Abstract 16628: Cognitive Dysfunction, Instrumental Activities of Daily Living, and Health-related Quality of Life in Heart Failure

Abstract

Introduction: Cognitive dysfunction is common in heart failure (HF), but relationships are unclear among cognitive dysfunction, performance-based instrumental activities of daily living (IADL), and health-related quality life (HRQL). Objectives: Guided by HRQL and IADL theories, hypotheses were: 1) worse cognitive function in global cognition, memory, executive function is associated with worse performance in IADL; 2) worse performance in IADL is associated with worse HRQL; and 3) IADL mediates the relationship between cognitive dysfunction and HRQL. Methods: In a cross-sectional analysis, baseline data were used from a randomized controlled trial of cognitive training in HF (N=256, mean age 66; 54% women; EF 49%; NYHA Class I=9%, II=36%, III=55%). Measures were: global cognition-Montreal Cognitive Assessment; memory-Hopkins Verbal Learning Test; executive function-Category fluency; IADL-Everyday Problem Test; and HRQL-Living with Heart Failure Questionnaire. Higher scores of cognitive and IADL measures indicate better performance. Higher scores of HRQL indicate worse HRQL. Covariates were age, gender, education, NYHA, and depressive symptoms. Multiple linear regressions were used to test hypotheses. Results: Hypothesis 1 was supported. Worse cognitive function in global cognition, memory, executive function was associated with worse IADL (β=0.38~0.45, p<.001, R 2 =0.19~0.22). Age and education were significant covariates. Hypothesis 2 was supported. Worse IADL was associated with worse HRQL (β =0.79, p <.001, R 2 =0.55). Gender, NYHA Class, and depressive symptoms were significant covariates. Hypothesis 3 was not tested because cognitive function was not significantly related to HRQL. Conclusions: Cognitive dysfunction was associated with worse performance in IADL. Worse performance in IADL was associated with worse HRQL. Interventions to improve HRQL may need to target improving performances in both cognitive function and IADL.