title: Executive dysfunction and depressive symptoms associated with reduced participation of people with severe congestive heart failure.
abstract: OBJECTIVE
  We investigated participation levels and relationships among cognition, depression, and participation for people with severe congestive heart failure (CHF).
  
  
  METHODS
  People with severe CHF (New York Heart Association Class III or IV) awaiting heart transplantation (N = 27) completed standardized tests of cognition and self-report measures of executive dysfunction, depressive symptoms, and participation.
  
  
  RESULTS
  Possible depression (64%) and cognitive impairment (15%-59%) were prevalent. Participants reported significant reductions in participation across all activity domains since CHF diagnosis (ps < .001). Worse executive dysfunction and depressive symptoms were associated with reduced participation and together accounted for 35%-46% of the variance in participation (ps < .01).
  
  
  CONCLUSIONS
  Participation restrictions associated with CHF are not limited to physically demanding activities and are significantly associated with executive dysfunction and depression. Cardiac rehabilitation should address cognitive and psychological functioning in the context of all life situations instead of focusing solely on physical function and disability.
authors.affiliation: Program in Occupational Therapy, Department of Neurology and Department of Psychiatry, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA. erfoster@wustl.edu
authors.forename: Erin R
authors.initials: ER
authors.lastname: Foster
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Cunnane
authors.forename: Dorothy F
authors.initials: DF
authors.lastname: Edwards
authors.forename: M Tracy
authors.initials: MT
authors.lastname: Morrison
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.forename: Edward M
authors.initials: EM
authors.lastname: Geltman
authors.forename: Allyson R
authors.initials: AR
authors.lastname: Zazulia
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D058992:Social Participation; D055815:Young Adult