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Ann Thorac Surg 2006;81:1738-1744
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Cognitive Dysfunction in Advanced Heart Failure and Prospective Cardiac Assist Device Patients

^a College of Medicine, Drexel University, Philadelphia, Pennsylvania
^b Department of Clinical and Health Psychology, Drexel University, Philadelphia, Pennsylvania
^c Behavioral Medicine, Christiana Care Health System, Wilmington, Delaware
^d Voorhees, New Jersey
^e Neuropsychology Department, Kessler Rehabilitation Research and Educational Corporation, West Orange, New Jersey
^f Psychology Department, Bryant College, Smithfield, Rhode Island
^g Cardio-Thoracic Surgery, Lankenau Hospital, Wynnewood, Pennsylvania
^h College of Medicine, University of California-Irvine, Irvine, California

Accepted for publication December 2, 2005.

^_* Address correspondence to Dr Petrucci, Drexel University College of Medicine, Psychiatry and Medicine, 245 N 15th Street, MS 115, Philadelphia, PA 19102 (Email: ralph.petrucci{at}drexelmed.edu).

BACKGROUND: Extended periods of hypoperfusion in an advanced heart failure (HF) places patients at high risk for neurobehavioral compromise, which has not been studied systematically. It is also not clear how intravenous inotropic therapy and mechanical cardiac assist devices (MCAD) affect cognitive function.

METHODS: This prospective cross-sectional cognitive preliminary study evaluated 252 potential heart transplant candidates assessing functions in memory, motor, and processing speed. Patients were divided into three HF groups based on severity of disease: group 1 outpatients (n = 113), group 2 in-patients requiring inotropic infusion (n = 83), and group 3 inpatients likely requiring MCAD support (n = 56). Aggregate z-scores for memory, motor, and processing speed and independent samples t tests assessed intergroup differences on 13 cognitive measures.

RESULTS: A broad pattern of cognitive impairment was observed within the advanced HF group; fewer deficits were found in group 1 outpatients and more severe deficits in group 3 MCAD subjects. A difference in motor functions was observed as the earliest abnormality, with group 3 showing significant changes compared with group 1. The most dramatic changes were seen in domain mental processing speed along with specific verbal and visual memory functions, which were slower in group 3 compared with groups 1 and 2.

CONCLUSIONS: Cognitive deficits are common in advanced HF and worsen with increasing severity of HF. Appropriately designed and randomized studies will be needed to demonstrate if earlier MCAD implantation is warranted to arrest cognitive dysfunction and better postimplantation adaptation.

This article has been cited by other articles:

				R. L.C. Vogels, P. Scheltens, J. M. Schroeder-Tanka, and H. C. Weinstein Cognitive impairment in heart failure: A systematic review of the literature Eur J Heart Fail, May 1, 2007; 9(5): 440 - 449. [Abstract] [Full Text] [PDF]