Detecting and Evaluating Cognitive Impairment in Heart Failure Patients

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Case Questions

1. What do you think is Mr. Reynolds’ Cardiac Diagnosis?

Click on the icon below to reveal the expert’s answer:

Expert Answer


Mr. Reynolds has systolic heart failure stemming from coronary artery disease, and his symptoms put him in New York Heart Association class III.


2. Mr. Reynolds’ Heart Failure is well-managed with medications of different appropriate classes. (T/F)

T

CORRECT: MR. Reynolds’ Heart Failure is well managed with medications from different appropriate classes: ACE inhibitor, a beta- blocker and a diuretic.

F

INCORRECT


3. Based on what you already know about Mr. Reynolds, what are his other comorbidities that are NOT currently well controlled? Please select all that apply.

Asthma

Incorrect: Asthma is currently well controlled

Pain

Incorrect: Mr. Reynolds is currently not in pain

Insomnia

Correct: No insomnia is reported by the patient, or his family care partner, patient is able to fall asleep and to stay asleep, but he is awakening 3-4 X during the night to use the bathroom.

Anxiety

Incorrect: No anxiety is reported, patient does not appear to be anxious

Depression

Correct: Symptoms of depression are reported by Mr. Reynolds’ daughter Rose, patient reports feeling sad at times. Depression assessment is warranted.

  • Depression in older adults is frequently accompanied by cognitive symptoms that may resolve with improved mood.
  • Older adults with HF and cognitive impairment frequently experience apathy – depressed affect without stated depressed mood. Apathy has poor response to antidepressant medications.

Cognitive impairment

Correct: Symptoms of cognitive impairment are reported by Mr. Reynolds’ daughter Rose during interview and endorsed on AD8 screen, though patient denies memory problems. Cognitive assessment is warranted.


4. Now we will review Mr. Reynolds’ current medications. Which current medications are appropriate and have well defined indications?

Furosemide

Not recommended: Mr. Reynolds does not have fluid overload, his furosemide can be reduced or stopped, to relieve his orthostatic hypotension and nocturia. Over-treatment with diuretics, in older adults, can results in fatigue and confusion.

Naproxen

Not recommended: Mr. Reynolds does not complain of pain. Naproxen should be stopped as it can worsen heart failure.

Albuterol inhaler

Recommended: Even though patient does not report active asthma symptoms, he still requires a rescue inhaler

Diphenhydramine

Not recommended: Mr. Reynolds dose not experience insomnia, diphenhydramine should be stopped because it is highly anticholinergic. Anticholinergic effects include: confusion, cognitive impairment, delirium, dry mouth, constipation, urinary retention.

Clonazepam

Not recommended: Mr. Reynolds does not have anxiety, Clonazepam should be gradually discontinued. Benzodiazepines increases risk of cognitive impairment, unsteady gait, psychomotor impairment, accidents, and delirium.


Green answers are correct.
Red answers are not correct.