Alagiakrishnan Kannayiram, Mah Darren, Ahmed Ali, Ezekowitz Justin
Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada.
University of Alberta Hospital, B146, Clinical Sciences Building, 8440-112 Street, Edmonton, T6G 2G3, Canada.
Heart Fail Rev. 2016 Nov;21(6):661-673. doi: 10.1007/s10741-016-9568-1.
Cognitive impairment (CI) is common in older adults with heart failure (HF). The prevalence of CI is higher among patients with HF than in those without. The spectrum of CI in HF is similar to that observed in the general population and may range from delirium to isolated memory or non-memory-related deficits to dementia. Both HF with reduced ejection fraction and HF with preserved ejection fraction have been associated with defects in different domains of cognition. Numerous risk factors have been shown to contribute to CI in HF. Additionally, various pathophysiological mechanisms related to HF can contribute to cognitive decline. These conditions are not routinely screened for in clinical practice settings with HF populations, and guidelines on optimal assessment strategies are lacking. Validated tools and criteria should be used to differentiate acute cognitive decline (delirium) from chronic cognitive decline such as mild cognitive impairment and dementia. CI in HF has been associated with higher rates of disability and impairment in self-care activities that may in turn increase healthcare cost, hospital readmission and mortality. Early detection of CI may improve clinical outcomes in older adults with HF. Appropriate HF management strategies may also help to reduce CI in patients with HF, and future research is needed to develop and test newer and more effective interventions to improve outcomes in patients with HF and CI.
认知障碍（CI）在老年心力衰竭（HF）患者中很常见。HF患者中CI的患病率高于无HF的患者。HF中CI的范围与一般人群中观察到的相似，可能从谵妄到孤立的记忆或与记忆无关的缺陷再到痴呆。射血分数降低的HF和射血分数保留的HF均与不同认知领域的缺陷有关。已证明许多危险因素会导致HF患者出现CI。此外，与HF相关的各种病理生理机制也会导致认知能力下降。在HF人群的临床实践环境中，这些情况并未常规筛查，并且缺乏关于最佳评估策略的指南。应使用经过验证的工具和标准来区分急性认知下降（谵妄）与慢性认知下降，如轻度认知障碍和痴呆。HF中的CI与更高的残疾率和自我护理活动障碍相关，这反过来可能会增加医疗成本、住院再入院率和死亡率。早期发现CI可能会改善老年HF患者的临床结局。适当的HF管理策略也可能有助于降低HF患者的CI，未来需要开展研究来开发和测试更新、更有效的干预措施，以改善HF和CI患者的结局。
