title: Longitudinal cognitive performance in older adults with cardiovascular disease: evidence for improvement in heart failure.
abstract: BACKGROUND
  Cardiovascular disease (CVD) and particularly heart failure (HF) have been associated with cognitive impairment in cross-sectional studies, but it is unclear how cognitive impairment progresses over time in older adults with these conditions.
  
  
  OBJECTIVE
  The aim of this study was to prospectively examine cognitive function in patients with HF versus other forms of CVD.
  
  
  METHODS
  Seventy-five older adults (aged 53-84 years) with CVD underwent Doppler echocardiogram to evaluate cardiac status and 2 administrations of the Dementia Rating Scale (DRS), a test of global cognitive functioning, 12 months apart.
  
  
  RESULTS
  Although DRS performance did not statistically differ between groups at either administration, a significant between-group difference in the rate of cognitive change emerged (lambda = 0.87; F = 10.50; P = .002; omega 2 = 0.11). Follow-up analyses revealed that patients with HF improved significantly on global DRS performance, whereas patients with other forms of CVD remained stable. More specifically, patients with HF showed improvement on subscales of attention, initiation/perseveration, and conceptualization. Exploratory analyses indicated that higher diastolic blood pressure at baseline was associated with improved DRS performance in patients with HF (r = 0.38; P = .02).
  
  
  CONCLUSIONS
  Patients with HF exhibited modest cognitive improvements during 12 months, particularly in attention and executive functioning. Higher diastolic blood pressure at baseline was associated with improvement. These results suggest that cognitive impairment in patients with HF may be modifiable and that improved blood pressure control may be an important contributor to improved function. Further prospective studies are needed to replicate results and determine underlying mechanisms.
authors.affiliation: Department of Psychology, Kent State University, Kent, Ohio 44242, USA. kstanek@kent.edu
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Stanek
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.forename: Robert H
authors.initials: RH
authors.lastname: Paul
authors.forename: Athena
authors.initials: A
authors.lastname: Poppas
authors.forename: Angela L
authors.initials: AL
authors.lastname: Jefferson
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Sweet
authors.forename: Karin F
authors.initials: KF
authors.lastname: Hoth
authors.forename: Andreana P
authors.initials: AP
authors.lastname: Haley
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003971:Diastole; D017548:Echocardiography, Transesophageal; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method