Nonfocal transient neurological attacks are related to cognitive impairment in patients with heart failure

Eline A. Oudeman*, Jacoba P. Greving, Astrid M. Hooghiemstra, Hans-Peter Brunner-La Rocca, Geert Jan Biessels, L. Jaap Kappelle, M. J. Daemen, M. A. van Buchem, R. J. van der Geest, M. J. P. van Osch, A. de Roos, W. M. van der Flier, A. C. van Rossum, M. A. Ikram, P. J. Koudstaal, W. J. Niessen, R. van Oostenbrugge, M. L. Bots, Heart-Brain Connection Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction Nonfocal transient neurological attacks (TNAs) are associated with an increased risk of future dementia, but it is unclear whether TNAs are also associated with concurrent cognitive impairment. We hypothesized that recent TNAs are related to worse cognitive functioning. We tested our hypothesis in patients with heart failure, as these patients are at risk of cerebral hypoperfusion, which might play a role in the etiology of TNAs.

Methods We performed neuropsychological testing in all patients with heart failure enrolled in the Heart Brain Connection study. We assessed global cognition, attention-psychomotor speed, executive functioning, memory and language. All patients were interviewed with a standardized questionnaire on the occurrence of TNAs in the preceding 6 months. We studied associations between TNAs and cognitive functioning with linear and logistic regression analyses, adjusted for age, sex and education. We performed additional analyses in patients without previous stroke or TIA and in patients without brain infarction on MRI.

Results Thirty-seven (23%) of 158 patients (mean age 70 years, 67% men) experienced one or more TNAs. Patients with a recent TNA were more likely to be impaired on >= 1 cognitive domains than patients without TNAs [41% vs. 18%, adjusted odds ratio 4.6, 95% confidence interval (CI) 1.8-11.8]. Patients with TNAs performed worse than patients without TNAs on global cognition (mean difference in z scores -0.36, 95% CI -0.54 to -0.18), and on the cognitive domains attention-psychomotor speed (mean difference -0.40, 95% CI -0.66 to -0.14), memory (mean difference -0.57, 95% CI -0.98 to -0.15) and language (mean difference -0.47, 95% CI -0.79 to -0.16). These associations were independent of cardiac output and volume of white matter hyperintensities. Subgroup analyses in patients without previous stroke or TIA or brain infarction on MRI (n=78) yielded comparable results, with the exception of the cognitive domain language, which was no longer different between patients with and without TNAs.

Conclusion Among patients with heart failure, TNAs are associated with cognitive impairment, which warrants the need for more clinical awareness of this problem.

Original languageEnglish
Pages (from-to)2035-2042
Number of pages8
JournalJournal of Neurology
Volume266
Issue number8
DOIs
Publication statusPublished - Aug 2019

Keywords

  • Cognitive functioning
  • Cognitive impairment
  • Transient neurological attacks
  • Heart failure
  • CEREBRAL-BLOOD-FLOW
  • PARTICIPANTS AGED 24-81
  • NORMATIVE DATA
  • ISCHEMIC ATTACK
  • EDUCATION
  • STATEMENT
  • DEMENTIA
  • DISEASE
  • RISK
  • SEX

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