Influence of physiological and psychological factors on cognitive dysfunction in heart failure patients.

AIM: Our study aimed to examine factors that contribute to cognitive dysfunction in patients with heart failure (HF). BACKGROUND: Although a majority of patients with HF have mild to moderate cognitive impairment, little is known about factors that influence progressive cognitive decline in this population. METHODS: We examined the influence of physiological factors (NYHA functional class II - IV, ejection fraction, co-morbidity burden, polypharmacy), psychosocial factors (anxiety, depression, evaluation for advanced therapy), and associated toxicities (anticholinergic drug burden), on cognitive dysfunction. Data were analyzed using mean (SE) for continuous variables and frequency and percent for categorical variables. Differences between NYHA functional classification (Class II vs. Class III/IV) were examined using Chi Square. Linear regression models were used to assess associations among model variables. RESULTS: Of the 113 participants with HF, Class III-IV HF were more cognitively impaired than those with NYHA Class II (p < 0.0001), had higher anxiety (p = 0.002), and depression (p = 0.003), and lower EF (p = 0.041). A majority of participants had a moderate anticholinergic drug burden, and NYHA Class III/IV participants had significantly higher medication counts than Class II participants (p = 0.034). Regression analysis found that NYHA Class III/IV, anxiety, depression and evaluation for advanced therapy significantly influenced cognitive dysfunction. CONCLUSIONS: Findings support a high prevalence of cognitive dysfunction, anxiety, and depression in NYHA class II-IV with a greater level of cognitive dysfunction in class III/IV patients.

Psychological Distress and Attitudes Toward Seeking Professional Psychological Services Among Black Women: the Role of Past Mental Health Treatment.

Black women are one of the most underserved and undertreated minority groups in the USA. While Black women generally do not seek professional psychological services to manage psychological distress, recent findings suggest an openness to mental health treatment as a form of self-care. This study investigated the relationship among symptoms of anxiety, depression, and post-traumatic stress as a predictor of attitudes toward professional psychological help (i.e., psychological openness, help-seeking propensity, and indifference to stigma) in a sample of 205 Black women. We also examined if past mental health treatment (i.e., counseling or therapy) moderated these relationships. Results indicated that symptoms of anxiety, depression, and post-traumatic stress were all negatively associated with help-seeking propensity and indifference to stigma. Only symptoms of post-traumatic stress were negatively associated with psychological openness. Findings also demonstrated that past mental health treatment moderated the relationship among depressive symptoms and help-seeking propensity and indifference to stigma, respectively. Specifically, as depressive symptoms increased, help-seeking propensity significantly decreased among participants who had not reported past mental health treatment. Additionally, indifference to stigma decreased with increased symptoms of depression, though the decline in indifference to stigma was greater among those who did not report past mental health treatment. We also found similar results for symptoms of post-traumatic stress with regard to indifference to stigma. Findings suggest that Black women's past mental health treatment may be relevant to understanding attitudes toward seeking professional psychological services when experiencing high psychological distress.

Punishment on Pause: Preliminary Evidence That Mindfulness Training Modifies Neural Responses in a Reactive Aggression Task.

Reactive aggression, a hostile retaliatory response to perceived threat, has been attributed to failures in emotion regulation. Interventions for reactive aggression have largely focused on cognitive control training, which target top-down emotion regulation mechanisms to inhibit aggressive impulses. Recent theory suggests that mindfulness training (MT) improves emotion regulation via both top-down and bottom-up neural mechanisms and has thus been proposed as an alternative treatment for aggression. Using this framework, the current pilot study examined how MT impacts functional brain physiology in the regulation of reactive aggression. Participants were randomly assigned to 2 weeks of MT (n = 11) or structurally equivalent active coping training (CT) that emphasizes cognitive control (n = 12). Following training, participants underwent functional magnetic resonance imaging (fMRI) during a retaliatory aggression task, a 16-trial game in which participants could respond to provocation by choosing whether or not to retaliate in the next round. Training groups did not differ in levels of aggression displayed. However, participants assigned to MT exhibited enhanced ventromedial prefrontal cortex (vmPFC) recruitment during punishment events (i.e., the aversive consequence of losing) relative to those receiving active CT. Conversely, the active coping group demonstrated greater dorsomedial prefrontal cortex (dmPFC) activation when deciding how much to retaliate, in line with a bolstered top-down behavior monitoring function. The findings suggest that mindfulness and cognitive control training may regulate aggression via different neural circuits and at different temporal stages of the provocation-aggression cycle. Trial Registration: identification no. NCT03485807.