Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure
- Giuseppe Zuccalà,
- Caterina Cattel,
- Ester Manes-Gravina,
- Maria G Di Niro,
- Alberto Cocchi,
- Roberto Bernabei
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Dr Giuseppe Zuccalà, Istituto di Medicina Interna e Geriatria, Università Cattolica del S Cuore, L go F Vito, 1 - 00168 Rome, Italy. Phone +39-6-305 1190; fax +39-6-305 1911
- Received 29 November 1997
- Revised 2 May 1997
- Accepted 9 May 1997
Abstract
OBJECTIVES Cognitive impairment has been reported in middle aged patients with end stage heart failure. This cross sectional study assessed the prevalence and determinants of cognitive dysfunction in older patients with mild to moderate heart failure.
METHODS 57 consecutive patients (mean age 76.7 years) with chronic heart failure underwent physical examination, blood chemistry, urinalysis, chest radiography ECG, Doppler echocardiography, and the mini mental state examination (MMSE), mental deterioration battery, depression scale of the Center for Epidemiological Studies (CES-D), Katz activities of daily living, and instrumental activities of daily living 24 hours before hospital discharge.
RESULTS MMSE scores <24 were found in 53% of participants. The MMSE score was associated with left ventricular ejection fraction according to a non-linear correlation, so that cognitive performance was significantly lower in subjects with left ventricular ejection fraction ≤30%. The same pattern of correlation was evidenced between left ventricular ejection fraction and both the attention sub-item of MMSE and the Raven test score. In a multivariate linear regression model, after adjusting for age, sex, and a series of clinical data and objective tests, both age (β=−0.30; P=0.038) and the natural log of left ventricular ejection fraction (β=0.58; P=0.001) were associated with the MMSE score.
CONCLUSION Cognitive impairment in older patients with chronic heart failure is common, and independently associated with lower left ventricular ejection fraction. Given the overwhelming incidence and prevalence of heart failure in older populations, early detection of cognitive impairment in these subjects with prompt, intensive treatment of left ventricular systolic dysfunction may prevent or delay a remarkable proportion of dementia in advanced age.
