Journal of Cardiac Failure
Volume 14, Issue 4 , Pages 290-295, May 2008

Factors Contributing to Global Cognitive Impairment in Heart Failure: Results From a Population-Based Cohort

  • Patrick M. Pullicino, MD

      Affiliations

    • Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent, United Kingdom
    • Corresponding Author InformationReprint requests: Patrick Pullicino, MD, Room 103, KIHMS, Research and Development Centre, University of Kent, Canterbury, CT2 7PD, Kent, United Kingdom.
    • ,
  • Virginia G. Wadley, PhD

      Affiliations

    • Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care
    • ,
  • Leslie A. McClure, PhD

      Affiliations

    • Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
    • ,
  • Monika M. Safford, MD

      Affiliations

    • Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
    • ,
  • Ronald M. Lazar, PhD

      Affiliations

    • Department of Neurology, Columbia University, New York, New York
    • ,
  • Marc Klapholz, MD

      Affiliations

    • Department of Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
    • ,
  • Ali Ahmed, MD, MPH

      Affiliations

    • Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care
    • Department of Medicine, Veteran Affairs Medical Center, Birmingham, Alabama
    • ,
  • Virginia J. Howard, MSPH

      Affiliations

    • Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
    • ,
  • George Howard, DrPH

      Affiliations

    • Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama

Received 7 September 2007; received in revised form 6 December 2007; accepted 4 January 2008. published online 31 March 2008.

Abstract 

Background

Heart failure (HF) and cognitive impairment are both common in older adults. However, the association between the two has not been well studied.

Methods and Results

We explored the relationship between very probable HF, determined by self-reported symptoms, and cognitive impairment, defined as four or fewer correct on the Six-item Screener, in 14,089 participants of the Reasons for Geographic and Racial Differences in Stroke cohort. We determined the effect of adding demographic, socioeconomic status (SES), health behavior, and comorbidity covariates. In the univariate model, participants with very probable HF were 1.51 (95% confidence interval: 1.15–1.96) times more likely to have cognitive impairment than those without HF. As covariates were added to the model, the relationship between HF and cognitive impairment was attenuated and lost statistical significance after adjustment for depression. Demographic variables, Stroke Belt location (1.28 [1.11–1.48]), SES factors, prior stroke (1.43 [1.18–1.73]), and depression (1.66 [1.38–2.01]) remained significant in the multivariable model. Higher hemoglobin was associated (0.95 [0.9–1.00]) with modestly reduced odds of cognitive impairment.

Conclusions

The relationship between cognitive impairment and HF can be accounted for by multiple demographic and SES factors, and by comorbidities, some of which are modifiable. Persons with HF and cognitive impairment should be screened for anemia and depression.

Key Words: Anemia, depression, neuropsychology, stroke

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 This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation. Amgen did not have any role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation or approval of the manuscript. The manuscript was sent to Amgen for review before submission for publication.

PII: S1071-9164(08)00021-3

doi:10.1016/j.cardfail.2008.01.003

Journal of Cardiac Failure
Volume 14, Issue 4 , Pages 290-295, May 2008

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