Cognitive Impairment Assessment In Heart Failure Patients in Singapore
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Cognitive Impairment Assessment In Heart Failure Patients in Singapore


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Heart failure is amongst the major causes of mortality in the modern world, where the prevalence for the adult population is around 6-10%; while for elderly over 70 years, its ≥ 10% (Leto and Feola, 2014). Over the years, Heart failure (HF) has impacted the quality of life of the people, and further increased the hospital costs. As per a report by Elsevier (2009), many older patients with HF have been found to have increased precedence of dementia, memory problems and cognitive challenges. In their review, Dardiotis et al. (2012), argues that the cognitive impairment (CI) mechanism for the HF patients is though unclear, yet, it can be associated with the ischemic brain damage and impaired cerebral vessel reactivity, associated with the condition.

Owing to the CI, the patients with HF have increased challenges in following the dietary and lifestyle changes, which further contributes towards their increased hospital visits and poor life quality. In their review, Celutkiene et al. (2016) argues that CI can be a poor prognostic sign for the HF patients, since beyond the inability to 'remember the instructions', poor CI has been associative with disruption of the blood–brain barrier, cerebral hypo-perfusion, and oxidative damage (Celutkiene et al. 2016). While, many western studies have assessed the impact of CI in the HF patient (Grubb, Simpson & Fox, 2000; cited by Vogels et al, 2007). There is an evident gap in the context of the Asian population, where it is reflected that the markers of cerbero vascular ailments are studied in the context of dementia patients, yet, the reverse relations remain under-studied (Hilal et al. 2015). The study advocates the need for the standardization for the assessment of CI in the HF patients. It is thus argued that there is a need for the guideline which asses the neuropsychological parameters, yet, at the same time is adapted as per the local language and culture of the patients. through this pilot study, the of our Singapore-adapted National Institute of Neurological Disease and Stroke – Canadian Stroke Network (NINDS-CSN) neurocognitive battery of tests (NINDS-CSN) tool in heart failure patients has been indicated for this purpose. The study will assess the experience and obstacle of using this tool in the Singaporean HF patients for CI assessment. The results will help in forming future guideline for screening CI in heart failure patients within the Asian countries.



As per a study conducted by Leto and Feola (2014), that cognitive functioning and the elements of memory, working memory, executive functioning, language and visuo-spatial functioning are collectively impacted in any cognitive imbalance. In their study, Harkness et al. (2011) noted that the patients above 65 years with HF background had cognitive impairment, as was assessed as per Montreal cognitive assessment (MOCA) test, with a test of 17–25. Other tests in this realm includes the Rivermead Behavioural memory test, and the mini mental state examination (MMSE) which in past has suggested the presence of CI owing to the acute decompensation in patients of myocardial infarction/stroke (Leto and Feola, 2014). 

A comprehension of the same, provides not only the level of cognitive impairment for the patients, but also prepare the physicians in preparing a framework for the addressing of the patients' needs through an effective framework. The increased distress in the patients of HF is to be expected in view of the mortality rate of the condition. However, as per Finkelstein (2017), there is also a need to understand the level of emotional and cognitive impact the ailment has on the patient to further understand the prognosis of the condition. However, as Finkelstein (2017) points out, there is a lack of research with respect to this group in the past within Singapore.

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