Background

The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population.

Purpose

To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients’ functional status.

Methods

This study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke’s Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE).

Results

100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT.

Conclusions

Psychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.

中文翻译：

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心理运动速度是参加心脏康复的老年慢性心力衰竭（CHF）患者功能状态的预测指标。

背景

慢性心力衰竭（CHF）中心理，神经心理功能障碍和功能/临床变量之间的关联已在文献中得到了广泛解决。但是，只有少数研究调查了老年人口中的这些关联。

目的

为了评估老年CHF患者的心理/神经心理特征，探索与临床/功能变量的相互关系，并确定患者功能状态的潜在独立预测因子。

方法

这项研究是采用多中心观察设计进行的。进行以下评估：焦虑（医院焦虑和抑郁量表，HADS），抑郁（老年抑郁量表，GDS），认知障碍（Addenbrooke认知检查修订版，ACE-R），执行功能（前额评估电池，FAB），建设性能力（钟表测试，CDT），精神运动速度和交替注意力（足迹制作测试，TMT-A / B），功能状态（6分钟步行测试，6MWT）和临床变量（纽约心脏协会，NYHA；脑钠尿）肽，BNP；左心室射血分数，LVEF；左心室舒张末期直径，LVEDD；左心室舒张末期容积，LVEDV；三尖瓣环平面收缩期偏移，TAPSE）。

结果

该研究包括100名CHF患者（平均年龄：74.9±7.1岁；平均LVEF：36.1±13.4）。分别在16％和24.5％的患者中观察到焦虑和抑郁症状。年龄与TMT-A和CDT有关（分别为r = 0.49，p <0.001和r = -0.32，p = 0.001），Log-BNP与ACE-R-Fluency子测试有关（r = -0.22，p = 0.034），而6MWT与ACE-R-Memory子测试和TMT-A有关（r = 0.24，p = 0.031和r = -0.32，p = 0.005）。焦虑和抑郁症状均与ACE-R总得分有关（r = -0.25，p = 0.013和r = -0.32，p = 0.002），抑郁症状与CDT有关（r = -0.23，p = 0.024）。在多元回归分析中，Log-BNP和TMT-A是功能状态的重要且独立的预测指标：

结论

心理和神经心理学筛查以及对精神运动速度（TMT-A）的评估，可能为接受心脏康复的老年CHF患者提供有用的信息。