心力衰竭发病后认知功能的轨迹

Trajectory of Cognitive Function After Incident Heart Failure.

作者信息

Shore Supriya, Li Hanyu, Zhang Min, Whitney Rachael, Gross Alden L, Bhatt Ankeet S, Nallamothu Brahmajee K, Giordani Bruno, Briceño Emily M, Sussman Jeremy B, Gutierrez Jose, Yaffe Kristine, Griswold Michael, Johansen Michelle C, Lopez Oscar L, Gottesman Rebecca F, Sidney Stephen, Heckbert Susan R, Rundek Tatjana, Hughes Timothy M, Longstreth William T, Levine Deborah A

机构信息

University of Michigan, Ann Arbor, MI, USA.

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

出版信息

medRxiv. 2024 Feb 11:2024.02.09.24302608. doi: 10.1101/2024.02.09.24302608.

DOI:10.1101/2024.02.09.24302608

PMID:38370803

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10871464/

Abstract

BACKGROUND

The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition.

METHODS

This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a -score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition.

RESULTS

The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes.

CONCLUSIONS

In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.

摘要

背景

新发心力衰竭（HF）后认知变化的程度尚不清楚。我们评估了在考虑HF前的认知轨迹和已知认知决定因素后，新发HF是否与认知功能变化相关。

方法

这项汇总队列研究纳入了1971 - 2019年来自美国六项基于人群的队列研究中无HF、中风或痴呆的成年人：社区动脉粥样硬化风险研究、青年成年人冠状动脉风险发展研究、心血管健康研究、弗雷明汉后代研究、多民族动脉粥样硬化研究和北曼哈顿研究。线性混合效应模型估计了HF发生时的认知变化（截距变化）以及HF发生后数年的认知变化率（斜率变化），同时控制HF前的认知轨迹和参与者因素。整体认知变化是主要结局。执行功能和记忆变化是次要结局。认知结局标准化为z评分指标（均值[标准差]，50[10]）；1分的差异代表认知上0.1标准差的差异。

结果

该研究纳入了29614名成年人（均值[标准差]年龄为61.1[10.5]岁，55%为女性，70.3%为白人，22.2%为黑人，7.5%为西班牙裔）。在中位随访6.6（第一四分位数 - 第三四分位数：5 - 19.8）年期间，1407名（4.7%）成年人发生了新发HF。新发HF与事件发生时整体认知的急性下降（-1.08分；95%置信区间 - 1.36，-0.80）和执行功能的急性下降（-0.65分；95%置信区间 - 0.96，-0.34）相关，但与记忆（-0.51分；95%置信区间 - 1.37，0.35）无关。HF后整体认知急性下降幅度更大的情况见于年龄较大、女性和白人种族者。与无HF个体相比，发生新发HF的个体在整体认知（每年 - 0.15分；95%置信区间，-0.21，-0.09）和执行功能（每年 - 0.16分；95%置信区间 - 0.23，-0.09）方面的下降速度比HF前斜率更快，但记忆方面（每年 - 0.11分；95%置信区间 - 0.26，0.04）并非如此。