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brain cognition, heart failure, magnetic resonance imaging



  1. Serber, Stacy L.
  2. Kumar, Rajesh
  3. Woo, Mary A.
  4. Macey, Paul M.
  5. Fonarow, Gregg C.
  6. Harper, Ronald M.


Background: Cognitive impairment, assessed using paper-and-pencil tests, occurs with multiple syndromes, including heart failure; however, relationships between test performance and brain injury are unclear.


Objectives: To determine the extent of brain injury assessed by magnetic resonance T2 relaxometry procedures in a mixed sample with cognitive impairment as measured by the Mini-Mental State Examination, Trailmaking Test parts A (TMT-A) and B (TMT-B), and the Watson Clock-Drawing Test (CDT).


Methods: A comparative design was used with a convenience sample of 66 participants (age 48.2 +/- 8.4 years, 41 males, 52 right-handed). Normal and abnormal performances on cognitive tests were compared using T2 relaxation values across the brain (p < .005). Fifty-four of the participants were healthy, and 12 had heart failure (New York Heart Association classes II-III, left ventricular ejection fraction <0.40).


Results: All participants scored normally on the Mini-Mental State Examination; thus, this test was excluded from further analysis. Abnormal cognitive scores were found in 14-20% of the participants, with significant brain injury appearing in participants with abnormal test scores. Injured structures included frontal, temporal, parietal, insular, and cingulate cortices; corpus callosum; and caudate. The CDT results showed the greatest extent of structural injury. The TMT-A test demonstrated relationships to specific injury sites, whereas the TMT-B showed relationships only to isolated areas of damage.


Discussion: The findings suggest that paper-and-pencil cognitive tests relate to injury in brain structures, with CDT values relating to the greatest extent of injury. Specific damage sites may correlate with unique tests, such as TMT-A. Specialized tests should be developed that would indicate neural injury in specific areas.