Various studies have observed cognitive deficit, including memory impairment, in heart failure. However, most have focused on patients with end-stage disease awaiting cardiac transplantation, with little being known about memory function in moderate heart failure. Grubb et al compared the prevalence of memory impairment between patients with prior myocardial infarction and symptomatic moderate-to-severe left ventricular dysfunction (New York Heart Association functional class III or IV), and controls with preserved left ventricular function. The measures of memory function were the Rivermead Behavioural Memory Test, which identifies deficits of episodic long-term memory (the ability to transfer information from short- to long-term memory), and the digits-for-ward and digits-backward subtests from the revised Wechsler memory scale for short-term working memory. The results showed no evidence of clinically important memory impairment vs the controls.
Several factors may increase the prevalence of cognitive impairment in advanced heart failure:
Anxiety and depression are more common in patients with severe or limiting symptoms, and can decrease performance in cognitive tasks.
Cerebral perfusion may be decreased in end-stage disease due to a low resting cardiac output, but is often normal at rest in patients with less severe heart failure.
Atrial fibrillation is more prevalent in advanced disease, with associated embolism contributing to impaired cognitive function.
In conclusion, memory impairment is not associated with stable moderate-to-severe heart failure after myocardial infarction and is therefore unlikely to affect compliance with any aspect of the treatment regime. However, physicians should be alert to the possibility of anxiety and/or depression, which are relatively common in this group and require appropriate management. Conversely, memory impairment is a feature of end-stage heart failure.
symptom; diagnosis; memory impairment; cognitive alteration; neuropsychological function; cerebral perfusion; psychology; functional status
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