Cognitive decline and conversion to MCI and dementia in heart failure: A 12‐year follow‐up study

• Published in: Alzheimer's & dementia Vol. 16
• Main Authors: Jung, Miyeon J, Apostolova, Liana G., Gao, Sujuan, Burney, Heather, Saykin, Andrew J., Pressler, Susan J
• Format: Journal Article
• Language: English
• Published: 01-12-2020
• ISSN: 1552-5260; 1552-5279
• DOI: 10.1002/alz.045685

Background
Cognitive decline and development of mild cognitive impairment (MCI) and dementia over time in heart failure (HF) have not been fully examined. The purpose of this study was to compare (1) cognitive decline and (2) time to convert to MCI or dementia between people with and without HF.
Method
Data were retrieved from the National Alzheimer’s Coordinating Center database in September 2017. People with baseline dementia were excluded. Cognitive decline was assessed using changes in age, education, and gender‐adjusted z‐scores of verbal memory (Logical Memory Test delayed recall), attention (Digit Span Forward, Trail Making Test A), executive function (Trail Making B, Digit Symbol Test), and language (Category Fluency, Boston Naming Test) over 12 years. Time to convert was assessed using diagnosis of cognitive status by neurologists at each visit. Statistical analyses were conducted using multivariable Cox Proportional Hazards Models after adjusting for covariates (e.g., comorbidity, APOE carrier status).
Result
Among 4,149 participants, 87 had HF (66 with normal cognition, 21 with MCI) at baseline Median years of follow‐up was 6 (SD=2; range = 1‐12). At baseline, compared with non‐HF participants, HF participants were significantly older, had less education and more comorbidities, and were more likely to have MCI. Compared with non‐HF participants, HF participants had faster decline in attention (time by group interaction b=‐0.059, p=.0007), executive function (b=‐0.095, p=.0006) and language (b=‐0.051, p=.0137) but not memory (b=‐0.055, p=.0595) over 12 years after controlling for covariates and baseline cognitive status. Time to convert from normal cognition to MCI was not significantly different between participants with and without HF. Similarly, time to convert from MCI to dementia did not differ between the groups. The small number of HF participants may have limited the ability to detect 50% survival probability.
Conclusion
Participants with HF had accelerated cognitive decline, especially in the domains of attention, executive function, and language compared with people without HF. The effect of HF on time to convert needs to be tested in larger samples.