Identifying cognitive impairment in heart failure: A review of screening measures

Objectives: To identify and evaluate screening tools that have been used in heart failure (HF), and determine their usefulness and feasibility in the clinical setting. Background: There is increasing evidence that HF is associated with a pattern of cognitive impairment (CI) characterized by subtle deficits particularly in the domains of memory, attention, and executive function with increasing evidence of mild cognitive impairment (MCI). A standard, effective CI screening measure for HF has not been identified. Methods: A review of the literature published from January 2000 to May 2011 was conducted to identify studies that used one or more screening instrument to identify or describe CI in HF. Results: Seven screening instruments were identified across the 23 studies reviewed. The screening approaches vary in length, cut points, scoring methods, and cognitive domains covered. Conclusions: The Mini Mental State Exam is the most frequently used screening measure, but does not appear to be an adequate instrument to detect the type of cognitive impairment seen in HF. Combining instruments such as the Clock Drawing test with the Abbreviated Mental test would screen for deficits in the appropriate cognitive domains. The Montreal Cognitive Assessment is more comprehensive and appears to be a suitable screening tool for HF. A standard, brief, sensitive screening instrument designed to detect subtle cognitive impairment in the areas of attention, memory, executive function, and psychomotor speed should be adopted for use in HF.