Riegel Barbara, Bennett Jill A, Davis Andra, Carlson Beverly, Montague John, Robin Howard, Glaser Dale
School of Nursing, University of Pennsylvania, USA.
Am J Crit Care. 2002 Nov;11(6):520-8.
Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment.
To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment.
A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality < 269 mOsm/kg), and dehydration (serum osmolality > or = 295 mOsm/kg).
Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample.
Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.
临床医生需要简便的方法来筛查心力衰竭患者的认知障碍。如果能够识别出认知障碍的相关因素，那么更多早期认知障碍患者在问题影响治疗依从性之前就能得到治疗。
描述心力衰竭患者的认知障碍情况，探讨4种认知障碍测量方法的实用性，并评估认知障碍的相关因素。
采用描述性、相关性设计。对42例心力衰竭患者进行了4种认知筛查测量：波士顿诊断性失语检查的指令分测验和复杂观念材料分测验、简易精神状态检查表及画钟测验。认知障碍定义为在4种测量方法中至少1种上的表现低于标准化（T分数）临界值。认知障碍的可能相关因素包括年龄、教育程度、低血压、液体超负荷（血清渗透压<269 mOsm/kg）和脱水（血清渗透压≥295 mOsm/kg）。
42名参与者中有12名（28.6%）检测出认知障碍。4种筛查测试的有效性各不相同，但画钟测验显示12名受损患者中有50%存在障碍。在该样本中，4种测量方法的标准化总分与年龄、教育程度、低血压、液体超负荷或脱水均无显著相关性。
认知障碍在心力衰竭患者中相对常见。画钟测验在检测认知障碍方面最有用，尽管它不能用于检测言语学习或延迟回忆方面的问题，也不应作为心力衰竭患者的唯一筛查方法。认知障碍的相关因素需要进一步研究。
