scholarly journals Cognitive Impairment in Acute Heart Failure: Narrative Review

2021 ◽  
Vol 8 (12) ◽  
pp. 184
Author(s):  
Ioannis Ventoulis ◽  
Angelos Arfaras-Melainis ◽  
John Parissis ◽  
Eftihia Polyzogopoulou
Keyword(s):  
Heart Failure ◽  
Cognitive Impairment ◽  
Acute Heart Failure ◽  
Time Course ◽  
Wide Spectrum ◽  
Narrative Review ◽  
Limited Attention ◽  
Screening Methods ◽  
Cognitive Screening ◽  
Cognitive Changes

Cognitive impairment (CI) represents a common but often veiled comorbidity in patients with acute heart failure (AHF) that deserves more clinical attention. In the AHF setting, it manifests as varying degrees of deficits in one or more cognitive domains across a wide spectrum ranging from mild CI to severe global neurocognitive disorder. On the basis of the significant negative implications of CI on quality of life and its overwhelming association with poor outcomes, there is a compelling need for establishment of detailed consensus guidelines on cognitive screening methods to be systematically implemented in the population of patients with heart failure (HF). Since limited attention has been drawn exclusively on the field of CI in AHF thus far, the present narrative review aims to shed further light on the topic. The underlying pathophysiological mechanisms of CI in AHF remain poorly understood and seem to be multifactorial. Different pathophysiological pathways may come into play, depending on the clinical phenotype of AHF. There is some evidence that cognitive decline closely follows the perturbations incurred across the long-term disease trajectory of HF, both along the time course of stable chronic HF as well as during episodes of HF exacerbation. CI in AHF remains a rather under recognized scientific field that poses many challenges, since there are still many unresolved issues regarding cognitive changes in patients hospitalized with AHF that need to be thoroughly addressed.

Effect of Drugs on Effective Vascular Compliance in Acute Heart Failure

1975 ◽  
Vol 53 (5) ◽  
pp. 850-858 ◽  
Author(s):  
Pierre Larochelle ◽  
Richard I. Ogilvie
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Time Course ◽  
Ethacrynic Acid ◽  
Circulatory Arrest ◽  
Aortic Constriction ◽  
Venous Bypass ◽  
Vascular Compliance ◽  
Effective Vascular Compliance ◽  
Sustained Increase

Effective vascular compliance determined by the ΔV/ΔP relationship was measured repeatedly in anesthetized open-chest dogs without circulatory arrest utilizing a closed circuit venous bypass system with a constant cardiac output. Production of acute heart failure by gradual aortic constriction was associated with a significant decrease in total effective vascular compliance. The effect of loading and 20-min maintenance doses of different drugs on vascular compliance of animals in acute heart failure was studied. Phenoxybenzamine (total dose 2 mg/kg) produced a rapid and sustained increase in effective vascular compliance and theophylline (12 mg/kg) produced an increase which was more gradual in development than with phenoxybenzamine. Morphine (1 mg/kg) produced a rapid but transient increase in compliance. In contrast, ethacrynic acid (100 mg) or nitroglycerin (0.6 or 1.2 mg) did not alter vascular compliance significantly. These agents differ markedly in the magnitude and time-course of effect on effective vascular compliance.

Early Worsening Heart Failure in Patients Admitted for Acute Heart Failure: Time Course, Hemodynamic Predictors, and Outcome

2009 ◽  
Vol 15 (8) ◽  
pp. 639-644 ◽  
Author(s):  
Guillermo Torre-Amione ◽  
Olga Milo-Cotter ◽  
Edo Kaluski ◽  
Loic Perchenet ◽  
Isaac Kobrin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Time Course ◽  
Failure Time ◽  
Early Worsening

scholarly journals Comparative study of pharmacological correction strategies for moderate cognitive impairment in hypertensive patients

2019 ◽  
Vol 11 (2) ◽  
pp. 52-59
Author(s):  
O. V. Vorobyeva ◽  
Zh. M. Sizova ◽  
L. M. Bogatyreva
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Comparative Study ◽  
Time Course ◽  
Dopamine Receptor Agonist ◽  
Cognitive Changes ◽  
Hypertensive Patients ◽  
Blood Pressure Targets ◽  
Pharmacological Correction

Objective: to investigate the prevalence of cognitive impairment (CI) and possibilities of its pharmacological correction in hypertensive patients, by comparatively evaluating the efficiency of different treatment options: antihypertensive therapy and its combinations with vasoactive drugs and the dopamine receptor agonist piribedil.Patients and methods. At the first stage of the investigation, the prevalence of CI was assessed in a continuous sample of hypertensive patients (n=350). The second stage included a naturalistic comparative study of the efficiency of various therapeutic strategies for moderate CI (MCI) in patients with Stage 1–2 hypertension (n=91). This investigation lasted 48 weeks and consisted of a 24-week treatment period and a 24-weeks follow-up period.Results and discussion. CI was diagnosed in 83.4% of patients in the continuous sample, while it reached the level of dementia in 16.9%. Therapy aimed at achieving and maintaining blood pressure (BP) targets did not lead to the regression of MCI. However, BP correction in combination with a 24-week piribedil therapy cycle was optimal in patients with CI. By the end of treatment, the Montreal Cognitive Assessment (MoCa) scores increased from 24.5Ѓ}0.8 to 27.5Ѓ}0.6 (p<0.05) and from 24.9Ѓ}0.7 to 27.1Ѓ}0.8 (p<0.05) in the groups of patients randomized to supplemental piribedil alone or in combination with nootropic and/or vascular drugs, respectively. There were no intergroup differences in the groups of patients randomized to supplemental piribedil. The time course of cognitive changes in the further follow-up period showed a longterm positive effect of piribedil on cognitive function.Conclusion. It is necessary to regularly screen for cognitive dysfunction in hypertensive patients. The most effective treatment in combination with a long-term piribedil therapy cycle for hypertension-associated MCI was to promote the achievement and retention of blood pressure targets.

scholarly journals Time Course Changes in Urinary Angiotensinogen and Circulating N-Terminal Pro-B-Type Natriuretic Peptide in Patients Hospitalized with Acute Heart Failure

2020 ◽  
Vol 59 (22) ◽  
pp. 2839-2847
Author(s):  
Shota Yokoyama ◽  
Ryo Kawakami ◽  
Atsushi Tobiume ◽  
Keisuke Onishi ◽  
Takuro Fujita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Time Course ◽  
Urinary Angiotensinogen ◽  
Course Changes

Pathological and cognitive changes in patients with type 2 diabetes mellitus and comorbid MCI and protective hypoglycemic therapies: a narrative review

2019 ◽  
Vol 30 (7) ◽  
pp. 757-770 ◽  
Author(s):  
Xiao Zhang ◽  
Zhao Huang-Fu ◽  
Xing-Ying Lang ◽  
Pu Chun ◽  
Yan-Yan Chi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Glucose Metabolism ◽  
Narrative Review ◽  
Cognitive Changes ◽  
Significant Health

AbstractType 2 diabetes mellitus (T2DM) is becoming a significant health issue worldwide. Many studies support the hypothesis that patients with T2DM have a higher-than-expected incidence of mild cognitive impairment (MCI) than individuals without diabetes. Based on the results from recent studies, MCI might be associated with the effects of T2DM on glucose metabolism and brain atrophy. As a narrative review, we will illuminate pathological and cognitive changes in patients with T2DM and comorbid MCI and protective hypoglycemic therapies. The early abnormal signs of cognition must be elucidated, and extensive investigations are needed to develop improved therapies for use in the clinic.

How to measure dyspnea in acute heart failure?

2009 ◽  
Vol 66 (9) ◽  
pp. 639-642 ◽  
Author(s):  
Thenral Socrates ◽  
Alexandre Mebazaa
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Acute Heart Failure ◽  
Analogue Scale ◽  
Time Course ◽  
Sitting Position ◽  
Point Scale ◽  
Course Of Disease ◽  
Important Target

Dyspnea is the most common presenting symptom of patients with acute heart failure (AHF). Although dyspnea is an important target for treatment in clinical practice and clinical trials, there remains a lack of consensus on how to assess it. We describe and recommend to use absolute scales such the Likert 5-point or the Visual Analogue Scale rather than any comparator scale such as the Likert 7-point scale. We further recommend starting dyspnea measurements in sitting position and perform, if possible, similar measurements in lying position. The same set of measurements may be repeated as needed during the time course of disease and the treatment.

Abstract WP427: Cognitive Function of Ten-year Stroke Survivors Compared to Non-stroke Individuals: the Lund Stroke Register

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hossein Delavaran ◽  
Ann-Cathrin Jönsson ◽  
Håkan Lövkvist ◽  
Susanne Iwarsson ◽  
Sölve Elmståhl ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Executive Dysfunction ◽  
Screening Methods ◽  
Stroke Survivors ◽  
Cognitive Screening ◽  
Severe Cognitive Impairment ◽  
Post Stroke ◽  
Increased Risk

Introduction: Post-stroke cognitive impairment (PSCI) has a considerable impact on patients and society. However, the characteristics and prevalence of long-term PSCI may be influenced by assessment methods and selection bias. We therefore used two cognitive screening methods to assess PSCI in ten-year stroke survivors, made comparisons with non-stroke individuals, and compared these screening methods. Methods: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered and compared in a population-based consecutive sample of ten-year stroke survivors. In addition, age- and sex-matched non-stroke controls were assessed with the MMSE. Regression analyses adjusting for education compared the stroke survivors’ MMSE performance with the controls. Moderate/severe cognitive impairment, approximating to dementia, was defined using MMSE<24 and MoCA<20 as cut-offs. To detect those with mild cognitive impairment, alternative cut-offs of MMSE<27 and MoCA<25 were also used. Results: In total, 127 of 145 stroke survivors participated. The total MMSE-scores were similar for stroke survivors (median 27) and 354 controls (median 27; p =0.922); as well as proportions with MMSE<24 (23% vs. 17%; p =0.175) or MMSE<27 (47% vs. 49%; p =0.671). After adjustment for education, stroke survivors showed an increased risk for moderate/severe cognitive impairment defined by MMSE<24 (OR=1.82; p =0.036). Executive dysfunction was seen in 42% of the stroke survivors vs. 16% of the controls as evaluated by MMSE ( p <0.001). According to MoCA, moderate/severe cognitive impairment (MoCA<20) was observed in 28% of the stroke survivors; any degree of cognitive impairment (MoCA<25) was seen in 61%; and 45-61% displayed executive function deficits. Conclusions: PSCI including executive dysfunction is common among ten-year stroke survivors, who have an increased risk of moderate/severe cognitive impairment compared to non-stroke controls. The prevalence of long-term PSCI may have been previously underestimated, and MoCA may be more suitable for post-stroke cognitive assessment.

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