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Cognitive Deficits in Chronic Heart Failure

Pressler, Susan J.; Subramanian, Usha; Kareken, David; Perkins, Susan M.; Gradus-Pizlo, Irmina; Sauvé, Mary Jane; Ding, Yan; Kim, JinShil; Sloan, Rebecca; Jaynes, Heather; Shaw, Rose Mary

doi: 10.1097/NNR.0b013e3181d1a747

Background: Patients with heart failure (HF) have been found to have cognitive deficits, but it remains unclear whether these deficits are associated with HF or with aging or comorbid conditions common in HF.

Objectives: The purpose of this study was (a) to determine the types, the frequency, and the severity of cognitive deficits among patients with chronic HF compared with age- and education-matched healthy participants and participants with major medical conditions other than HF, and (b) to evaluate the relationships between HF severity, age, and comorbidities and cognitive deficits.

Methods: A sample of 414 participants completed the study (249 HF patients, 63 healthy and 102 medical participants). The HF patients completed measures of HF severity, comorbidity (multiple comorbidity, depressive symptoms), and neuropsychological functioning. Blood pressure and oxygen saturation were assessed at interview; clinical variables were abstracted from records. Participants in the comparison groups completed the same measures as the HF patients except those specific to HF.

Results: Compared with the healthy and medical participants, HF patients had poorer memory, psychomotor speed, and executive function. Significantly more HF patients (24%) had deficits in three or more domains. Higher (worse) HF severity was associated with more cognitive deficits; HF severity interacted with age to explain deficits in executive function. Surprisingly, men with HF had poorer memory, psychomotor speed, and visuospatial recall ability than women. Multiple comorbidity, hypertension, depressive symptoms, and medications were not associated with cognitive deficits in this sample.

Discussion: HF results in losses in memory, psychomotor speed, and executive function in almost one fourth of patients. Patients with more severe HF are at risk for cognitive deficits. Older patients with more severe HF may have more problems in executive function, and men with HF may be at increased risk for cognitive deficits. Studies are urgently needed to identify the mechanisms for the cognitive deficits in HF and to test innovative interventions to prevent cognitive loss and decline.

Susan J. Pressler, DNS, RN, is Professor, School of Nursing, University of Michigan, Ann Arbor.

Usha Subramanian, MD, MS, is Associate Professor, Department of Medicine, Indiana University, Indianapolis, and Physician, Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, Indiana.

David Kareken, PhD, is Associate Professor, Division of Neuropsychology; Susan M. Perkins, PhD, is Associate Professor, Division of Biostatistics; and Irmina Gradus-Pizlo, MD, is Associate Professor, Krannert Institute of Cardiology, Indiana University, Indianapolis.

Mary Jane Sauvá, DNSc, RN, is Adjunct Professor, School of Nursing, University of California at San Francisco.

Yan Ding, MS, is Biostatistician, Division of Biostatistics, Indiana University, Indianapolis.

JinShil Kim, PhD, RN, was Assistant Professor, College of Nursing, Michigan State University, East Lansing.

Rebecca Sloan, PhD, RN, is Associate Professor, School of Nursing; and Heather Jaynes, MSN, RN, is Clinical Nurse Specialist, Indiana University, Indianapolis.

Rose Mary Shaw, PsyD, is Clinical Psychologist, Wright State University, Dayton, Ohio.

Accepted for publication October 14, 2009.

This study was funded by the National Institute of Nursing Research (R01NR008147).

The authors thank for the assistance with recruitment and data collection the following: Kari Berron, RN, MSN and Mary Walsh, MD, The Care Group, Indianapolis, IN; Joan Barr, RN, MSN, and James Hafer, RN, MSN, Clarian Health Partners, Indianapolis, IN; Cynthia Adams, RN, PhD; Sara Fickle, RN, MSN; Cynthia Kennedy, RN, MSN; Jeanne Majors, RN, MSN; Sharon Sipos, AD; and Linda Trowbridge, RN, Community Health Network of Indianapolis; Maureen Bender, RN, MSN; Mandrelle Dreu Doerstler, RN, MSN; Amber Hunt, BA; Janet Kain, MS; Klarisa Laye, RN, BSN; Elisa Liou, BA; Kristen Mather, RN, MSN; Laura Parker; and Janice Powers, RN, PhD, Indiana University School of Nursing.

Corresponding author: Susan J. Pressler, RN, DNS, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.