Abstract 15085: The Association Between Oxidative Stress, Inflammation and Cognitive Impairment in Older Heart Failure Patients

Abstract

Background: Cognitive impairment (CI) is a major problem commonly seen in older heart failure (HF) patients. CI negatively impacts on the patient’s capacity to understand and follow complex medical treatments potentially leading to increased hospital readmissions and mortality rates. Previous research suggests that mechanisms underlying CI in these patients include changes in cerebral blood flow. Inflammation and oxidative stress may also contribute to CI, however their effects in the context of HF have not been investigated.

Objectives: a) to extend the range of cognitive measures which might be vulnerable to HF using a well-validated assessment instrument and b) to investigate whether inflammation and oxidative stress are associated with CI in older HF patients (aged ≥60 years).

Methods: A total of 40 patients with HF (NYHA class II, III or IV) and 40 healthy controls matched for age and gender completed the study. Cognitive function was assessed using the Cognitive Drug Research^® computerised test battery and executive functioning was assessed by the Trail Making-B (TM-B) and Stroop tasks. Cerebral blood flow (CBF; Transcranial Doppler) and biomarkers were measured, including oxidative stress by determinable reactive oxygen metabolites (d-ROMs) and systemic inflammation as measured by high sensitive C-reactive protein (hsCRP).

Results: Compared to healthy controls (67±5.3 years), HF patients (68±7.0 years) performed significantly slower on the power of attention cognitive domain (1270±123 ms verses 1191±87 ms, p<.01). As expected, patients performed worse than controls on TM-B (106±42 ms verses 86±64 ms, p<.01). Patients’ plasma d-ROM levels were significantly higher than controls (467±91 vs 352±84 Ucarr, p<.001). Furthermore, analyses of covariance suggest that in addition to CBF, mechanisms for impairments in power of attention and executive functioning include d-ROMs and hsCRP.

Conclusions: 1. D-ROM is a useful measure of oxidative stress in HF; 2. Systemic inflammation and oxidative stress may represent additional mechanisms for impaired cognitive function in HF and 3. Anti-inflammatories and antioxidants merit investigation as novel interventions to ameliorate cognitive decline in HF.