Validation of an instrument to measure cognitive function in patients with heart failure
2008
Background: Heart Failure (HF) patients are
reported to have twice the risk of having cognitive deficits
compared to the general population. Cognitive deficit in HF is
subtle and reversible. Cognitive deficit has a significant impact
on HF patients’ choices for planning their lifestyle, financial,
legal and personal affairs. Cognitive deficit also may decrease
compliance and cause delay in seeking health care, which
potentially could increase the risk of mortality and morbidity and
thus increase health care cost due to frequent hospitalization.
Although cognitive deficit is common among people with HF,
cognitive screening is not routinely performed due to lack of a
simple screening tool and the misconception that cognitive changes
are part of normal aging. Objective: To compare the Montreal
Cognitive Assessment (MoCA) with the Mini Mental Status Examination
(MMSE) regarding their reliability and appropriateness as tools to
measure cognitive function in persons with HF, and to validate both
measures against physiologic measures of cerebral perfusion.
Design: Cross sectional Setting and Sample: Ninety community
dwelling adults aged 50 and above with a clinical diagnosis of HF,
cared for by cardiologists affiliated with a tertiary university
hospital, who met the inclusion criteria were enrolled from January
to June of 2007. Measurement: Participants were simultaneously
administered the MMSE and the MoCA along with questionnaires to
measure covariates including: co-morbidity, depression, disability,
and the six-minute walk test. Clinical and demographic data were
collected via a questionnaire developed for the study. Cerebral
perfusion was measured using transcranial doppler to obtain
cerebral perfusion pressure (CPP) and impedance cardiograph to
obtain cardiac index (CI). Results: Participants were predominately
men 59 (66%), Caucasian (78%), aged 50-89 with mean age 62 (SD + 9
years), 54 % were in NYHA class II, and 32 % in NYHA class III, 80%
were in HF stage C, and 77% had low ejection fraction (<40%).
Hierarchical multiple regression and logistic regression analyses
revealed no significant correlation between cerebral perfusion
measures (CPP & CI) and cognitive measures (MMSE & MoCA).
However, the MoCA was found to be more sensitive than the MMSE in
identifying subtle cognitive changes. Forty nine (54.4%) of the
participants scored below the cut of score of 26 on the MoCA
suggesting mild cognitive impairment and 15 (16.7%) scored less
than 22 on the MoCA suggesting severe cognitive impairment while,
only two participants (2.2 %) scored less than 24 on the MMSE.
Sixty two of the participants (68.9%) scored poorly on the
Visuo-spatial/executive domain, short term memory (61.1%), and
delayed recall (86.7%) supporting current literature on domains of
subtle cognitive changes seen in HF. Language deficit was reported
among HF patients as poor IQ or learning skills by Mauro and
colleagues, which were identified among 64.4% of the participants
in our study. The MoCA also demonstrated an increased sensitivity
of 96% and…
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