Frequent cognitive impairment in patients with disorders along the heart-brain axis

Abstract

Background and Purpose-Patients with cardiovascular disease are at increased risk for cognitive decline. We studied theoccurrence and profile of cognitive impairment in 3 patient groups as exemplar conditions of hemodynamic disturbancesat different levels of the heart-brain axis, including patients with heart failure (HF), carotid occlusive disease (COD), andpatients with cognitive complaints and vascular brain injury on magnetic resonance imaging (possible vascular cognitiveimpairment [VCI]).Methods-In 555 participants (160 HF, 107 COD, 160 possible VCI, 128 reference participants; 68±9 years; 36% F; MiniMental State Examination 28±2), we assessed cognitive functioning with a comprehensive test battery. Test scores weretransformed into z-scores. Compound z-scores were constructed for: memory, language, attention/psychomotor speed,executive functioning, and global cognitive functioning. We rated cognitive domains as impaired when z-score=-1.5. Basedon the number of impaired domains, patients were classified as cognitively normal, minor, or major cognitive impairment.We used general linear models and ?2 tests to compare cognitive functioning between patient groups and the reference group.Results-Age, sex, and education adjusted global cognitive functioning z-score was lower in patients with COD (ß[SE]=-0.46 [0.10], P<0.001) and possible VCI (ß [SE]=-0.80 [0.09], P<0.001) compared with reference participants.On all domains, z-scores were lower in patients with COD and possible VCI compared with reference participants.Patients with HF had lower z-scores on attention/speed and language compared with reference participants. Cognitiveimpairment was observed in 18% of HF, 36% of COD, and 45% possible VCI. There was no difference in profile ofimpaired cognitive domains between patient groups. Memory and attention-psychomotor speed were most commonlyaffected, followed by executive functioning and language.Conclusions-A substantial part of patients with HF and COD had cognitive impairment, which warrants vigilancefor the occurrence of cognitive impairment. These results underline the importance of an integrative approach inmedicine in patients presenting with disorders in the heart-brain axis.