Cardiac Disease and Cognitive Impairment
Cardiac Disease and Cognitive Impairment
Cognitive impairment in cardiac patients may interfere with disease management. This review describes studies examining specific cognitive impairments in cardiac patients and studies that investigate the link between echocardiographic and cognitive measures. Executive function impairments were frequently reported in different patient groups. Also, lower cardiac output and worse left ventricular diastolic function are linked to executive function deficits. In cardiac patients, special attention should be paid to these executive function impairments in view of their role in disease management and independent living. Interventions that stimulate executive function should be encouraged and integrated in cardiac treatment protocols.
The increasingly expanding ageing population has resulted in a higher prevalence of cardiac disease and due to treatment possibilities patients live longer. Frequently prevalent cardiac diseases in the older population include coronary artery disease, that is, 43% of men and 41% of women aged 81 years, and atrial fibrillation, that is, 13% of persons aged 81–90 years. The proportion of heart failure patients increases with age and heart failure patients with preserved ejection fraction account for about half of clinical heart failure patients.
Although these diseases can be handled better due to current medical care, embolic stroke or chronic cerebral hypoperfusion due to for instance atherosclerosis or reduced cardiac output may lead to cognitive impairment. In fact, cardiac disease is associated with increased risk for cognitive impairment and dementia. More specifically, large cohort studies have revealed a link between increased risk for dementia and for instance atherosclerosis and atrial fibrillation. Naturally, having dementia restricts one's possibility to effectively manage care of a concomitant medical condition. Cognitive impairment not necessarily leading to dementia may however also limit an individual in managing one's health when facing a complex chronic illness. Specific cognitive deficits, that is, memory impairment and executive function deficits such as problems with regulation of one's behaviour may negatively influence self-management of an illness, such as reduced medication adherence. Other executive function deficits such as planning difficulties and reduced cognitive flexibility may result in missed appointments and inability to make diet changes. In general, intact executive functions are crucial for the management of chronic conditions.
The majority of case–control studies concerning the relationship between cardiac function and cognition have focused on cognitive performance in heart failure patients. There are fewer studies examining cognition in persons with a further specified cardiac disease as heart failure with either impaired or preserved ejection fraction, or another type of cardiac disease such as atrial fibrillation. The aims of the present review are twofold: the first aim is to provide an overview of studies that investigate the presence of cognitive impairments in patients with a specific type of cardiac disease. Since the origin of specific cognitive impairments in cardiac patients is likely multi-factorial, the second aim of the study is to include studies that investigate the relationship between cognitive impairments and cardiac function measured by echocardiography.
Abstract and Introduction
Abstract
Cognitive impairment in cardiac patients may interfere with disease management. This review describes studies examining specific cognitive impairments in cardiac patients and studies that investigate the link between echocardiographic and cognitive measures. Executive function impairments were frequently reported in different patient groups. Also, lower cardiac output and worse left ventricular diastolic function are linked to executive function deficits. In cardiac patients, special attention should be paid to these executive function impairments in view of their role in disease management and independent living. Interventions that stimulate executive function should be encouraged and integrated in cardiac treatment protocols.
Introduction
The increasingly expanding ageing population has resulted in a higher prevalence of cardiac disease and due to treatment possibilities patients live longer. Frequently prevalent cardiac diseases in the older population include coronary artery disease, that is, 43% of men and 41% of women aged 81 years, and atrial fibrillation, that is, 13% of persons aged 81–90 years. The proportion of heart failure patients increases with age and heart failure patients with preserved ejection fraction account for about half of clinical heart failure patients.
Although these diseases can be handled better due to current medical care, embolic stroke or chronic cerebral hypoperfusion due to for instance atherosclerosis or reduced cardiac output may lead to cognitive impairment. In fact, cardiac disease is associated with increased risk for cognitive impairment and dementia. More specifically, large cohort studies have revealed a link between increased risk for dementia and for instance atherosclerosis and atrial fibrillation. Naturally, having dementia restricts one's possibility to effectively manage care of a concomitant medical condition. Cognitive impairment not necessarily leading to dementia may however also limit an individual in managing one's health when facing a complex chronic illness. Specific cognitive deficits, that is, memory impairment and executive function deficits such as problems with regulation of one's behaviour may negatively influence self-management of an illness, such as reduced medication adherence. Other executive function deficits such as planning difficulties and reduced cognitive flexibility may result in missed appointments and inability to make diet changes. In general, intact executive functions are crucial for the management of chronic conditions.
The majority of case–control studies concerning the relationship between cardiac function and cognition have focused on cognitive performance in heart failure patients. There are fewer studies examining cognition in persons with a further specified cardiac disease as heart failure with either impaired or preserved ejection fraction, or another type of cardiac disease such as atrial fibrillation. The aims of the present review are twofold: the first aim is to provide an overview of studies that investigate the presence of cognitive impairments in patients with a specific type of cardiac disease. Since the origin of specific cognitive impairments in cardiac patients is likely multi-factorial, the second aim of the study is to include studies that investigate the relationship between cognitive impairments and cardiac function measured by echocardiography.
