Disease-Targeted Treatment Improves Cognitive Function in Patients with Precapillary Pulmonary Hypertension

• Published in: Respiration Vol. 90; no. 5; p. 376
• Main Authors: Somaini, Gina, Stamm, Adriana, Müller-Mottet, Séverine, Hasler, Elisabeth, Keusch, Stephan, Hildenbrand, Florian F, Furian, Michael, Speich, Rudolf, Bloch, Konrad E, Ulrich, Silvia
• Format: Journal Article
• Language: English
• Published: Switzerland 01-11-2015
• Subjects: Adult; Aged; Analysis of Variance; Antihypertensive Agents - administration & dosage; Capillaries - pathology; Cardiac Catheterization; Cognition - drug effects; Cognition - physiology; Cohort Studies; Drug Delivery Systems - methods; Exercise Tolerance - drug effects; Exercise Tolerance - physiology; Female; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - mortality; Hypoxia-Ischemia, Brain - prevention & control; Male; Middle Aged; Multivariate Analysis; Pilot Projects; Predictive Value of Tests; Prospective Studies; Pulmonary Circulation - drug effects; Quality of Life; Regression Analysis; Severity of Illness Index; Spectroscopy, Near-Infrared - methods; Switzerland; Vasodilator Agents - administration & dosage; Switzerland
• ISSN: 1423-0356
• DOI: 10.1159/000439227

Patients with pulmonary hypertension (PH) may suffer from cognitive deficits that potentially relate to reduced oxygen delivery and cerebral tissue oxygenation (CTO).
To evaluate the hypothesis that cognitive function improves with therapy, along with improved CTO.
Twenty incident patients with arterial or chronic thromboembolic PH had CTO monitoring by near-infrared spectroscopy during diagnostic right heart catheterization. Cognitive tests [Trail Making Tests (TMTs), Victoria Stroop tests and the Five-Point Test (5PT)], the 6-min walk distance (6MWD) test, New York Heart Association (NYHA) class and health-related quality of life (HRQoL) were assessed and repeated after 3 months of disease-targeted medication.
At baseline, 45% of PH patients had cognitive deficits. At 3 months, the patients had improved on the TMT A and the Stroop 2 test [37 s (27; 55) versus 30 s (24; 42), p < 0.05, and 18 s (16; 22) versus 16 s (15; 20), p < 0.01], whereas CTO remained unchanged. Arterial oxygen saturation, NYHA class, 6MWD and HRQoL had also improved. Baseline CTO was the strongest predictor of cognitive function, even in multivariate analysis including age, 6MWD and HRQoL. Improvements in cognitive function were not associated with changes in CTO.
In patients with PH, 3 months of disease-targeted medication resulted in better cognitive function. Although CTO was the strongest predictor of cognitive function at baseline, it did not change during target therapy. The results of this pilot study should be confirmed in an adequately powered controlled trial.