender Differences in the Impact of Cognitive Function on Health Literacy among Older Adults with Heart Failure

Heart failure (HF)-related cognitive decline is a common condition and may be associated with health literacy. However, gender differences in this context have not been explored fully. This secondary data analysis aimed to identify gender differences in the impact of cognitive function on health literacy among older patients with HF. A total of 135 patients (75 men and 60 women) with a mean age of 73.01 ± 6.45 years were recruited. Older women with HF had higher cognitive impairment (15%) and inadequate health literacy (56.7%) compared to men. Cognitive function was the strongest predictor of health literacy in men (β = 3.668, p < 0.001) and women (β = 2.926, p = 0.004). Notably elderly women are likely to face double the burden of the influence of cognitive function on health literacy in comparison with men. It is necessary to assess cognitive function and health literacy during HF illness trajectories on a regular basis. Healthcare professionals working with patients with HF should be aware of gender differences in cognitive function and health literacy and the importance of assessing these factors.

Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future

Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure

OBJECTIVE

Heart failure affects more than 5 million U.S. adults, and approximately 20% of individuals with heart failure experience depressive symptoms. Depression is detrimental to prognosis in heart failure, conferring approximately a 2-fold increase in mortality risk. Medication nonadherence may help explain this relationship because depressed patients are less likely to adhere to the medication regimen.

METHOD

Depression, electronically monitored medication adherence, and mortality were measured in a sample of 308 patients with heart failure participating in a study of self-management behavior. Cardiovascular and all-cause mortality data were obtained from the Centers for Disease Control and Prevention's National Death Index (median 2.9-year follow-up). Cox proportional hazards regression was used to assess the relationship between depression and mortality, with and without adjustment for age, gender, disease severity, and medication nonadherence.

RESULTS

In adjusted analyses, depression was associated with an increased all-cause mortality risk (hazard ratio 1.87; 95% confidence interval 1.04-3.37). Depression was not related to cardiovascular mortality, potentially because of a low number of cardiac-related deaths. When medication nonadherence was added to the model, nonadherence (hazard ratio 1.01; 95% confidence interval 1.004-1.02), but not depression, predicted all-cause mortality risk.

CONCLUSIONS

Depressive symptoms confer increased all-cause mortality risk in heart failure, and medication nonadherence contributes to this relationship. Depression and nonadherence represent potentially modifiable risk factors for poor prognosis. Future research is needed to understand whether interventions that concomitantly target these factors can improve outcomes. (PsycINFO Database Record

Cognitive Impairment Among Elderly Patients With Chronic Heart Failure and Related Factors

Background

Patients with heart failure (HF) older than 65 years have a two-fold increased risk of cognitive impairment than elders without HF. Identifying factors affecting cognitive impairment in HF may present targets for intervention.

Objectives

The aim of the present study was to determine cognitive function and related factors among elderly patients with heart failure.

Patients and Methods

In this cross-sectional study, 184 elderly patients with heart failure were selected from four Mazandaran University of Medical Sciences teaching hospitals using convenience sampling. Data were collected from patients’ medical records and by interview, using the abbreviated mental test, geriatric depression scale, and Charlson comorbidity index.

Results

There were significant relationships between cognitive status and living arrangement (P < 0.001), education (P < 0.001), hypertension (P = 0.039), anemia (P = 0.046), Charlson comorbidity index (P < 0.001) and geriatric depression scale (P < 0.001).

Conclusions

Screening of cognitive impairment in elderly patients with heart failure seems necessary.

The association between atrial fibrillation and cognitive function in patients with heart failure

BACKGROUND

Atrial fibrillation (AF) is associated with cognitive impairment in heart failure (HF).

AIMS

The purpose of this study was to examine whether AF independently predicted cognitive function in HF patients after controlling for more demographic, medical and psychological characteristics, and whether the timing of AF onset in relation to HF diagnosis independently contributed to cognitive function in HF patients with AF.

METHODS

A total of 188 hospitalized HF patients (62.8% male, age 66.3±10.6 years) completed cognitive function assessment with the Montreal Cognitive Assessment (MoCA). A history of AF, along with other medical characteristics, was ascertained through a review of participants' medical charts. The timing of AF onset in relation to HF diagnosis was categorized into AF occurring prior to HF diagnosis (i.e. prior AF) and AF developing after HF diagnosis (i.e. incident AF).

RESULTS

Altogether 72 participants had a positive diagnostic history of AF. Specifically, 41 had prior AF, and 31 developed AF subsequently. In HF patients, AF was associated with poorer performance on cognitive function after controlling for more confounders (β=-0.112, ΔR²=0.010, p=0.046). Among HF patients with AF, incident AF independently predicted poorer cognitive function (β=-0.238, ΔR²=0.027, p=0.047).

CONCLUSION

AF independently contributes to cognitive function in HF patients after adjusting for more confounding variables. The timing of AF onset in relation to HF diagnosis independently predicts cognitive function in HF patients with AF. Prospective studies are needed to elucidate possible mechanisms for the association between AF and cognitive function in HF populations.

Cognitive Function in Heart Failure Is Associated With Nonsomatic Symptoms of Depression But Not Somatic Symptoms

BACKGROUND

Patients with heart failure (HF) have high rates of cognitive impairment and depressive symptoms. Depressive symptoms have been associated with greater cognitive impairments in HF; however, it is not known whether particular clusters of depressive symptoms are more detrimental to cognition than others.

OBJECTIVE

The aim of this study was to identify whether somatic and/or nonsomatic depressive symptom clusters were associated with cognitive function in persons with HF.

METHODS

Participants were 326 HF patients (40.5% women, 26.7% non-white race-ethnicity, aged 68.6 ± 9.7 years). Depressive symptoms were measured using a depression questionnaire commonly used in medical populations: the Patient Health Questionnaire-9. Somatic and nonsomatic subscale scores were created using previous factor analytic results. A neuropsychological battery tested attention, executive function, and memory. Composites were created using averages of age-adjusted scaled scores. Regressions adjusting for demographic and clinical factors were conducted.

RESULTS

Regressions revealed that Patient Health Questionnaire-9 total was associated with attention (β = -.14, P = .008) and executive function (β = -.17, P = .001). When analyzed separately, the nonsomatic subscale, but not the somatic symptoms subscale (P values ≥ .092), was associated with attention scores (β = -.15, P = .004) and memory (β = -.11, P = .044). Both nonsomatic (β = -.18, P < .001) and somatic (β = -.11, P = .048) symptoms were related to executive function. When included together, only the nonsomatic symptom cluster was associated with attention (β = -.15, P = .020) and executive function (β = -.19, P = .003).

CONCLUSIONS

Greater overall depressive symptom severity was associated with poorer performance on multiple cognitive domains, an effect driven primarily by the nonsomatic symptoms of depression.

CLINICAL IMPLICATIONS

These findings suggest that screening explicitly for nonsomatic depressive symptoms may be warranted and that the mechanisms underlying the depression-cognitive function relationship in HF are not solely related to sleep or appetite disturbance. Thus, interventions that target patients' somatic symptoms only (eg, poor appetite or fatigue) may not yield maximum cognitive benefit compared with a comprehensive treatment that targets depressed mood, anhedonia, and other nonsomatic symptoms.

Executive function moderates the relationship between depressive symptoms and resting heart rate variability in heart failure

Heart failure (HF) is associated with high rates of depression. In turn, depression is associated with reduced heart rate variability (HRV), a marker of parasympathetic dysfunction and poorer cardiac outcomes. Cognitive impairment--especially executive dysfunction--is also highly prevalent in HF, but it is unknown whether executive function (EF) impacts the depression-HRV relationship. The primary objective of this paper is to examine whether EF moderates the relationship between depression and HRV in HF. Participants were 109 HF patients. Depressive symptoms were measured using the Beck Depression Inventory-II. EF was assessed using a composite of age-adjusted T scores on the Frontal Assessment Battery, Trail Making Test B, and Stroop Color Word subtest. Parasympathetic function was assessed using resting high frequency HRV (HF-HRV). Multiple hierarchical regression was used to conduct BDI × EF moderation analyses. BDI scores were associated with reduced resting HF-HRV (p < .05). No main effects were detected between EF and resting HF-HRV (p > .05). However, EF moderated the relationship between BDI scores and resting HF-HRV (β = 0.59, p < .01). Simple slope analyses revealed that among participants with poorer EF, higher BDI scores were associated with lower resting HF-HRV (p < .001). Structural brain changes common in HF may contribute to lower EF, increased depression, and poorer autonomic functioning. Alternatively, the results may indicate that individuals with intact EF engage in self-care strategies that negate the detrimental impact of depression on autonomic function. Additional work is needed to clarify these possibilities and the potential benefits of treating depression in HF patients with different cognitive abilities.

Daily Physical Activity Is Associated with Subcortical Brain Volume and Cognition in Heart Failure

Cognitive impairment in heart failure (HF) is believed to in part stem from structural brain alterations, including shrinkage of subcortical regions. Fortunately, neurocognitive dysfunction in HF can be mitigated by physical activity (PA), though mechanisms for this phenomenon are unclear. PA is protective against age-related cognitive decline that may involve improved structural integrity to brain regions sensitive to aging (e.g., subcortical structures). Yet, no study has examined the benefits of PA on the brain in HF and we sought to do so and clarify related cognitive implications. Fifty older adults with HF completed a neuropsychological battery and wore an accelerometer for 7 days. All participants underwent brain MRI. This study targeted subcortical brain volume given subcortical alterations are often observed in HF and the sensitivity of PA to subcortical structures in other patient populations. Participants averaged 4348.49 (SD=2092.08) steps per day and greater daily steps predicted better attention/executive function, episodic memory, and language abilities, p's<.05. Medical and demographically adjusted regression analyses revealed higher daily steps per day predicted greater subcortical volume, with specific effects for the thalamus and ventral diencephalon, p's<.05. Greater subcortical volume was associated with better attention/executive function, p<.05. Higher daily PA was associated with increased subcortical brain volume and better cognition in older adults with HF. Longitudinal work is needed to clarify whether daily PA can attenuate brain atrophy in HF to reduce accelerated cognitive decline in this population.

Grooved Pegboard for adult employed South Africans: socio-demographic influences

The Grooved Pegboard is a widely used test of psychomotor speed, and a number of socio-demographic and psychological influences on performance have been reported. To accurately interpret Grooved Pegboard results, the effects of these influences need to be considered. This study investigated the effects of socio-demographic, psychological, and anthropometric variables on performance in a sample of 3272 healthy adult South Africans. Age and gender were the largest contributors to variance in scores and should be used for reporting normative data. While separate norms may not be required for other variables, clinicians need to be sensitive to the effects of education levels and home language when administering and interpreting results. Work context, province of origin, non-clinical mood states, and body mass are probably less important when interpreting pegboard results.

Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure

Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80% of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population.

The association between cognitive function and self-care in patients with chronic heart failure

BACKGROUND

Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression.

METHODS

This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses.

RESULTS

Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression.

CONCLUSIONS

Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.

Pre-operative history of depression and cognitive changes in bariatric surgery patients

Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery.

The MoCA and MMSE as screeners for cognitive impairment in a heart failure population: a study with comprehensive neuropsychological testing

OBJECTIVE

To examine the ability of the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to detect cognitive impairment in persons with heart failure (HF).

BACKGROUND

Although the MMSE and MoCA are commonly used screeners in HF, no research team has validated their performance against neuropsychological testing.

METHODS

Participants were 106 patients with HF (49.1% male, 68.13 ± 9.82 years) who completed the MoCA, MMSE, and a full neuropsychological battery. Sensitivity and specificity were examined. Discriminant function analyses tested whether the screeners correctly detected cognitive impairment.

RESULTS

A MoCA score <25 and MMSE score of <28 yielded optimal sensitivity/specificity (.64/.66 and .70/.66, respectively). The MoCA correctly classified 65% of patients, Wilk's lambda = .91, χ(2)(1) = 9.89, p < .01, and the MMSE correctly classified 68%, Wilk's lambda = .87, χ(2)(1) = 14.26, p < .001.

CONCLUSIONS

In HF, both the MoCA and MMSE are useful in identifying the majority of patients with and without cognitive impairment. Both tests misclassified approximately one-third of patients, so continued monitoring and evaluation of patients is needed in conjunction with screening.

Reduced cerebral perfusion predicts greater depressive symptoms and cognitive dysfunction at a 1-year follow-up in patients with heart failure

OBJECTIVE

Cerebral hypoperfusion is common in heart failure (HF) and believed to underlie poor neurocognitive outcomes in this population. Up to 42% of HF patients also exhibit depressive symptomatology that may stem from reduced cerebral blood flow. However, no study has examined this possibility or whether reduced brain perfusion increases risk for future cognitive dysfunction in older adults with HF.

METHODS

One hundred HF patients underwent transcranial Doppler ultrasonagraphy to quantify global cerebral blood flow velocity (CBF-V) and were administered a cognitive test battery to assess global cognition, attention/executive function, and memory abilities. All participants then completed the Beck Depression Inventory-II to assess depressive symptomatology. These procedures were performed at baseline and at 12-month follow-up.

RESULTS

Repeated measures revealed that CBF-V declined over the 12-month period. Regression analyses showed that reduced baseline CBF-V predicted worse performances in attention/executive function (p < 0.05 for all) and a trend for memory (p = 0.09) in addition to greater depressive symptomatology (p < 0.05) at the 12-month follow-up, even after controlling for baseline factors and medical and demographic variables.

CONCLUSIONS

Cerebral perfusion declined over time and was associated with poorer cognitive function and greater depressive symptoms at a 1-year follow-up in HF. Prospective studies with long-term follow-ups that employ neuroimaging are needed to examine whether cognitive dysfunction and depression in HF stem from the adverse effects of cerebral hypoperfusion on the cerebral structure.

The interactive effects of cerebral perfusion and depression on cognitive function in older adults with heart failure

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.

Cognitive performance in older adults with stable heart failure: longitudinal evidence for stability and improvement

Cognitive impairment is prevalent in heart failure (HF), though substantial variability in the pattern of cognitive impairment is found across studies. To clarify the nature of cognitive impairment in HF, we examined longitudinal trajectories across multiple domains of cognition in HF patients using latent growth class modeling. 115 HF patients completed a neuropsychological battery at baseline, 3-months and 12-months. Participants also completed the Beck Depression Inventory-II (BDI-II). Latent class growth analyses revealed a three-class model for attention/executive function, four-class model for memory, and a three-class model for language. The slope for attention/executive function and language remained stable, while improvements were noted in memory performance. Education and BDI-II significantly predicted the intercept for attention/executive function and language abilities. The BDI-II also predicted baseline memory. The current findings suggest that multiple performance-based classes of neuropsychological test performance exist within cognitive domains, though case-controlled prospective studies with extended follow-ups are needed to fully elucidate changes and predictors of cognitive function in HF.

Depressive symptomatology, exercise adherence, and fitness are associated with reduced cognitive performance in heart failure

OBJECTIVE

Depression is common in heart failure (HF) and associated with reduced cognitive function. The current study used structrual equation modeling to examine whether depression adversely impacts cognitive function in HF through its adverse affects on exercise adherence and cardiovascular fitness.

METHOD

158 HF patients completed neuropsychological testing, physical fitness test, Beck depression inventory-II (BDI-II), and measures assessing exercise adherence and physical exertion.

RESULTS

The model demonstrated excellent model fit and increased scores on the BDI-II negatively affected exercise adherence and cardiovascular fitness. There was a strong inverse association between cardiovascular fitness and cognitive function. Sobel test showed a significant indirect pathway between the BDI-II and cognitive function through cardiovascular fitness.

DISCUSSION

This study suggests depression in HF may adversely impact cognitive function through reduced cardiovascular fitness. Prospective studies are needed to determine whether treatment of depression can lead to better lifestyle behaviors and ultimately improve neurocognitive outcomes in HF.

Cerebral perfusion is associated with white matter hyperintensities in older adults with heart failure

Cognitive impairment is common in heart failure (HF) and believed to be the result of cerebral hypoperfusion and subsequent brain changes including white matter hyperintensities (WMHs). The current study examined the association between cerebral blood flow and WMHs in patients with HF and the relationship between WMHs and cognitive impairment. Sixty-nine patients with HF completed the Mini-Mental State Examination (MMSE) and underwent echocardiography, transcranial Doppler sonography for cerebral blood flow velocity of the middle cerebral artery, and brain magnetic resonance imaging. Multivariable hierarchical regression analyses controlling for medical and demographic characteristics as well as intracranial volume showed reduced cerebral blood flow velocity of the middle cerebral artery was associated with greater WMHs (β=-0.34, P=.02). Follow-up regression analyses adjusting for the same medical and demographic factors in addition to cerebral perfusion also revealed marginal significance between increased WMHs and poorer performance on the MMSE (β=-0.26, P=.05). This study suggests that reduced cerebral perfusion is associated with greater WMHs in older adults with HF. These findings support the widely proposed mechanism of cognitive impairment in HF patients and prospective studies are needed to confirm these results.

Apathy and cognitive test performance in patients undergoing cardiac testing

Background. Psychiatric comorbidity is common in patients with cardiovascular disease, with the literature indicating that this population may be at risk for apathy. The current study examined the prevalence of apathy in patients with cardiovascular disease and its relation to aspects of cognitive function. Methods. 123 participants from an outpatient cardiology clinic completed a brief neuropsychological battery, a cardiac stress test, and demographic information, medical history, and depression symptomatology self-report measures. Participants also completed the Apathy Evaluation Scale to quantify apathy. Results. These subjects reported limited levels of apathy and depression. Increased depressive symptomatology, history of heart attack, and metabolic equivalents were significantly correlated with apathy (P < 0.05). Partial correlations adjusting for these factors revealed significant correlations between behavioral apathy and a measure of executive function and the other apathy subscale with a measure of attention. Conclusion. Findings revealed that apathy was not prevalent in this sample though associated with medical variables. Apathy was largely unrelated to cognitive function. This pattern may be a result of the mild levels of cardiovascular disease and cognitive dysfunction in the current sample. Future studies in samples with severe cardiovascular disease or neuropsychological impairment may provide insight into these associations.

Cognitive function and treatment adherence in older adults with heart failure

OBJECTIVE

Treatment recommendation and guidelines for patients with heart failure (HF) can be complex, and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors. Although previous work has identified several medical, demographic, and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF, little is known about the contribution of cognitive impairment to reported treatment adherence in this population.

METHODS

A total of 149 persons with HF (mean [standard deviation] = 68.08 [10.74] years) completed a brief fitness assessment and neuropsychological testing. Treatment adherence was assessed using the Heart Failure Compliance Questionnaire, a brief measure that asks participants to report their adherence to a variety of recommended health behaviors (i.e., medication management, diet, and exercise, among others).

RESULTS

The percentage of participants who reported poor overall adherence was 16.1%, with particularly high rates of nonadherence to dietary and exercise recommendations. Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention (β = .26, p = .01), executive function (β = .18, p = .04), and language (β = .22, p = .01) was associated with poorer overall adherence. Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments, medication management, and dietary recommendations (p < .05 for all).

CONCLUSIONS

The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF. Prospective studies that objectively measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00871897.

Patient reports of cognitive problems are not associated with neuropsychological test performance in bariatric surgery candidates

BACKGROUND

Recent work shows that cognitive deficits are common in bariatric surgery candidates and are associated with reduced weight loss at 12 months postoperatively. Because preoperative neuropsychological assessment is not available for all patients at all sites, many care providers ask patients to self-report their level of cognitive dysfunction. However, the accuracy of patient self-report of cognitive abilities has not been empirically examined.

METHODS

Eighty-one bariatric surgery candidates completed self-report measures of cognitive functioning and neuropsychological tests of memory and other cognitive abilities.

RESULTS

Analyses found no association between subjective report of cognitive function and objective performance on neuropsychological testing. However, persons with history of major depressive disorder reported experiencing greater cognitive deficits.

CONCLUSIONS

These findings suggest that bariatric surgery candidates have little insight into their current level of cognitive function. Future work is needed to confirm these findings and identify brief, objective measures of cognitive function that are sensitive to deficits in bariatric surgery candidates.

Does depression impact cognitive impairment in patients with heart failure?

Prevalence studies have noted the cooccurrence of cognitive decline and depression in persons with heart failure. Cognitive impairment is associated with significant mortality and deteriorated quality of life, likely due to impairments in memory and executive function, which impact a patient's ability to understand and comply with prescribed treatment plans. This is especially true in complex diseases such as heart failure. Evidence from literature supports the possibility of a pathophysiological relationship between cognitive impairment, depression, and heart failure. Yet, very few studies have sought to investigate this relationship. This paper reviews current literature on the association between depression and cognitive impairment in persons with heart failure and explores possible mechanisms explaining this complex triad.