Cognitive Impairment in Heart Failure-A Review

Abstract

Cognitive impairment (CI) is common in heart failure (HF). Patients with HF demonstrate reduced global cognition as well as deficits in multiple cognitive domains compared to controls. Degree of CI may be related to HF severity. HF has also been associated with an increased risk of dementia. Anatomical brain changes have been observed in patients with HF, including grey matter atrophy and increased white matter lesions. Patients with HF and CI have poorer functional independence and self-care, more frequent rehospitalisations as well as increased mortality. Pathophysiological pathways linking HF and CI have been proposed, including cerebral hypoperfusion and impaired cerebrovascular autoregulation, systemic inflammation, proteotoxicity and thromboembolic disease. However, these mechanisms are poorly understood. We conducted a search on MEDLINE, Embase and Scopus for original research exploring the connection between HF and CI. We then reviewed the relevant literature and discuss the associations between HF and CI, the patterns of brain injury in HF and their potential mechanisms, as well as the recognition and management of CI in patients with HF.

Keywords: cerebral haemodynamics; cognitive impairment; dementia; heart failure.

Figure 1

Summary of the reported pathophysiology, brain changes and impact of cognitive impairment in heart failure. *Proteotoxicity may be a shared disease pathology between specific cardiomyopathies and CI.

Figure 2

Summary of potential pathophysiological pathways linking heart failure and cognitive impairment. Dotted line: the mechanisms by which systemic inflammation may contribute to brain changes and cognitive impairment in heart failure are not well described. Dashed line: proteotoxicity may be a shared disease pathology between specific cardiomyopathies and CI. IL, interleukin; TNF, tumour necrosis factor.