Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia.
J Card Fail. 2013 Sep;19(9):641-6. doi: 10.1016/j.cardfail.2013.08.001.
Cognitive impairments are prevalent in heart failure (HF) patients, worsening outcomes but often undetected.The aim of this study was to screen HF outpatients for mild cognitive impairment (MCI), determine the areas of cognition affected, patient awareness of cognitive change, and associated factors.
HF patients (n = 128) newly registered for the Management of Cardiac Function program, free from neurocognitive disorder, and with sufficient visual acuity were assessed with the use of the Montreal Cognitive Assessment tool (MoCA). MCI was classified as MoCA score ≤22. The sample was elderly (mean, 80.65 years; SD, 11.52). Mean MoCA score was 24.58 (SD 3.45), 22% were classified as impaired, 45% had noticed a change in cognition, and 15% reported that they were affected in their daily lives. Patients noticing this impact had lower MoCA scores (22.74, SD 3.0) than those who did not (25.17, SD 2.96; P ≤ .02). Most impairments occurred for delayed recall, visuospatial/executive function, and abstraction. The odds of impairment increased by the presence of ischemic heart disease (odds ratio, 4.18; 95% confidence interval, 1.15-15.69).
In HF outpatients without a dementia diagnosis, MCI is prevalent. Screening for MCI and incorporation of compensatory strategies are essential.
认知障碍在心力衰竭（HF）患者中较为普遍，会使预后恶化，但往往难以察觉。本研究旨在筛查 HF 门诊患者是否存在轻度认知障碍（MCI），确定受影响的认知领域、患者对认知变化的意识，以及相关因素。
新登记参加“心脏功能管理计划”、无神经认知障碍且视力足够的 HF 患者，使用蒙特利尔认知评估工具（MoCA）进行评估。MCI 被定义为 MoCA 评分≤22。该样本年龄较大（平均 80.65 岁，标准差 11.52）。平均 MoCA 得分为 24.58（标准差 3.45），22%的患者被归类为受损，45%的患者注意到认知变化，15%的患者报告日常生活受到影响。注意到这种影响的患者 MoCA 评分较低（22.74，标准差 3.0），而未注意到的患者评分较高（25.17，标准差 2.96；P≤0.02）。大多数损害发生在延迟回忆、视空间/执行功能和抽象方面。缺血性心脏病的存在使受损的可能性增加（比值比，4.18；95%置信区间，1.15-15.69）。
在没有痴呆诊断的 HF 门诊患者中，MCI 较为普遍。筛查 MCI 并采用补偿策略至关重要。
