Brain Fog After Heart Failure Improves With Walking And Brain Games
The older you get, the more likely you are to worry about keeping your memory intact. If you are among the 5.7 million adults in the United States living with heart failure, a potentially fatal condition, you might have another reason for concernbrain fog, a subtle form of memory loss.¹
Certainly, losing your mental alertness is something youd want to avoid or postpone long into the future. To address this concern, a research team from Emory University initiated a study to explored whether people with heart failure who do brain exercises in combination with aerobic exercise might improve their cognitive losses or lessen the forgetfulness that occurs, often too subtle for most individuals to notice.²
Memory fogginess commonly occurs after heart failure and may be lessened by doing BrainHQ exercises and walking. Photo: 123rf
The fix is relatively simpleexercising your brain and your body appear to lessen this so-called brain fog,² according to a study appearing in the American Journal of Geriatric Psychiatry.
Memory Loss Due To Anxiety
Memory loss is a usual anxiety symptom. The person loses track of where things belong, where they were left, and sometimes what they are called. Sometimes the person describes things in a round about fashion because he just can’t remember the names for them. Anxiety is like being in a panic all of the time.
How Is Vascular Dementia Diagnosed
In addition to a complete medical history and physical exam, your healthcare provider may order some of the following:
- Computed tomography . This imaging test uses X-rays and a computer to make horizontal, or axial images of the brain. CT scans are more detailed than general X-rays.
- FDG-PET scan. This is a PET scan of the brain that uses a special tracer to light up regions of the brain.
- Electroencephalogram . This test measures electrical activity in the brain
- Magnetic resonance imaging . This test uses large magnets, radiofrequencies, and a computer to make detailed images of the brain.
- Neuropsychological assessments. These tests can help sort out vascular dementia from other types of dementia and Alzheimer’s.
- Neuropsychiatric evaluation. This may be done to rule out a psychiatric condition that may resemble dementia.
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Concussions And Head Injuries
Concussions and traumatic head injuries can cause short-term memory impairment, but some research has found that they can also increase the likelihood for the development of dementia over the years.
Be sure to take steps like wearing protective headgear and helmets when playing sports. And, if you do sustain a concussion, it’s important to let your head fully heal before returning to regular activities and participating in sports. Discuss any headaches and concentration difficulties after a head injury with your doctor.
Visuospatial And Constructional Function
Visuospatial function allows a correct identification of objects in the surrounding environment and of their spatial relation and, consequently, a proper use of them. Impairment in visuospatial function limits topographical orientation, localization of points in space and judgement of direction and distance, cause visual object agnosia with difficulty to cope with facial or color recognition and alter visuoconstructive abilities . Several areas of parietal lobes, lateral prefrontal cortex, occipital cortex, medial and inferior temporal cortex, basal ganglia and white matter regions form a complex network that control visuospatial function.
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Circle Back To Function
Functionally speaking we will already be looking at certain things during our regular assessments, such as their ability to complete activities of daily living and perform their basic care needs, manage their medications and any other tasks that they would normally complete. These tasks may warrant the usual intervention by the therapy team but may also warrant support and education to the caregivers as these patients may require more support from a cognitive standpoint than they did previously.
During bathing and dressing tasks, depending on the severity of cognitive impairment, the person may have difficulty with sequencing the steps involved, they may be forgetful and perseverate on one aspect of the task, they may not have the ability to initiate basic hygiene needs, or be able to recognize if things have been completed thoroughly. This would be a great opportunity for the Speech Language Pathologist to coordinate with the Occupational therapist in order to institute the appropriate strategies and increase carryover of skills from one session to the next.
Do Physical And Mental Fitness Help Preserve Heart Health
The main finding is that the group that did both aerobic and brain exercises showed improvement in memory and functional measurements, Dr. Mahncke tells EndocrineWeb. Combining the two had the biggest effect.
There is very limited evidence that exercise or cognitive training is associated with improvement of mild cognitive impairment in heart failure, the authors note. This analysis provides evidence that a combined approach may be superior to either strategy alone to improve cognitive function in persons with stable heart failure.
However, a large randomized trial should be performed to determine if the beneficial effects of these interventional strategies are linked to improvement in mild cognitive impairment or whether the progression to dementia was simply slowed, the authors suggest.
Dr. Costanzo says she doesnt feel that the Emory University meta-analysis can be considered conclusive. The study group was made of just 69 patients, she points out. So they only used one percent of the patients they screened and it was not only a limited duration study but very selective and may not be representative of the heart failure population at large. Additionally, the study participants showed improvement in just one domain, verbal memory, and that improvement was not sustained beyond three months.
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Be Aware Of Patients’ Limitations
Heart failure often involves a complex treatment regimen that can be difficult to understand. Grogan likes patients to have a family member or caregiver at doctor appointments to understand the medications, the rationale for taking them, and the importance of being consistent on doses.
Richard S. Isaacson, MD, agrees. He is a neurologist at the University of Miami School of Medicine. âPeople with heart failure are going to have trouble understanding because their thinking skills are not as strong as they used to be. They often have multiple medical problems and difficulty understanding what they can do to help themselves,â he says. Handouts explaining heart failure and its treatments can often help remind people what they need to do and why they need to do it.
In the second study, Australian researchers ran mental tests on 35 people with heart failure, 56 people with another type of heart disease, and 64 healthy people. They also used magnetic resonance imaging scans to look at differences in the volume of grey matter in the brain.
People with heart failure had more problems with their immediate and long-term memory and had slower reaction speed than their healthy counterparts. The brain changes occurred in areas of the brain linked to demanding mental tasks and emotional processing.
Exactly why this occurs is not yet understood, the study authors report.
Can Brain Fog Be Improved By Lifestyle Strategies
To evaluate whether there is an effective treatment strategy, the researchers initiated a pilot study of 69 individuals, ages 51-71 years old, looking at the effects of a walking program combined with a brain training intervention on cognitive function in people receiving care for heart failure.²
The testing group comprised 54% women and 55% African American individuals.² The subjects, all of whom had been diagnosed with heart failure and who had confirmed brain fog, were divided into three groups:
BrainHQ training plus walking
Since the brain training and exercise group showed the strongest improvements in memory, the authors attributed that benefit to the brain training alone, says Henry Mahncke, PhD and CEO of the San Francisco-based Posit Science, who developed the memory training games that were used in the study.³
There are many cognitive training programs that have shown no beneficial effect or had poor results. However, BrainHQ has proven differentthere are more than 150 published papers showing benefits from BrainHQ exercises, Dr. Mahncke says.
In a recent review by five Alzheimer’s research centers, for example, BrainHQ was the only brain training program to achieve multiple “gold-standard” peer-reviewed papers showing efficacy most of the other brain training programs had none at all.
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Heart Problems Tied To Early Signs Of Dementia
Called vascular dementia, it is a type of mental decline thatâs thought to be caused by problems in blood flow to the brain. It is believed to be different from the loss of memory and function that happens in Alzheimerâs disease, which is linked to the buildup of proteins in the brain.
The study, which is published in the journal JAMA Neurology, followed 1,450 men and women in the Rochester, Minn., area. At the start of the study, all participants, who were in their 70s and 80s, were free of memory loss or thinking difficulties. Researchers gave them tests to measure brain function every 15 months.
After about four years, 348 people in the study had developed some form of mild cognitive impairment . This can include problems such as memory loss, having trouble making decisions, coming up with the right words, or navigating a familiar neighborhood.
Of those people, 94 had developed the type of mild cognitive impairment linked to vascular dementia. This type does not include memory loss, but does include the other problems such as with decision making, reasoning, and visual-spatial relations.
The link was particularly strong in women. Women with heart problems were about three times more likely to develop it than women without heart concerns. The link was not significant in men.
Pathophysiology Of Ci In Hf
Reduced Cerebral Blood Flow
It has well-established that HF usually has unfavorable effect on cerebral perfusion with decreased cerebral blood flow . According to previous studies, CBF could be reduced by nearly 1430% in chronic HF depending on the severity and chronicity of HF. Despite this, it can be managed using medical treatment, cardiac resynchronization therapy, left ventricular assist devices and heart transplantation . Several factors determine the reduced CBF in patients with HF. In addition to the systematic hypoperfusion caused by reduced cardiac output and blood pressure , the distortion of cerebrovascular autoregulation also appear to play critical roles in decreasing CBF . The cerebral autoregulation ability help maintain the adequate blood flow in the brain after using vasodilators. However, in patients with HF, microcirculatory changes, such as endothelial dysfunctions, reduced nitric oxide bioavailability, and vascular smooth muscle proliferations may lead to impaired cerebral autoregulation and abnormal cerebrovascular reactivity which appears as significant determinants of reduced CBF in HF .
Inflammation, Oxidation, and Immunity
In brief, the inflammation, oxidative stress, and immune response aggravate cognitive functions mainly via disruption of the BBB, damaging white matter and actitation of glial cells and, consequently, leading to CI .
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Ace Inhibitors And Angiotensin Receptor Blockers And Beta
ACE inhibitors and angiotensin receptor blockers have been shown to improve cognitive function in both hypertension and HF.4750 Beta-blockers worsen dizziness and hypotension in HF which is a theoretical risk for worsening cognitive function in fragile elderly HF patients. Sacubitril/valsartan in the PARADIGM-HF trial, whilst reducing mortality and morbidity was associated with more hypotension compared to patients randomized to enalapril,51 and there is an as yet unresolved concern about its potential to promoting Alzheimers disease52 via inhibition of NEP degradation of -amyloid and the potential accumulation of A in the brain. However, analyses of PARADIGM did not find any increased risk of dementia or Alzheimers.53,54
Devices used to treat HF such as left ventricular assist devices carry an increased risk of embolic stroke, bleeding, and thrombotic complications.55 Changes in systemic immune state, platelet function, and acquired von Willebrand syndrome may potentially lead to cerebral infarction and haemorrhage. Other devices such as Veno-arterial extracorporeal membrane oxygenation are similarly thought to lead to an increased risk of thrombosis, bleeding, and neurologic events.
When Its Time To See A Doctor
If youre not sure if loss of memory warrants a doctor visit, consider:
- Does your memory loss disrupt daily activities?
- How often do the lapses occur?
- Whats being forgottendetails of a conversation, or the conversation in its entirety?
- Are there signs of confusion ?
- Is the memory loss getting worse?
If someone is having trouble remembering the day of the weeknot the date, but Monday, Tuesday, Wednesdaythats concerning, says Dr. Karlawish. Other concerning signs are repetitive questions: They get an answer, then several minutes later, they ask the same question. Or they repeat a story: something about a recent event, but then 20 minutes later, they tell you the same story.
Its not unusual for people to deny theyre having memory problems or to downplay the issue, but a prompt diagnosis is important.
Arrive at some reasonable, common understanding that you ought to get it looked into, says Dr. Karlawish. They dont have to agree on everything youve seen, and you dont have to make it a confrontation. Just get to the point where you can agree that Gee, it would be good to get this checked out. Then, the key is to go with them to the appointment.
You dont need to find a specialist for an initial consultation. Instead, look close to home.
Start with a doctor who knows you well, so a primary care physician, says Dr. Karlawish. Ideally, people go in with someone who knows them wella spouse, child or close friendwho can speak to what theyve been seeing.
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Cognitive Impairment In Hf Patients: Cognitive Areas And Cerebral Regions Involved
Cognitive damage in HF involves different domains,, in particular HF adversely affects learning memory and delay recall, attention, executive function, psychomotor speed and working memory. Language and visuospatial ability are less affected in patients with HF even if very few studies assessed them in these patients.
In a cross-sectional study involving 249 patients with chronic systolic HF compared to age and education-matched 63 healthy people and 102 participants with major chronic disease other than HF, HF patients showed worse score in memory , psychomotor speed and executive functions assessed through validated tools for psychomotor speed and TMT-B and controlled oral word association for executive function). In the systematic review by Vogels pooled analysis showed diminished performance in memory, psychomotor speed/attention and global cognition when comparing HF patients to healthy subjects. Also in 577 hospitalized patients with acute HF, mean age 71 years, females about 50% of the sample, 33% showed memory problems, 40% slower processing speed and 56% impairment in executive tasks.
Neuroanatomical damages may concern both grey and white matter and they can be studied through magnetic resonance imaging with several methods such as T1 or T2-weighted images, voxel-based morphometry, diffusion technique, functional MRI.
Pathophysiology Cellular Mechanism And Risk Factors Of Ci In Hf
The underlying mechanism proposed for CI in HF is multifactorial but not fully elucidated. It is important to understand the pathophysiological mechanism regarding CI in HF for a promising diagnostic and therapeutic approach. Existing evidence indicated that hemodynamic alterations and molecular mechanisms may play important roles in the interaction between HF and CI. Also, common cardiovascular and non-cardiovascular comorbidities burden further link HF and CI with risk factors which have not been well established. A systematic summary addressing the potential pathophysiology and mechanisms is illustrated in Figure 3.
Figure 3. Proposed pathophysiology of cognitive impairment in heart failure. A, amyloid- BBB, blood-brain barrier BP, blood pressure CBF, cerebral blood flow CI, cognitive impairment CO, cardiac output HF, heart failure.
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Attention And Working Memory
Attention is the skill to focus selectively on a stimulus and it’s essential also for performance in different cognitive tasks. Cerebral areas involved in attention are many cortical and subcortical structures such as the frontal and parietal association cortex, basal ganglia, anterior cingulated cortex and the cerebellum. Working memory is the ability to actively hold multiple image and verbal information in mind, integrate and manipulate them and then retrieve them if necessary in a short time. The prefrontal cortex is crucial for the control of working memory but also parietal cortex, anterior cingulate, basal ganglia and cerebellar regions participate.
Monitoring Cognitive Function In Heart Failure
Multiple validated questionnaires exist to screen for, and to an extent, grade cognitive impairment. These include the Mini-Mental Status Examination and the Montreal Cognitive Assessment . Mildest on the spectrum of cognitive decline syndromes is mild cognitive impairment . It is advisable to screen for cognitive impairment, as it is similarly for depression when a patient is admitted with acute HF. Screening and review should also be regularly performed in the outpatient review setting, although primary care can often pick up earlier milder changes, perhaps being reported by carers and family members. The MMSE has been used to screen for cognitive deficits, but it is not very sensitive in detecting MCI. The MoCA has been said to be more sensitive to subtle changes.22 These screening tools can be helpful in differentiating acute from chronic cognitive decline in HF. The questionnaires detect clinical cognitive decline, whereas the pathophysiological antecedents may be there months or years earlier. For example, cerebral atrophy, white matter hyperintensities,23 loss of grey matter,24 and silent cerebral infarcts25 are frequent imaging findings in HF patients with and without cognitive dysfunction.26,27
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