Cognitive function and left ventricular assist device implantation

Abstract

Background: Cognitive impairment is frequent in patients with heart failure (HF) and can lead to poor quality of life and increased risk of mortality. The Montreal Cognitive Assessment (MoCA) is a simple screening tool that is sensitive to mild cognitive impairment (MCI) and that has been validated in the settings of neurologic and cardiovascular disease. This study determined the extent of cognitive impairment in patients with HF undergoing evaluation for advanced surgical therapy and evaluated changes in MoCA score with follow-up cognitive assessment at 8 months after left ventricular assist device (LVAD) implantation.

Methods: As part of routine assessment for LVAD candidacy, 176 patients with advanced HF were administered the MoCA; 56 patients were reevaluated 8 months after LVAD implantation.

Results: Patients with MCI, indicated by MoCA score <26 out of 30, made up 67% of the study cohort. MCI was associated with significantly older age, higher CHADS2 (congestive HF, hypertension, age >75 years, diabetes mellitus, prior stroke or transient ischemic attack) risk score, statin use, history of stroke and hypertension, and reduced serum cholesterol levels. In 56 patients who underwent follow-up evaluation after LVAD implantation, total MoCA score and visuospatial, executive, and delayed recall cognitive domains were significantly improved.

Conclusions: This study assessed the use of the MoCA in patients with end-stage HF being evaluated for advanced surgical therapy. We found the MoCA to be a rapid, simple, and powerful tool for detecting cognitive impairment in these patients. MCI was highly prevalent in the cohort. Significant improvement in overall MoCA score was noted after LVAD implantation.

Keywords: Montreal Cognitive Assessment (MoCA); cognitive function; heart failure (HF); left ventricular assist device (LVAD); mild cognitive impairment (MCI).