Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study
IntroductionCognitive decline in older adults with heart failure (HF) may be influenced by educational level and depressive symptoms. This study assesses the impact of these factors on cognitive function in this patient population to mitigate cognitive decline and improve overall health in this vuln...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1566400/full |
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| author | Marta Wleklik Christopher S. Lee Maria Jędrzejczyk Heba Aldossary Heba Aldossary Izabella Uchmanowicz Izabella Uchmanowicz |
| author_facet | Marta Wleklik Christopher S. Lee Maria Jędrzejczyk Heba Aldossary Heba Aldossary Izabella Uchmanowicz Izabella Uchmanowicz |
| author_sort | Marta Wleklik |
| collection | DOAJ |
| description | IntroductionCognitive decline in older adults with heart failure (HF) may be influenced by educational level and depressive symptoms. This study assesses the impact of these factors on cognitive function in this patient population to mitigate cognitive decline and improve overall health in this vulnerable population.AimTo identify the predictors of cognitive impairment in older patients with heart failure using a longitudinal mixed-model analysis.Material and methodsA 250 HF patients aged 60 and older with an MMSE score ≥24 was evaluated. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), mental health with the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), and nutritional status with the Mini Nutritional Assessment (MNA). Data were collected in three stages: baseline during hospitalization and at two subsequent hospital follow-ups. A linear mixed model analyzed the relationship between educational level, depressive symptoms, and MMSE scores, with a significance level set at p < 0.05.ResultsThe mean baseline MMSE score was 26.5 (SD = 2.1), suggesting good initial cognitive function among participants. Results from the linear mixed model indicated that each additional year of education correlated with a 0.161-point increase in MMSE scores (95%CI: 0.1–0.222, p < 0.001). Conversely, higher depressive symptoms were associated with poorer cognitive outcomes; specifically, each one-point increase in the HADS depression subscale corresponded to a 0.115-point decrease in MMSE scores (95%CI: −0.183 to −0.046, p = 0.001). Other factors, including age, sex, residence, and various comorbidities, did not show statistically significant associations with cognitive decline. At each stage of the study, approximately 8%, 11%, and 11% of patients, respectively, scored above the HADS cut-off for anxiety or depression, while an additional 13%, 12%, and 15% showed borderline scores. According to the PHQ-9, depressive symptoms of varying severity were present in 54% of patients at Stage I and II, and in 58% at Stage III.ConclusionsThis study shows that greater educational background is associated with improved cognitive function, while higher levels of anxiety and depression are linked to cognitive decline in older adults with heart failure. These results highlight the importance of integrating mental health and education in interventions aimed at enhancing cognitive health in this population. |
| format | Article |
| id | doaj-art-73e048fba7634057a8b7aed4b5d506be |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-73e048fba7634057a8b7aed4b5d506be2025-08-20T03:53:42ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-04-011210.3389/fcvm.2025.15664001566400Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure studyMarta Wleklik0Christopher S. Lee1Maria Jędrzejczyk2Heba Aldossary3Heba Aldossary4Izabella Uchmanowicz5Izabella Uchmanowicz6Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, PolandBoston College William F. Connell School of Nursing, Chestnut Hill, MA, United StatesDepartment of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, PolandDepartment of Nursing, Prince Sultan Military College of Health Sciences, Dhahran, Saudi ArabiaFrances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OH, United StatesDepartment of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, PolandCentre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, United KingdomIntroductionCognitive decline in older adults with heart failure (HF) may be influenced by educational level and depressive symptoms. This study assesses the impact of these factors on cognitive function in this patient population to mitigate cognitive decline and improve overall health in this vulnerable population.AimTo identify the predictors of cognitive impairment in older patients with heart failure using a longitudinal mixed-model analysis.Material and methodsA 250 HF patients aged 60 and older with an MMSE score ≥24 was evaluated. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), mental health with the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), and nutritional status with the Mini Nutritional Assessment (MNA). Data were collected in three stages: baseline during hospitalization and at two subsequent hospital follow-ups. A linear mixed model analyzed the relationship between educational level, depressive symptoms, and MMSE scores, with a significance level set at p < 0.05.ResultsThe mean baseline MMSE score was 26.5 (SD = 2.1), suggesting good initial cognitive function among participants. Results from the linear mixed model indicated that each additional year of education correlated with a 0.161-point increase in MMSE scores (95%CI: 0.1–0.222, p < 0.001). Conversely, higher depressive symptoms were associated with poorer cognitive outcomes; specifically, each one-point increase in the HADS depression subscale corresponded to a 0.115-point decrease in MMSE scores (95%CI: −0.183 to −0.046, p = 0.001). Other factors, including age, sex, residence, and various comorbidities, did not show statistically significant associations with cognitive decline. At each stage of the study, approximately 8%, 11%, and 11% of patients, respectively, scored above the HADS cut-off for anxiety or depression, while an additional 13%, 12%, and 15% showed borderline scores. According to the PHQ-9, depressive symptoms of varying severity were present in 54% of patients at Stage I and II, and in 58% at Stage III.ConclusionsThis study shows that greater educational background is associated with improved cognitive function, while higher levels of anxiety and depression are linked to cognitive decline in older adults with heart failure. These results highlight the importance of integrating mental health and education in interventions aimed at enhancing cognitive health in this population.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1566400/fullheart failurecognitive impairmentdepressionfrailty syndromeelderly |
| spellingShingle | Marta Wleklik Christopher S. Lee Maria Jędrzejczyk Heba Aldossary Heba Aldossary Izabella Uchmanowicz Izabella Uchmanowicz Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study Frontiers in Cardiovascular Medicine heart failure cognitive impairment depression frailty syndrome elderly |
| title | Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study |
| title_full | Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study |
| title_fullStr | Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study |
| title_full_unstemmed | Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study |
| title_short | Association of education level and depression with cognitive decline: findings from the examining cognitive health outcomes in heart failure study |
| title_sort | association of education level and depression with cognitive decline findings from the examining cognitive health outcomes in heart failure study |
| topic | heart failure cognitive impairment depression frailty syndrome elderly |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1566400/full |
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