title: Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction.
abstract: BACKGROUND
  Mild cognitive dysfunction is common among adults with heart failure (HF). We hypothesized that mild cognitive dysfunction would be associated with poor HF self-care behaviors, particularly patients' ability to respond to symptoms.
  
  
  METHODS
  We analyzed data on 148 participants in an observational study of symptoms in adults with moderate-to-advanced HF. Mild cognitive dysfunction was measured with the Montreal Cognitive Assessment (MoCA; range, 0-30), using cutoff scores for the general population (26) and for adults with cardiovascular disease (24). Heart failure self-care management (evaluation and response to HF symptoms) was measured with the Self-care of HF Index, and consulting behaviors (calling a provider when symptoms occur) were measured using the European HF Self-care Behavior Scale-9. Generalized linear modeling and hierarchical linear modeling were used to quantify the relationship between MoCA cutoff scores and indices of HF self-care.
  
  
  RESULTS
  The mean age of the sample was 57 ± 12 years, 61.5% were men, and 58.8% had class III/IV HF; the mean left ventricular ejection fraction was 28% ± 12%. Using MoCA scores of 26 and 24, respectively, 33.1% and 14.2% of the sample had mild cognitive dysfunction. Controlling for common confounders, participants with MoCA scores lower than 26 reported self-care comparable with that of participants with MoCA scores of 26 or higher. Participants with MoCA scores lower than 24, however, reported 21.5% worse self-care management (P = 0.014) and 51% worse consulting behaviors (P < 0.001) compared with participants with MoCA scores of 24 or higher.
  
  
  CONCLUSIONS
  A disease-specific cutoff for mild cognitive dysfunction reveals marked differences patients' ability to recognize and respond to HF symptoms when they occur. Adults with HF and mild cognitive dysfunction are a vulnerable patient group in great need of interventions that complement HF self-care.
authors.affiliation: Christopher S. Lee, PhD, RN Assistant Professor, School of Nursing, Oregon Health & Science University, Portland. Jill M. Gelow, MD, MPH Assistant Professor and Heart Failure Cardiologist, School of Medicine, Oregon Health & Science University, Portland. Julie T. Bidwell, BSN, RN PhD Student, School of Nursing, Oregon Health & Science University, Portland. James O. Mudd, MD Assistant Professor and Heart Failure Cardiologist, School of Nursing, Oregon Health & Science University, Portland. Jennifer K. Green, MS Research Associate, School of Nursing, Oregon Health & Science University, Portland. Corrine Y. Jurgens, PhD, RN Associate Dean for Research and Clinical Associate Professor, School of Nursing, Stony Brook University, New York. Diana S. Woodruff-Pak, PhD Professor of Psychology and Neurology, Neuroscience Program, Temple University, Philadelphia, Pennsylvania.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.forename: Jill M
authors.initials: JM
authors.lastname: Gelow
authors.forename: Julie T
authors.initials: JT
authors.lastname: Bidwell
authors.forename: James O
authors.initials: JO
authors.lastname: Mudd
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Green
authors.forename: Corrine Y
authors.initials: CY
authors.lastname: Jurgens
authors.forename: Diana S
authors.initials: DS
authors.lastname: Woodruff-Pak
mesh_terms: D003072:Cognition Disorders / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012648:Self Care; D012720:Severity of Illness Index