title: The interactive effects of cerebral perfusion and depression on cognitive function in older adults with heart failure.
abstract: OBJECTIVE
  Depression is common among persons with heart failure (HF) and has been linked to cognitive impairment in this population. The mechanisms of this relationship are unclear, and the current study examined whether cerebral perfusion moderates the association between depressive symptoms and cognitive impairment in patients with HF.
  
  
  METHODS
  Persons with HF (n = 89; mean [standard deviation] age = 67.61 [11.78] years) completed neuropsychological testing and impedance cardiography. Depressive symptoms were assessed using the Beck Depression Inventory II, and transcranial Doppler was used to quantify cerebral perfusion.
  
  
  RESULTS
  Depression was associated with reduced performance on tasks assessing attention/executive function (r = -0.28), language (r = -0.0.30), and motor function (r = -0.28) in unadjusted models (p values <.05). Global cerebral blood flow was correlated with memory performance (r = 0.22, p = .040) but not with other tasks. A moderation analysis was performed using hierarchical regression models for attention/executive function, memory, language, and motor function. For each model, medical and demographic characteristics were entered into the initial blocks, and the final block consisted of an interaction term between global cerebral blood flow velocity and the Beck Depression Inventory II. The interaction between greater depressive symptoms and decreased global cerebral blood flow velocity was associated with greater deficits in attention/executive function (β = .32, ΔR(2) = 0.08, p = .003).
  
  
  CONCLUSIONS
  Depressive symptoms and cerebral hypoperfusion interact to adversely affect cognitive performance in older adults with HF. Longitudinal studies are needed to clarify this relationship and elucidate subsequent neuropathology.
authors.affiliation: Department of Psychology, Kent State University, Kent, OH 44242, USA. Malosco@kent.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Alosco
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Spitznagel
authors.forename: Naftali
authors.initials: N
authors.lastname: Raz
authors.forename: Ronald
authors.initials: R
authors.lastname: Cohen
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Sweet
authors.forename: Sarah
authors.initials: S
authors.lastname: Garcia
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.forename: Manfred
authors.initials: M
authors.lastname: van Dulmen
authors.forename: Joel
authors.initials: J
authors.lastname: Hughes
authors.forename: Jim
authors.initials: J
authors.lastname: Rosneck
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention / Q000502:physiology; D001783:Blood Flow Velocity; D002307:Cardiography, Impedance; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D056344:Executive Function / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D007802:Language; D016014:Linear Models; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
keywords: cardiovascular disease; cerebral blood flow velocity; cerebral perfusion; cognitive impairment; depression; heart failure