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Factors Associated With Increased Risk for Dementia in Individuals Age 80 Years or Older With Congestive Heart Failure

Hjelm, Carina MS, RN, CCRN; Broström, Anders PhD, RN; Dahl, Anna PhD; Johansson, Boo PhD; Fredrikson, Mats PhD; Strömberg, Anna PhD, RN, FAAN

The Journal of Cardiovascular Nursing: January/February 2014 - Volume 29 - Issue 1 - p 82–90
doi: 10.1097/JCN.0b013e318275543d

Background and Research Objective: An increasing body of evidence shows that individuals diagnosed with congestive heart failure (CHF) are at a higher risk for dementia. However, the prevalence rate of dementia among persons with CHF in very old individuals has not been previously reported, and little is known about the comorbidities that place old persons with CHF at a higher risk for dementia. The aim of this study was to compare the prevalence of dementia in individuals 80 years or older who have CHF with that in individuals without CHF and to identify factors related to dementia in individuals diagnosed with CHF.

Methods: A total of 702 participants from a Swedish population-based longitudinal study (Octogenerian Twin) were included. The group consisted of same-sex twin pairs, age 80 years or older, and 138 participants had CHF. Dementia was diagnosed according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Generalized estimating equations including gender, age and educational level, waist circumference, diabetes, hypertension, smoking, depression, and blood values were used in a case-control analysis.

Results: Individuals with CHF had a significantly higher prevalence of vascular dementia, 16% vs 6% (P < 0.001), and of all types of dementia, 40% vs 30% (P < 0.01), than those not diagnosed with CHF. The generalized estimating equation models showed that depression, hypertension, and/or increased levels of homocysteine were all associated with a higher risk for dementia in individuals with CHF. Diabetes was specifically associated with an increased risk for vascular dementia.

Conclusions: The prevalence of dementia was higher among individuals with CHF than in those without CHF. Diabetes, depression, and hypertension in patients with CHF require special attention from healthcare professionals because these conditions are associated with an elevated risk for dementia. Higher levels of homocysteine were also found to be a marker of dementia in patients with CHF. Further research is needed to identify the factors related to dementia in individuals 80 years or older diagnosed with CHF.

Carina Hjelm, MS, RN, CCRN Critical Care Registered Nurse, Department of Medical and Health Sciences, Division of Nursing Science, Linköping University; Department of Cardiothoracic Surgery, Linköping University Hospital, Sweden.

Anders Broström, PhD, RN Associate Professor, Department of Clinical Neurophysiology, Linköping University Hospital, Sweden; Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden.

Anna Dahl, PhD Researcher, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.

Boo Johansson, PhD Professor, Department of Psychology, University of Gothenburg, Sweden.

Mats Fredrikson, PhD Senior Lecturer, Department of Clinical and Experimental Medicine, Division of Occupational and Environmental Medicine, Linköping, Sweden.

Anna Strömberg, PhD, RN, FAAN Professor, Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; Department of Cardiology, Linköping University Hospital, Sweden.

The authors have no funding or conflicts of interest to disclose.

Correspondence Carina Hjelm, MS, RN, CCRN, Department of Medical and Health Sciences, Division of Nursing Science, 58185 Linköping University, Linköping, Sweden (

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins