Abstract 3585: Characterization of Cognitive Deficits in Heart Failure Patients
Introduction: Neurocognitive defects have been described in patients with chronic heart failure (HF). A high prevalence of memory impairment, motor speed and processing of higher level information was described in patients with end stage HF. We sought to further characterize these deficits and explore their correlation with hemodynamics.
Methods: We retrospectively analyzed 756 patients with end-stage HF who were evaluated for cardiac transplantation at the University of Minnesota between 1988 and 2005. Formal neuropsychological (NP) evaluation is part of the standard transplant evaluation. Demographic information, etiology of HF, hemodynamics, echocardiographic findings, and neurological histories were assessed. Tests evaluating memory retention, set shifting, concentration, and graphomotor learning were included in the analysis. Correlation between these measures and hemodynamics were obtained. Patients with a history of neurological disease and ventricular assist device were excluded from the correlation analysis.
Results: Baseline characteristics are listed in table⇓. Results of NP testing were compared to standard norms. Scores on intellectual measures, learning and retention, set shifting, planning, and concentration were low average to mildly impaired. The average IQ was 89, compared to 100 in the general population. 462 patients were included in the correlation analyses. Elevated RAP (r=0.198, p=0.001) and PCWP (r=−0.144, p=0.006), and reduced CO (r=0.139, p=0.024) were associated with lower scores on graphomotor learning (Digit Symbol test). In addition, elevated RAP was associated with poorer performance in mental flexibility and psychomotor speed (Trails Making Test B).
Conclusion: In a heterogeneous heart failure population, mild cognitive defects, including reduced IQ and deficits related to memory, concentration, and set shifting are common and are associated with hemodynamic derangements rather than reduced EF.