Sex differences in cognitive functioning in patients with heart failure

International Journal of Cardiology, vol. 418, pp. 132603

Abstract

BACKGROUND: Cognitive impairment is common in patients with heart failure (HF) and impacts patients' life. Sex differences in HF-characteristics are well-established. We hypothesized that women and men with HF also differ in cognitive functioning and that this may be related to sex differences in HF-characteristics and vascular brain injury. METHODS: In the Heart-Brain Connection Study, 162 clinically stable HF patients (mean age 69.7 ± 10.0, 33 % women) underwent neuropsychological assessments and brain-MRI. Test results were standardized into z-scores for memory, language, attention/speed, executive functioning, and global cognition. Using linear models adjusted for age and education, we calculated sex differences (women-to-men: W-M∆) in cognitive functioning and examined effects of HF- and vascular brain injury-characteristics on these differences. RESULTS: Men more often had an ischemic cause of HF and lower NYHA-classes, whereas women more often had preserved left ventricular ejection fractions (LVEF). Women had a higher volume of white matter hyperintensities (WMHs) whereas non-lacunar infarcts and microbleeds were more prevalent in men. Women performed better on global cognition than men (W-M∆ in z-score 0.20, 95 %CI 0.03-0.37), predominantly on memory (0.40, 0.02-0.78). These differences were associated with ischemic HF-etiology, as adjustment attenuated these sex differences. After adjustment for non-lacunar infarcts, global cognition difference persisted, but the difference in memory functioning attenuated. Adjustments for NYHA-class, LVEF, WMHs, and microbleeds did not change the results. CONCLUSION: Women and men with HF differ in cognitive functioning, predominantly in memory functioning, these differences were related to some sex differences in HF-characteristics and vascular brain injury, but not to all.

Authors 11

1. Sanne Kuipers corresponding

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: s.kuipers-2@umcutrecht.nl

2. L. Jaap Kappelle

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

3. Jacoba P. Greving

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands

4. Raquel P. Amier

   Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands

5. Jeroen de Bresser Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

6. Esther E. Bron

   Erasmus MC

   Affiliation as printed

   Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands

7. Anna Elisabeth Leeuwis

   Amsterdam Neuroscience · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam

   Affiliation as printed

   Alzheimer Center Amsterdam & Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands

8. Nick Marcks

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands

9. Hester M. den Ruijter

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

10. Geert Jan Biessels

    Utrecht University · University Medical Center Utrecht

    Affiliation as printed

    Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

11. Lieza Geertje Exalto

    Utrecht University · University Medical Center Utrecht

    Affiliation as printed

    Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands