Cognitive Impairment Is Independently Associated With Reduced Instrumental Activities of Daily Living in Persons With Heart Failure
Cognitive Impairment Is Independently Associated With Reduced Instrumental Activities of Daily Living in Persons With Heart Failure
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DOI：
10.1097/jcn.0b013e318216a6cd
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发表时间：
2012-01-01
影响因子：
2
通讯作者：
Gunstad, John
中科院分区：
文献类型：
--
作者：
Alosco, Michael L.;Spitznagel, Mary Beth;Gunstad, John
背景：心力衰竭（HF）是一种致残性疾病，经常影响工具性日常生活活动（工具性ADL）。尽管这一人群的残疾率很高，但人们对这一人群中认知障碍对工具性ADL的影响知之甚少。目的：本研究旨在探讨认知功能是否预测工具性ADL的表现与HF的人。研究方法：HF患者（N = 122; 68.49 [SD，9.43]岁; 35.2%女性）完成了神经心理学测试、健康评估和自我报告的工具和基本ADL功能，作为更大方案的一部分。神经心理学测试包括简易精神状态检查和连线测试A和B。2分钟的台阶测试估计健身。工具性和基本ADL功能是基于Lawton-Brody日常生活活动量表的自我报告。分层回归分析用于确定认知功能对HF患者ADL的独立贡献。结果如下：心力衰竭患者报告工具性ADL受损率较高，但表示基本ADL需要很少或不需要帮助。认知功能对驾驶（R2变化=.07，P = .03）和药物管理（R2变化= .14，P < .001）的预测有效性增加。在每种情况下，较差的神经心理测试性能与较差的工具ADL功能。结论：在HF患者中，认知表现是独立驾驶和药物管理的独立预测因素。维持或改善HF患者认知功能的策略可能有助于患者在日常生活中保持功能独立。
Background: Heart failure (HF) is a disabling disease that often affects instrumental activities of daily living (instrumental ADLs). Despite high rates of disability in this population, little is known about the effects of cognitive impairment on instrumental ADLs in this population. Objective: The current study examined whether cognitive functioning predicts instrumental ADL performance in persons with HF. Methods: Persons with HF (N = 122; 68.49 [SD, 9.43] years; 35.2% female) completed neuropsychological testing, fitness assessment, and self-reported instrumental and basic ADL function as part of a larger protocol. Neuropsychological tests included the Mini-Mental State Examination and Trail Making Tests A and B. The 2-minute step test estimated fitness. Instrumental and basic ADL function was based on self-report on the Lawton-Brody Activities of Daily Living Scale. Hierarchical regression analyses were used to determine the independent contribution of cognitive function to ADLs in HF. Results: Heart failure patients reported high rates of impairments in instrumental ADLs, but indicated requiring little or no assistance with basic ADLs. Cognitive function showed incremental predictive validity for driving (R-2 change =.07, P = .03) and medication management (R 2 change = .14, P < .001). In each case, poorer neuropsychological test performance was associated with poorer instrumental ADL function. Conclusion: In persons with HF, cognitive performance is an independent predictor of independence in driving and medication management. Strategies to maintain or improve cognitive functioning in HF may help patients remain functionally independent in their daily living.