Clinical treatment reverses attentional deficits in congestive heart failure.

Osvaldo P Almeida,Sérgio Tamai

doi:10.1186/1471-2318-1-2

Abstract

BackgroundCongestive heart failure (CHF) is associated with cognitive deficits, particularly of memory and attention. The present study aims to clarify whether clinical treatment can reverse the attentional deficits of patients with CHF.MethodsA convenience sample of 50 patients with CHF functional class IV and 30 elderly controls were recruited from a teaching hospital in Brazil. Participants received a clinical and cognitive examination that included the Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination of the Elderly (CAMCOG), Digit Span, Digit-Symbol Substitution, and Letter Cancellation test. The cognitive performance of CHF patients was reassessed 6 weeks after the introduction of clinical treatment.ResultsTwenty-seven CHF subjects had MMSE<24, compared to only 10 of the controls (p = 0.07). CHF patients also had lower CAMCOG scores (mean = 71.8) than controls (mean = 82.0; p < 0.01). Digit Span, Digit Symbol and Letter Cancellation scores were lower for patients with CHF than controls (p < 0.01). Similarly patients with CHF took longer to complete the Trail Making A (p = 0.07) and B (p < 0.01). CAMCOG scores and left ventricular ejection fraction were moderately correlated (rho = 0.4, p < 0.01). Nineteen patients were lost for follow-up (11 deceased). Clinical treatment was associated with significant improvement of cognitive scores, particularly on the Digit Symbol (p < 0.01) and Letter Cancellation Tests (p < 0.01). Digit Span, Digit Symbol, Letter Cancellation and Trail Making scores of treated CHF patients and controls were similar (p > 0.10).ConclusionsCHF is associated with deficits in attention and psychomotor speed. These deficits improve with clinical treatment.

Highlights

Congestive heart failure (CHF) is a common complication of most diseases of the heart
A recent meta-analysis confirmed that cognitive impairment, attentional deficits, are prominent amongst CHF patients [8]. It seems that people with severe forms of CHF have greater difficulty than mild cases to perform tasks such as digit span and trail making [9]. These results indicate that the attentional deficits associated with CHF may become more pronounced with increasing severity of illness, it is unclear whether clinical treatment can reverse these deficits
Our results showed that there was a moderate correlation between ejection fraction (EF) and Cambridge Cognitive Examination of the Elderly (CAMCOG) scores

Summary

Introduction

Congestive heart failure (CHF) is a common complication of most diseases of the heart. Depression rates, for example, seem to be high (up to 58%) both in inpatient and outpatient settings [4,5] Another important, but neglected, aspect of the quality of life of patients with CHF is cognitive functioning. Reports indicated that up to 80% of patients with severe CHF display deficits in memory and other cognitive abilities [6]. The consequences of these deficits are not clear, but it is conceivable that patients with cognitive impairment have even higher morbidity and mortality rates. Congestive heart failure (CHF) is associated with cognitive deficits, of memory and attention.

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Conclusion