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Baby B, McKinnon A, Patterson K, Patel H, Sharma R, Carter C, Griffin R, Burns C, Chang F, Guilcher SJ, Lee L, Fadaleh SA, Patel T. Tools to measure barriers to medication management capacity in older adults: a scoping review. BMC Geriatr 2024; 24:285. [PMID: 38532328 DOI: 10.1186/s12877-024-04893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications. PURPOSE 1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers. METHODS The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus. RESULTS AND DISCUSSION In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA). CONCLUSION This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.
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Affiliation(s)
- Bincy Baby
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Hawa Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Rishabh Sharma
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Griffin
- National Research Council Canada, Ottawa, ON, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Sara Jt Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Sara Abu Fadaleh
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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Nonaka Y, Fujii R, Tanaka S, Tabira K. Effect of cognitive impairment at admission on activities of daily living at discharge in older patients with heart failure. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2024; 14:78-83. [PMID: 38196778 PMCID: PMC10776209 DOI: 10.11336/jjcrs.14.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 01/11/2024]
Abstract
Nonaka Y, Fujii R, Tanaka S, Tabira K. Effect of cognitive impairment at admission on activities of daily living at discharge in older patients with heart failure. Jpn J Compr Rehabil Sci 2023; 14: 78‒83. Objective Hasegawa's Dementia Scale-Revised (HDS-R) is widely used as a screening test for cognitive function in older adults. In this study, we examined the effect of cognitive impairment (CI) at admission on activities of daily living (ADL) at discharge in older patients with heart failure (HF). Methods This retrospective observational study included 394 patients hospitalized for acute decompensated HF between April 2016 and December 2022. Data on age, sex, body mass index, length of hospital stay, initiation of rehabilitation, New York Heart Association (NYHA) class, Charlson Comorbidity Index, medication, brain natriuretic peptide levels, left ventricular ejection fraction, renal function, hemoglobin level, serum albumin level, Geriatric Nutritional Risk Index (GNRI), Barthel Index (BI), and HDS-R score were analyzed using the χ2 test, unpaired t test, Mann-Whitney U test, and multiple linear regression. Results Among 394 patients, 102 who met the final inclusion criteria were included in the study. Based on previous studies, patients were divided into a high BI group (N = 44) and a low BI group (N = 58). Multiple linear regression analysis showed that CI at admission independently affected BI at discharge even after adjusting for confounding effects of age, NYHA class, GNRI, and BI at admission. Conclusions Our study showed that the presence or absence of CI may influence ADL improvement in rehabilitation interventions aimed at improving ADL in older patients with HF.
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Affiliation(s)
- Yuki Nonaka
- Graduate School of Health Science, Kio University, Koryo, Nara, Japan
- Musashigaoka Clinical Research Center, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto, Kumamoto, Japan
| | - Ren Fujii
- Musashigaoka Clinical Research Center, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto, Kumamoto, Japan
| | - Shinichiro Tanaka
- Musashigaoka Clinical Research Center, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto, Kumamoto, Japan
| | - Kazuyuki Tabira
- Graduate School of Health Science, Kio University, Koryo, Nara, Japan
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Pressler SJ, Jung M, Giordani B, Titler MG, Gradus-Pizlo I, Lake KR, Wierenga KL, Clark DG, Perkins SM, Smith DG, Mocci E, Dorsey SG. Evaluating depressive symptoms, BDNF Val66Met, and APOE-ε4 as moderators of response to computerized cognitive training in heart failure. Heart Lung 2023; 59:146-156. [PMID: 36805256 PMCID: PMC10065971 DOI: 10.1016/j.hrtlng.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF). OBJECTIVES The purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL). METHODS 256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators. RESULTS As previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results. CONCLUSIONS Studies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.
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Affiliation(s)
- Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Bruno Giordani
- University of Michigan, Michigan Alzheimer's Disease Research Center and Department of Psychiatry, Suite C, 2101 Commonwealth Blvd., Ann Arbor, MI 48105, United States.
| | - Marita G Titler
- University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109-5482, United States.
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA 92868-32988, United States.
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States
| | - Kelly L Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - David G Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202, United States.
| | - Susan M Perkins
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202, United States.
| | - Dean G Smith
- Louisiana State University School of Public Health 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112.
| | - Evelina Mocci
- University of Maryland School of Nursing, Department of Pain and Translational Science, 655 West Lombard Street, Baltimore, MD 21201, United States.
| | - Susan G Dorsey
- University of Maryland School of Nursing, Department of Pain and Translational Science, 655 West Lombard Street, Baltimore, MD 21201, United States.
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Robinson TL, Gogniat MA, Jean KR, Miller LS. Pre-Morbid IQ Moderates the Relationship between Cognitive Performance and Performance-Based Functional Status in Older Adults. Clin Gerontol 2022; 45:722-732. [PMID: 32543295 DOI: 10.1080/07317115.2020.1769784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The current study sought to evaluate the relationship between cognitive performance and Instrumental Activities of Daily Living (IADL) performance in a population of community dwelling older adults, and assess to what extent this relationship is moderated by cognitive reserve (Premorbid-IQ)Methods: 123 community-dwelling older adults completed a general cognitive assessment, a word-reading based premorbid-IQ estimate (PMIQE) measure, and the performance-based Direct Assessment of Functional Status, Revised (DAFS-R). Moderated regression analysis was used to assess the influence of PMIQE on the relationship between cognitive performance and IADLs.Results: There was a significant main effect of cognitive performance on IADLs, and no main effect of PMIQE on functional IADLs. There was a significant moderating effect of PMIQE on the relationship between cognitive performance and IADLs performance, such that at higher levels of PMIQE, cognitive performance scores became slightly less predictive of weaknesses in IADLs.Conclusions: Results suggest that for individuals with high reserve, assessment of cognitive performance alone may not be robust a predictor of IADLs functioning.Clinical implications: In estimating functional abilities as a consequence of cognitive performance, consideration should be given to premorbid-IQ/cognitive reserve.
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Affiliation(s)
- Talia L Robinson
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Marissa A Gogniat
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Kharine R Jean
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - L Stephen Miller
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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Jung M, Apostolova LG, Moser DK, Gradus‐Pizlo I, Gao S, Rogers JL, Pressler SJ. Virtual reality cognitive intervention for heart failure: CORE study protocol. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12230. [PMID: 35317082 PMCID: PMC8923344 DOI: 10.1002/trc2.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022]
Abstract
Introduction Heart failure (HF) is a prevalent, serious chronic illness that affects 6.5 million adults in the United States. Among patients with HF, the prevalence of attention impairment is reported to range from 15% to 27%. Although attention is fundamental to human activities including HF self-care, cognitive interventions for patients with HF that target improvement in attention are scarce. The COgnitive intervention to Restore attention using nature Environment (CORE) study aims to test the preliminary efficacy of the newly developed Nature-VR, a virtual reality-based cognitive intervention that is based on the restorative effects of nature. Nature-VR development was guided by Attention Restoration Theory. The target outcomes are attention, HF self-care, and health-related quality of life (HRQoL). Our exploratory aims examine the associations between attention and several putative/established HF biomarkers (eg, oxygen saturation, brain-derived neurotrophic factor, apolipoprotein E, dopamine receptor, and dopamine transporter genes) as well as the effect of Nature-VR on cognitive performance in other domains (ie, global cognition, memory, visuospatial, executive function, and language), cardiac and neurological events, and mortality. Methods This single-blinded, two-group randomized-controlled pilot study will enroll 74 participants with HF. The Nature-VR intervention group will view three-dimensional nature pictures using a virtual reality headset for 10 minutes per day, 5 days per week for 4 weeks (a total of 200 minutes). The active comparison group, Urban-VR, will view three-dimensional urban pictures using a virtual reality headset to match the Nature-VR intervention in intervention dose and delivery mode, but not in content. After baseline interviews, four follow-up interviews will be conducted to assess sustained effects of Nature-VR at 4, 8, 26, and 52 weeks. Discussion The importance and novelty of this study consists of using a first-of-its kind, immersive virtual reality technology to target attention and in investigating the health outcomes of the Nature-VR cognitive intervention among patients with HF.
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Affiliation(s)
- Miyeon Jung
- Indiana University School of NursingIndianapolisIndianaUSA
| | - Liana G. Apostolova
- Indiana University School of Medicine, Department of Neurology, Radiology, and Medical and Molecular GeneticsIndianapolisIndianaUSA
| | - Debra K. Moser
- University of Kentucky College of NursingLexingtonKentuckyUSA
| | - Irmina Gradus‐Pizlo
- Department of MedicineUniversity of California Irvine School of MedicineOrangeCaliforniaUSA
| | - Sujuan Gao
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jeff L. Rogers
- Indiana University UITS Advanced Visualization LabIndianapolisIndianaUSA
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Pressler SJ, Jung M, Gradus-Pizlo I, Titler M, Smith D, Gao S, Lake KR, Burney H, Clark D, Wierenga K, Dorsey SG, Giordani B. Randomized Controlled Trial of a Cognitive Intervention to Improve Memory in Heart Failure. J Card Fail 2021; 28:519-530. [PMID: 34763080 DOI: 10.1016/j.cardfail.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The objective of this 3-arm randomized controlled trial was to evaluate efficacy of computerized cognitive training (CCT) to improve primary outcomes of delayed recall memory and serum brain-derived neurotrophic factor (BDNF) levels and secondary outcomes of working memory, instrumental activities of daily living (IADL), and health-related quality of life (HRQL) among patients with heart failure (HF). METHODS AND RESULTS Patients (N = 256) were randomly assigned to 8 weeks of CCT using BrainHQ, computerized crossword puzzles active control intervention, and usual care. All patients received weekly nurse enhancement interventions. Data were collected at enrollment and baseline visits and at 10 weeks and 4 and 8 months. In mixed effects models, there were no statistically significant group or group by time differences in outcomes. There were statistically significant differences over time in all outcomes in all groups. Patients improved over time on measures of delayed recall memory, working memory, IADL, and HRQL and had decreased serum BDNF. CONCLUSIONS CCT did not improve outcomes compared with the active control intervention and usual care. Nurse enhancement interventions may have led to improved outcomes over time. Future studies are needed to test nurse enhancement interventions in combination with other cognitive interventions to improve memory in HF. LAYSUMMARY In 256 patients with heart failure, 8 weeks of computerized cognitive training, computerized crossword puzzles, or usual care were studied for effects on (1st) recall memory and serum brain-derived neurotrophic factor (BDNF) and (2nd) working memory, instrumental activities of daily living (IADL), and health-related quality of life (HRQL). Measurements were at baseline, 10 weeks, 4- and 8-months. Nurse enhancement interventions (e.g., support, assessment) were provided. Recall memory, working memory, IADL, and HRQL improved over time. There were no statistically significant differences among treatment groups over time. BDNF unexpectedly decreased. Nurse enhancement interventions may explain improved outcomes. Future studies are needed.
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Affiliation(s)
- Susan J Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202.
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Irmina Gradus-Pizlo
- University of California Irvine School of Medicine, 333 City Blvd, West, Suite 400, Orange, CA
| | - Marita Titler
- University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, Michigan 48109-5482
| | - Dean Smith
- Louisiana State University School of Public Health, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112
| | - Sujuan Gao
- Indiana University School of Medicine, Department of Biostatistics, 410 West 10(th) Street, Suite 3000, Indianapolis, IN 46202
| | - Kittie Reid Lake
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Heather Burney
- Indiana University School of Medicine, Department of Biostatistics, 410 West 10(th) Street, Suite 3000, Indianapolis, IN 46202
| | - David Clark
- Indiana University School of Medicine, 355 W. 16th Street, Suite 4020, Indianapolis, IN 46202
| | - Kelly Wierenga
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202
| | - Susan G Dorsey
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21201
| | - Bruno Giordani
- University of Michigan, Michigan Alzheimer's Disease Research Center, Suite C, 2101 Commonwealth Blvd. Ann Arbor MI 48105
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Brunette AM, Warner K, Holm KE, Meschede K, Wamboldt FS, Kozora E, Moser DJ, Make BJ, Crapo JD, Moreau KL, Weinberger HD, Bowler R, Hoth KF. Daily Activities: The Impact of COPD and Cognitive Dysfunction. Arch Clin Neuropsychol 2021; 36:acaa090 767 779-767. [PMID: 33103191 PMCID: PMC8500183 DOI: 10.1093/arclin/acaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation; however, pulmonary function does not fully account for patients' functional difficulties. The primary aim of the study was to determine the association between several domains of cognition and daily activity among those with COPD. METHOD Eighty-nine former smokers completed a neuropsychological battery including measures across multiple domains of cognition, pulmonary function measures, and daily activity questionnaires. Using a cross-sectional design, we compared daily activity between former smokers with and without COPD using two measures (St. George's Respiratory Questionnaire [SGRQ] Activity Subscale and Lawton Instrumental Activities of Daily Living [IADL] Scale) and examined the association between cognition and daily activity among those with COPD. RESULTS As expected, former smokers with COPD reported more difficulty than those without COPD on both activity measures (SGRQ Activity Subscale p < .001; Lawton IADL Scale p = .040). Among former smokers with COPD, poorer delayed recall was associated with more difficulty with daily activities (SGRQ Activity Subscale) (p = .038) while adjusting for severity of airflow limitation, exercise tolerance, oxygen use, dyspnea, and symptoms of anxiety and depression. CONCLUSION The findings suggest that cognition is associated with daily activity in patients with COPD. Future research should examine whether cognitive interventions may help to maximize patients' engagement in daily activities.
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Affiliation(s)
- Amanda M Brunette
- University of Iowa, Department of Psychological and Brain Sciences, Iowa City, IA 52242, USA
| | - Kelsey Warner
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- Hennepin Healthcare, Department of Speech-Language Pathology, Minneapolis, MN 55404, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO 80045, USA
| | - Kimberly Meschede
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - David J Moser
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
- Denver Veterans Administration Medical Center, Geriatric Research Education and Clinical Center, Denver, CO 80220 USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Russell Bowler
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Iowa, Iowa Neuroscience Institute, Iowa City, IA 52242, USA
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Selection of Comprehensive Assessment Categories Based on the International Classification of Functioning, Disability, and Health for Elderly Patients with Heart Failure: A Delphi Survey among Registered Instructors of Cardiac Rehabilitation. Occup Ther Int 2021; 2021:6666203. [PMID: 34257628 PMCID: PMC8257385 DOI: 10.1155/2021/6666203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
The development of a comprehensive assessment tool based on the International Classification of Functioning, Disability, and Health (ICF) for elderly patients with heart failure is urgently required. In this study, we classified the ICF categories relevant to heart failure in the elderly through a Delphi survey (3-step questionnaire survey) of 108 Registered Instructors of Cardiac Rehabilitation in the Hiroshima Prefecture. Questionnaires were conducted using postal mail or a web-based platform. The survey was conducted three times, and the survey results were provided as feedback to the participants in the second and third rounds. More than 80% of the respondents selected categories according to the ICF core set methodology. Data were collected from December 2018 to March 2019, with 67, 54, and 46 participants in the first, second, and third rounds, respectively. A total of 58 ICF items were adopted based on the results: 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. This study is characterised by the inclusion of a large number of ICF items for mental function. This result seems to be influenced by the increasing interest in cognitive dysfunction in elderly patients with heart failure. The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients.
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Schiltz NK, Dolansky MA, Warner DF, Stange KC, Gravenstein S, Koroukian SM. Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Machine Learning. J Gen Intern Med 2020; 35:2865-2872. [PMID: 32728960 PMCID: PMC7573020 DOI: 10.1007/s11606-020-05982-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limitations in instrumental activities of daily living (IADL) hinder a person's ability to live independently in the community and self-manage their conditions, but its impact on hospital readmission has not been firmly established. OBJECTIVE To test the importance of IADL dependency as a predictor of 30-day readmissions and quantify its impact relative to other morbidities. DESIGN A retrospective cohort study of the population-based Health and Retirement Study linked to Medicare claims data. Random forest was used to rank each predictor variable in terms of its ability to predict readmission. Classification and regression tree (CART) was used to identify complex multimorbidity combinations associated with high or low risk of readmission. Generalized linear regression was used to estimate the adjusted relative risk of readmission for IADL limitations. SUBJECTS Hospitalizations of adults age 65 and older (n = 20,007), from 6617 unique subjects. MAIN MEASURES The main outcome was 30-day all-cause unplanned readmission. The main predictor of interest was self-reported IADL limitation. Other key predictors were self-reported complex multimorbidity including chronic diseases, geriatric syndromes, and activities of daily living (ADL) limitations, along with demographic, socioeconomic, and behavioral factors. KEY RESULTS The overall 30-day readmission rate in the study was 16.4%. Random forest analysis ranked ADLs and IADL limitations as the two most important predictors of 30-day readmission. CART identified hospitalizations of patients with IADL limitations and diabetes as a subgroup at the highest risk of readmission (26% readmitted). Multivariable regression analyses showed that ADL limitations were associated with 1.17 (1.06-1.29) times higher risk of readmission even after adjusting for other patient covariates. Risk prediction was modest though for even the best model (AUC = 0.612). CONCLUSIONS IADL limitations are key predictors of 30-day readmission as demonstrated using several machine learning methods. Routine assessment of functional abilities in hospital settings could help identify those most at risk.
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Affiliation(s)
- Nicholas K Schiltz
- Frances Payne Bolton School of Nursing , Case Western Reserve University, 10900 Euclid Avenue, Room 459H, Cleveland, OH, 44106-7343, USA. .,Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing , Case Western Reserve University, 10900 Euclid Avenue, Room 459H, Cleveland, OH, 44106-7343, USA.,Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David F Warner
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kurt C Stange
- Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Family & Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA.,Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Siran M Koroukian
- Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Viveiros J, Sethares KA, Westlake C. Executive dysfunction is associated with self-care confidence in patients with heart failure. Appl Nurs Res 2020; 54:151312. [PMID: 32650899 DOI: 10.1016/j.apnr.2020.151312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/16/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
AIM To explore differences in self-care maintenance, management and confidence levels between American heart failure (HF) patients with and without executive dysfunction. BACKGROUND Evidence indicates some aspect of cognitive impairment is prevalent in up to 75% of the HF patient population. Moreover, cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. There is limited understanding of the role executive function, a domain of cognitive performance, has on self-care behaviors for patients with HF. METHOD This secondary analysis examined the role of executive function, measured by the Clock Drawing Test (CDT), in relation to self-care measures. The Self Care of Heart Failure Index v6.2 (SCHFI v6.2) was used to measure self-care maintenance, management, and confidence. RESULTS Participants had a mean age of 75.1 ± 12.5 years, identified as male (59.4%), with New York Heart Association (NYHA) class III (57.3%). Executive function impairment was present in 28% of the sample. Comparison of self-care maintenance and management scores between the two groups were not significant. However, participants with executive dysfunction demonstrated an average self-care confidence score of 48.6 ± 23.3, while participants with no executive function impairment demonstrated a higher average self-care confidence score of 61.5 ± 18.4. Differences in self-care confidence scores between the groups were statistically significant (p = .014). CONCLUSIONS HF self-care confidence is considered a moderator of self-care behaviors. Understanding the influence executive function has on self-care confidence may lead to a better understanding of those needing greater support with self-care behaviors.
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Affiliation(s)
- Jennifer Viveiros
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA.
| | - Kristen A Sethares
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA
| | - Cheryl Westlake
- Memorial Care Shared Services, 17360 Brookhurst Street, Fountain Valley, CA 92708, USA.
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11
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Bohannon RW, Crouch RH. Two-Minute Step Test of Exercise Capacity: Systematic Review of Procedures, Performance, and Clinimetric Properties. J Geriatr Phys Ther 2020; 42:105-112. [PMID: 29210933 DOI: 10.1519/jpt.0000000000000164] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The 2-minute step test (TMST) is one of many alternatives for measuring exercise capacity. First introduced in 1999 as part of the Senior Fitness Test, the TMST has the advantage of requiring limited space, only a few minutes' time, and no expensive equipment. These advantages notwithstanding, the test must be clinimetrically sound if it is to be recommended. We sought therefore to summarize the literature addressing TMST performance and measurement properties. METHODS Relevant literature was identified by searches of 3 electronic databases (PubMed, Scopus, and Cumulative Index of Nursing and Allied Health) and hand searches. Inclusion of an article required that it described use of the TMST of Rikli and Jones and that it focused on adults. Articles published in a language other than English were excluded. Studies were abstracted for information on participants, TMST description, and findings. RESULTS AND DISCUSSION Thirty articles were deemed appropriate based on inclusion and exclusion criteria. The participants in the studies included community-dwelling healthy older adults and adults with assorted pathologies. Studies described varied methods of conducting the TMST. Among tests in which steps for one side were counted over a full 2 minutes, the mean number of steps among populations ranged from 29.1 for patients with chronic stroke to 110.8 for older osteoporotic women. Numerous reviewed studies provide support for the validity of the TMST. Only one study addressed reliability and none focused on responsiveness. Normative data have been proffered. CONCLUSIONS The TMST has been widely used since first introduced, albeit not always as originally described. There is considerable evidence for the validity of the test, but its reliability and responsiveness are not yet firmly established.
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Affiliation(s)
- Richard W Bohannon
- Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Lillington, North Carolina
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Cerebrovascular Correlates of Subclinical Attentional Disturbances in Non-stroke Cardiovascular Disease. Neuroscience 2019; 421:144-151. [PMID: 31682956 DOI: 10.1016/j.neuroscience.2019.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022]
Abstract
Evidence suggests that cerebrovascular hemodynamic disturbances underlie cognitive deterioration secondary to cardiovascular disease (CVD), including manifestations other than stroke, but the mechanisms remain unclear. To date, the majority of studies have used neuropsychological measures validated for the detection of clinically significant cognitive decline but lack the sensitivity to accurately detect subclinical or subtle cognitive changes. The N2 and P3 components of the event-related potential are sensitive markers of attention and cognitive processing, and are valuable in the assessment of age-related cognitive changes and neurodegenerative disease. The aims of this study were to test (a) the sensitivity of N2 and P3 components in differentiating older adults with CVD from healthy controls, and (b) whether cerebrovascular hemodynamics are associated with alterations in attention in persons with non-stroke CVD. Older adults with CVD (n = 20) and healthy older adults (n = 20) without cognitive impairment or history of stroke and matched for age, were recruited. Cerebral blood flow velocity of the middle cerebral artery (MCAv) and Gosling's Pulsatility Index (PI) were assessed using Transcranial Doppler ultrasound (TCD). ERPs were elicited using a two-tone auditory oddball task. N2 amplitude was significantly reduced in the CVD group at midline frontal, central and parietal sites (p < .05, d > 0.6). No significant group differences were observed in N2 latency, P3 amplitude, or P3 latency. Further, MCAv and PI were strongly associated with N2 amplitude in the CVD group, such that greater MCAv was associated with reductions in N2 amplitude (b = -0.58, p = .018), whilst PI was associated with increases in N2 amplitude (b = 0.66, p = .006). No relationships between MCAv or PI with N2 or P3 ERP components were observed in the healthy control group. The data reported here suggest that a reduction in N2 amplitude may be an important objective indicator of subclinical cognitive and attentional alterations in non-stroke CVD, and support the notion that cerebrovascular hemodynamic disturbances play a role in the pathogenesis of cognitive deterioration secondary to non-stroke CVD.
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Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, Pekler G. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev 2019; 15:291-303. [PMID: 31456512 PMCID: PMC8142355 DOI: 10.2174/1573403x15666190313112841] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Monica Pernia
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee TN, United States
| | - Shobhana Chaudhari
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
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14
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Pressler SJ, Giordani B, Titler M, Gradus-Pizlo I, Smith D, Dorsey SG, Gao S, Jung M. Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study. J Cardiovasc Nurs 2019; 33:344-355. [PMID: 29601367 PMCID: PMC5995611 DOI: 10.1097/jcn.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure.
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Affiliation(s)
- Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202,
| | - Bruno Giordani
- University of Michigan School of Medicine, Neuropsychology Program, Department of Psychiatry, 2101 Commonwealth Dr., Ste. C, Ann Arbor, MI 48104,
| | - Marita Titler
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109,
| | - Irmina Gradus-Pizlo
- University of California, Irvine, Division of Cardiology, 101 City Drive South, City Tower 400, Orange, CA 92868,
| | - Dean Smith
- Louisiana State University Health Sciences Center School of Public Health, 2020 Gravier St., New Orleans, LA 70112,
| | - Susan G. Dorsey
- University of Maryland School of Nursing Department of Pain and Transitional Symptom Science, Room 727, 655 West Lombard St., Baltimore, MD 21201,
| | - Sujuan Gao
- Indiana University School of Medicine, Department of Biostatistics, 410 W. 10 St., Suite 3000,
| | - Miyeon Jung
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202,
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15
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Lovell J, Pham T, Noaman SQ, Davis MC, Johnson M, Ibrahim JE. Self-management of heart failure in dementia and cognitive impairment: a systematic review. BMC Cardiovasc Disord 2019; 19:99. [PMID: 31035921 PMCID: PMC6489234 DOI: 10.1186/s12872-019-1077-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/11/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The cornerstone of effective management in heart failure (HF) is the ability to self-care. Aims include i) To determine factors influencing self-care in HF patients with cognitive impairment (CI) and ii) to determine the influence of cognitive domains on self-care in patients with HF and CI. METHODS MEDLINE, CINAHL, EMBASE, EBSCOHost, PsychINFO, ProQuest Research Library, Health Technology Assessment Database, The Cochrane Library, Web of Science and Scopus databases were systematically searched. Original research describing the relationship between cognition and HF self-care in community-dwelling older persons with dementia/CI in English, published in a peer-reviewed journal from 1stJanuary(2000)-22ndMarch(2016) was identified. Study and population characteristics, data sources, self-care processes, methods of cognitive assessment, cognitive domains affected, study outcomes, impact of impairment, and other risk factors of self-care impairment were abstracted by two reviewers. RESULTS Of 10,688 studies identified, 14 met the inclusion criteria. Patients with HF and CI ranged from 14 to 73%. Where reported, self-care maintenance adequacy ranged from 50 to 61%; self-care management adequacy ranged from 14 to 36% and self-care confidence adequacy ranged from 0 to 44% on the Self-care of Heart Failure Index (SCHFI). All but one study predicted poor self-care ability according to poor outcome on cognitive testing. Additionally, specific cognitive domain deficits impaired self-care. Subjects with lower cognitive scores were less likely to seek assistance while subjects with depression had poor self-care abilities. CONCLUSIONS Clinicians must consider the type and severity of impairments in cognitive domains to tailor management. Awareness of depression, self-confidence and support access may modulate self-care ability.
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Affiliation(s)
- Janaka Lovell
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Tony Pham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Samer Q Noaman
- Department of Cardiology, Alfred Health, Victoria, 3004, Australia
| | | | - Marilyn Johnson
- Institute of Transport Studies, Monash University, Victoria, 3800, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Abstract
Objective: The purpose of this critical review was to evaluate the current state of research regarding the incremental value of neuropsychological assessment in clinical practice, above and beyond what can be accounted for on the basis of demographic, medical, and other diagnostic variables. The focus was on neurological and other medical conditions across the lifespan where there is known risk for presence or future development of cognitive impairment.Method: Eligible investigations were group studies that had been published after 01/01/2000 in English in peer-reviewed journals and that had used standardized neuropsychological measures and reported on objective outcome criterion variables. They were identified through PubMed and PsychInfo electronic databases on the basis of predefined specific selection criteria. Reference lists of identified articles were also reviewed to identify potential additional sources. The Grades of Recommendation, Assessment, Development and Evaluation Working Group's (GRADE) criteria were used to evaluate quality of studies.Results: Fifty-six studies met the final selection criteria, including 2 randomized-controlled trials, 9 prospective cohort studies, 12 retrospective cohort studies, 21 inception cohort studies, 2 case control studies, and 10 case series studies. The preponderance of the evidence was strongly supportive with regard to the incremental value of neuropsychological assessment in the care of persons with mild cognitive impairment/dementia and traumatic brain injury. Evidence was moderately supportive with regard to stroke, epilepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder. Participation in neuropsychological evaluations was also associated with cost savings.Conclusions: Neuropsychological assessment can improve both diagnostic classification and prediction of long-term daily-life outcomes in patients across the lifespan. Future high-quality prospective cohort studies and randomized-controlled trials are necessary to demonstrate more definitively the incremental value of neuropsychological assessment in the management of patients with various neurological and other medical conditions.
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Affiliation(s)
- Jacobus Donders
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
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17
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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18
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Lan H, Hawkins LA, Kashner M, Perez E, Firek CJ, Silvet H. Cognitive impairment predicts mortality in outpatient veterans with heart failure. Heart Lung 2018; 47:546-552. [PMID: 30143364 DOI: 10.1016/j.hrtlng.2018.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND In our prior study of 250 outpatient veterans with heart failure (HF), 58% had unrecognized cognitive impairment (CI) which was linked to worsened medication adherence. Literature suggests HF patients with CI have poorer clinical outcomes including higher mortality. OBJECTIVE The study is to examine mortality rates in outpatients with HF and undiagnosed CI compared to their cognitively intact peers. METHODS This is a retrospective study for all-cause mortality. RESULTS During the 3-year follow up, 64/250 (25.6%) patients died: 20/106 (18.9%) with no CI, 29/104 (27.9%) with mild CI, and 15/40 (37.5%) with severe CI. Patients with CI were at increased risk for mortality (hazard ratio 1.82, p = 0.038). Those with severe CI had the worst outcome (hazard ratio 2.710, p = 0.011). CONCLUSIONS CI was an independent risk factor for mortality in patients with heart failure when controlling for age and markers of disease severity. Cognitive screening should be performed routinely to identify patients at greater risk for adverse outcomes.
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Affiliation(s)
- Howard Lan
- Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA; VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Lee Ann Hawkins
- Indiana Wesleyan University, 4201 S Washington St, Marion, IN 46953, USA.
| | - Michael Kashner
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Elena Perez
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Christopher J Firek
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
| | - Helme Silvet
- VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
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Long-term cognitive impairment and delirium in intensive care: A prospective cohort study. Aust Crit Care 2018; 31:204-211. [DOI: 10.1016/j.aucc.2017.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 11/21/2022] Open
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20
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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Abstract
BACKGROUND Cognitive deficits are found in up to 73% of persons with heart failure (HF) and are associated with increased mortality and other poor clinical outcomes. It is known that women have better memory test performance than men do in healthy samples, but gender differences in cognitive performance in the context of HF are not well understood and may have important clinical implications. OBJECTIVE The objective of this study was to examine possible gender differences in cognitive function in a sample of individuals with HF (98.9% New York Heart Association class II and III). METHODS A total of 183 adults with HF (116 men and 67 women) completed a neuropsychological test battery as part of a larger project. Measures were chosen to assess functioning in attention/executive function and memory. RESULTS After controlling for demographic and medical factors, multivariate analysis of covariance revealed that men and women differed on memory test performance (λ = 0.90, F4, 169 = 4.76, P = .001). Post hoc comparisons revealed that women performed better on California Verbal Learning Test Learning, Short Recall, and Delayed Recall. No differences emerged on tests of attention/executive function (λ = 0.97, F5, 168 = 0.96, P = .44). CONCLUSIONS In this sample of persons with HF, men exhibited poorer performance on memory measures than women did. Future studies are needed to determine the underlying mechanisms for this pattern and its possible influence on daily function.
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23
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Kim J, Shin MS, Hwang SY, Park E, Lim YH, Shim JL, Kim SH, Kim YH, An M. Memory loss and decreased executive function are associated with limited functional capacity in patients with heart failure compared to patients with other medical conditions. Heart Lung 2018; 47:61-67. [DOI: 10.1016/j.hrtlng.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/28/2022]
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Lycholip E, Thon Aamodt I, Lie I, Šimbelytė T, Puronaitė R, Hillege H, de Vries A, Kraai I, Stromberg A, Jaarsma T, Čelutkienė J. The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study. Patient Prefer Adherence 2018; 12:1113-1122. [PMID: 29983549 PMCID: PMC6027682 DOI: 10.2147/ppa.s162219] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited. AIMS This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care. METHODS In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69±11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ). RESULTS The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p<0.01) but not in the TM+ICT-guided-DMS group. Factors associated with self-care worsening were as follows: higher physical subscale of MLHFQ (per 10 points, p<0.05), lower left ventricular ejection fraction (LVEF) (per 5%, p<0.05), lower New York Heart Association (NYHA) class (class III vs class II, p<0.05). The subgroups of patients who had an initial EHFScBs total score >28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score ≤8, demonstrated the greatest potential to improve self-care during the study. CONCLUSION TM did not have an advantage on self-care improvement. Poor physical aspect of quality of life, lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression.
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Affiliation(s)
- Edita Lycholip
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,
- Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania,
| | - Ina Thon Aamodt
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Irene Lie
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Toma Šimbelytė
- Clinic of Internal Medicine, Centre of Family and Internal Medicine, Vilnius University Santaros Clinics, Vilnius University, Vilnius, Lithuania
| | - Roma Puronaitė
- Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania,
- Centre of Informatics and Development, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
- Institute of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania
| | - Hans Hillege
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arjen de Vries
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Imke Kraai
- PRA Health Sciences - Early Development Services, Groningen, the Netherlands
| | - Anna Stromberg
- Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linkoping University, Norrkoping, Sweden
| | - Jelena Čelutkienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,
- Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania,
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25
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Bürker BS, Gude E, Gullestad L, Grov I, Relbo Authen A, Andreassen AK, Havik OE, Dew MA, Fiane AE, Haraldsen IR, Malt UF, Andersson S. Cognitive function among long-term survivors of heart transplantation. Clin Transplant 2017; 31. [PMID: 29055147 DOI: 10.1111/ctr.13143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cognitive impairment is documented early after heart transplantation (HTx), but we lack data on cognitive function beyond the fourth year post-transplant. Against the background of good long-term survival, this knowledge is necessary to improve clinical care throughout the entire post-transplant period. METHODS We assessed cognitive function with a neuropsychological test battery in a sample of HTx recipients ≥16 years post-transplant. To improve clinical utility, we also applied adapted consensus criteria for Mild Cognitive Impairment (MCI). Furthermore, we explored sociodemographic and clinical characteristics possibly related to cognitive function. RESULTS Thirty-seven subjects were included 20.3 (±3.8) years after HTx. Mean age was 57.5 (±14.2) years, and 18.9% were women. Up to 38.9% exhibited impaired test performance (ie, performance at least 1.5 standard deviations below the normative mean) on several individual cognitive measures, especially on measures of processing speed, executive functions, memory, and language functions. One subject was diagnosed with dementia, and 30.1% qualified for MCI. Those with MCI had lower hemoglobin than those without. CONCLUSIONS A substantial proportion of long-term survivors of HTx might be cognitively impaired. The level of impairment appears comparable to what is defined as MCI in the literature. Modifiable factors related to cognitive impairment might exist.
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Affiliation(s)
- Britta S Bürker
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry of Old Age, Oslo University Hospital - Ullevål, Oslo, Norway.,Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Odd E Havik
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arnt E Fiane
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ira R Haraldsen
- Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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26
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Randomized Crossover Study of the Natural Restorative Environment Intervention to Improve Attention and Mood in Heart Failure. J Cardiovasc Nurs 2017; 32:464-479. [DOI: 10.1097/jcn.0000000000000368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Howell EH, Senapati A, Hsich E, Gorodeski EZ. Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study. SAGE Open Med 2017; 5:2050312117700301. [PMID: 28540048 PMCID: PMC5433792 DOI: 10.1177/2050312117700301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Cognitive impairment is highly prevalent among older adults (aged ≥65 years) hospitalized for heart failure and has been associated with poor outcomes. Poor medication self-management skills have been associated with poor outcomes in this population as well. The presence and extent of an association between cognitive impairment and poor medication self-management skills in this population has not been clearly defined. Objective: We assessed the cognition of consecutive older adults hospitalized for heart failure, in relation to their medication self-management skills. Methods: We conducted a cross-sectional study of older adults (aged ≥65 years) who were hospitalized for heart failure and were being discharged home. Prior to discharge, we assessed cognition using the Mini-Cog. We also tested patients’ ability to read a pill bottle label, open a pill bottle safety cap, and allocate mock pills to a pill box. Pill allocation performance was assessed quantitatively (counts of errors of omission and commission) and qualitatively (patterns suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based slips). Results: Of 55 participants, 22% were found to have cognitive impairment. Patients with cognitive impairment tended to be older as compared to those without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with cognitive impairment had a higher prevalence of inability to read pill bottle label (prevalence ratio = 5.8, 95% confidence interval = 3.2–10.5, p = 0.001) and inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence interval = 1.3–8.4, p = 0.03). While most patients (65%) had pill-allocation errors regardless of cognition, those patients with cognitive impairment tended to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as well as more knowledge-based mistakes (75% vs 40%, p = 0.03). Conclusion: There is an association between cognitive impairment and poor medication self-management skills. Medication taking failures due to poor medication self-management skills may be part of the pathway linking cognitive impairment to poor post-discharge outcomes among patients with heart failure transitioning from hospital to home.
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Affiliation(s)
- Erik H Howell
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alpana Senapati
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Eileen Hsich
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
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28
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Bürker BS, Gullestad L, Gude E, Relbo Authen A, Grov I, Hol PK, Andreassen AK, Arora S, Dew MA, Fiane AE, Haraldsen IR, Malt UF, Andersson S. Cognitive function after heart transplantation: Comparing everolimus-based and calcineurin inhibitor-based regimens. Clin Transplant 2017; 31. [PMID: 28185318 DOI: 10.1111/ctr.12927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies have shown conflicting results concerning the occurrence of cognitive impairment after successful heart transplantation (HTx). Another unresolved issue is the possible differential impact of immunosuppressants on cognitive function. In this study, we describe cognitive function in a cohort of HTx recipients and subsequently compare cognitive function between subjects on either everolimus- or calcineurin inhibitor (CNI)-based immunosuppression. METHODS Cognitive function, covering attention, processing speed, executive functions, memory, and language functions, was assessed with a neuropsychological test battery. Thirty-seven subjects were included (everolimus group: n=20; CNI group: n=17). The extent of cerebrovascular pathology was assessed with magnetic resonance imaging. RESULTS About 40% of subjects had cognitive impairment, defined as performance at least 1.5 standard deviations below normative mean in one or several cognitive domains. Cerebrovascular pathology was present in 33.3%. There were no statistically significant differences between treatment groups across cognitive domains. CONCLUSIONS Given the high prevalence of cognitive impairment in the sample, plus the known negative impact of cognitive impairment on clinical outcome, our results indicate that cognitive assessment should be an integrated part of routine clinical follow-up after HTx. However, everolimus- and CNI-based immunosuppressive regimens did not show differential impacts on cognitive function.
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Affiliation(s)
- Britta S Bürker
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Per K Hol
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Satish Arora
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Arnt E Fiane
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ira R Haraldsen
- Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Alagiakrishnan K, Mah D, Dyck JR, Senthilselvan A, Ezekowitz J. Comparison of two commonly used clinical cognitive screening tests to diagnose mild cognitive impairment in heart failure with the golden standard European Consortium Criteria. Int J Cardiol 2017; 228:558-562. [DOI: 10.1016/j.ijcard.2016.11.193] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 01/08/2023]
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30
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Stewart MW, Traylor AC, Bratzke LC. Nutrition and Cognition in Older Adults With Heart Failure: A Systematic Review. J Gerontol Nurs 2017; 41:50-9. [PMID: 26505248 DOI: 10.3928/00989134-20151015-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 09/02/2015] [Indexed: 11/20/2022]
Abstract
Cognitive impairment is commonly observed in older adults with heart failure; nutrition is a possible contributing factor. The purpose of the current systematic review is to examine the relationship between nutrition and cognition in older adults with heart failure. A literature review was performed through August 2015 that examined published, peer-reviewed studies from PubMed, PsycINFO, CINAHL, and Web of Science. Four articles were selected for inclusion. Findings revealed that poorer nutritional habits were associated with poorer attention, executive functioning, and memory in older adults with heart failure. Nutritional biomarkers, including anemia, hyponatremia, hypokalemia, hyperglycemia, and hypoalbuminemia, were also associated with cognitive impairment. More research is needed to explore the relationship between nutrition and cognition in this population. Descriptive studies will inform scientists as they design and test nutritional interventions to optimize cognitive function in older adults with heart failure.
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31
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Norberg EB, Löfgren B, Boman K, Wennberg P, Brännström M. A client-centred programme focusing energy conservation for people with heart failure. Scand J Occup Ther 2017; 24:455-467. [PMID: 28052703 DOI: 10.1080/11038128.2016.1272631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF). METHODS The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed. RESULTS The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice. CONCLUSIONS This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.
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Affiliation(s)
- Eva-Britt Norberg
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Britta Löfgren
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Kurt Boman
- b Department of Public Health and Clinical Medicine , Research Unit, Medcine Skellefteå, Umeå University , Skellefteå , Sweden
| | - Patrik Wennberg
- c Department of Public Health and Clinical Medicine , Family Medicine, Umeå University , Umeå , Sweden
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32
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Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 2016; 22:1-11. [DOI: 10.1007/s10741-016-9587-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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33
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Reduced Gray Matter Volume Is Associated With Poorer Instrumental Activities of Daily Living Performance in Heart Failure. J Cardiovasc Nurs 2016; 31:31-41. [PMID: 25419946 DOI: 10.1097/jcn.0000000000000218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure patients require assistance with instrumental activities of daily living in part because of the high rates of cognitive impairment in this population. Structural brain insult (eg, reduced gray matter volume) is theorized to underlie cognitive dysfunction in heart failure, although no study has examined the association among gray matter, cognition, and instrumental activities of daily living in heart failure. OBJECTIVES The aim of this study was to investigate the associations among gray matter volume, cognitive function, and functional ability in heart failure. METHODS A total of 81 heart failure patients completed a cognitive test battery and the Lawton-Brody self-report questionnaire to assess instrumental activities of daily living. Participants underwent magnetic resonance imaging to quantify total gray matter and subcortical gray matter volume. RESULTS Impairments in instrumental activities of daily living were common in this sample of HF patients. Regression analyses controlling for demographic and medical confounders showed that smaller total gray matter volume predicted decreased scores on the instrumental activities of daily living composite, with specific associations noted for medication management and independence in driving. Interaction analyses showed that reduced total gray matter volume interacted with worse attention/executive function and memory to negatively impact instrumental activities of daily living. CONCLUSIONS Smaller gray matter volume is associated with greater impairment in instrumental activities of daily living in persons with heart failure, possibly via cognitive dysfunction. Prospective studies are needed to clarify the utility of clinical correlates of gray matter volume (eg, cognitive dysfunction) in identifying heart failure patients at risk for functional decline and determine whether interventions that target improved brain and cognitive function can preserve functional independence in this high-risk population.
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34
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The Association Between Mild Cognitive Impairment and Self-care in Adults With Chronic Heart Failure: A Systematic Review and Narrative Synthesis. J Cardiovasc Nurs 2016; 30:382-93. [PMID: 24988321 DOI: 10.1097/jcn.0000000000000173] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Emerging evidence suggests that heart failure (HF) patients who have mild cognitive impairment (MCI) may experience greater difficulty with self-care. OBJECTIVE This article reports a systematic review that addressed the objective "What is the evidence for an association between MCI and self-care, measured in 1 or more of the self-care domains related to HF, in adults who have a diagnosis of chronic HF?" METHOD We adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the review and synthesis of quantitative research studies that formally measured both cognitive function and self-care in HF patients and sought to describe the relationship between these factors. RESULTS Ninety-one potentially relevant studies were located; 10 studies (2006-2014) were included. Because of heterogeneity in the retrieved studies, meta-analysis was not possible. Narrative synthesis found growing evidence regarding the association between MCI and adverse effects on self-care in HF. Nine studies reported significant positive associations between MCI and self-care in HF, either specifically in relation to medication adherence or more generic measures of self-care activity. One study reported a significant, negative correlation between cognitive function and self-care, suggesting that worse cognitive function was associated with better self-care; however, this is partially explained by a small sample size and mixed methodology. CONCLUSIONS These findings have implications for clinical practice. It is known that HF patients have difficulty with self-care, and the influence of cognitive function needs to be considered when providing professional support. Further research to determine the feasibility and acceptability of cognitive assessment in routine clinical care is recommended.
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35
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Vellone E, Pancani L, Greco A, Steca P, Riegel B. Self-care confidence may be more important than cognition to influence self-care behaviors in adults with heart failure: Testing a mediation model. Int J Nurs Stud 2016; 60:191-9. [PMID: 27297380 DOI: 10.1016/j.ijnurstu.2016.04.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/03/2016] [Accepted: 04/25/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding. OBJECTIVES The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. DESIGN Secondary analysis of data from a descriptive study. SETTINGS Three out-patient sites in Pennsylvania and Delaware, USA. PARTICIPANTS A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). METHODS Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. RESULTS Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929-.968; root mean squared error of approximation range: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care. CONCLUSIONS Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population.
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Affiliation(s)
- Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Andrea Greco
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Patrizia Steca
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Barbara Riegel
- Edith Clemmer Steinbright Professor of Gerontology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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36
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Relationship between neurocognitive functioning and medication management ability over the first 6 months following allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 51:841-7. [DOI: 10.1038/bmt.2016.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/29/2015] [Accepted: 12/18/2015] [Indexed: 12/21/2022]
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37
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Effects of an aerobic exercise program on driving performance in adults with cardiovascular disease. Int J Rehabil Res 2016; 39:117-22. [PMID: 26756849 DOI: 10.1097/mrr.0000000000000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease (CVD) has been linked to decreases in driving performance and an increased crash risk. Regular exercise has been linked to improved driving performance among healthy adults. The aim of the current study was to investigate the relationship between a 12-week cardiac rehabilitation (CR) program and driving performance among individuals with CVD. Twenty-five individuals, including 12 cardiac adults and 13 healthy adults, took part in this study. Simulated driving performance was assessed using a standardized demerit-based scoring system at 0 and 12 weeks. Cardiac participants completed a 12-week CR program between evaluations. At baseline, cardiac participants had a higher number of demerit points than healthy adults (120.9±38.1 vs. 94.7±28.3, P=0.04). At follow-up, there was an improvement in both groups' driving evaluations, but the improvement was greater among the cardiac group such that there was no longer a difference in driving performance between both groups (94.6±30 vs. 86.9±34.8, P=0.51). Participation in an aerobic exercise-based CR program appears to lead to improvements in simulated driving performances of individuals with CVD.
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38
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Preliminary Investigation on the Association between Depressive Symptoms and Driving Performance in Heart Failure. Geriatrics (Basel) 2015; 1:geriatrics1010002. [PMID: 31022798 PMCID: PMC6371127 DOI: 10.3390/geriatrics1010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) patients commit many errors on driving simulation tasks and cognitive dysfunction appears to be one important contributor to impaired driving in HF. Clinical modifiers of cognition may also play a key role. In particular, depression is common in HF patients, linked with cognitive dysfunction, and contributes to reduced driving fitness in non-HF samples. However, the associations among depressive symptoms, cognition, and driving in HF are unclear. Eighteen HF patients completed a validated simulated driving scenario, the Beck Depression Inventory-II (BDI-II), and a cognitive test battery. Partial correlations controlling for demographic and medical confounds showed higher BDI-II score correlated with greater number of collisions, centerline crossings, and % time out of lane. Increased depressive symptoms correlated with lower attention/executive function, and reduced performance in this domain was associated with a greater number of collisions, centerline crossing, and % time out of lane. Depressive symptoms may be related to poorer driving performance in HF, perhaps through association with cognitive dysfunction. However, larger studies with on-road testing are needed to replicate our preliminary findings before recommendations for clinical practice can be made.
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Nazir A, Smucker WD. Heart Failure in Post-Acute and Long-Term Care: Evidence and Strategies to Improve Transitions, Clinical Care, and Quality of Life. J Am Med Dir Assoc 2015; 16:825-31. [DOI: 10.1016/j.jamda.2015.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/12/2022]
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40
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Alosco ML, Hayes SM. Structural brain alterations in heart failure: a review of the literature and implications for risk of Alzheimer's disease. Heart Fail Rev 2015; 20:561-71. [PMID: 25896528 PMCID: PMC5543407 DOI: 10.1007/s10741-015-9488-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiovascular disease is a recognized contributor to the pathogenesis of Alzheimer's disease (AD). Heart failure (HF) is a cardiovascular subtype that can be used to model the contribution of cardiovascular disease to AD. Neuroimaging research indicates that HF patients exhibit a diverse range of structural brain alterations and epidemiological studies suggest HF may be an important risk factor for AD. The neural alterations observed in HF may overlap with those observed in AD and contribute to increased risk of AD in HF patients. To examine this possibility, we reviewed structural MRI studies in persons with HF. We examined subcortical brain regions affected in the early stages of AD (medial temporal lobes), as well as cortical alterations that typically occur in the later stages of AD. Our review indicates that patients with HF exhibit greater neural atrophy and white matter microstructural alterations of nearly every region of the Papez circuit (e.g., hippocampus, cingulate gyrus, thalamus, mammillary bodies, and fornix), as well-significant alterations in cortical and cerebellar regions. Based on animal research and past work in AD patients, the mechanisms for structural brain changes in HF may stem from reductions in cerebral blood flow subsequent to cardiac deficiency. This review supports the hypothesis that HF may contribute to AD risk via widespread structural brain changes, including many of the same regions affected by AD. Case-controlled prospective neuroimaging studies with long-term follow-ups are needed to clarify the risk of AD in HF and elucidate the neural underpinnings of AD risk in HF.
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Affiliation(s)
- Michael L Alosco
- Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA,
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41
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Vellone E, Fida R, D'Agostino F, Mottola A, Juarez-Vela R, Alvaro R, Riegel B. Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure. Int J Nurs Stud 2015; 52:1705-13. [PMID: 26169451 DOI: 10.1016/j.ijnurstu.2015.06.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care. OBJECTIVE The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. DESIGN A secondary analysis of data from a cross-sectional study. SETTING Outpatient heart failure clinics in 28 Italian provinces. PARTICIPANTS 628 Italian heart failure patients. METHODS We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data. RESULTS Participants were 73 years old on average (SD=11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index=1.0; root mean square error of approximation=0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management. CONCLUSION Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition.
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Affiliation(s)
- Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Roberta Fida
- Department of Psychology, Sapienza University of Rome, Italy
| | - Fabio D'Agostino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonella Mottola
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Raul Juarez-Vela
- Faculty of Health Sciences, University San Jorge, Zaragoza, Spain
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Hawkins MAW, Schaefer JT, Gunstad J, Dolansky MA, Redle JD, Josephson R, Moore SM, Hughes JW. What is your patient's cognitive profile? Three distinct subgroups of cognitive function in persons with heart failure. Appl Nurs Res 2015; 28:186-91. [PMID: 25510559 PMCID: PMC4409449 DOI: 10.1016/j.apnr.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/19/2014] [Accepted: 10/25/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to determine whether patients with heart failure (HF) have distinct profiles of cognitive impairment. BACKGROUND Cognitive impairment is common in HF. Recent work found three cognitive profiles in HF patients-(1) intact, (2) impaired, and (3) memory-impaired. We examined the reproducibility of these profiles and clarified mechanisms. METHODS HF patients (68.6 ± 9.7 years; N=329) completed neuropsychological testing. Composite scores were created for cognitive domains and used to identify clusters via agglomerative-hierarchical cluster analysis. RESULTS A 3-cluster solution emerged. Cluster 1 (n=109) had intact cognition. Cluster 2 (n=123) was impaired across all domains. Cluster 3 (n=97) had impaired memory only. Clusters differed in age, race, education, SES, IQ, BMI, and diabetes (ps ≤ .026) but not in mood, anxiety, cardiovascular, or pulmonary disease (ps ≥ .118). CONCLUSIONS We replicated three distinct patterns of cognitive function in persons with HF. These profiles may help providers offer tailored care to patients with different cognitive and clinical needs.
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Affiliation(s)
| | | | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Joseph D Redle
- Cardiovascular Research Institute, Summa Health System, Akron City Hospital, Akron, OH
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH; Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, OH; Cardiovascular Research Institute, Summa Health System, Akron City Hospital, Akron, OH
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Alosco ML, Spitznagel MB, Gunstad J. Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure. Heart Fail Rev 2015; 19:403-11. [PMID: 23743688 DOI: 10.1007/s10741-013-9399-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80% of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, 340 Kent Hall, Kent, OH, 44224, USA,
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44
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Hjelm CM, Broström A, Riegel B, Årestedt K, Strömberg A. The association between cognitive function and self-care in patients with chronic heart failure. Heart Lung 2015; 44:113-9. [PMID: 25682390 DOI: 10.1016/j.hrtlng.2014.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression. METHODS This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses. RESULTS Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression. CONCLUSIONS Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.
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Affiliation(s)
- Carina M Hjelm
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; Department of Cardiothoracic Surgery, County Council of Östergötland, Sweden.
| | - Anders Broström
- Department of Clinical Neurophysiology, County Council of Östergötland, Sweden; Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | - Barbara Riegel
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Kristofer Årestedt
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; School of Health and Caring Sciences, Linnaeus University Kalmar, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden; Department of Cardiology, County Council of Östergötland, Sweden
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Fraser KS, Heckman GA, McKelvie RS, Harkness K, Middleton LE, Hughson RL. Cerebral Hypoperfusion Is Exaggerated With an Upright Posture in Heart Failure. JACC-HEART FAILURE 2015; 3:168-75. [DOI: 10.1016/j.jchf.2014.07.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
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Butts B, Gary R. Coexisting Frailty, Cognitive Impairment, and Heart Failure: Implications for Clinical Care. JOURNAL OF CLINICAL OUTCOMES MANAGEMENT : JCOM 2015; 22:38-46. [PMID: 26594103 PMCID: PMC4650868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review some of the proposed pathways that increase frailty risk in older persons with heart failure and to discuss tools that may be used to assess for changes in physical and cognitive functioning in this population in order to assist with appropriate and timely intervention. METHODS Review of the literature. RESULTS Heart failure is the only cardiovascular disease that is increasing by epidemic proportions, largely due to an aging society and therapeutic advances in disease management. Because heart failure is largely a cardiogeriatric syndrome, age-related syndromes such as frailty and cognitive impairment are common in heart failure patients. Compared with age-matched counterparts, older adults with heart failure 4 to 6 times more likely to be frail or cognitively impaired. The reason for the high prevalence of frailty and cognitive impairment in this population is not well known but may likely reflect the synergistic effects of heart failure and aging, which may heighten vulnerability to stressors and accelerate loss of physiologic reserve. Despite the high prevalence of frailty and cognitive impairment in the heart failure population, these conditions are not routinely screened for in clinical practice settings and guidelines on optimal assessment strategies are lacking. CONCLUSION Persons with heart failure are at an increased risk for frailty, which may worsen symptoms, impair self-management, and lead to worse heart failure outcomes. Early detection of frailty and cognitive impairment may be an opportunity for intervention and a key strategy for improving clinical outcomes in older adults with heart failure.
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Affiliation(s)
- Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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47
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Ampadu J, Morley JE. Heart failure and cognitive dysfunction. Int J Cardiol 2015; 178:12-23. [DOI: 10.1016/j.ijcard.2014.10.087] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Patel A, Parikh R, Howell EH, Hsich E, Landers SH, Gorodeski EZ. Mini-cog performance: novel marker of post discharge risk among patients hospitalized for heart failure. Circ Heart Fail 2014; 8:8-16. [PMID: 25477431 DOI: 10.1161/circheartfailure.114.001438] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Heart failure (HF) guidelines recommend screening for cognitive impairment (CI) but do not identify how. The Mini-Cog is an ultrashort cognitive "vital signs" measure that has not been studied in patients hospitalized for HF. The purpose of this study was to evaluate whether CI as assessed by the Mini-Cog is associated with increased readmission or mortality risk after hospitalization for HF. METHODS AND RESULTS We analyzed 720 consecutive patients who completed the Mini-Cog as a part of routine clinical care during hospitalization for HF. Our primary outcome was time between hospital discharge and first occurrence of readmission or mortality. There was a high prevalence of CI as quantified by Mini-Cog performance (23% of cohort). During a mean follow-up time of 6 months, 342 (48%) patients were readmitted, and 24 (3%) died. Poor Mini-Cog performance was an independent predictor of composite outcome (adjusted hazard ratio, 1.90; 95% confidence interval, 1.47-2.44; P<0.0001) and was identified as the most important predictor among 55 variables by random survival forest analysis. Inclusion of Mini-Cog performance in risk models improved accuracy (bootstrapped c-index, 0.602 versus 0.624) and risk reclassification (category-free net reclassification improvement, 27%; 95% confidence interval, 14%-40%; P<0.001). Secondary analysis of initial 30 days post discharge showed effect modification by venue of discharge, whereby patients with CI discharged to a facility had longer time to outcome as compared with those discharged home. CONCLUSIONS Mini-Cog performance is a novel marker of posthospitalization risk. Discharge to facility rather than home may be protective for those patients with HF and CI. It is unknown whether structured in-home support would yield similar outcomes.
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Affiliation(s)
- Apurva Patel
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Roosha Parikh
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Erik H Howell
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Eileen Hsich
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Steven H Landers
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Eiran Z Gorodeski
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.).
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Cognitive impairment and cardiovascular diseases in the elderly. A heart-brain continuum hypothesis. Ageing Res Rev 2014; 18:41-52. [PMID: 25107566 DOI: 10.1016/j.arr.2014.07.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/09/2014] [Accepted: 07/17/2014] [Indexed: 12/30/2022]
Abstract
The aging population is increasing and, therefore, a higher prevalence of cardiac disease is emerging; including hypertension, coronary artery disease, atrial fibrillation and chronic heart failure. Large cohort studies have revealed a relationship among increased risk for cognitive impairment and dementia in cardiovascular diseases probably due to embolic stroke or chronic cerebral hypoperfusion. Thus, the aim of the present review is to overview the studies that investigate the presence and/or the development of cognitive impairments and dementia in patients with varied types of cardiovascular disease. Finally, a continuum among hypertension, coronary artery disease, atrial fibrillation and chronic heart failure with to the development of cognitive impairment and progression to dementia has been hypothesized.
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50
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Alosco ML, Penn MS, Brickman AM, Spitznagel MB, Cleveland MJ, Griffith EY, Narkhede A, Gunstad J. Preliminary observations on MRI correlates of driving independence and performance in persons with heart failure. Int J Neurosci 2014; 125:424-32. [DOI: 10.3109/00207454.2014.945643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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