Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, Varricchio M, Rengo F
Cattedra di Geriatria, Istituto di Medicina Interna, Cardiologia e Chirurgia Cardiovascolare, Università degli Studi di Napoli Federico II, Naples, Italy.
J Am Geriatr Soc. 1998 Nov;46(11):1343-8. doi: 10.1111/j.1532-5415.1998.tb05999.x.
Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable risk factors for cognitive impairment (CI) for older persons is a very important issue. We examined the cross-sectional relationship between CHF and CI in an older population.
A cross-sectional survey.
A total of 1339 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy.
Sociodemographic characteristics were recorded, as was the presence of cardiovascular diseases, including CHF classified according to the New York Heart Association (NYHA) guidelines for disease severity; CI evaluated by means of the Mini-Mental State Examination (MMSE), with a score of <24 indicating impairment; geriatric depression scale (GDS) rating; blood pressure (BP); and heart rate (HR).
The final sample numbered 1075; 172 subjects were excluded because of neurological disorders and psychotropic therapy, and 92 were excluded because their BP, HR, or cognitive examination was not recorded. Prevalence of CHF was 8.2%, and 23.0% of subjects scored <24 on the MMSE. The prevalence of CHF in subjects with an MMSE score of <24 and > or =24 was 20.2% and 4.6%, respectively (P < .001). Logistic regression analysis showed that CHF was associated independently with CI by sex, age, educational level, GDS, diabetes, hypertension, alcohol consumption, smoking, atrial fibrillation, systolic and diastolic BP, and HR. The risk of CI was 1.96-fold greater in subjects with CHF (odds ratio: 1.96; 95% confidence interval: 1.07-3.58; P < .028). Systolic BP decrease was correlated negatively with NYHA classes only in subjects with CI (r = -0.981; P < .020), whereas HR increase was correlated positively with NYHA classes only in subjects without CI (r = 0.985; P < .015).
In our population, CHF is associated with CI in subjects aged 65 years and older. Systolic BP reduction and the lack of HR increase, related to NYHA classes, might characterize cognitively impaired subjects with CHF.
充血性心力衰竭（CHF）具有潜在可预防性，识别老年人认知障碍（CI）的可改变风险因素是一个非常重要的问题。我们研究了老年人群中CHF与CI之间的横断面关系。
横断面调查。
从意大利南部坎帕尼亚地区的选民名单中选取了1339名65岁及以上的受试者。
记录社会人口学特征，以及心血管疾病的存在情况，包括根据纽约心脏协会（NYHA）疾病严重程度指南分类的CHF；通过简易精神状态检查表（MMSE）评估CI，得分<24表明存在障碍；老年抑郁量表（GDS）评分；血压（BP）；以及心率（HR）。
最终样本为1075人；172名受试者因神经系统疾病和精神药物治疗被排除，92名受试者因未记录其BP、HR或认知检查结果而被排除。CHF的患病率为8.2%，23.0%的受试者MMSE得分<24。MMSE得分<24和≥24的受试者中CHF的患病率分别为20.2%和4.6%（P<.001）。逻辑回归分析表明，CHF与CI独立相关，相关因素包括性别、年龄、教育水平、GDS、糖尿病、高血压、饮酒、吸烟、心房颤动、收缩压和舒张压以及HR。CHF患者发生CI的风险高1.96倍（比值比：1.96；95%置信区间：1.07 - 3.58；P<.028）。仅在CI患者中，收缩压降低与NYHA分级呈负相关（r = -0.981；P<.020），而仅在无CI患者中，心率增加与NYHA分级呈正相关（r = 0.985；P<.015）。
在我们的研究人群中，65岁及以上的CHF患者与CI相关。与NYHA分级相关的收缩压降低和心率未增加可能是CHF认知障碍患者的特征。
