Cognitive influences on self-care decision making in persons with heart failure
Cognitive influences on self-care decision making in persons with heart failure
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DOI：
10.1016/j.ahj.2007.04.058
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发表时间：
2007-09-01
影响因子：
4.8
通讯作者：
Riegel, Barbar A.
中科院分区：
文献类型：
--
作者：
Dickson, Victoria V.;Tkacs, Nancy;Riegel, Barbar A.
背景：尽管在治疗方面取得了进步，但心力衰竭与高住院率、低生活质量和过早死亡有关。旨在提高患者照顾自己能力的教育是疾病管理计划不可或缺的组成部分。真正的自我护理需要患者根据症状做出决定，但30%到50%的心力衰竭人群中记录的认知缺陷可能会使日常决策具有挑战性。在将心力衰竭自我护理描述为一个自然主义的决策过程后，我们探索了已知存在于心力衰竭患者中的认知缺陷。心力衰竭自我护理中的问题与心力衰竭相关的神经改变进行了分析。作为一个神经过程，决策已经。被追踪到前额叶皮质的区域，也就是心力衰竭中受缺血、脑梗塞和低氧血症影响的区域。由此导致的记忆、注意力和执行功能的缺陷可能会损害对早期症状和推理的感知和解释，从而推迟早期治疗的实施。令人信服的证据表明，对决策至关重要的神经过程位于受心力衰竭影响的相同结构中。因为自我照顾需要学习、感知、解释和反应的认知能力，所以需要研究来辨别神经缺陷如何影响这些能力、决策和自我照顾行为。
Background Despite advances in management, heart failure is associated with high rates of hospitalization, poor quality of life, and early death. Education intended to improve patients' abilities to care for themselves is an integral component of disease management programs. True self-care requires that patients make decisions about symptoms, but the cognitive deficits documented in 30% to 50% of the heart failure population may make daily decision making challenging. After describing heart failure self-care as a naturalistic decision making process, we explore cognitive deficits known to exist in persons with heart failure. Problems in heart failure self-care are analyzed in relation to neural alterations associated with heart failure. As a neural process, decision making has. been traced to regions of the prefrontal cortex, the same areas that are affected by ischemia, infarction, and hypoxemia in heart failure. Resulting deficits in memory, attention, and executive function may impair the perception and interpretation of early symptoms and reasoning and, thereby, delay early treatment implementation.Conclusions There is. compelling evidence that the neural processes critical to decision making are located in the same structures that are affected by heart failure. Because self-care requires the cognitive ability to learn, perceive, interpret, and respond, research is needed to discern how neural deficits affects these abilities, decision-making, and self-care behaviors.