Zuccalà Giuseppe, Marzetti Emanuele, Cesari Matteo, Lo Monaco Maria R, Antonica Livia, Cocchi Alberto, Carbonin Pierugo, Bernabei Roberto
Catholic University of the Sacred Heart, Largo F. Vito, I-00168 Rome, Italy.
Am J Med. 2005 May;118(5):496-502. doi: 10.1016/j.amjmed.2005.01.030.
Cognitive impairment is an exceedingly prevalent condition among patients with heart failure, independently associated with disability and mortality. However, the determinants of cognitive dysfunction associated with heart failure are still unclear. We assessed the correlates of cognitive impairment among patients with heart failure enrolled in a multicenter pharmacoepidemiology survey.
The association with cognition of demographic characteristics, objective tests and measures, medications, and comorbid conditions was assessed in 1511 patients with heart failure who had been admitted to 81 hospitals throughout Italy. Cognitive impairment was defined by a Hodkinson Abbreviated Mental Test score < 7.
According to multivariate logistic regression modeling, age (per each decade: OR = 2.01; 95% confidence interval [CI] 1.72-2.35), the comorbidity score (OR 1.11; 95% CI 1.03-1.20), education (OR 0.88; 95% CI 0.84-0.2), low serum albumin (OR 1.78; 95% CI 1.35-2.34), sodium (OR 1.56; 95% CI 1.06-2.29), and potassium levels (OR 1.58; 95% CI 1.09-2.29), hyperglycemia (OR 1.33; 95% CI 1.02-1.73), anemia (OR 1.38; 95% CI 1.09-1.75), and systolic blood pressure levels > or = 130 mm Hg (OR 0.60; 95% CI 0.37-0.97) were independently associated with cognitive impairment, after adjusting for potential confounders. Among participants with abnormal laboratory findings on admission, restoration of normal glucose, potassium, and hemoglobin levels during hospital stay was associated with improved cognitive performance at discharge.
Cognitive impairment among patients with heart failure is associated with several comorbid conditions, some of which are potentially treatable. This highlights the key role of comprehensive approach to the assessment and treatment of patients with heart failure.
认知障碍在心力衰竭患者中极为普遍，与残疾和死亡率独立相关。然而，与心力衰竭相关的认知功能障碍的决定因素仍不清楚。我们评估了参与一项多中心药物流行病学调查的心力衰竭患者中认知障碍的相关因素。
在意大利各地81家医院收治的1511例心力衰竭患者中，评估了人口统计学特征、客观检查和测量、药物治疗及合并症与认知的关联。认知障碍定义为霍金森简易精神测试评分<7分。
根据多因素逻辑回归模型，在调整潜在混杂因素后，年龄（每增加十岁：比值比[OR]=2.01；95%置信区间[CI]1.72-2.35）、合并症评分（OR 1.11；95%CI 1.03-1.20）、教育程度（OR 0.88；95%CI 0.84-0.2）、低血清白蛋白（OR 1.78；95%CI 1.35-2.34）、钠（OR 1.56；95%CI 1.06-2.29）、钾水平（OR 1.58；95%CI 1.09-2.29）、高血糖（OR 1.33；95%CI 1.02-1.73）、贫血（OR 1.38；95%CI 1.09-1.75）以及收缩压水平≥130 mmHg（OR 0.60；95%CI 0.37-0.97）均与认知障碍独立相关。在入院时实验室检查结果异常的参与者中，住院期间血糖、钾和血红蛋白水平恢复正常与出院时认知功能改善相关。
心力衰竭患者的认知障碍与多种合并症相关，其中一些合并症可能是可治疗的。这凸显了对心力衰竭患者进行综合评估和治疗方法的关键作用。
