Abstract
Simple SummaryCompared to the general population, patients with heart failure have reduced cognition and increased dementia risk. Brain changes have been observed in these individuals, including reduced brain volumes and abnormal areas suggestive of ischaemia (lack of blood and hence oxygen supply to tissues). Patients with heart failure who have cognitive impairment have poorer self-care and are at increased risk of rehospitalisation and death. Causes of cognitive impairment in heart failure have been suggested, including reduced blood supply to the brain, inflammatory processes, protein abnormalities and thromboembolic disease (formation of blood clots which may travel to the brain and impede blood flow). In this article, we discuss these potential causes linking heart failure and cognitive impairment, and discuss the recognition and management of cognitive impairment in patients with heart failure.Cognitive impairment (CI) is common in heart failure (HF). Patients with HF demonstrate reduced global cognition as well as deficits in multiple cognitive domains compared to controls. Degree of CI may be related to HF severity. HF has also been associated with an increased risk of dementia. Anatomical brain changes have been observed in patients with HF, including grey matter atrophy and increased white matter lesions. Patients with HF and CI have poorer functional independence and self-care, more frequent rehospitalisations as well as increased mortality. Pathophysiological pathways linking HF and CI have been proposed, including cerebral hypoperfusion and impaired cerebrovascular autoregulation, systemic inflammation, proteotoxicity and thromboembolic disease. However, these mechanisms are poorly understood. We conducted a search on MEDLINE, Embase and Scopus for original research exploring the connection between HF and CI. We then reviewed the relevant literature and discuss the associations between HF and CI, the patterns of brain injury in HF and their potential mechanisms, as well as the recognition and management of CI in patients with HF.
Highlights
Cognitive impairment (CI) in patients with heart failure (HF) is common, with a reported prevalence of 20–80% [1–8]
Patients with HF demonstrate increased cognitive deficits compared to controls in several cognitive domains [9] and have poorer self-care and treatment adherence [10]
Jefferson et al observed that a lower cardiac index among subjects of the Framingham Offspring Cohort was associated with higher all-cause dementia and Alzheimer’s risk [29]
Summary
Cognitive impairment (CI) in patients with heart failure (HF) is common, with a reported prevalence of 20–80% [1–8]. Patients with HF demonstrate increased cognitive deficits compared to controls in several cognitive domains [9] and have poorer self-care and treatment adherence [10]. Cerebrovascular haemodynamics and structural brain changes have been postulated to contribute to the cognitive deficits seen in patients with HF [11]. MMoorreeimimppoorrttaannttllyy,, CCII iinn HHFF iiss aassssoocciiaatteedd wwiitthh aa ppoooorr pprrooggnnoossiiss [[1122]]. AAlltthhoouugghh CCII iiss pprreevv-aalleennttaammoonnggppaatiteienntstswwitihthHHFFanadndhahsaas asigsinginfiicfaicnatnimt ipmapctacotnotnhetsheesinedinivdidivuidalusa[l1s2[,1132],1, 3th],e tphaetphaotphhoypshioylsoigoylobgeyhbinedhihnodwhoHwF HinFfluinefnluceesnccoesgncoitgivneitfiuvnecftuionnctrioemn raeinmsapinosorployournlyduernsdtoeord- . SItnoothdi.sInartthicislea, rwtieclree,vwieewretvhieewassthoeciaastisooncsiabtieotnwsebeentwHeFeannHdFCaI,ntdheCpI,atthteerpnastotefrbnrsaoinf binrjauirny ininjuHryF iannHd Fthaenirdptohteeinrtpiaoltmenetciahlamniescmhsa,naissmwse,llaasswtheell raescothgenriteicoongannitdiomnaannadgemmaennatgoefmCeInitn opfaCtiIenints pwaittihenHtsF.wAitghraHpFh.icAsugmrampharicy souf mthme raerpyoortfetdhepartehpooprhteydsioplaotghyo,pbhrayisnioclhoagnyg, ebsraainnd cihmapnagcetsoafnCdIiimnpHaFctios fshCoIwinnHinFFisigsuhroew1n. Impairments in Memory, Executive function, Psychomotor speed etc. Reduced self-care, Reduced functional independence, Increased rehospitalisation, Increased mortality.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
