Cognitive function and treatment adherence in older adults with heart failure.
Cognitive function and treatment adherence in older adults with heart failure.
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心力衰竭老年人的认知功能和治疗依从性。
DOI：
10.1097/psy.0b013e318272ef2a
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发表时间：
2012-11
影响因子：
3.3
通讯作者：
Gunstad J
中科院分区：
文献类型：
--
作者：
Alosco ML;Spitznagel MB;van Dulmen M;Raz N;Cohen R;Sweet LH;Colbert LH;Josephson R;Hughes J;Rosneck J;Gunstad J
心力衰竭（HF）患者的治疗建议和指南可能很复杂，过去的工作表明HF患者对推荐的健康行为的依从性较低。虽然以前的工作已经确定了几个医疗，人口统计学和社会心理预测HF人的能力，坚持治疗的建议，很少有人知道的贡献，认知功能障碍，报告的治疗依从性在这一人群。149名HF患者（68.08岁; SD = 10.74）完成了简短的健康评估和神经心理学测试。使用心力衰竭依从性问卷评估治疗依从性，这是一种简短的测量方法，要求参与者报告他们对各种推荐健康行为的依从性（即，药物管理、饮食、锻炼等）。16.1%的参与者表示总体遵守情况较差，其中不遵守饮食和锻炼建议的比例特别高。调整可能混淆的分层回归分析显示，注意力（β = 0.26，p = 0.01）、执行功能（β = 0.18，p = 0.04）和语言（β = 0.22，p = 0.01）方面的表现下降与总体依从性较差相关。后续分析显示，这些认知领域与诸如保持医生预约、药物管理和饮食建议等行为相关（所有p <0.05）。目前的研究结果表明，认知功能是老年HF患者依从性的独立贡献者。需要进行客观测量治疗依从性的前瞻性研究，以澄清这些发现，并确定可能的策略，以改善这一人群的结局。
Treatment recommendation and guidelines for patients with heart failure (HF) can be complex, and past work has shown HF patients to demonstrate low rates of adherence to recommended health behaviors. While previous work has identified several medical, demographic, and psychosocial predictors of HF persons’ capacity to adhere to treatment recommendations, little is known about the contribution of cognitive impairment to reported treatment adherence in this population. 149 persons with HF (68.08 years; SD = 10.74) completed a brief fitness assessment and neuropsychological testing. Treatment adherence was assessed using the Heart Failure Compliance Questionnaire, a brief measure that asks participants to report their adherence to a variety of recommended health behaviors (i.e., medication management, diet, exercise, among others). 16.1% of participants reported poor overall adherence, with particularly high rates of non-adherence to dietary and exercise recommendations. Hierarchical regression analyses adjusting for possible confounds revealed reduced performance on attention (β = .26, p = .01), executive function (β = .18, p = .04), and language (β = .22, p = .01) were associated with poorer overall adherence. Follow-up analyses showed these cognitive domains were associated with behaviors such as keeping doctor appointments, medication management, and dietary recommendations (p < .05 for all). The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF. Prospective studies that objectively measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population.