Cognitive Function Does Not Impact Self-reported Health-Related Quality of Life in Heart Failure Patients.
Cognitive Function Does Not Impact Self-reported Health-Related Quality of Life in Heart Failure Patients.
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DOI：
10.1097/jcn.0000000000000277
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发表时间：
2016-09
期刊：
影响因子：
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通讯作者：
Hughes JW
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作者：
Gathright EC;Fulcher MJ;Dolansky MA;Gunstad J;Redle JD;Josephson R;Moore SM;Hughes JW
患有心力衰竭（HF）的成年人通常表现出多个认知功能领域的障碍，并报告健康相关生活质量（HRQoL）较差。令人惊讶的是，在仔细评估的样本中，认知缺陷通常与HRQoL无关（Pressler，Subramanian，& Kareken，2010）。例外是记忆力，它与HRQoL仅弱相关。然而，认知缺陷会干扰自我护理和疾病自我管理，预计会影响HRQoL。我们试图验证这一违反直觉的发现，在一个大的良好的表征样本的HF患者使用一个良好的验证神经心理电池。参与者是从两个医学中心招募的302名成年人（63%男性），主要是白人（72.5%）HF患者（68.7 ± 9.6岁）。使用堪萨斯城心肌病问卷（KCCQ）评估自我报告的HRQoL。参与者完成了神经心理电池检查注意力，执行功能，记忆力和视觉空间功能。采用分层多元线性回归进行分析。在29.5%的样本中观察到轻度整体认知障碍（改良简易精神状态检查评分< 90）。在控制了性别、抑郁、HF严重程度、病前智商、合并症和教育的情况下，只有执行功能预测HRQoL，β = 0.17，p <0.05。然而，执行功能仅占HRQoL方差的0.6%。认知功能通常不能预测HF患者的HRQoL，与Pressler等人（2010）一致。HF患者HRQoL的相关因素似乎不包括轻度认知功能障碍。其他因素可能发挥更大的作用，例如疾病严重程度、年龄和抑郁症状（Pressler等人，2010年）。未来的研究应该调查HF患者HRQoL的可改变的决定因素，以找到在这种慢性疾病期间保持HRQoL的干预措施。
Adults with heart failure (HF) often demonstrate impairment across multiple domains of cognitive functioning and report poor health-related quality of life (HRQoL). Surprisingly, cognitive deficits were generally not associated with HRQoL in a carefully evaluated sample (Pressler, Subramanian, & Kareken, 2010). The exception was memory, which was only weakly associated with HRQoL. However, cognitive deficits interfere with self-care and disease self-management, which could be expected to affect HRQoL. We sought to verify this counter-intuitive finding in a large well-characterized sample of HF patients using a well-validated neuropsychological battery. Participants were 302 adults (63% male) predominately Caucasian (72.5%) HF patients (68.7 ± 9.6 years) recruited from two medical centers. Self-reported HRQoL was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Participants completed a neuropsychological battery examining attention, executive function, memory, and visuospatial functioning. Hierarchical multiple linear regression was used for analyses. Mild global cognitive impairment was observed in 29.5% of the sample (Modified Mini-Mental State Examination score < 90). Controlling for gender, depression, HF severity, premorbid IQ, comorbidities, and education, only executive function predicted HRQoL, β = .17, p < .05. However, executive function only accounted for .6% of the variance in HRQoL. Cognitive function generally did not predict HRQoL in HF patients, consistent with Pressler et al. (2010). The correlates of HRQoL in HF do not appear to include mild cognitive impairment. Other factors may play a bigger role such as disease severity, age and depressive symptoms (Pressler et al., 2010). Future studies should investigate modifiable determinants of HRQoL in HF patients, toward the goal of finding interventions that preserve HRQoL during this chronic illness.