NEUROPSYCHOLOGICAL FUNCTION IN PATIENTS WITH END-STAGE HEART-FAILURE BEFORE AND AFTER CARDIAC TRANSPLANTATION

This study was performed to examine cognitive function in patients wit h end-stage heart failure, to identify possible cardiovascular factors associated with cognitive function, and to evaluate changes in cognit ive function in a subgroup of patients who received heart transplantat ion. An extensive battery of neuropsychological tests were given to 62 patients with end-stage cardiac failure as part of their evaluation f or cardiac transplantation. Most patients were consecutive referrals, not selected because of cognitive complaints. A small subgroup of tran splanted (n = 7) and non-transplanted (n = 4) patients received a repe at neuropsychological examination. At initial examination, approximate ly 50% of the patients met criteria for impairment in reference to nor mal control values. Higher stroke volume index and cardiac index and l ower right atrial pressure were correlated with better cognitive funct ion. In the subgroup of patients re-examined, the transplanted patient s demonstrated significantly improved cognitive function, whereas the non-transplanted subjects were unchanged. These data indicate that in patients with end-stage heart failure there is a high prevalence of im paired cognitive function which is related to measures of cardiovascul ar efficiency. Preliminary evidence suggests that these impairments ma y be partially ameliorated by cardiac transplantation.