Cognitive Function in Heart Failure Patients

Heart failure is a complex clinical syndrome characterised by the heart’s inability to maintain adequate circulation, leading to systemic and cerebral hypoperfusion. Cognitive impairment is increasingly recognised as a common comorbidity in this population, affecting up to half of older patients. Domains most often compromised include attention, executive function, processing speed and memory. Underlying mechanisms encompass reduced cerebral blood flow, impaired cerebrovascular autoregulation, chronic inflammation, neurohumoral activation and oxidative stress. Structural neuroimaging has revealed grey matter atrophy, white matter lesions and disruptions in network connectivity that correlate with cognitive decrements. The cognitive burden in heart failure carries important consequences for self-care, medication adherence and functional independence, and is associated with higher rates of rehospitalisation and mortality. Differences in cognitive profiles have been observed between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction, suggesting that tailored assessment and management strategies are essential. Early identification and intervention may mitigate progression of cognitive decline and improve overall prognosis in this vulnerable group.

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Recent clinical trials examining sodium-glucose cotransporter-2 inhibitors in elderly patients with heart failure and type 2 diabetes have demonstrated significant gains in global cognitive scores over six months, accompanied by reductions in oxidative stress and platelet activation biomarkers. These findings suggest that modulation of metabolic and inflammatory pathways may confer neuroprotective benefits in heart failure populations. Advanced diffusion tensor imaging studies have characterised altered brain network architecture in chronic heart failure patients with cognitive impairment, revealing reductions in global and local efficiency, clustering and small-world attributes. Disrupted connectivity in frontal and posterior cingulate regions correlates with deficits in executive function, attention and visuospatial processing, highlighting network dysfunction as a predictor of cognitive decline. A recent review of biomarker studies has identified interleukin-6 as a promising serial marker for monitoring both cardiac status and associated cognitive decline, while pointing to emerging candidates that require validation in large cohorts. Together, these diverse lines of inquiry underscore the interconnection between haemodynamic, inflammatory and neurostructural changes driving cognitive dysfunction in heart failure.

Cognitive Function in Heart Failure Patients publication trend

The graph below shows the total number of articles in cognitive function in heart failure patients across all publications each year (not limited to Nature Index journals).

Technical terms

Heart failure: A syndrome in which the heart cannot pump sufficient blood to meet the body’s needs, leading to fluid retention and organ hypoperfusion.

Cognitive impairment: A reduction in cognitive domains such as memory, attention, executive function and processing speed beyond that expected for age.

HFpEF (heart failure with preserved ejection fraction): A subtype of heart failure where left ventricular ejection fraction remains ≥50%, often associated with diastolic dysfunction.

Diffusion tensor imaging: An MRI technique that maps the diffusion of water molecules in white matter tracts, enabling assessment of network connectivity.

Global efficiency: A graph theory metric quantifying the capacity for information transfer across an entire network.

Local efficiency: A measure of how efficiently information is exchanged within a node’s immediate neighbourhood in a network.

Oxidative stress biomarkers: Circulating molecules, such as 8-isoprostane, that indicate the balance between free radicals and antioxidant defences.

References

1. Effects of SGLT2-Inhibitors on Comprehensive Geriatric Assessment, Biomarkers of Oxidative Stress, and Platelet Activation in Elderly Diabetic Patients with Heart Failure with Preserved Ejection Fraction. International Journal of Molecular Sciences (2024).
2. Altered brain networks and connections in chronic heart failure patients complicated with cognitive impairment. Frontiers in Aging Neuroscience (2023).
3. A Set of Possible Markers for Monitoring Heart Failure and Cognitive Impairment Associated: A Review of Literature from the Past 5 Years. Biomolecules (2024).
4. Cognitive Impairment in Heart Failure—A Review. Biology (2022).