Heart attacks and cognitive decline

Mild cognitive impairment, especially memory loss, is prevalent in patients with heart failure and contributes to poor clinical outcomes and higher mortality. A study completed in February looked at this issue. The primary aim of this study (Exercise and Cognitive Training as a Strategy to Improve Neurocognitive Outcomes in Heart Failure: a pilot study) was to evaluate the efficacy of an aerobic exercise (walking) and cognitive training intervention on cognitive function compared to exercise alone.

While heart failure is distressing alone, its interaction with cognitive decline creates a downward spiral. The study authors point out that heart failure “negatively impacts function in most cognitive domains” adversely affecting a patient’s “capacity to participate in essential self-care activities, such as managing complex medication regimens and adhering to dietary restrictions.” 

The cognitive impact is often serious, with an estimated 25 to 50 percent of stable chronic heart failure patients experiencing pre-dementia conditions of mild to moderate cognitive impairment.

This is the first study to measure the impact of a combined regimen of physical exercise and brain exercise on heart failure patients.

The main finding of the study was that participants in the combined aerobic exercise and cognitive training program had significant improvement in verbal memory at 3 months and a trend for sustained improvement at 6-months compared to exercise alone or the attention control usual care groups. In addition, the combined group also had significant improvement in the six-minute walk distance at 3 months compared to the other groups.

Since exercise and cognitive therapy were associated with improved memory in some of the people in the study further investigation the authors of the study believe that more research should be undertaken in a larger trial. The relationship between functional capacity and cognitive function also needs further study.

There is very limited evidence that exercise or cognitive training is associated with improvement of mild cognitive impairment in heart failure. This study provides evidence that a combined approach may be superior to either strategy alone for improving cognitive function in persons with stable heart failure. Large, high-quality randomized trials are needed to determine if the beneficial effects of these intervention strategies are associated with improvement in mild cognitive impairment or slow the progression to dementia.