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.