Neuropsychiatric Symptoms and Executive Functioning Impairment in Patients with Advanced Heart Failure: A Pilot Study

Abstract

<h3>Purpose</h3> Beyond depression and anxiety, little is known about neuropsychiatric and cognitive symptoms associated with advanced heart failure (HF). We hypothesize that HF patients experience significant neuropsychiatric symptoms and executive functioning impairment. <h3>Methods</h3> We enrolled patients presenting for consideration of left ventricular assist device (LVAD) implantation or heart transplant. Participants completed the Brief Symptom Inventory (BSI), Behavioral Rating of Executive Functioning for Adults (BRIEF-A), and the Posttraumatic Stress Disorder (PTSD) Checklist civilian version (PCL-C) questionnaires. These tools queried symptoms of neuropsychiatric conditions, executive functioning impairment, and PTSD. We also explored associations between clinical characteristics and neuropsychiatric symptoms. <h3>Results</h3> Twenty-seven participants, mean age 57.1 (± 11) years, 70% male, consented for study participation. Eight patients (29.6%) screened positive for PTSD. Significant correlations were found between the depression subscale and Stanford Integrated Psychosocial Assessment for Transplant scores (r=0.45, p=0.02), the somatization subscale and age (r=0.44, p=0.03). Females were significantly more likely to screen positive on the Task Monitor subscale (r=0.41, p=0.04) and Metacognitive Index (r=0.54, p=0.005). No significant associations were found between diabetes mellitus, and NYHA class with BSI, BRIEF-A, or PCL-C scores. <h3>Conclusion</h3> HF patients being considered for advanced therapies are at increased risk for experiencing neuropsychiatric and cognitive symptoms, the majority of which were not associated with age, NYHA class, or comorbidities. Comprehensive screening for mental health and cognitive problems could identify opportunities for multidisciplinary interventions and ultimately improve patient outcomes after LVAD implantation and transplant.