Reduction in Gray Matter Volume Is Related to ADL Performance in Heart Failure

Study Questions:

Is there an association among gray matter volume, cognitive function, and functional ability in heart failure?


Eighty-one patients, who were a subset of patients from a larger National Institutes of Health funded study, completed a cognitive function test and Lawton-Brody self-report questionnaire to assess instrumental activities of daily living (ADL). All patients underwent magnetic resonance imaging (MRI) to quantify gray matter volume.


The mean age of the participants was 68 years (range 50-83 years); 60.5% were male, with a mean education level of 13.8 years. The majority of the participants (75.5% male, 75% female) had below-average levels of physical fitness, as determined by 2-minute step test. Small gray matter volume was associated with a low level of instrumental ADL, specifically to management of medications (r70 = 0.28, p = 0.02) and independence in transportation (r70 = 0.24, p = 0.04). Memory was also impacted by reduction in gray matter (F12, 68 = 2.82, p < 0.01). Shopping, housekeeping duties, and laundry were also associated with small gray matter volume, which reflected higher levels of physical functioning. After controlling for demographic, medical, and clinical variables, regression analyses noted an interaction among total gray matter volume, attention/executive function, and ability to perform ADL (p = 0.03).


Patients with heart failure are at risk for accelerated brain atrophy. The reduction in gray matter makes medication management and driving difficult due to a need for higher cognitive function. Not all patients with heart failure can have MRIs, but the impact of accelerated cognitive decline can affect patient ability to independently participate in self-care.


Brain atrophy impacts patients’ ability to accurately take medication and to make follow-up appointments, and can therefore potentially worsen outcomes. Routine cognitive assessments can help to identify patients who are having cognitive decline and are in need of social support with medication administration and transportation.

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