Advertisement

Aging Clinical and Experimental Research

, Volume 24, Issue 5, pp 468–474 | Cite as

The 2-minute step test is independently associated with cognitive function in older adults with heart failure

  • Michael L. AloscoEmail author
  • Mary Beth Spitznagel
  • Naftali Raz
  • Ronald Cohen
  • Lawrence H. Sweet
  • Lisa H. Colbert
  • Richard Josephson
  • Donna Waechter
  • Joel Hughes
  • Jim Rosneck
  • John Gunstad
Original Article

Abstract

Background and aims: Cognitive impairment is common in persons with heart failure (HF), and measures like the 6-minute walk test (6MWT) are known to correspond to level of impairment. The 2-minute step test (2MST) has been suggested as a more practical alternative to the 6MWT, though no study has examined whether it is associated with cognitive impairment in persons with HF. This study examined whether the 2MST is associated with cognitive function in older adults with HF. Methods: Older adults with HF (n=145; 68.97±9.31 yrs) completed the 2MST and a neuropsychological test battery that assessed function in multiple cognitive domains. Results: Consistent with past work, HF patients exhibited high rates of cognitive impairment. Hierarchical regression analyses adjusting for demographic and medical characteristics found that the 2MST accounted for unique variance in global cognitive function (ΔR2=0.09, p<0.001), executive function (ΔR2=0.03, p<0.05), and language (ΔR2=0.10, p<0.001). A trend emerged for attention (ΔR2=0.02, p=0.09). Follow-up tests indicated that better 2MST performance was significantly correlated with better global cognitive function, attention, executive, and language test performance. Conclusion: The current results indicate that the 2MST is associated with cognitive function in older adults with HF. Further work is needed to clarify underlying mechanisms for this association and the value of implementing the 2MST during routine visits.

Key words

Heart failure 2-minute step test cognitive function older adults 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Roger V, Go A, Lloyd-Jones DM et al. Heart disease and stroke statistics 2011 update: a report from the American Heart Association. Circulation 2011; 123: e18–209.PubMedCrossRefGoogle Scholar
  2. 2.
    Seo Y, Roberts BL, Pina I, Dolansky M. Predictors of motor tasks essential for daily activities among persons with heart failure. J Card Fail 2008; 14: 296–302.PubMedCrossRefGoogle Scholar
  3. 3.
    Bennett SJ, Oldridge NB, Eckert G et al. Comparison of quality of life measures in heart failure. Nurs Res 2003; 52: 207–16.PubMedCrossRefGoogle Scholar
  4. 4.
    Bekelman DB, Rumsfeld JS, Havranek EP et al. Symptom burden, depression, and spiritual well-being: A comparison of heart failure and advanced cancer patients. J Gen Intern Med 2009; 24: 592–8.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Pressler SJ, Subramanian U, Kareken D et al. Cognitive deficits and health related quality of life in chronic heart failure. J Cardiovasc Nurs 2010; 25: 189–98.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Zuccala G, Pedone C, Cesari M et al. The effects of cognitive impairment on mortality among hospitalized patients with heart failure. Am J Med 2003; 115: 97–103.PubMedCrossRefGoogle Scholar
  7. 7.
    Bennett SJ, Cordes DK, Westmoreland G, Castro R, Donnelly E. Self-care strategies for symptom management in patients with chronic heart failure. Nurs Res 2000; 49: 139–45.PubMedCrossRefGoogle Scholar
  8. 8.
    Vogels RLC, Scheltens P, Schroeder-Tanka JM, Weinstein HC. Cognitive impairment in heart failure: A systematic review of the literature. Eur J Heart Fail 2007; 9: 440–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Sloan RS, Pressler SJ. Cognitive deficits in heart failure: Re-cognition of vulnerability as a strange new world. J Cardiovasc Nurs 2009; 24: 241–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Hoth KF, Poppas A, Moser DJ, Paul RH, Cohen RA. Cardiac dysfunction and cognition in older adults with heart failure. Cogn Behav Neurol 2008; 21: 65–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Baldasseroni S, Mossello E, Romboli B et al. Relationship between cognitive function and 6-minute walking test in older outpatients with chronic heart failure. Aging Clin Exp Res 2010; 22: 308–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Faggiano P, D’Aloia A, Gualeni A, Brentana L, Dei Cas L. The 6-minute walking test in chronic heart failure: indications, interpretation and limitations from a review of the literature. Eur J Heart Fail 2004; 6: 687–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Rozanska-Kirschke A, Kocur P, Wilk M, Dylewicz P. The Fullerton Fitness Test as an index of fitness in the elderly. Med Rehabil 2006; 10: 9–16.Google Scholar
  14. 14.
    Jones CJ, Rikli RE. Measuring functional fitness of older adults. J Active Aging 2002; March April: 24–30.Google Scholar
  15. 15.
    Nixon PA, Joswiak ML, Fricker FJ. A six-minute walk test for assessing exercise tolerance in severly ill children. J Pediatr 1996; 129: 362–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Bittner V, Weiner DH, Yusuf S et al. Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. JAMA 1993; 270: 1702–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Teng E, Chui H. The Modified Mini-Mental (3MS) examination. J Clin Psychiatry 1987; 48: 314–8.PubMedGoogle Scholar
  18. 18.
    Bland RC, Newman SC. Mild dementia or cognitive impairment: the Modified Mini-Mental State examination (3MS) as a screen for dementia. Can J Psychiatry 2001; 46: 506–10.PubMedGoogle Scholar
  19. 19.
    Spreen O, Strauss E. A compendium of Neuropsychological tests. New York: Oxford University Press, 1991.Google Scholar
  20. 20.
    Smith A. Clinical psychological practice and principals of neuropsychological assessment. In Walker C (Ed) Handbook of clinical psychology: Theory, Research, and practice. Homewood, IL: Dorsey Press, 1983.Google Scholar
  21. 21.
    Wechsler D. Manual for the Wechsler Adult Intelligence Scale-Third Ed. San Antonio, TX: The Psychological Corporation, 1997.Google Scholar
  22. 22.
    Dikmen S, Heaton R, Grant I, Temkin N. Test-retest reliability of the Expanded Halstead Reitan Neuropsychological Test Battery. J Int Neuropsychol Soc 1999; 5: 346–56.PubMedGoogle Scholar
  23. 23.
    Echemendia RJ, Lovell MR, Collins MW, Prigatano GP (August 20, 1999). Presented at: 107th Annual Meeting of the American Psychological Association (Washington, DC)Google Scholar
  24. 24.
    Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a frontal assessment battery at bedside. Neurology 2000; 55: 1621–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Stroop JR. Studies of interference in serial verbal reaction. J Exp Psychol 1935; 18: 643–62.CrossRefGoogle Scholar
  26. 26.
    Gifford DR, Cummings JL. Evaluating dementia screening tests. Methodological standard to rate their performance. Neurology 1999; 52: 224–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Siegrist M. Test-Retest reliability of different versions of the stroop test. J Psychol 1997; 131: 299–306.CrossRefGoogle Scholar
  28. 28.
    Van der Elst W, Van Boxtel MP, Van Breukelen GJP, Jolles J. The Stroop Color-Word Test: Influence of Age, Sex, and Education; and Normative Data for a Large Sample Across the Adult Age Range. Assessment 2006; 13: 62–79.PubMedCrossRefGoogle Scholar
  29. 29.
    Delis D, Kramer J, Kaplan E, Ober B. California Verbal Learning Test-Second Ed: Adult Version. Manual. Psychological Corporation, 2000.Google Scholar
  30. 30.
    Hawkins KA, Sledge WH, Orlean JE et al. Normative implications of the relationship between reading vocabulary and Boston Naming Test performance. Arch Clin Neuropsychol 1993; 8: 525–37.PubMedCrossRefGoogle Scholar
  31. 31.
    Morris J, Heyman A, Mohs R et al. The consortium to establish a registry for Alzheimer’s disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimers disease. Neurology 1989; 39: 1159–65.PubMedCrossRefGoogle Scholar
  32. 32.
    Cooper D, Epker M, Lacritz L et al. Effects of practice on category fluency in Alzheimer’s disease. Clin Neuropsychol 2001; 15: 125–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Arnau R, Meagher M, Norris M, Bramson R. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol 2001; 20: 112–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Beck AT, Steer RA, Brown GK. Beck Depression Inventory (2nd ed). San Antonio, TX: The Psychological Corporation, 1996.Google Scholar
  35. 35.
    Haug H, Eggers R. Morphometry of the human cortex cerebri and corpus striatum during aging. Neurobiol Aging 1991; 12: 336–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Raz N, Gunning-Dixon FM, Head D, Dupuis JH, Acker JD. Neuroanatomical correlates of cognitive aging: Evidence from structural magnetic resonance imaging. Neuropsychology 1998; 12: 95–114.PubMedCrossRefGoogle Scholar
  37. 37.
    Stromberg A, Martensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs 2003; 2: 7–18.PubMedCrossRefGoogle Scholar
  38. 38.
    Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure: A meta analytic review of prevalence, intervention effects, and association with clinical outcomes. J Am Coll Cardiol 2006; 48: 1527–37.PubMedCrossRefGoogle Scholar
  39. 39.
    Pullicino PM, Wadley YG, McClure LY, et al. Factors contributing to global cognitive impairment in heart failure: Results from a population-based cohort. J Card Fail 2008; 14: 290–5.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Rockwood K, Ebly E, Hachinski V, Hogan D. Presence and treatment of vascular risk factors in patients with vascular cognitive impairment. Arch Neurol 1997; 54: 33–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Rosamond W, Flegal K, Furie K et al. Heart disease and stroke statistics — 2008 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117: e25–146.PubMedCrossRefGoogle Scholar
  42. 42.
    Rich MW. Heart failure in the 21st century: A cardiogeriatric syndrome. J Gerontol A Biol Sci Med Sci 2000; 56: M88–96.CrossRefGoogle Scholar
  43. 43.
    Chen Y, Vaccarino V, Williams CS, Butler J, Berkman LF, Krumholz HM. Risk factors for heat failure in the elderly: A prospective community-based study. Am J Med 1999; 106: 605–12.PubMedCrossRefGoogle Scholar
  44. 44.
    Hunt SA. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005; 46: e1–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Duda MK, O’Shea KM, Stanley WC. (omega)-3 polyunsaturated fatty acid supplementation for the treatment of heart failure: mechanisms and clinical potential. Cardiovasc Res 2009; 84: 33–41.PubMedCrossRefGoogle Scholar
  46. 46.
    Devore EE, Stampfer MJ, Breteler MM et al. Dietary fat intake and cognitive decline in women with type 2 diabetes. Diabetes Care 2009; 32: 635–40.PubMedCrossRefGoogle Scholar
  47. 47.
    Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking test for assessing exercise capacity in chronic heart failure. BMJ 1986; 292: 653–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Colcombe, SJ, Kramer AF, Erickson KL et al. Cardiovascular fitness, cortical plasticity, and aging. Proceedings of the National Academy of Science USA, 2004; 101: 3316–21.CrossRefGoogle Scholar
  49. 49.
    Stanek KM, Gunstad J, Spitznagel MB et al. Improvements in cognitive function following cardiac rehabilitation for older adults with cardiovascular disease. Int J Neurosci 2011; 121: 86–93.PubMedCrossRefGoogle Scholar
  50. 50.
    Tanne D, Freimark D, Poreh A et al. Cognitive functions in severe congestive heart failure before and after an exercise training program. Int J Cardiol 2005; 103: 145–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Beer C, Ebenezer E, Fenner S et al. Contributors to cognitive impairment in congestive heart failure: a pilot case-control study. J Intern Med 2009; 39: 600–5.CrossRefGoogle Scholar
  52. 52.
    Alosco ML, Spitznagel MB, Cohen R et al. Cognitive impairment is independently associated with reduced instrumental activities of daily living in persons with heart failure. J Cardiovasc Nurs 2012; 27: 44–50PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Apostolovic S, Jankovic-Tomasevic R, Salinger-Martinovic S et al. Frequency and significance of unrecognized chronic obstructive pulmonary disease in elderly patients with stable heart failure. Aging Clin Exp Re 2011; 23: 337–42. Epub 2010 Oct 12CrossRefGoogle Scholar
  54. 54.
    Ingle L, Rigby AS, Nabb S, Jones PK, Clark AL, Cleland JG. Clinical determinant of poor six-minute walk test performance in patients with left ventricular systolic dysfunction and no major structural heart disease. Eur J Heart Fail 2006; 8: 321–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Thakur N, Blanc PD, Julian LJ et al. COPD and cognitive impairment: the role of hypoxemia and oxygen therapy. Int J Chron Obstruct Pulmon Dis 2010; 5: 263–9.PubMedCentralPubMedGoogle Scholar
  56. 56.
    Zuccala G, Cattel C, Manes-Gravina E, Di Niro MG, Cocchi A, Bernabel R. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry 1997; 63: 509–12.PubMedCrossRefGoogle Scholar
  57. 57.
    Sink KM, Leng X, Williamson J et al. Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: results from the Cardiovascular Health Study. Arch Intern Med 2009; 169: 1195–202.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Antonelli Incalzi R, Pedone C, Pahor M, Onder G, Carbonin PU; Gruppo Italiano di Farmacovigilanza nell’Anziano. Trends in prescribing ACE-inhibitors for congestive heart failure in elderly people. Aging Clin Exp Res 2002; 14: 516–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2012

Authors and Affiliations

  • Michael L. Alosco
    • 1
    Email author
  • Mary Beth Spitznagel
    • 1
    • 2
  • Naftali Raz
    • 3
  • Ronald Cohen
    • 4
  • Lawrence H. Sweet
    • 5
  • Lisa H. Colbert
    • 6
  • Richard Josephson
    • 7
    • 8
    • 9
  • Donna Waechter
    • 2
  • Joel Hughes
    • 1
    • 2
  • Jim Rosneck
    • 2
  • John Gunstad
    • 1
    • 2
  1. 1.Department of PsychologyKent State UniversityKentUSA
  2. 2.Department of Psychiatry, Summa Health SystemAkron City HospitalAkronUSA
  3. 3.Institute of GerontologyWayne State UniversityDetroitUSA
  4. 4.Department of CardiologyRhode Island Medical CenterProvidenceUSA
  5. 5.Department of Psychiatry and Human BehaviorBrown Medical SchoolProvidenceUSA
  6. 6.Department of KinesiologyUniversity of WisconsinMadisonUSA
  7. 7.University Hospitals Case Medical Center and Department of MedicineClevelandUSA
  8. 8.Harrington-McLaughlin Heart & Vascular InstituteClevelandUSA
  9. 9.Case Western Reserve University School of MedicineClevelandUSA

Personalised recommendations