title: Disease-Targeted Treatment Improves Cognitive Function in Patients with Precapillary Pulmonary Hypertension.
abstract: BACKGROUND
  Patients with pulmonary hypertension (PH) may suffer from cognitive deficits that potentially relate to reduced oxygen delivery and cerebral tissue oxygenation (CTO).
  
  
  OBJECTIVE
  To evaluate the hypothesis that cognitive function improves with therapy, along with improved CTO.
  
  
  METHODS
  Twenty incident patients with arterial or chronic thromboembolic PH had CTO monitoring by near-infrared spectroscopy during diagnostic right heart catheterization. Cognitive tests [Trail Making Tests (TMTs), Victoria Stroop tests and the Five-Point Test (5PT)], the 6-min walk distance (6MWD) test, New York Heart Association (NYHA) class and health-related quality of life (HRQoL) were assessed and repeated after 3 months of disease-targeted medication.
  
  
  RESULTS
  At baseline, 45% of PH patients had cognitive deficits. At 3 months, the patients had improved on the TMT A and the Stroop 2 test [37 s (27; 55) versus 30 s (24; 42), p < 0.05, and 18 s (16; 22) versus 16 s (15; 20), p < 0.01], whereas CTO remained unchanged. Arterial oxygen saturation, NYHA class, 6MWD and HRQoL had also improved. Baseline CTO was the strongest predictor of cognitive function, even in multivariate analysis including age, 6MWD and HRQoL. Improvements in cognitive function were not associated with changes in CTO.
  
  
  CONCLUSIONS
  In patients with PH, 3 months of disease-targeted medication resulted in better cognitive function. Although CTO was the strongest predictor of cognitive function at baseline, it did not change during target therapy. The results of this pilot study should be confirmed in an adequately powered controlled trial.
authors.affiliation: Pulmonology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Gina
authors.initials: G
authors.lastname: Somaini
authors.forename: Adriana
authors.initials: A
authors.lastname: Stamm
authors.forename: Séverine
authors.initials: S
authors.lastname: Müller-Mottet
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hasler
authors.forename: Stephan
authors.initials: S
authors.lastname: Keusch
authors.forename: Florian F
authors.initials: FF
authors.lastname: Hildenbrand
authors.forename: Michael
authors.initials: M
authors.lastname: Furian
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.forename: Konrad E
authors.initials: KE
authors.lastname: Bloch
authors.forename: Silvia
authors.initials: S
authors.lastname: Ulrich
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D002196:Capillaries / Q000473:pathology; D006328:Cardiac Catheterization; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D015331:Cohort Studies; D016503:Drug Delivery Systems / Q000379:methods*; D017079:Exercise Tolerance / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000187:drug effects*; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D013557:Switzerland; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents