Trojano Luigi, Antonelli Incalzi Raffaele, Acanfora Domenico, Picone Costantino, Mecocci Patrizia, Rengo Franco
Dept. of Psychology, 2nd University of Naples, Caserta, Italy.
J Neurol. 2003 Dec;250(12):1456-63. doi: 10.1007/s00415-003-0249-3.
Congestive heart failure (CHF) has been proposed as a possible cause of cognitive dysfunction but only a few studies have directly assessed cognitive performance in CHF. The aim of the present study was to compare the cognitive patterns of patients with CHF and patients having cardiovascular diseases uncomplicated by CHF (no-CHF group). In a multicenter observational case-control study, we studied 149 hospitalized elderly CHF patients in the New York Heart Association (NYHA) class II (CHFm, m: moderate), 159 CHF patients in NYHA class III-IV (CHFs, s: severe), and 207 no-CHF patients. Patients underwent a multidimensional assessment and neuropsychological tests for the following cognitive domains: attention, visual-spatial intelligence, verbal attainment, verbal and visuo-spatial memory. Neuropsychological performances of groups were compared by multivariate analysis. Correlates of an abnormal performance on at least three neuropsychological tests were assessed by logistic regression analysis. CHFs performed worse than no-CHF patients on 4 of the 7 neuropsychological measures, the largest difference being in tests of attention and verbal learning (p < 0.001). Prevalence of abnormal performance on at least 3 tests was 57.9 % in CHFs, 43% in CHFm and 34.3 % in no-CHF groups (chi square = 17.3, p < 0.0001). The following qualified as independent correlates of the outcome at logistic regression analysis: CHFs group membership (Odds Ratio-OR = 2.56, 95% Confidence Interval-CI = 1.49-4.40), depression (OR = 2.37, 95% CI = 1.54-3.66), hypertension (OR = 1.88, 95% CI = 1.18-2.99). Our results demonstrate that cognitive impairment is common among CHF patients and seems to be causally related to CHF severity, depression and hypertension. The cognitive dysfunction also characterizes a relevant fraction of patients with cardiovascular diseases uncomplicated by CHF.
充血性心力衰竭（CHF）已被提出可能是认知功能障碍的一个原因，但只有少数研究直接评估了CHF患者的认知表现。本研究的目的是比较CHF患者与无CHF的心血管疾病患者（非CHF组）的认知模式。在一项多中心观察性病例对照研究中，我们研究了149例纽约心脏协会（NYHA）II级住院老年CHF患者（CHFm，m：中度）、159例NYHA III-IV级CHF患者（CHFs，s：重度）和207例非CHF患者。患者接受了多维度评估和针对以下认知领域的神经心理学测试：注意力、视觉空间智力、语言能力、语言和视觉空间记忆。通过多变量分析比较了各组的神经心理学表现。通过逻辑回归分析评估了至少三项神经心理学测试表现异常的相关因素。在7项神经心理学测量中的4项上，CHFs组的表现比非CHF患者差，最大差异在于注意力测试和语言学习测试（p<0.001）。至少3项测试表现异常的患病率在CHFs组中为57.9%，在CHFm组中为43%，在非CHF组中为34.3%（卡方=17.3，p<0.0001）。在逻辑回归分析中，以下因素被确定为该结果的独立相关因素：CHFs组成员身份（优势比-OR=2.56，95%置信区间-CI=1.49-4.4）、抑郁（OR=2.37，95%CI=1.54-3.66）、高血压（OR=1.88，95%CI=1.18-2.99）。我们的结果表明，认知障碍在CHF患者中很常见，并且似乎与CHF严重程度、抑郁和高血压存在因果关系。认知功能障碍在无CHF的心血管疾病患者中也占相当比例。
