Need for Cognitive Screening in Patients with Heart Failure

Monday, 13 July 2009: 2:45 PM

Ponrathi R. Athilingam, PhD, RN, ACNP
School of Nursing, University of Rochester, Rochester, NY

Learning Objective 1: understand the magnitude and risk of cognitive deficit in heart failure

Learning Objective 2: understand the need for early cognitive screening in patients with heart failure

Purpose: This research compared the Montreal Cognitive Assessment (MoCA) and the Mini Mental Status Examination (MMSE) regarding their reliability and appropriateness to measure early cognitive changes in patients with heart failure (HF). HF patients have twice the risk of having cognitive deficit (CD) than the general population that may impact adherence to self-care and delay seeking care. Standard of HF care doesn’t call for cognitive screening hence, not routinely performed.           

Methods: A cross sectional study enrolled ninety community dwelling adults aged 50 and above in stable HF. Participants were administered the MMSE and MoCA, questionnaires to measure co-morbidity, depression, disability, and completed a six-minute walk test. Clinical and demographic data were collected via questionnaire. Cerebral perfusion pressure was measured via transcranial doppler and cardiac index via impedance cardiograph.

Results: Most participants were men (66%), Caucasian (78%), aged 50 to 89 (62 ± 9 years), 80% were in HF stage C, and 77% had ejection fraction <40%. The MoCA identified 54% participants with mild cognitive impairment and 17% with moderate cognitive impairment with a score of (24.86 ± 2.81) compared to 2.2% on the MMSE with a score of (28.96 ± 1.66). The results confirm findings of researchers that the MMSE is not sensitive to identify subtle cognitive changes in HF. Also, the MoCA identified pattern of CD in specific neuropsychological domains: delayed recall 87%, Visuo-spatial 69%, memory 61%, and attention 47%; that validates findings of several researchers. Conclusion: The results indicate that MoCA may be a sensitive screening tool in identifying subtle cognitive changes than MMSE. Early identification of CD may help prevent permanent CD and may improve adherence to self-care. An appropriately designed longitudinal study is warranted to validate MoCA, explore use of clinical cut off score <22 on the MoCA, and other factors that may influence CD in HF.