title: The association between cognitive function and objective adherence to dietary sodium guidelines in patients with heart failure.
abstract: BACKGROUND
  Although cognitive impairment is common in heart failure (HF) patients, its effects on sodium adherence recommendations are unknown.
  
  
  OBJECTIVE
  Our aim is to examine if cognitive function is associated with patient sodium adherence.
  
  
  METHODS
  Sodium collection/excretion and cognitive function were assessed for 339 HF patients over a 5-8-week period. Neuropsychological testing was performed at baseline (Visit 1), whereas two 24-hour urine samples were collected within 7 weeks postbaseline. The ability to collect two 24-hour urine samples and the estimation of sodium excretion levels from these samples were used to estimate sodium adherence recommendations.
  
  
  RESULTS
  Nearly half (47%) of the study participants (n=159) were unable to give two valid 24-hour urine samples. Participants who were unable to adhere to two valid 24-hour urine samples had significantly poorer attention and global cognition tests (P<0.044), with a trend for poorer executive function (P=0.064). Among those with valid samples, urine sodium level was not associated with global cognitive function, attention, executive function, or memory after adjusting for covariates. Female sex was associated with lower sodium excretion (all P<0.01); individuals with knowledge of sodium guidelines had less intake of sodium, resulting in excretion of less sodium (all P≤0.03). Conversely, higher socioeconomic status (SES) and body mass index (BMI) were associated with greater sodium (all P≤0.02 and P≤0.01).
  
  
  CONCLUSIONS
  Adherence to urine sodium collection was poor, especially among those with poorer cognitive function. Sodium consumption exceeded recommended amounts and was unrelated to cognitive function. Interventions for improving sodium adherence should focus on at-risk groups (high SES and BMI) and at improving knowledge of recommended salt intake.
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA.
authors.forename: Julie T
authors.initials: JT
authors.lastname: Schaefer
authors.affiliation: Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
authors.forename: Misty Aw
authors.initials: MA
authors.lastname: Hawkins
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.affiliation: Ohio Health Heart and Vascular Physicians, Columbus, OH, USA.
authors.forename: Anup
authors.initials: A
authors.lastname: Basuray
authors.affiliation: Department of Cardiology, Summa Health System, Akron City Hospital, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Redle
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, UT, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, OH, USA; Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Josephson
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Moore
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hughes
keywords: attention; cardiac; executive function; memory; salt intake; urine collection