CONGESTIVE-HEART-FAILURE AND COGNITIVE IMPAIRMENT IN AN OLDER POPULATION

OBJECTIVE: Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable risk factors for cognitive impair ment (CI) for older persons is a very important issue. We examined the cross-sectional relation ship between CHF and CI in an older populati on. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: A tota l of 1339 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. MEASUREMENTS: Sociodemo graphic characteristics were recorded, as was the presence of cardiova scular diseases, including CHF classified according to the New York He art Association (NYHA) guidelines for disease severity; CI evaluated b y means of the Mini-Mental State Examination (MMSE), with a score of < 24 indicating impairment; geriatric depression scale (GDS) rating; blo od pressure (BP); and heart rate (HR). RESULTS: The final sample numbe red 10075; 172 subjects were excluded because of neurological disorder s and psychotropic therapy, and 92 were excluded because their BP, HR, or cognitive examination was not recorded. Prevalence of CHF was 8.2% , and 23.0% of subjects scored <24 on the MMSE. The prevalence of CHF in subjects with an MMSE score of <24 and greater than or equal to 24 was 20.2% and 4.6%, respectively (P < .001). Logistic regression analy sis showed that CHF was associated independently with CI by sex, age, educational level, GDS, diabetes, hypertension, alcohol consumption, s moking, atrial fibrillation, systolic and diastolic BP, and HR. The ri sk of CI was 1.96-fold greater in subjects with CHF (odds ratio: 1.96; 95% confidence interval: 1.07-3.58; P < .028). Systolic BP decrease w as correlated negatively with NYHA classes only in subjects with CI (r = -0.981; P < .020), whereas HR increase was correlated positively wi th NYHA classes only in subjects without CI (r = 0.985; P < .015). CON CLUSIONS: In our population, CHF is associated with CI in subjects age d 65 years and older. Systolic BP reduction and the lack of HR increas e, related to NYHA classes, might characterize cognitively impaired su bjects with CHF.