title: Cognitive function and self-care management in older patients with heart failure.
abstract: OBJECTIVE
  People with heart failure have difficulty with self-care management. We do not know if patients with heart failure have difficulty with self-care management due to underlying, mild cognitive impairment (MCI). The purpose of this study was to determine whether MCI, as identified on a simple screening tool, is significantly associated with self-care management in a sample of community dwelling older patients with heart failure.
  
  
  RESULTS
  Using a cross-sectional design, heart failure patients (n=100, mean age 72 SD 10 years) attending an outpatient heart failure clinic completed the Montreal Cognitive Assessment tool (MoCA), Self-Care in Heart Failure Index (SCHFI) and Geriatric Depression Scale. The presence of MCI, as defined by a MoCA score <26, was present in 73% patients; 21% had an adequate self-care management SCHFI score; and 12% reported symptoms of depression. Participants with a MoCA score <26 vs. ≥ 26 scored significantly lower on the self-care management subscale of the SCHFI (48.1 SD 24 vs. 59.3 SD 22 respectively, p=0.035). Using backward regression, the final model was fitted to self-care management while controlling for age and sex and was significant, with (F= 7.04 df (3, 96), and p<0.001), accounting for 18% of the total variance in self-care management (R (2) = 18.03%). The MoCA score was the only variable which remained in the model significantly with p= 0.001.
  
  
  CONCLUSIONS
  Findings from this study highlight the difficulty older heart failure patients have with self-care management and the need to include formal screening for MCI when exploring variables contributing to self-care management in heart failure patients.
authors.affiliation: 1McMaster University, Hamilton, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harkness
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
authors.forename: Noori
authors.initials: N
authors.lastname: Akhtar-Danesh
authors.forename: Catherine
authors.initials: C
authors.lastname: Demers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gunn
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000150:complications* / Q000175:diagnosis; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009483:Neuropsychological Tests; D010348:Patient Care Team; D012111:Residence Characteristics; D012648:Self Care / Q000379:methods* / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology
keywords: Self-care management; cognitive function; heart failure