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Executive dysfunction is independently associated with reduced functional independence in heart failure

Authors

  • Michael L Alosco BA,

    Doctoral Student in Psychology, Corresponding author
    1. Department of Psychology, Kent State University, Kent, OH, USA
    • Correspondence: Michaell Alosco, Doctoral Student, Department of Psychology, Kent State University, Kent, OH 44242, USA. Telephone: +1 203 417 1892.

      E-mail: Malosco@kent.edu

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  • Mary Beth Spitznagel PhD,

    Assistant Professor
    1. Department of Psychology, Kent State University, Kent, OH, USA
    2. Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA
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  • Naftali Raz PhD,

    Associate Director for Life-Span Cognitive Neuroscience
    1. Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI, USA
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  • Ronald Cohen PhD,

    Director and Professor
    1. Aging and Memory Center of at the University of Florida, Gainesville, FL, USA
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  • Lawrence H Sweet PhD,

    Gary R Sperduto Professor of Clinical Psychology
    1. Department of Psychology, University of Georgia, Athens, GA, USA
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  • Lisa H Colbert PhD,

    Associate Professor
    1. Department of Kinesiology, University of Wisconsin, Madison, WI, USA
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  • Richard Josephson MS, MD,

    Professor of Medicine
    1. University Hospitals Case Medical Center and Department of Medicine, Cleveland, OH, USA
    2. Harrington Heart & Vascular Institute, Cleveland, OH, USA
    3. Case Western Reserve University School of Medicine, Cleveland, OH, USA
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  • Manfred van Dulmen PhD,

    Associate Professor
    1. Department of Psychology, Kent State University, Kent, OH, USA
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  • Joel Hughes PhD,

    Associate Professor
    1. Department of Psychology, Kent State University, Kent, OH, USA
    2. Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA
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  • Jim Rosneck MS,

    Director of Cardiovascular & Pulmonary Rehabilitation
    1. Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA
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  • John Gunstad PhD

    Associate Professor
    1. Department of Psychology, Kent State University, Kent, OH, USA
    2. Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA
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Abstract

Aims and objectives

To examine the independent association between executive function with instrumental activities of daily living and health behaviours in older adults with heart failure.

Background

Executive function is an important contributor to functional independence as it consists of cognitive processes needed for decision-making, planning, organising and behavioural monitoring. Impairment in this domain is common in heart failure patients and associated with reduced performance of instrumental activities of daily living in many medical and neurological populations. However, the contribution of executive functions to functional independence and healthy lifestyle choices in heart failure patients has not been fully examined.

Design

Cross-sectional analyses.

Methods

One hundred and seventy-five heart failure patients completed a neuropsychological battery and echocardiogram. Participants also completed the Lawton–Brody Instrumental Activities of Daily Living Scale and reported current cigarette use.

Results

Hierarchical regressions revealed that reduced executive function was independently associated with worse instrumental activity of daily living performance with a specific association for decreased ability to manage medications. Partial correlations showed that executive dysfunction was associated with current cigarette use.

Conclusions

Our findings suggest that executive dysfunction is associated with poorer functional independence and contributes to unhealthy behaviours in heart failure. Future studies should examine whether heart failure patients benefit from formal organisation schema (i.e. pill organisers) to maintain independence.

Relevance to clinical practice

Screening of executive function in heart failure patients may provide key insight into their ability to perform daily tasks, including the management of treatment recommendations.

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