Alosco Michael L, Spitznagel Mary Beth, Cohen Ronald, Sweet Lawrence H, Colbert Lisa H, Josephson Richard, Hughes Joel, Rosneck Jim, Gunstad John
Department of Psychology, Kent State University, USA
Department of Psychology, Kent State University, USA Department of Psychiatry, Akron City Hospital, USA.
Eur J Cardiovasc Nurs. 2014 Aug;13(4):304-10. doi: 10.1177/1474515113494026. Epub 2013 Jun 9.
Occurrences of impaired activities of daily living (ADL) are common in heart failure (HF) patients and contribute to the elevated mortality and hospitalization rates in this population. Cognitive impairment is also prevalent in HF, though its ability to predict functional decline over time is unknown.
This study examined the longitudinal pattern of activities of daily living (ADL) in HF persons and whether reduced baseline cognitive status predicts functional decline in this population.
Altogether 110 persons with HF completed the Lawton-Brody Instrumental Activities of Daily Living (IADL) scale and were administered the Modified Mini-Mental Status Examination (3MS) at baseline and a 12-month follow-up. Three composite scores were derived from the Lawton-Brody scale, including total, instrumental, and basic ADL.
HF patients reported high rates of baseline impairments in instrumental ADL, including shopping, food preparation, housekeeping duties, laundry, among others. Repeated measures analyses showed significant declines in total and instrumental ADL from baseline to the 12-month follow-up in HF (p<0.05). Hierarchical regression analyses showed that poorer baseline performance on the 3MS predicted worse total ADL performance at 12-months (β=0.15, p=0.049), including greater dependence in shopping, driving, feeding, and physical ambulation (p<0.05 for all).
The current results show that HF patients report significant functional decline over a 12-month period and brief cognitive tests can identify those patients at highest risk for decline. If replicated, such findings encourage the use of cognitive screening measures to identify HF patients most likely to require assistance with ADL tasks.
日常生活活动能力受损在心力衰竭（HF）患者中很常见，这导致了该人群死亡率和住院率的升高。认知障碍在HF患者中也很普遍，但其预测随时间推移功能下降的能力尚不清楚。
本研究调查了HF患者日常生活活动（ADL）的纵向模式，以及基线认知状态降低是否能预测该人群的功能下降。
共有110名HF患者完成了Lawton-Brody日常生活工具性活动（IADL）量表，并在基线和12个月随访时接受了改良简易精神状态检查（3MS）。从Lawton-Brody量表中得出三个综合得分，包括总ADL、工具性ADL和基本ADL。
HF患者报告在工具性ADL方面基线受损率较高，包括购物、食物准备、家务、洗衣等。重复测量分析显示，HF患者从基线到12个月随访时，总ADL和工具性ADL有显著下降（p<0.05）。分层回归分析显示，3MS基线表现较差可预测12个月时总ADL表现更差（β=0.15，p=0.049），包括在购物、驾驶、进食和身体移动方面的依赖性更强（所有p<0.05）。
目前的结果表明，HF患者在12个月期间功能显著下降，简短的认知测试可以识别出功能下降风险最高的患者。如果得到重复验证，这些发现鼓励使用认知筛查措施来识别最有可能需要ADL任务协助的HF患者。
