title: Chronic renal dysfunction and anaemia are associated with cognitive impairment in older patients with heart failure.
abstract: OBJECTIVE
  Cognitive impairment, anaemia and chronic kidney disease (CKD) are associated with mortality and disability in chronic heart failure patients. We hypothesized that anaemia and CKD are independent predictors of cognitive impairment in older patients with heart failure.
  
  
  METHODS
  One hundred and ninety community-living elderly patients aged at least 70 years, treated with optimized therapy for heart failure in stable clinical conditions, were prospectively studied. They underwent clinical and multidimensional assessment. Cognitive status was assessed by the Mini Mental State Examination. Cognitive impairment was defined as the Mini Mental State Examination score adjusted by age and educational level below 24. CKD was defined as the Cockcroft-Gault glomerular filtration rate below 60  ml/min and anaemia as haemoglobin below 12  g/dl.
  
  
  RESULTS
  Cognitive impairment was diagnosed in 38.9% of patients, CKD in 85.7% and anaemia in 42.6%. Age, female sex, BMI, education less than 5 years, depressive symptoms, anaemia, CKD, disability and worse quality of life were significantly associated with cognitive impairment. Cognitive impairment involved primarily global cognitive deficit, memory, mental speed, attention, calculation and language. A significant relationship between haemoglobin levels and cognitive impairment was found, with the range of 15-16.5  g/dl having the lower prevalence of cognitive impairment (19.4%). At multivariate analysis, advanced age, low education level, anaemia and CKD were independently associated with cognitive impairment. Cox analysis showed that cognitive impairment was an independent predictor of hospitalization for worsening heart failure alone and combined with all-cause death.
  
  
  CONCLUSIONS
  Cognitive impairment is common in elderly heart failure patients and is independently associated with anaemia and renal dysfunction. Further studies are needed to assess whether optimal treatment of anaemia and CKD may prevent the development of cognitive impairment in heart failure patients.
authors.affiliation: aHeart Failure Clinic, 1st Cardiology/C.C.U. Unit, Cardiovascular Department, San Camillo Hospital b2nd Cardiology Unit, Department of Cardiology, San Giovanni Hospital, Rome cCardiovascular Center and University, Trieste dHeart Failure Clinic, Division of Cardiology, San Martino Hospital, Belluno eHeart Failure Clinic, Division of Cardiology, Villa Bianca Hospital, Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Maria Denitza
authors.initials: MD
authors.lastname: Tinti
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Stefano
authors.initials: S
authors.lastname: Tolone
authors.forename: Gaetano
authors.initials: G
authors.lastname: Pero
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology*; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*
chemical_list: D006454:Hemoglobins