title: Reduced Gray Matter Volume Is Associated With Poorer Instrumental Activities of Daily Living Performance in Heart Failure.
abstract: BACKGROUND
  Heart failure patients require assistance with instrumental activities of daily living in part because of the high rates of cognitive impairment in this population. Structural brain insult (eg, reduced gray matter volume) is theorized to underlie cognitive dysfunction in heart failure, although no study has examined the association among gray matter, cognition, and instrumental activities of daily living in heart failure.
  
  
  OBJECTIVE
  The aim of this study was to investigate the associations among gray matter volume, cognitive function, and functional ability in heart failure.
  
  
  METHODS
  A total of 81 heart failure patients completed a cognitive test battery and the Lawton-Brody self-report questionnaire to assess instrumental activities of daily living. Participants underwent magnetic resonance imaging to quantify total gray matter and subcortical gray matter volume.
  
  
  RESULTS
  Impairments in instrumental activities of daily living were common in this sample of HF patients. Regression analyses controlling for demographic and medical confounders showed that smaller total gray matter volume predicted decreased scores on the instrumental activities of daily living composite, with specific associations noted for medication management and independence in driving. Interaction analyses showed that reduced total gray matter volume interacted with worse attention/executive function and memory to negatively impact instrumental activities of daily living.
  
  
  CONCLUSIONS
  Smaller gray matter volume is associated with greater impairment in instrumental activities of daily living in persons with heart failure, possibly via cognitive dysfunction. Prospective studies are needed to clarify the utility of clinical correlates of gray matter volume (eg, cognitive dysfunction) in identifying heart failure patients at risk for functional decline and determine whether interventions that target improved brain and cognitive function can preserve functional independence in this high-risk population.
authors.affiliation: Michael L. Alosco, MA Graduate student, Department of Psychological Sciences, Kent State University, Ohio. Adam M. Brickman, PhD College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and Associate Professor of Neuropsychology, the Aging Brain, Department of Neurology, Columbia University, New York. Mary Beth Spitznagel, PhD Assistant Professor, Department of Psychological Sciences, Kent State University; and Department of Psychiatry, Summa Health System, Akron City Hospital, Ohio. Atul Narkhede, MS College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University, New York. Erica Y. Griffith, BS College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University, New York. Ronald Cohen, PhD Professor and Director, Cognitive Aging and Memory Program Departments of Neurology Psychiatry and the Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville. Lawrence H. Sweet, PhD Gary R. Sperduto Professor of Clinical Psychology, Department of Psychology, University of Georgia, Athens. Richard Josephson, MS, MD Medical Director of CICU and CVP Rehabilitation, University Hospitals Case Medical Center Cleveland; Harrington Heart & Vascular Institute; and Professor of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio. Joel Hughes, PhD Assistant Professor, Department of Psychological Sciences, Kent State University; and Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, Ohio. John Gunstad, PhD Assistant Professor, Department of Psychological Sciences, Kent State University, Ohio.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Alosco
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Spitznagel
authors.forename: Atul
authors.initials: A
authors.lastname: Narkhede
authors.forename: Erica Y
authors.initials: EY
authors.lastname: Griffith
authors.forename: Ronald
authors.initials: R
authors.lastname: Cohen
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Sweet
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.forename: Joel
authors.initials: J
authors.lastname: Hughes
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology*; D056344:Executive Function; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006333:Heart Failure / Q000473:pathology* / Q000523:psychology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012959:Socioeconomic Factors