Cognitive impairment (CI) is increasingly recognized as a common adverse consequence of heart failure (HF). Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients' decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches. 1. Introduction Heart failure (HF) is a major and growing health problem in the developed world that affects 1-2% of the adult population and 6–10% of people over the age of 65 [1, 2]. HF is associated with frequent hospital admissions, reduced quality of life, significant morbidity, and increased mortality [3–6]. It is estimated that elderly HF patients have high readmission rates ranging from 40 to 50% within 6 months [7]. Significant predictors of HF decompensation and high readmission rates include patients’ poor compliance with therapy and diet restrictions, and their failure to recognize early symptoms of HF deterioration which may be the consequences of cognitive impairment (CI) and poor insight [8]. Several studies have demonstrated that CI is particularly common in HF with 30% to 80% of patients with HF experiencing some degree of cognitive impairment [9, 10]. This wide range in CI prevalence estimates is believed to be the result of diverse study designs, HF severity, age of patients, sample sizes, neuropsychological tests, and diagnostic criteria between different studies. HF adversely affects various aspects of cognitive functioning, including attention, learning ability and delay recall, working memory, executive function, and psychomotor speed [9–11]. Areas of cognition less affected are the
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