Faulkner Kenneth M, Chien Christopher V, Denfeld Quin E, Gelow Jill M, Lyons Karen S, Grady Kathleen L, Mudd James O, Lee Christopher S
J Cardiovasc Nurs. 2022;37(1):31-40. doi: 10.1097/JCN.0000000000000709.
Left ventricular assist devices (LVADs) are a common treatment of advanced heart failure, but cognitive dysfunction, which is common in heart failure, could limit the ability to perform postimplantation LVAD care. Implantation of an LVAD has been associated with improved cerebral perfusion and may improve cognitive function post implantation.
The aim of this study was to quantify longitudinal change in cognitive function after LVAD implantation.
A secondary analysis of data on 101 adults was completed to evaluate cognitive function before implantation and again at 1, 3, and 6 months post implantation of an LVAD. Latent growth curve modeling was conducted to characterize change over time. Serial versions of the Montreal Cognitive Assessment were used to measure overall (total) cognitive function and function in 6 cognitive domains.
There was moderate, nonlinear improvement from preimplantation to 6 months post implantation in Montreal Cognitive Assessment total score (Hedges' g = 0.50) and in short-term memory (Hedges' g = 0.64). There also were small, nonlinear improvements in visuospatial ability, executive function, and attention from preimplantation to 6 months post implantation (Hedges' g = 0.20-0.28). The greatest improvements were observed in the first 3 months after implantation and were followed by smaller, sustained improvements or no additional significant change.
Implantation of an LVAD is associated with significant, nonlinear improvement in short-term memory and global cognitive function, with the most significant improvements occurring in the first 3 months after implantation. Clinicians should anticipate improvements in cognitive function after LVAD implantation and modify postimplantation education to maximize effectiveness of LVAD self-care.
左心室辅助装置（LVAD）是晚期心力衰竭的常见治疗方法，但认知功能障碍在心力衰竭中很常见，可能会限制LVAD植入后护理的执行能力。LVAD植入与脑灌注改善有关，可能会改善植入后的认知功能。
本研究的目的是量化LVAD植入后认知功能的纵向变化。
完成了对101名成年人数据的二次分析，以评估LVAD植入前以及植入后1、3和6个月时的认知功能。进行了潜在生长曲线建模以描述随时间的变化。使用蒙特利尔认知评估的系列版本来测量整体（总）认知功能以及6个认知领域的功能。
从植入前到植入后6个月，蒙特利尔认知评估总分（Hedges' g = 0.50）和短期记忆（Hedges' g = 0.64）有中度的非线性改善。从植入前到植入后6个月，视觉空间能力、执行功能和注意力也有小的非线性改善（Hedges' g = 0.20 - 0.28）。在植入后的前3个月观察到最大的改善，随后是较小的持续改善或没有额外的显著变化。
LVAD植入与短期记忆和整体认知功能的显著非线性改善相关联，最显著的改善发生在植入后的前3个月。临床医生应预期LVAD植入后认知功能会有所改善，并调整植入后的教育方式以最大限度提高LVAD自我护理的效果。
