Global Cognition, Executive Function Negatively Affected by Incident HF

Incident heart failure (HF) is accompanied by decreases in global cognition and executive function and associated with long-term persistent declines in these cognitive domains, according to results of a study published in Circulation: Heart Failure.

Multiple cardiovascular disorders have been associated with cognitive dysfunction. However, it remains unclear whether incident HF affects cognition.

Investigators from the University of Michigan pooled data for this study from 6 prospective cohorts that collected data in the United States between 1971 and 2019: the Atherosclerosis Risk in Communities Study (ARIC), Coronary Artery Risk Development in Young Adults Study (CARDIA), Cardiovascular Health Study (CHS), Framingham Offspring Study (FOS), Multi-Ethnic Study of Atherosclerosis (MESA), and Northern Manhattan Study (NOMAS). Individuals (N=29,614) who received at least 1 cognitive assessment during follow-up were evaluated for changes in cognitive outcomes on the basis of incident HF.

The individuals with (n=1407) and without (n=28,207) incident HF had mean ages of 65.3±12.7 and 52.8±16.6 years at study enrollment (P <.001), 54.6% and 54.5% were women, 72.5% and 70.2% were White (P <.001), 23.2% and 34.0% had a college degree or higher (P <.001), and they had BMIs of 28.4±5.5 and 27.9±5.6 (P <.001), respectively.

At the first cognitive assessment, the patients with incident HF had lower global cognition (mean, 50.1 vs 51.6; P <.001) and executive function (mean, 49.4 vs 51.7; P <.001) scores but similar memory scores (mean, 50.9 vs 50.9; P =.34) than those without HF.

After incident HF diagnosis, global cognition scores decreased by 1.1 points and executive function by 0.6 points. After adjusting for pre-diagnosis score trajectories, a diagnosis of HF was associated with a yearly decrease in global cognition score of 0.1 points and executive function score of 0.2 points. The change in memory scores after HF diagnosis, as well as longitudinally, only tended to be decreased.

Global cognition and executive function scores were modified by age, race and ethnicity, and gender. Global cognition scores decreased by 1.52 points at HF diagnosis per 10-year increase in age, increased by 0.84 points at diagnosis among Black individuals compared with White individuals, and decreased by 0.74 points at diagnosis among women compared with men. Executive function scores increased by 0.37 points per year after HF diagnosis per 10-year age increase and increased by 1.59 points at diagnosis among Black individuals compared with White individuals.

Results of sensitivity analyses that included only the subset of individuals (n=24,090) who received 2 or more cognitive assessments during follow-up were consistent with the main analysis.

This study may have been confounded by the fact that HF is often diagnosed at later stages rather than at symptom onset.

The study authors concluded, “…participants with incident HF diagnosis, compared with participants without HF, had initial decreases in GC [global cognition] and executive function and faster, persistent declines in GC and executive function after accounting for pre-HF cognitive trajectories and comorbidities like stroke.”

This article originally appeared on The Cardiology Advisor