Heart Failure and Cognitive Function in the General Population: The Hoorn Study

AIM: To examine whether reduced cognitive functioning can be observed in early stages of left ventricular (LV) dysfunction and heart failure. METHODS AND RESULTS: In 313 individuals aged 59-87 years from the longitudinal non-demented population-based Hoorn Study, echocardiography was performed to measure markers of LV systolic and diastolic function at baseline (2000-01) and follow-up (2005-09), together with standardized physical examinations and brain natriuretic peptide (BNP) measurements. Heart failure was assessed echocardiographically at the follow-up examination only. Cognitive tests for information processing speed, memory, and attention and executive functioning were administered at follow-up. Linear regression analyses showed that baseline markers of LV diastolic function, but not LV systolic function, were associated with lower scores on attention and executive functioning at follow-up. Individuals with higher baseline BNP had lower scores on all three cognitive domains: standardized regression coefficients were -0.16 (-0.26 to -0.05), -0.17 (-0.28 to -0.05), and -0.28 (-0.37 to -0.19). Worse LV systolic and diastolic function at follow-up were associated with a worse performance on attention and executive functioning. Furthermore, individuals with heart failure at follow-up had lower scores on attention and executive functioning: -0.21 (-0.41 to -0.00). Higher BNP at follow-up was also associated with worse attention and executive functioning, even after adjustment for baseline BNP. CONCLUSIONS: Worse cognitive functioning can already be observed in early stages of LV dysfunction and heart failure. BNP is a target for further investigation as a risk factor for cognitive decline in the general population.