Persons with heart failure (HF) frequently exhibit cognitive impairment with deficits in attention and memory. Depression is common in HF though its possible contribution to cognitive impairment is unknown. Cognitive dysfunction and depression may share common mechanisms in HF, as both are associated with similar abnormalities on neuroimaging. A total of 116 participants with HF ( 6 8 . 5 3 ± 9 . 3 0 years) completed a neuropsychological battery and self-report measures of depression. Regression models showed depression incrementally and independently predicted test performance in all cognitive domains. Follow-up partial correlations revealed that greater depressive symptoms were associated with poorer performance on tests of attention, executive function, psychomotor speed, and language. These results indicate that depressive symptoms are associated with poorer cognitive performance in HF though further work is needed to clarify mechanisms for this association and possible cognitive benefits of treating depression in persons with HF. 1. Introduction Heart failure (HF) is prevalent and now affects more than five million Americans [1]. Older adults with HF have high rates of mortality, hospital admissions, and debilitating symptoms such as shortness of breath, fatigue, and susceptibility to other medical problems [2]. Though less frequently examined, mental health issues are common in persons with HF. Many patients report decline in memory and other cognitive abilities and an estimated 25% to 75% of HF patients exhibit impairment on neuropsychological testing compared to normative data [3]. Deficits emerge in multiple cognitive abilities, specifically various types of memory [4, 5]. Executive functions such as attention and problem solving are also impaired. Similarly, depression is also common in persons with HF [6]. Though rates vary across studies, an estimated 21%–36% of heart failure patients can be diagnosed with depression, on the basis of both clinical diagnoses and elevated rates on various depression questionnaires [7, 8]. Few studies have directly examined the association between cognitive impairment and depression in persons with HF despite the likelihood of common mechanisms. For example, persons with HF exhibit numerous pathological changes on neuroimaging, including greater atrophy and the presence of white matter hyperintensities, frequently in frontal brain regions [9]. In turn, these changes are associated with increased depressive symptoms in healthy older adults and other patient samples [10, 11]. Such findings suggest that depression
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