Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
J Am Geriatr Soc. 2012 Sep;60(9):1724-9. doi: 10.1111/j.1532-5415.2012.04097.x. Epub 2012 Aug 6.
To determine the prevalence of cognitive impairment in older adults with heart failure (HF).
Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims.
United States, community.
Six thousand one hundred eighty-nine individuals aged 67 and older.
An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups.
The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02).
Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.
确定老年心力衰竭（HF）患者认知障碍的患病率。
对全国代表性的健康与退休研究（Health and Retirement Study）2004 年波次数据进行的横断面分析，该研究与 2002 年至 2004 年医疗保险管理索赔数据相链接。
美国，社区。
6189 名年龄在 67 岁及以上的个体。
采用自我报告和代理人报告心脏问题的组合，以及在管理文件中使用标准 HF 诊断代码的一个或多个医疗保险索赔的存在，开发了一种算法。在此算法的基础上，创建了三个类别来描述 HF 诊断的可能性：HF 高或中度可能性、HF 低可能性和无 HF。使用认知功能的筛选测量或根据代理人评分来评估认知功能。为这三个组计算了认知障碍的年龄调整患病率估计值。
HF 患者中与痴呆一致的认知障碍的患病率为 15%，轻度认知障碍的患病率为 24%。HF 患者发生痴呆的几率明显更高，即使在调整了年龄、教育程度、净资产和既往卒中后（比值比=1.52，95%置信区间=1.14-2.02）。
认知障碍在老年 HF 患者中很常见，且与痴呆的风险独立相关。认知评估应常规纳入 HF 重点护理模式。
