Cognitive impairment in Chagas disease patients in Brazil, 2007–2021: A cross-sectional study

Abstract

Introduction Chagas Disease (CD) is frequently associated with heart failure (HF). Cognitive impairment is reported, but whether it results from CD or is a nonspecific symptom of HF is unknown. We aimed to compare cognitive function of HF patients with or without CD. Methods Multicenter cross-sectional study of HF patients. Investigators blinded to the etiology of HF evaluated global cognition and domains of memory, executive and visuospatial function. Logistic regression tested the association between CD and cognitive impairment (Z-score < −1.5) in each domain adjusted for age, sex, educational level and left ventricular ejection fraction. Results We recruited 518 patients, 250 (48.3%) with CD. Cognitive impairment was more common in CD vs. non-CD patients (27.1% vs 13.1%, p < 0.001), mostly in memory (10.4% vs 5.0%, p = 0.022) and visuospatial function (45.2% vs 29.6%, p < 0.001). In the multivariable analysis, CD remained associated with global cognitive impairment (odds ratio 1.90; 95% CI 1.13–3.21, p = 0.016) and visuospatial function impairment (OR 1.56; 95% CI 1.02–2.39, p = 0.039). Discussion Chagas disease is associated with cognitive impairment independently of heart failure severity, suggesting other competing mechanisms.