慢性心力衰竭中的认知缺陷。
Cognitive deficits in chronic heart failure.
机构信息
School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA.
出版信息
Nurs Res. 2010 Mar-Apr;59(2):127-39. doi: 10.1097/NNR.0b013e3181d1a747.
BACKGROUND
Patients with heart failure (HF) have been found to have cognitive deficits, but it remains unclear whether these deficits are associated with HF or with aging or comorbid conditions common in HF.
OBJECTIVES
: The purpose of this study was (a) to determine the types, the frequency, and the severity of cognitive deficits among patients with chronic HF compared with age- and education-matched healthy participants and participants with major medical conditions other than HF, and (b) to evaluate the relationships between HF severity, age, and comorbidities and cognitive deficits.
METHODS
A sample of 414 participants completed the study (249 HF patients, 63 healthy and 102 medical participants). The HF patients completed measures of HF severity, comorbidity (multiple comorbidity, depressive symptoms), and neuropsychological functioning. Blood pressure and oxygen saturation were assessed at interview; clinical variables were abstracted from records. Participants in the comparison groups completed the same measures as the HF patients except those specific to HF.
RESULTS
Compared with the healthy and medical participants, HF patients had poorer memory, psychomotor speed, and executive function. Significantly more HF patients (24%) had deficits in three or more domains. Higher (worse) HF severity was associated with more cognitive deficits; HF severity interacted with age to explain deficits in executive function. Surprisingly, men with HF had poorer memory, psychomotor speed, and visuospatial recall ability than women. Multiple comorbidity, hypertension, depressive symptoms, and medications were not associated with cognitive deficits in this sample.
DISCUSSION
HF results in losses in memory, psychomotor speed, and executive function in almost one fourth of patients. Patients with more severe HF are at risk for cognitive deficits. Older patients with more severe HF may have more problems in executive function, and men with HF may be at increased risk for cognitive deficits. Studies are urgently needed to identify the mechanisms for the cognitive deficits in HF and to test innovative interventions to prevent cognitive loss and decline.
背景
心力衰竭（HF）患者被发现存在认知缺陷，但目前尚不清楚这些缺陷是与 HF 相关，还是与 HF 常见的衰老或合并症相关。
目的
本研究旨在：（a）确定与年龄和教育相匹配的健康参与者以及除 HF 以外患有其他主要疾病的参与者相比，慢性 HF 患者的认知缺陷类型、频率和严重程度；（b）评估 HF 严重程度、年龄和合并症与认知缺陷之间的关系。
方法
共有 414 名参与者完成了这项研究（249 名 HF 患者，63 名健康参与者和 102 名医学参与者）。HF 患者完成了 HF 严重程度、合并症（多种合并症、抑郁症状）和神经心理学功能的测量。在访谈时评估了血压和血氧饱和度；从记录中提取了临床变量。比较组的参与者除了那些特定于 HF 的测量外，还完成了与 HF 患者相同的测量。
结果
与健康和医学参与者相比，HF 患者的记忆、心理运动速度和执行功能较差。有明显更多的 HF 患者（24%）存在三个或更多领域的缺陷。更高（更差）的 HF 严重程度与更多的认知缺陷相关；HF 严重程度与年龄相互作用，解释了执行功能的缺陷。令人惊讶的是，患有 HF 的男性的记忆、心理运动速度和视觉空间回忆能力比女性差。在这个样本中，多种合并症、高血压、抑郁症状和药物治疗与认知缺陷无关。
讨论
HF 导致近四分之一的患者出现记忆、心理运动速度和执行功能的丧失。HF 更为严重的患者存在认知缺陷的风险。HF 更为严重的老年患者可能在执行功能方面存在更多问题，而 HF 男性可能存在认知缺陷的风险增加。迫切需要研究来确定 HF 认知缺陷的机制，并测试预防认知丧失和衰退的创新干预措施。
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