Department of General Medicine, Alfred Hospital, Melbourne, Australia.
Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia.
Curr Heart Fail Rep. 2022 Oct;19(5):303-315. doi: 10.1007/s11897-022-00564-z. Epub 2022 Aug 13.
There is increasing recognition of the prevalence and impact of cognitive dysfunction (CD) in heart failure (HF) patients. This contemporary review appraises the evidence for epidemiological association, direct pathophysiological links and emerging pharmacological and non-pharmacological interventions. Furthermore, we present evidence for care models that aim to mitigate the morbidity and poor quality of life associated with these dual processes and propose future work to improve outcomes.
CD disproportionately affects heart failure patients, even accounting for known comorbid risk factors, and this may extend to subclinical left ventricular dysfunction. Neuroimaging studies now provide evidence of anatomical and functional differences which support previously postulated mechanisms of reduced cerebral blood flow, micro-embolism and systemic inflammation. Interventions such as multidisciplinary ambulatory HF care, education and memory training improve HF outcomes perhaps to a greater degree in those with comorbid CD. Additionally, optimisation of standard heart failure care (cardiac rehabilitation, pharmacological and device therapy) may lead to additional cognitive benefits. Epidemiological, neuroimaging and intervention studies provide evidence for the causal association between HF and CD, although evidence for Alzheimer's dementia is less certain. Specific reporting of cognitive outcomes in HF trials and evaluation of targeted interventions is required to further guide care provision.
认知功能障碍（CD）在心力衰竭（HF）患者中的普遍性和影响日益受到认识。本综述评估了流行病学关联、直接病理生理联系以及新兴的药理学和非药理学干预措施的证据。此外，我们还提供了旨在减轻与这两个过程相关的发病率和生活质量下降的护理模式的证据，并提出了改善结果的未来工作。
CD 不成比例地影响 HF 患者，即使考虑到已知的合并症风险因素，这种情况甚至可能扩展到亚临床左心室功能障碍。神经影像学研究现在提供了支持先前提出的降低脑血流量、微栓塞和全身炎症机制的解剖和功能差异的证据。多学科门诊 HF 护理、教育和记忆训练等干预措施改善 HF 结局，在合并 CD 的患者中可能效果更大。此外，优化标准 HF 治疗（心脏康复、药物和器械治疗）可能会带来额外的认知益处。流行病学、神经影像学和干预研究为 HF 和 CD 之间的因果关系提供了证据，尽管 HF 和阿尔茨海默病痴呆之间的证据不太确定。需要在 HF 试验中报告认知结果并评估针对性干预措施，以进一步指导护理提供。
