Relationships Among Cognitive Function and Cerebral Blood Flow, Oxidative Stress, and Inflammation in Older Heart Failure Patients

Background The mechanisms for cognitive impairment in heart failure (HF) are unclear. We investigated the relative contributions of cerebral blood flow velocity (BFV), oxidative stress, and inflammation to HF-associated cognitive impairment. Methods and Results Thirty-six HF patients (≥60 years) and 40 healthy controls (68 ± 7 vs 67 ± 5 years, P > .05; 69% vs 50% male, P > .05) completed the Cognitive Drug Research computerized assessment battery and Stroop tasks. Common carotid (CCA) and middle cerebral arterial BFV were obtained by transcranial Doppler. Blood samples were collected for oxidant (diacron-reactive oxygen metabolites; F₂-isoprostanes), antioxidant (coenzyme Q₁₀; CoQ₁₀), and inflammatory markers (high-sensitivity C-reactive protein). Compared with controls, patients exhibited impaired attention (Cognitive Drug Research's Power of Attention domain, congruent Stroop) and executive function (incongruent Stroop). Multiple regression modeling showed that CCA-BFV and CoQ₁₀ but not group predicted performance on attention and executive function. Additionally, in HF patients, CCA-BFV and CoQ₁₀ (β = −0.34 vs β = −0.35) were significant predictors of attention, and CCA-BFV (β = −0.34) was a predictor of executive function. Conclusions Power of Attention and executive function is impaired in older HF patients, and reduced CCA-BFV and CoQ₁₀ are associated with worse cognition. Interventions addressing these mechanisms may improve cognition in older HF patients.