Heart Failure and Cognitive Screening: Prevalence of Cognitive Decline and Associated Factors
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2025.222976Keywords:
Cognition, Neuropsychological tests, Risk factors, Heart failureAbstract
Introduction: Heart Failure is a debilitating condition in which the heart cannot adequately supply the oxygen demands of peripheral organs. Its prevalence is high and is associated with significant morbidity and mortality. Recently, the importance of the bidirectional interconnection between the heart and brain in the progression of heart failure has been recognized. Cognitive Deficit, characterized by decline in domains of cognitive function, is an additional concern in these patients. Objective: to compare the cognitive performance of patients diagnosed with heart failure and individuals without this condition, as well as verify the possible cognitive domains affected and the risk factors associated with cognitive dysfunction. Methods: This is a cross-sectional, descriptive-comparative study, between two distinct groups, composed of patients with heart failure and individuals without this condition. A cognitive screening was carried out on community members and patients who received outpatient care in cardiology reference hospitals in the state of Maranhão, Brazil. Data were collected and obtained through interviews with participants, analysis of medical reports and performance of cognitive screening tests: Mini-Mental State Examination - MMSE and the Montreal Cognitive Assessment - MoCA. Results: In the group with heart failure, 82 patients were included, of which 63.41% were male, with a mean age of 59.40±12.92 years. In the group without heart failure, composed of 101 individuals, the average age was 46.61±12.28 years and the majority of participants were female (79.21%). After applying the MMSE test, cognitive performance below expectations was observed in 43 patients in the group with heart failure (52.43%) and in 48 participants in the group without heart failure (47.52%), with no statistical difference between the groups. . Regarding the MoCA test, a statistical difference was observed between both groups in relation to cognitive function, with 15 patients showing lower cognitive performance in the group with heart failure (18.29%) and in the group without heart failure, only 10 individuals ( 9.90%). The study found that patients with heart failure showed impairments in the cognitive functions of orientation, attention, language and delayed recall, compared to individuals without heart failure. Conclusion: the importance of regular cognitive screening in patients with HF is highlighted to identify changes early and implement interventions. Additional investigations are needed to better understand these changes and develop effective therapeutic strategies.
Downloads
References
1. Jarab AS, Hamam HW, Al-Qerem WA, Abu Heshmeh SR, Mukattash TL, Alefishat EA. Health-related quality of life and its associated factors among outpatients with heart failure: a cross-sectional study. Health Qual Life Outcomes. 2023;21:73.
2. Soares VL, Pereira C, Carvalho AC, Mota TP, Groehs RV, Bacal F, et al. Janot de Matos LDN. Prevalence and association between cognition, anxiety, and depression in patients hospitalized with heart failure. Int J Cardiovasc Sci. 2023;36:e20210226.
3. Lee HP, Hsu WY, Liu YH, Chang YC, Cheng SM, Chiang HH. Sense of coherence as a mediator between functional status and health-related quality of life in patients with heart failure. J Nurs Res. 2024;32(1).
4. Traub J, Otto M, Sell R, Homola GA, Steinacker P, Oeckl P, et al. Serum glial fibrillary acidic protein indicates memory impairment in patients with chronic heart failure. ESC Heart Fail. 2022;9:2626-2634.
5. Althammer F, Roy RK, Kirchner MK, Campos-Lira E, Whitley KE, Davis S, et al. Angiotensin II–mediated neuroinflammation in the hippocampus contributes to neuronal deficits and cognitive impairment in heart failure rats. Hypertension. 2023;80:1258–1273.
6. Wang M, Xu B, Hou X, Shi Q, Zhao H, Gui Q, et al. Altered brain networks and connections in chronic heart failure patients complicated with cognitive impairment. Front Aging Neurosci. 2023;15:1-6.
7. Junga M, Apostolova LG, Gao S, Burney HN, Lai D, Foroud T, et al. Testing influences of APOE and BDNF genes and heart failure on cognitive function. Heart Lung. 2020;00:1-8.
8. Xu C, Tao X, Ma X, Zhao R, Cao Z. Cognitive dysfunction after heart disease: a manifestation of the heart-brain axis. Oxid Med Cell Longev. 2021;2021:4899688.
9. Sargent L, Flattery M, Shah K, Price ET, Tirado C, Oliveira T, et al. Influence of physiological and psychological factors on cognitive dysfunction in heart failure patients. Appl Nurs Res. 2020;56:151375.
10. Dridi H, Liu Y, Reiken S, Liu X, Argyrousi EK, Yuan Q, et al. Heart failure-induced cognitive dysfunction is mediated by intracellular Ca2+ leak through ryanodine receptor type 2. Nat Neurosci. 2023;26:1365-1378.
11. Yang M, Sun D, Wang Y, Yan M, Zheng J, Ren J. Cognitive impairment in heart failure: landscape, challenges, and future directions. Front Cardiovasc Med. 2021;8:831734.
12. Liori S, Arfaras-Melainis A, Bistola V, Polyzogopoulou E, Parissis J. Cognitive impairment in heart failure: clinical implications, tools of assessment, and therapeutic considerations. Heart Fail Rev. 2021 May 3;27(4):993-999.
13. Yap NLX, Kor Q, Teo YN, Teo YH, Syn NL, Evangelista LKM, et al. Prevalence and incidence of cognitive impairment and dementia in heart failure: a systematic review, meta-analysis and meta-regression. Hellenic J Cardiol. 2022;67:48-58.
14. Markousis-Mavrogenis G, Noutsias M, Rigopoulos AG, Giannakopoulou A, Gatzonis S, Pons RM, et al. The Emerging Role of Combined Brain/Heart Magnetic Resonance Imaging for the Evaluation of Brain/Heart Interaction in Heart Failure. J Clin Med. 2022 Jul 11;11(14):4009.
15. Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr. 2003;61(3-B):777-781.
16. Cesar KG, Yassuda MS, Porto FHG, Brucki SMD, Nitrini R. MoCA Test: normative and diagnostic accuracy data for seniors with heterogeneous educational levels in Brazil. Arq Neuropsiquiatr. 2019 Nov;77(11).
17. Holm H, Bachus E, Jujic A, Nilsson ED, Wadström B, Molvin J, et al. Cognitive test results are associated with mortality and rehospitalization in heart failure: Swedish prospective cohort study. ESC Heart Fail. 2020;7:2948-2955.
18. Vellone E, Chialà O, Boyne J, Klompstra L, Evangelista LS, Back M, et al. Cognitive impairment in patients with heart failure: an international study. ESC Heart Fail. 2020;7:47-54.
19. Oud FMM, Spies PE, Braam RL, Van Munster BC. Recognition of cognitive impairment and depressive symptoms in older patients with heart failure. Neth Heart J. 2021;29(7-8):377–382.
20. Ampadu J, Morley JE. Heart failure and cognitive dysfunction. Int J Cardiol. 2015;178:12e23.
21. Johansen MC, Gottesman RF. Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease. 2021 Aug;41(4):463-472.
22. Larner AJ. Mini-Mental State Examination: diagnostic test accuracy study in primary care referrals. Neurodegenerative disease management. 2018;8(5):301-305.
23. Park MS, Kim EJ. A Correlative Relationship Between Heart Failure and Cognitive Impairment: A Narrative Review. J Korean Med Sci. 2023;38(39):e334.
24. Ovsenik A, Podbregar M, Fabjan A. Cerebral blood flow impairment and cognitive decline in heart failure. Brain Behav. 2021;11:e02176.
25. Babayigit E, Murat S, Mert KU, Cavusoglu Y. Assessment of Cerebral Blood Flow Velocities with Transcranial Doppler Ultrasonography in Heart Failure Patients with Reduced Ejection Fraction. J Stroke Cerebrovasc Dis. 2021;30(5):105706.
26. Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, et al. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev. 2019;15:291-303.
27. Chimagomedova ASh, Dzhioeva ZR, Akhilgova ZM, Kurkina MV, Avtandilov AG. Cognitive impairment in heart failure: the role of microcirculation abnormalities. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2020;120(10 vyp 2):54–60.
28. Taylor JL, Barnes JN, Johnson BD. The Utility of High Intensity Interval Training to Improve Cognitive Aging in Heart Disease Patients. Int J Environ Res Public Health. 2022;19:16926.
29. Tsukakoshi D, Yamamoto S, Takeda S, Furuhashi K, Sato M. Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review. Ther Clin Risk Manag. 2022;18:1009–1028.
30. Frey A, Homola GA, Henneges C, Mühlbauer L, Sell R, Kraft P, et al. Temporal changes in total and hippocampal brain volume and cognitive function in patients with chronic heart failure - the COGNITION.MATTERS-HF cohort study. Eur Heart J. 2021 Apr 21;42(16):1569-1578.
31. Almeida OP, Garrido GJ, Beer C, Lautenschlager NT, Arnolda L, Flicker L. Cognitive and brain changes associated with ischaemic heart disease and heart failure. Eur Heart J. 2012;33:1769–1776.
32. Traub J, Schließer M, Morbach C, Frantz S, Pham M, Störk S, et al. Internal carotid artery blood flow and pulsatility index in cognitively impaired people with chronic heart failure. ESC Heart Fail. 2023;1–6.
33. Afiune FG, Rassi S, Afiune Neto A. Cognitive Alterations in Elderly Patients with Heart Failure. Int J Cardiovasc Sci. 2022;35(3):364-372.
34. Kewcharoen J, Trongtorsak A, Kanitsoraphan C, Prasitlumkum N, Mekritthikrai R, Techorueangwiwat C, et al. Cognitive impairment and 30-day rehospitalization rate in patients with acute heart failure: A systematic review and meta-analysis. Indian Heart J. 2019;71:52-59.
35. Gilstrap LG, Gorodeski EZ, Goyal P. Heart failure and cognitive impairment: Complexity that requires a new approach. J Am Geriatr Soc. 2022;70(6):1652–1654.
36. Gagnon C, Saillant K, Olmand M, Gayda M, Nigam A, Bouabdallaoui N, et al. Performances on the Montreal Cognitive Assessment Along the Cardiovascular Disease Continuum. Arch Clin Neuropsychol. 2022;37:117–124.
37. Potter EL, Ramkumar S, Wright L, Marwick TH. Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment: a cross-sectional study in a subclinical heart failure screening programme. BMJ Open. 2021;11:e045896.
38. Nijskens CM, Thomas EG, Rhodius‐Meester HFM, Daemen MJAP, Biessels GJ, Handoko ML, et al. Is it time for Heart–Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure. Clin Cardiol. 2024;47:e24200.
39. Traub J, Otto M, Sell R, Göpfert D, Homola G, Steinacker P, et al. Serum phosphorylated tau protein 181 and neurofilament light chain in cognitively impaired heart failure patients. Alzheimer’s Res Ther. 2022;14(1):149.
40. Timmermans EJ, Leeuwis AE, Bots ML, van Alphen JL, Biessels GJ, Brunner-La Rocca HP, et al. Neighbourhood walkability in relation to cognitive functioning in patients with disorders along the heart-brain axis. Health Place. 2023;79:102956.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Carla Priscilla Belchior Marques Sampaio, Leandro Marques da Silva, Nair Eloá dos Santos Guimarães, Luiza Pinto Moreno, Emmanuela de Jesus Furtado Ferreira, José Albuquerque de Figueiredo Neto, Gedean Souza Pontes
This work is licensed under a Creative Commons Attribution 4.0 International License.
