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The influence of heart failure on longitudinal changes in cognition among individuals 80 years of age and older
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Jönköping University, Sweden.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University, Sweden.
Jönköping University, Sweden.
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2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 7-8, 994-1003 p.Article in journal (Refereed) Published
Abstract [en]

Aim.  The aim of this study was to examine the relationship between heart failure and specific cognitive abilities in octogenarians with regard to level and change over time.

Background.  Cognitive impairment is influenced by many factors, and the impact of heart failure is debated. Intact cognitive ability is crucial for successful self-care in patients with heart failure. Middle-aged patients with heart failure seem to have an increased risk of cognitive impairment. No studies have examined the association between heart failure and longitudinal cognitive changes in octogenarians (individuals 80 years and older).

Design.  A prospective longitudinal design.

Methods.  Cognitive tests were carried out five times (1991–2002) in 702 octogenarians from the Swedish Twin Registry, including same-sex twin pairs. The test battery included the measurement of processing speed, visuospatial ability, short-term, episodic and semantic memory. Latent growth curve modelling was employed to measure change and performance over time and compares the group diagnosed with heart failure to individuals without a heart failure diagnosis.

Results.  At baseline, the participants’ mean age was 83·5 years, 67% were women and 13% suffered from heart failure. Individuals diagnosed with heart failure scored significantly lower in spatial abilities and episodic memory than participants not diagnosed with heart failure. Moreover, measures of episodic memory declined more over time in individuals diagnosed with heart failure. There were no significant differences between the groups in other cognitive tests.

Conclusion.  Spatial problems and episodic memory have implications for everyday life. This might contribute to decreased adherence to prescribed therapy and self-care management and lead to socio-behavioural problems because of an impaired capacity to drive, read and write.

Relevance to clinical practice.  Nurses should take into account in their assessment that cognitive impairment may restrain elderly heart failure patient’s ability to make decisions and perform self-care actions. Patient education strategies should also be adapted to cognitive ability.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012. Vol. 21, no 7-8, 994-1003 p.
Keyword [en]
chronic heart failure, cognitive dysfunction, episodic memory, heart failure, neuropsychological testing, octogenarians, patient education, self-care, spatial abilities
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-74495DOI: 10.1111/j.1365-2702.2011.03817.xISI: 000301427600012PubMedID: 21883570OAI: diva2:486029

funding agencies|Health Research Council in the South-East of Sweden||Faculty of Health Science at LinkopingUniversity||US National Institute on Aging of the National Institutes of Health| NIA:AG08861 |Swedish Council for Working Life and Social Research||Adlerbertska Foundation||Hjalmar Svensson Foundation||Knut and Alice Wallenberg Foundation||Wennergren Foundations||Wilhelm and Martina Lundgrens Foundation||Department of Medical Epidemiology and Biostatistics||Karolinska Institute, Stockholm, Institute of Gerontology, School of Health Sciences, Jonkoping||

Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2014-04-16Bibliographically approved
In thesis
1. Cognitive function in elderly patients with chronic heart failure
Open this publication in new window or tab >>Cognitive function in elderly patients with chronic heart failure
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]


Approximately 1-2% of the adult population in developed countries suffer from heart failure (HF), with the prevalence rising to more than 10% among patients 80 years of age or older. The HF syndrome is associated with elevated mortality and morbidity, and decreased quality of life. Cognitive dysfunction has been reported in patients suffering from a variety of cardiovascular disorders. However, few studies have systematically assessed cognitive performance in HF patients, its prevalence and other factors influencing cognition in HF patients. Further, it is of great interest to understand the relationship between self-care in HF and cognition. It may be important to screen for cognitive dysfunction as it may influence HF patients’ ability to perform self-care, e.g. make lifestyle changes, adhere to medical treatment and monitor, evaluate and treat symptoms of deterioration.


The overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care.

Design and method

This thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included.

Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients.


Study I found that  octogenarians with HF had significantly poorer spatial performance and episodic memory, and that the episodic memory declined more over time compared to a non-HF population of the same ages.

Study II showed that octogenarians with HF had a significantly higher prevalence of vascular dementia, 16% vs. 6%, and all types of dementia, 40% vs. 30%, than those not diagnosed with HF. Factors related to dementia in individuals with HF were depression, hypertension and increased levels of homocysteine. Diabetes was associated with an increased risk for vascular dementia.

In study III we found that  HF patients with sleep disordered breathing (SDB) (apnoea-hypopnoea index >15) had significantly higher saturation time < 90%, more difficulties maintaining sleep and lower levels of daytime sleepiness compared to those in the non-SDB group. Cognitive function did not differ between the SDB and the non-SDB-group. Only insomnia was associated with a decreased global cognititive function measured with the Mini Mental State Examination instrument.

Finally, in study IV, the relationship between self-care and different dimensions of cognitive function was explored. Psycho- and visuomotor function (speed and attention) was the only dimension of cognitive function associated with self-care.


Octogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems.  

Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 72 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1365
Chronic heart failure, cognitive dysfunction, dementia, elderly, oldest-old, prevalence, risk factors, self-care, sleep
National Category
urn:nbn:se:liu:diva-96398 (URN)978-91-7519-602-2 (print) (ISBN)
Public defence
2013-09-13, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Swedish Heart Lung Foundation
Available from: 2013-08-27 Created: 2013-08-18 Last updated: 2013-09-03Bibliographically approved

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Hjelm, CarinaBroström, AndersStrömberg, Anna
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Nursing ScienceFaculty of Health SciencesDepartment of Thoracic and Vascular SurgeryDepartment of Clinical NeurophysiologyDepartment of Cardiology in Linköping
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