Cognitive dysfunction in advanced heart failure and prospective cardiac assist device patients.
BACKGROUND
Extended periods of hypoperfusion in an advanced heart failure (HF) places patients at high risk for neurobehavioral compromise, which has not been studied systematically. It is also not clear how intravenous inotropic therapy and mechanical cardiac assist devices (MCAD) affect cognitive function.


METHODS
This prospective cross-sectional cognitive preliminary study evaluated 252 potential heart transplant candidates assessing functions in memory, motor, and processing speed. Patients were divided into three HF groups based on severity of disease: group 1 outpatients (n = 113), group 2 in-patients requiring inotropic infusion (n = 83), and group 3 inpatients likely requiring MCAD support (n = 56). Aggregate z-scores for memory, motor, and processing speed and independent samples t tests assessed intergroup differences on 13 cognitive measures.


RESULTS
A broad pattern of cognitive impairment was observed within the advanced HF group; fewer deficits were found in group 1 outpatients and more severe deficits in group 3 MCAD subjects. A difference in motor functions was observed as the earliest abnormality, with group 3 showing significant changes compared with group 1. The most dramatic changes were seen in domain mental processing speed along with specific verbal and visual memory functions, which were slower in group 3 compared with groups 1 and 2.


CONCLUSIONS
Cognitive deficits are common in advanced HF and worsen with increasing severity of HF. Appropriately designed and randomized studies will be needed to demonstrate if earlier MCAD implantation is warranted to arrest cognitive dysfunction and better postimplantation adaptation.
Petrucci
Ralph J
RJ
College of Medicine, Drexel University, Philadelphia, Pennsylvania 19102, USA. ralph.petrucci@drexelmed.edu
Truesdell
Karen C
KC
Carter
Anne
A
Goldstein
Naomi E
NE
Russell
Megan M
MM
Dilkes
Danielle
D
Fitzpatrick
Jane M
JM
Thomas
Carole E
CE
Keenan
Margaret E
ME
Lazarus
Lewis A
LA
Chiaravalloti
Nancy D
ND
Trunzo
Joseph J
JJ
Verjans
Johan W
JW
Holmes
Elena C
EC
Samuels
Louis E
LE
Narula
Jagat
J
D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D018737:Hand Strength; D006333:Heart Failure / Q000453:epidemiology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009048:Motor Skills; D009483:Neuropsychological Tests; D011446:Prospective Studies; D014145:Trail Making Test