Abstract
BackgroundCognition is a multidimensional construct and to our knowledge, no previous studies have examined the independent contribution of specific domains of cognition to health related quality of life. To determine whether executive functions are independently associated with health related quality of life assessed using Quality Adjusted Life Years (QALYs) calculated from the EuroQol EQ-5D (EQ-5D) in older women after adjusting for known covariates, including global cognition. Therefore, we conducted a secondary analysis of community-dwelling older women aged 65-75 years who participated in a 12-month randomized controlled trial of resistance training. We assessed global cognition using the Mini-Mental State Examination (MMSE) and executive functions using the: 1) Stroop Test; 2) Trail Making Test (Part B) and 3) Digits Verbal Span Backwards Test. We calculated QALYs from the EQ-5D administered at baseline, 6 months and 12 months.ResultsOur multivariate linear regression model demonstrated the specific executive processes of set shifting and working memory, as measured by Trail Making Test (Part B) and Digits Verbal Span Backward Test (p < 0.01) respectively, were independently associated with QALYs after accounting for age, comorbidities, general mobility, and global cognition. The final model explained 50% of the variation in QALYs.ConclusionsOur study highlights the specific executive processes of set shifting and working memory were independently associated with QALYs -- a measure of health related quality of life. Given that executive functions explain variability in QALYs, clinicians may need to consider assessing executive functions when measuring health related quality of life. Further, the EQ-5D may be used to track changes in health status over time and serve as a screening tool for clinicians.Trial RegistrationClinicalTrials.gov Identifier: NCT00426881.
Highlights
Cognition is a multidimensional construct and to our knowledge, no previous studies have examined the independent contribution of specific domains of cognition to health related quality of life
Both set shifting and working memory, were independently associated Health related quality of life (HRQL), measured by Quality Adjusted Life Years (QALYs) calculated from the EQ-5D health state utility value (HSUV)
We note that our small study sample consisted only of older community dwelling women who were cognitively intact; we cannot say with certainty that these findings are generalizable to older women with mild cognitive impairment or dementia, older men, other age groups and adults who are not community-dwelling
Summary
Cognition is a multidimensional construct and to our knowledge, no previous studies have examined the independent contribution of specific domains of cognition to health related quality of life. To determine whether executive functions are independently associated with health related quality of life assessed using Quality Adjusted Life Years (QALYs) calculated from the EuroQol EQ-5D (EQ-5D) in older women after adjusting for known covariates, including global cognition. Health related quality of life (HRQL) is an important construct that describes an individual's overall health status. It is commonly used in economic evaluations [1] as a measure of health benefit, and may be more responsive among populations with conditions associated with high morbidity [2]. HRQL is defined by several domains [3], with general agreement that emotion, physical and social are core domains These concur with WHO's definition of health - a state of complete physical, mental, and social.
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