Predictors of Mild Cognitive Dysfunction in an Advanced Heart Failure Population

Abstract

Purpose Heart failure (HF) is associated with cognitive impairment. Assessment of cognitive function is an important component for patient evaluation for mechanical circulatory support or cardiac transplantation. However, little is known about the mechanisms and risk factors for cognitive impairment. The purpose of this study was to identify risk factors for mild cognitive dysfunction in patients with advanced heart failure. Methods and Materials Subjects were prospectively recruited from our advanced heart failure clinic. Baseline demographics, co-morbidities, laboratory findings, and functional assessment were collected. To assess for cognitive dysfunction, all subjects underwent the Montreal Cognitive Assessment (MoCA) survey. A previously established cutoff score of less than 26 was used to categorize subjects with mild cognitive dysfunction. Hemodynamic data and cardiopulmonary stress test performance within 90 days of cognitive assessment were also collected. A 2-sided Fisher’s exact chi-square test was used to identify univariate clinical predictors of mild cognitive dysfunction. Logistic regression was used to evaluate clinical predictors in a multivariate model. Results A total of 183 subjects were recruited and completed the MoCA survey. Univariate predictors of mild cognitive dysfunction included hypertension (OR: 2.06, p = 0.02), ischemic cardiomyopathy (OR: 1.90, p = 0.05), non-Caucasian race (versus Caucasian, OR 3.24, p = 0.003), and age > 65 (OR 2.15, p = 0.04). Resting hemodynamics did not predict the presence of mild cognitive dysfunction. In multivariate analysis controlled for age and gender, hypertension (OR 4.10, p=0.034), non-Caucasian race (OR 10.67, p=0.022), and peak VO2 Conclusions Risk factors for mild cognitive dysfunction in heart failure include hypertension, race, and reduced peak VO2.