Heart Failure and Cognitive Impairment in the Atherosclerosis Risk in Communities (ARIC) Study

Lucy S. Witt, Jason Rotter, Sally C. Stearns, Rebecca F. Gottesman, Anna M. Kucharska-Newton, A. Richey Sharrett, Lisa M. Wruck, Jan Bressler, Carla A. Sueta, Patricia P. Chang

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background: Previous studies suggest that heart failure (HF) is an independent risk factor for cognitive decline. A better understanding of the relationship between HF, cognitive status, and cognitive decline in a community-based sample may help clinicians understand disease risk. Objective: To examine whether persons with HF have a higher prevalence of cognitive impairment and whether persons developing HF have more rapid cognitive decline. Design: This observational cohort study of American adults in the Atherosclerosis Risk in Communities (ARIC) study has two components: cross-sectional analysis examining the association between prevalent HF and cognition using multinomial logistic regression, and change over time analysis detailing the association between incident HF and change in cognition over 15 years. Participants: Among visit 5 (2011–2013) participants (median age 75 years), 6495 had neurocognitive information available for cross-sectional analysis. Change over time analysis examined the 5414 participants who had cognitive scores and no prevalent HF at visit 4 (1996–1998). Measurements: The primary outcome was cognitive status, classified as normal, mild cognitive impairment [MCI], and dementia on the basis of standardized cognitive tests (delayed word recall, word fluency, and digit symbol substitution). Cognitive change was examined over a 15-year period. Control variables included socio-demographic, vascular, and smoking/drinking measures. Results: At visit 5, participants with HF had a higher prevalence of dementia (adjusted relative risk ratio [RRR] = 1.60 [95% CI 1.13, 2.25]) and MCI (RRR = 1.36 [1.12, 1.64]) than those without HF. A decline in cognition between visits 4 and 5 was − 0.07 standard deviation units [− 0.13, − 0.01] greater among persons who developed HF compared to those who did not. Results did not differ by ejection fraction. Conclusion: HF is associated with neurocognitive dysfunction and decline independent of other co-morbid conditions. Further study is needed to determine the underlying pathophysiology.

Original languageEnglish
Pages (from-to)1721-1728
Number of pages8
JournalJournal of General Internal Medicine
Issue number10
StatePublished - Oct 1 2018

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Neurocognitive data is collected by U01 HL096812, HL096814, HL096899, HL096902, HL096917 with previous brain MRI examinations funded by R01-HL70825. Dr. Gottesman is supported by NIH/NIA grant K24 AG052573. We also thank Jo Ellen Rodgers, Pharm D for her insight and thoughtfulness. The authors thank the staff and participants of the ARIC study for their important contributions.

Publisher Copyright:
© 2018, Society of General Internal Medicine.


  • cognitive decline
  • cognitive impairment
  • dementia
  • heart failure

ASJC Scopus subject areas

  • Internal Medicine


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