Alosco Michael L, Brickman Adam M, Spitznagel Mary Beth, Narkhede Atul, Griffith Erica Y, Cohen Ronald, Sweet Lawrence H, Josephson Richard, Hughes Joel, Gunstad John
Michael L. Alosco, MA Graduate student, Department of Psychological Sciences, Kent State University, Ohio. Adam M. Brickman, PhD College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and Associate Professor of Neuropsychology, the Aging Brain, Department of Neurology, Columbia University, New York. Mary Beth Spitznagel, PhD Assistant Professor, Department of Psychological Sciences, Kent State University; and Department of Psychiatry, Summa Health System, Akron City Hospital, Ohio. Atul Narkhede, MS College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University, New York. Erica Y. Griffith, BS College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University, New York. Ronald Cohen, PhD Professor and Director, Cognitive Aging and Memory Program Departments of Neurology Psychiatry and the Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville. Lawrence H. Sweet, PhD Gary R. Sperduto Professor of Clinical Psychology, Department of Psychology, University of Georgia, Athens. Richard Josephson, MS, MD Medical Director of CICU and CVP Rehabilitation, University Hospitals Case Medical Center Cleveland; Harrington Heart & Vascular Institute; and Professor of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio. Joel Hughes, PhD Assistant Professor, Department of Psychological Sciences, Kent State University; and Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, Ohio. John Gunstad, PhD Assistant Professor, Department of Psychological Sciences, Kent State University, Ohio.
J Cardiovasc Nurs. 2016 Jan-Feb;31(1):31-41. doi: 10.1097/JCN.0000000000000218.
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.
The aim of this study was to investigate the associations among gray matter volume, cognitive function, and functional ability in heart failure.
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.
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.
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.
心力衰竭患者需要在日常生活工具性活动方面得到帮助，部分原因是该人群中认知障碍的发生率很高。尽管尚无研究考察心力衰竭患者的灰质、认知与日常生活工具性活动之间的关联，但理论上认为结构性脑损伤（如灰质体积减少）是心力衰竭认知功能障碍的基础。
本研究旨在调查心力衰竭患者的灰质体积、认知功能和功能能力之间的关联。
共有81名心力衰竭患者完成了一套认知测试以及用于评估日常生活工具性活动的Lawton-Brody自填问卷。参与者接受了磁共振成像检查，以量化全脑灰质和皮质下灰质体积。
在这个心力衰竭患者样本中，日常生活工具性活动受损很常见。在控制了人口统计学和医学混杂因素的回归分析中，全脑灰质体积较小预示着日常生活工具性活动综合评分降低，在药物管理和驾驶独立性方面存在特定关联。交互分析表明，全脑灰质体积减少与注意力/执行功能和记忆力较差相互作用，对日常生活工具性活动产生负面影响。
灰质体积较小与心力衰竭患者日常生活工具性活动的更大受损相关，可能是通过认知功能障碍。需要进行前瞻性研究，以阐明灰质体积的临床相关因素（如认知功能障碍）在识别有功能下降风险的心力衰竭患者中的作用，并确定针对改善脑和认知功能的干预措施是否能在这一高危人群中保持功能独立性。
