Cognitive decline in heart failure.
Cognitive impairment (CI) is common in older adults with heart failure (HF). The prevalence of CI is higher among patients with HF than in those without. The spectrum of CI in HF is similar to that observed in the general population and may range from delirium to isolated memory or non-memory-related deficits to dementia. Both HF with reduced ejection fraction and HF with preserved ejection fraction have been associated with defects in different domains of cognition. Numerous risk factors have been shown to contribute to CI in HF. Additionally, various pathophysiological mechanisms related to HF can contribute to cognitive decline. These conditions are not routinely screened for in clinical practice settings with HF populations, and guidelines on optimal assessment strategies are lacking. Validated tools and criteria should be used to differentiate acute cognitive decline (delirium) from chronic cognitive decline such as mild cognitive impairment and dementia. CI in HF has been associated with higher rates of disability and impairment in self-care activities that may in turn increase healthcare cost, hospital readmission and mortality. Early detection of CI may improve clinical outcomes in older adults with HF. Appropriate HF management strategies may also help to reduce CI in patients with HF, and future research is needed to develop and test newer and more effective interventions to improve outcomes in patients with HF and CI.
Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada. KAlagiakri@aol.com.|University of Alberta Hospital, B146, Clinical Sciences Building, 8440-112 Street, Edmonton, T6G 2G3, Canada. KAlagiakri@aol.com.
Kannayiram
K
Alagiakrishnan
Department of Medicine, University of Alberta, Edmonton, Canada.
Darren
D
Mah
Geriatrics and Extended Care Services, Veterans Affairs Medical Center, Washington, DC, USA.|George Washington University, Washington, DC, USA.
Ali
A
Ahmed
Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada.
Justin
J
Ezekowitz
D000368:Aged; D002302:Cardiac Output; D060825:Cognitive Dysfunction / Q000209:etiology* / Q000503:physiopathology*; D003693:Delirium / Q000209:etiology; D006333:Heart Failure / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008568:Memory; D012307:Risk Factors; D012648:Self Care
Delirium; Dementia; Heart failure; Mild cognitive impairment