Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano Institute, Pavia, Italy.
Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano Institute, Pavia, Italy.
PLoS One. 2020 Jul 2;15(7):e0235570. doi: 10.1371/journal.pone.0235570. eCollection 2020.
The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population.
To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients' functional status.
This study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke's Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE).
100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT.
Psychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.
在慢性心力衰竭（CHF）患者中，心理和神经心理学功能障碍与功能/临床变量之间的关系已在文献中广泛探讨。然而，只有少数研究调查了老年人中的这些关联。
评估老年 CHF 患者的心理/神经心理学特征，探讨与临床/功能变量的相互关系，并确定患者功能状态的潜在独立预测因素。
本研究采用多中心观察性设计进行。进行了以下评估：焦虑（医院焦虑和抑郁量表，HADS）、抑郁（老年抑郁量表，GDS）、认知障碍（改良 Addenbrooke 认知测验，ACE-R）、执行功能（额叶评估量表，FAB）、建构能力（画钟测验，CDT）、精神运动速度和交替注意（连线测试 A/B，TMT-A/B）、功能状态（6 分钟步行测试，6MWT）和临床变量（纽约心脏协会，NYHA；脑利钠肽，BNP；左心室射血分数，LVEF；左心室舒张末期直径，LVEDD；左心室舒张末期容积，LVEDV；三尖瓣环平面收缩位移，TAPSE）。
研究纳入了 100 名 CHF 患者（平均年龄：74.9±7.1 岁；平均 LVEF：36.1±13.4）。分别有 16%和 24.5%的患者出现焦虑和抑郁症状。年龄与 TMT-A 和 CDT 相关（r = 0.49，p<0.001 和 r = -0.32，p = 0.001），Log-BNP 与 ACE-R-Fluency 亚测试相关（r = -0.22，p = 0.034），6MWT 与 ACE-R-Memory 亚测试和 TMT-A 相关（r = 0.24，p = 0.031 和 r = -0.32，p = 0.005）。焦虑和抑郁症状均与 ACE-R-总分相关（r = -0.25，p = 0.013 和 r = -0.32，p = 0.002），抑郁症状与 CDT 相关（r = -0.23，p = 0.024）。在多元回归分析中，Log-BNP 和 TMT-A 是功能状态的显著和独立预测因子：Log-BNP 和 TMT-A 的检测结果越差，在 6MWT 中行走的距离越短。
心理和神经心理学筛查，以及精神运动速度（TMT-A）的评估，可为接受心脏康复的老年 CHF 患者提供有用的信息。
