Brain Fog After Heart Failure Improves with Walking and Brain Games

The older you get, the more likely you are to worry about keeping your memory intact. If you are among the 5.7 million adults in the United States living with heart failure, a potentially fatal condition, you might have another reason for concern—brain fog, a subtle form of memory loss.1

Certainly, losing your mental alertness is something you’d want to avoid or postpone long into the future. To address this concern, a research team from Emory University initiated a study to explored whether people with heart failure who do brain exercises in combination with aerobic exercise might improve their cognitive losses or lessen the forgetfulness that occurs, often too subtle for most individuals to notice.2

Doing both BrainHQ exercises and walking reduces brain fog after heart failure.Memory fogginess commonly occurs after heart failure and may be lessened by doing BrainHQ exercises and walking. Photo: 123rf

The fix is relatively simple—exercising your brain and your body appear to lessen this so-called brain fog,2 according to a study appearing in the American Journal of Geriatric Psychiatry.

Memory Loss Is Another Consequence of  Heart Failure

While the symptoms that anyone with heart failure may experience will vary, it’s common to have: edema (swelling in your ankles, stomach, legs, and feet), shortness of breath while trying to keep up with daily activities, trouble breathing when lying down, feeling chronically weak or tired, and, to experience weight gain, which then compounds the challenges of managing diabetes, heart disease, and all of the related symptoms.1

There is another troublesome concern to manage—a subtle form of memory loss, termed brain fog—that can develop in individuals with heart failure, says Johanna Contreras, MD, director of the Division of Heart Failure at Mount Sinai St. Luke’s in New York City. “With heart failure, cardiac output is lower than it should be and this can make you feel woozy.”  

Having heart failure means that heart is working at a reduced capacity, so less blood is pumped through the body including less than is needed getting to the brain, explains Maria Rosa Costanzo, MD, director of Heart Failure Research Advocate at the Heart Institute in Chicago. “Many heart failure patients have a decreased blood flow to the brain and that alone can cause cognitive problems,” she says.

“The vast majority of heart failure patients have comorbidities like type 2 diabetes (T2D) or chronic obstructive pulmonary disease (COPD),” Dr. Costanzo says. “Some of these other common conditions that commonly arise in patients with heart failure may also contribute to the cognitive impairments experienced by some heart failure patients.”

Brain fog, the illustrative description of how moderate cognitive impairment is experienced by patients, is vastly underestimated in individuals with heart failure, according to Dr. Costanzo. “And these are cognitive changes that you don’t necessarily detect in a normal conversation with a patient,” she says. “Therefore, testing is needed to identify what we consider moderate cognitive impairment. It is a very common problem, so anyone with heart failure should be evaluated for cognitive changes sooner, and more often,” she tells EndocrineWeb. 

Can Brain Fog Be Improved by Lifestyle Strategies?

To evaluate whether there is an effective treatment strategy, the researchers initiated a pilot study of 69 individuals, ages 51-71 years old, looking at the effects of a walking program (ie, aerobic exercise) combined with a brain training intervention on cognitive function in people receiving care for heart failure.2

The testing group comprised 54% women and 55% African American individuals.2 The subjects, all of whom had been diagnosed with heart failure and who had confirmed brain fog, were divided into three groups:

  • BrainHQ training plus walking
  • Walking alone
  • Usual care (ie, stretching and flexibility class offered by the New York Heart Association)

“Since the brain training and exercise group showed the strongest improvements in memory, the authors attributed that benefit to the brain training alone,” says Henry Mahncke, PhD and CEO of the San Francisco-based Posit Science, who developed the memory training games that were used in the study.3,4

There are many cognitive training programs that have shown no beneficial effect or had poor results. However, BrainHQ has proven different—there are more than 150 published papers showing benefits from BrainHQ exercises, Dr. Mahncke says.

In a recent review by five Alzheimer's research centers, for example, BrainHQ was the only brain training program to achieve multiple "gold-standard" peer-reviewed papers showing efficacy; most of the other brain training programs had none at all.

The researchers looked at both brain training and physical activity because physical activity is the recommended treatment (called the standard of care) in order to see if they could improve on the standard of care. The study had three groups: brain training plus exercise, exercise alone, and a control group (receiving usual care).

One group followed a traditional care plan while the second group did aerobic exercises during their follow-up. The third group was instructed to do both aerobic exercises and brain training exercises. The researchers concluded that participants in the combined aerobic exercise and cognitive training program improved their verbal memory “significantly” after three months,3 according to Dr. Mahncke.

Do Physical and Mental Fitness Help Preserve Heart Health?

“The main finding is that the group that did both aerobic and brain exercises showed improvement in memory and functional measurements,” Dr. Mahncke tells EndocrineWeb. “Combining the two had the biggest effect.”

“There is very limited evidence that exercise or cognitive training is associated with improvement of mild cognitive impairment in heart failure,” the authors note.  “This analysis provides evidence that a combined approach may be superior to either strategy alone to improve cognitive function in persons with stable heart failure.”

However, a large randomized trial should be performed to determine if the beneficial effects of these interventional strategies are linked to improvement in mild cognitive impairment or whether the progression to dementia was simply slowed, the authors suggest.

Dr. Costanzo says she doesn’t feel that the Emory University meta-analysis can be considered conclusive. “The study group was made of just 69 patients,” she points out. “So they only used one percent of the patients they screened and it was not only a limited duration study but very selective and may not be representative of the heart failure population at large. Additionally, the study participants showed improvement in just one domain, verbal memory, and that improvement was not sustained beyond three months.”

Therefore, it is premature to say that a combination of brain exercises and physical exercise is effective against the “brain fog” brought on by heart failure, she says, only that doing both therapies shows the greatest promise.

So what should you do to counter the “brain fog” at this point? “We advise our patients to exercise and stay engaged [mentally],” Dr. Costanzo says. “We work with the patient’s caregivers to make sure there is adherence to their medication and we put them in touch with a psychologist for counseling if there are concerns about depression, which is common in patients with heart failure.” 

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