Clinical Utility of Auditory Memory Testing in a Heart Failure Population
Dustin B. Hammers, PhD Assistant Professor, Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City. Miyeon Jung, MSN, RN Graduate Student, School of Nursing, University of Michigan, Ann Arbor. Susan Pressler, PhD, RN Professor and Associate Dean of Graduate Studies, School of Nursing, University of Michigan, Ann Arbor. Barbara-Jean Sullivan, PhD, NP Clinical Assistant Professor, School of Nursing, University of Michigan, and Anxiety Disorders Section, Department of Psychiatry, University of Michigan Depression Center, Ann Arbor. Todd Koelling, MD Associate Professor, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor. Bruno Giordani, PhD Associate Professor, Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor.The Journal of cardiovascular nursing (Impact Factor: 2.05). 06/2012; 28(5). DOI: 10.1097/JCN.0b013e318258abf3
BACKGROUND:: The self-care regimen necessary in heart failure (HF) is notably complex. A complication to integrating new knowledge and behaviors is that impaired cognition has been frequently reported in patients with HF, which significantly impacts patients' health, admission and mortality rates, and instrumental activities of daily living. OBJECTIVE:: The identification of reliable cognitive screening tools to assess potential difficulties in performing self-care for cardiac populations is essential. As such, the current purposes were to evaluate the validity and stability of the International Shopping List (ISL) auditory learning subtest from the computerized CogState battery as a screening tool in HF populations, determine the ISL's ability to predict functional declines, and evaluate the task's sensitivity in myocardial infarction. METHODS:: Forty patients with chronic HF were enrolled in a longitudinal study evaluating the impact of a cognitive training intervention. Baseline neuropsychological and behavioral measurements before treatment were used in the current study, including measures of auditory memory, orientation, verbal fluency, processing speed, and activities of daily living, and a subset of patients (n = 17) received repeat testing at 8 weeks on some tasks. Analyses also were performed with patients organized based on myocardial infarction status. RESULTS:: The current study indicated that the ISL performed comparably with an established measure of auditory memory (Hopkins Verbal Learning Test-Revised; r = 0.70, P < .001), displayed adequate coefficients of stability (r = 0.53-0.68), and successfully predicted declines over time in daily functioning (β = .47, P < .001) in our HF sample. CONCLUSIONS:: The computerized CogState auditory memory subtest, the ISL, seems to be a beneficial tool in evaluating cognitive change in HF patients. Particularly given its cross-cultural sensitivity and ease of administration and scoring, this task may provide assistance to quickly and reliably monitor memory functioning in these vulnerable patients and gauge their potential for self-care behaviors.
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ABSTRACT: Memory loss is common in heart failure (HF) patients but few interventions have been tested to treat it. The objective was to evaluate efficacy of a cognitive training intervention, Brain Fitness, to improve memory, serum brain-derived neurotrophic factor (BDNF) levels, working memory, processing speed, executive function, instrumental activities of daily living, mobility, depressive symptoms, and health-related quality of life. Twenty-seven HF patients were randomly assigned to Brain Fitness and health education active control interventions. Data were collected at baseline and 8 and 12 weeks. Linear mixed models analyses were completed. Patients in Brain Fitness group were older with lower ejection fraction. At 12 weeks, a group by time interaction effect was found for serum BDNF levels (p = .011); serum BDNF levels increased among patients who completed Brain Fitness and decreased among patients who completed health education. No differences were found in memory, but a group by time interaction (p = .046) effect was found for working memory. Findings support efficacy of Brain Fitness in improving working memory and serum BDNF levels as a biomarker of intervention response. A randomized controlled study is needed among a larger more diverse group of HF patients. Copyright © 2015 Elsevier Inc. All rights reserved.
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ABSTRACT: To evaluate the safety, efficacy, and performance of the TriGuard™ HDH Embolic Deflection Device (TriGuard) compared with no cerebral protection in patients undergoing transcatheter aortic valve implantation (TAVI). From February 2014 to March 2015, 85 subjects undergoing TAVI at 13 centres in Europe and Israel were randomized to TriGuard protection vs. no protection. Subjects underwent neurologic and cognitive evaluation at baseline, pre-discharge and 30 days; cerebral diffusion-weighted magnetic resonance imaging was performed at 4 ± 2 days post-procedure and at 30 days. Technical success, which included complete 3-vessel cerebral coverage, was achieved in 88.9% (40/45) of cases. The primary in-hospital procedural safety endpoint (death, stroke, life-threatening or disabling bleeding, stage 2 or 3 acute kidney injury, or major vascular complications) occurred in 21.7% of TriGuard and 30.8% of control subjects (P = 0.34). In the Per Treatment population (subjects with complete three-vessel cerebral coverage), TriGuard use was associated with greater freedom from new ischaemic brain lesions (26.9 vs. 11.5%), fewer new neurologic deficits detected by the National Institutes of Health Stroke Scale (3.1 vs. 15.4%), improved Montreal Cognitive Assessment (MoCA) scores, better performance on a delayed memory task (P = 0.028) at discharge, and a >2-fold increase in recovery of normal cognitive function (MoCA score >26) at 30 days. TriGuard cerebral protection during TAVI is safe and complete cerebral vessel coverage was achieved in 89% of subjects. In this exploratory study, subjects undergoing protected TAVI had more freedom from ischaemic brain lesions, fewer neurologic deficits, and improved cognitive function in some domains at discharge and 30 days compared with controls. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: firstname.lastname@example.org.
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ABSTRACT: Aims and objectivesTo evaluate the validity of the Chinese version of the CogState battery, a computerised cognitive testing among patients with heart failure in Taiwan.Background Cognitive deficits are common in patients with heart failure and a validated Chinese measurement is required for assessing cognitive change for this population. The CogState computerised battery is a measurement of cognitive function and has been validated in many languages, but not Chinese.DesignA cross-sectional study.MethodsA convenience sample consisted of 76 women with heart failure and 64 healthy women in northern Taiwan. Women completed the Chinese version of the CogState battery and the Montreal Cognitive Assessment. Construct validity of the Chinese version of the battery was evaluated by exploratory factor analysis and known-group comparisons. Convergent validity of the CogState tasks was examined by Pearson correlation coefficients.ResultsPrincipal components factor analysis with promax rotation showed two factors reflecting the speed and memory dimensions of the tests. Scores for CogState battery tasks showed significant differences between the heart failure and healthy control group. Examination of convergent validity of the CogState found a significant association with the Montreal Cognitive Assessment.Conclusion The Chinese CogState Battery has satisfactory construct and convergent validity to measure cognitive deficits in patients with heart failure in Taiwan.Relevance to clinical practiceThe Chinese CogState battery is a valid instrument for detecting cognitive deficits that may be subtle in the early stages, and identifying changes that provide insights into patients’ abilities to implement treatment accurately and consistently. Better interventions tailored to the needs of the cognitive impaired population can be developed.
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