The independent contribution of executive functions to health related quality of life in older women

Jennifer C Davis, Carlo A Marra, Mehdi Najafzadeh, Teresa Liu-Ambrose, Jennifer C Davis, Carlo A Marra, Mehdi Najafzadeh, Teresa Liu-Ambrose

Abstract

Background: Cognition is a multidimensional construct and to our knowledge, no previous studies have examined the independent contribution of specific domains of cognition to health related quality of life. To determine whether executive functions are independently associated with health related quality of life assessed using Quality Adjusted Life Years (QALYs) calculated from the EuroQol EQ-5D (EQ-5D) in older women after adjusting for known covariates, including global cognition. Therefore, we conducted a secondary analysis of community-dwelling older women aged 65-75 years who participated in a 12-month randomized controlled trial of resistance training. We assessed global cognition using the Mini-Mental State Examination (MMSE) and executive functions using the: 1) Stroop Test; 2) Trail Making Test (Part B) and 3) Digits Verbal Span Backwards Test. We calculated QALYs from the EQ-5D administered at baseline, 6 months and 12 months.

Results: Our multivariate linear regression model demonstrated the specific executive processes of set shifting and working memory, as measured by Trail Making Test (Part B) and Digits Verbal Span Backward Test (p < 0.01) respectively, were independently associated with QALYs after accounting for age, comorbidities, general mobility, and global cognition. The final model explained 50% of the variation in QALYs.

Conclusions: Our study highlights the specific executive processes of set shifting and working memory were independently associated with QALYs -- a measure of health related quality of life. Given that executive functions explain variability in QALYs, clinicians may need to consider assessing executive functions when measuring health related quality of life. Further, the EQ-5D may be used to track changes in health status over time and serve as a screening tool for clinicians.

Trial registration: ClinicalTrials.gov NCT00426881.

References

    1. Sadatsafavi M, Marra CA, Ayas NT, Stradling J, Fleetham J. Cost-effectiveness of oral appliances in the treatment of obstructive sleep apnoea-hypopnoea. Sleep Breath. 2009;13(3):241–252. doi: 10.1007/s11325-009-0248-4.
    1. Sach TH, Foss AJ, Gregson RM, Zaman A, Osborn F, Masud T, Harwood RH. Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. Br J Ophthalmol. 2007;91(12):1675–1679. doi: 10.1136/bjo.2007.118687.
    1. Matza LS, Swensen AR, Flood EM, Secnik K, Leidy NK. Assessment of health-related quality of life in children: a review of conceptual, methodological, and regulatory issues. Value Health. 2004;7(1):79–92. doi: 10.1111/j.1524-4733.2004.71273.x.
    1. World Health Organization. Constitution of the World Health Organization Geneva. 1948.
    1. Coons SJ. Health-related quality of life: let's measure and report it appropriately. Clin Ther. 2007;29(12):2746–2747. doi: 10.1016/j.clinthera.2007.12.031.
    1. Revicki DA, Osoba D, Fairclough D, Barofsky I, Berzon R, Leidy NK, Rothman M. Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Qual Life Res. 2000;9(8):887–900. doi: 10.1023/A:1008996223999.
    1. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993;118(8):622–629.
    1. Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, Esdaile JM, Anis AH. A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med. 2005;60(7):1571–1582. doi: 10.1016/j.socscimed.2004.08.034.
    1. Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997;35(11):1095–1108. doi: 10.1097/00005650-199711000-00002.
    1. Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ. 1986;5(1):1–30. doi: 10.1016/0167-6296(86)90020-2.
    1. Torrance GW. Utility approach to measuring health-related quality of life. J Chronic Dis. 1987;40(6):593–603. doi: 10.1016/0021-9681(87)90019-1.
    1. Drummond MF, Sculpher MJ, Torrance GW, O'Brien B, Stoddart GL. Methods for the economic evaluation for health care programmes. Third. New York. United States of America: Oxford University Press; 2005.
    1. Neumann PJ, Goldie SJ, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu Rev Public Health. 2000;21:587–611. doi: 10.1146/annurev.publhealth.21.1.587.
    1. Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ, Miller P, Mitchell DC, Demark-Wahnefried W. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA. 2009;301(18):1883–1891. doi: 10.1001/jama.2009.643.
    1. Jiang Y, Hesser JE. Patterns of health-related quality of life and patterns associated with health risks among Rhode Island adults. Health Qual Life Outcomes. 2008;6:49. doi: 10.1186/1477-7525-6-49.
    1. Rabins PV, Black BS. Measuring quality of life in dementia: purposes, goals, challenges and progress. Int Psychogeriatr. 2007;19(3):401–407. doi: 10.1017/S1041610207004863.
    1. Jonsson L, Andreasen N, Kilander L, Soininen H, Waldemar G, Nygaard H, Winblad B, Jonhagen ME, Hallikainen M, Wimo A. Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Dis Assoc Disord. 2006;20(1):49–55. doi: 10.1097/01.wad.0000201851.52707.c9.
    1. Royall DR, Lauterbach EC, Cummings JL, Reeve A, Rummans TA, Kaufer DI, LaFrance WC Jr, Coffey CE. Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci. 2002;14(4):377–405.
    1. Stuss DT, Alexander MP. Executive functions and the frontal lobes: a conceptual view. Psychol Res. 2000;63(3-4):289–298. doi: 10.1007/s004269900007.
    1. Kuo HK, Lipsitz LA. Cerebral white matter changes and geriatric syndromes: is there a link? J Gerontol A Biol Sci Med Sci. 2004;59(8):818–826.
    1. Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med. 2010;170(2):170–178. doi: 10.1001/archinternmed.2009.494.
    1. Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595–602. doi: 10.1016/j.jclinepi.2004.10.018.
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Royall DR, Polk M. Dementias that present with and without posterior cortical features: an important clinical distinction. J Am Geriatr Soc. 1998;46(1):98–105.
    1. Miyake A, Emerson MJ, Friedman NP. Assessment of executive functions in clinical settings: problems and recommendations. Semin Speech Lang. 2000;21(2):169–183. doi: 10.1055/s-2000-7563.
    1. Spreen O, Strauss E. A compendium of Neurological Tests, 2nd edition. New York: Oxford University Press; 1998.
    1. Wechsler D. Wechsler Adult Intelligence Scale--Revised. San Antonio: Psychological Corporation; 1981.
    1. Trenerry M, Crosson B, De Boe J. Stroop Neuropsychological Screening Test. Odessa, Florida: Psychological Assessment Resources, Incorporated; 1989.
    1. Feeny D, Furlong W, Torrance GW, Goldsmith CH, Zhu Z, DePauw S, Denton M, Boyle M. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care. 2002;40(2):113–128. doi: 10.1097/00005650-200202000-00006.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Brooks R, Robin R, de Charro F. The measurement and valuation of health status using EQ-5D: a European perspective (evidence from the EuroQoL BIOMED research programme) Netherlands: Kluwer Academic Publishers; 2003.
    1. Conner-Spady B, Suarez-Almazor ME. Variation in the estimation of quality-adjusted life-years by different preference-based instruments. Med Care. 2003;41(7):791–801. doi: 10.1097/00005650-200307000-00003.
    1. Kopec JA, Willison KD. A comparative review of four preference-weighted measures of health-related quality of life. J Clin Epidemiol. 2003;56(4):317–325. doi: 10.1016/S0895-4356(02)00609-1.
    1. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148.
    1. Oostenbrink JB, Al MJ. The analysis of incomplete cost data due to dropout. Health Econ. 2005;14(8):763–776. doi: 10.1002/hec.966.
    1. Ostbye T, Crosse E. Net economic costs of dementia in Canada. Cmaj. 1994;151(10):1457–1464.
    1. Kesse-Guyot E, Castetbon K, Estaquio C, Czernichow S, Galan P, Hercberg S. Association between the French nutritional guideline-based score and 6-year anthropometric changes in a French middle-aged adult cohort. Am J Epidemiol. 2009;170(6):757–765. doi: 10.1093/aje/kwp174.
    1. Iersel MBv, Kessels RPC, Bloem BR, Verbeek ALM, Olde Rikkert MGM. Executive Functions Are Associated With Gait and Balance in Community-Living Elderly People. J Gerontol A Biol Sci Med Sci. 2008;63(12):1344–1349.
    1. Liu-Ambrose T, Katarynych LA, Ashe MC, Nagamatsu LS, Hsu CL. Dual-task gait performance among community-dwelling senior women: the role of balance confidence and executive functions. J Gerontol A Biol Sci Med Sci. 2009;64(9):975–982.
    1. Stoehr GP, Lu SY, Lavery L, Bilt JV, Saxton JA, Chang CC, Ganguli M. Factors associated with adherence to medication regimens in older primary care patients: the Steel Valley Seniors Survey. Am J Geriatr Pharmacother. 2008;6(5):255–263. doi: 10.1016/j.amjopharm.2008.11.001.
    1. Kantor B, Mauger L, Richardson VE, Unroe KT. An analysis of an older driver evaluation program. J Am Geriatr Soc. 2004;52(8):1326–1330. doi: 10.1111/j.1532-5415.2004.52363.x.
    1. Johnson DR. Emotional attention set-shifting and its relationship to anxiety and emotion regulation. Emotion. 2009;9(5):681–690. doi: 10.1037/a0017095.
    1. Weiner DK, Rudy TE, Morrow L, Slaboda J, Lieber S. The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain. Pain Med. 2006;7(1):60–70. doi: 10.1111/j.1526-4637.2006.00091.x.
    1. West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bull. 1996;120(2):272–292. doi: 10.1037/0033-2909.120.2.272.
    1. Kuo H-K, Lipsitz LA. Cerebral White Matter Changes and Geriatric Syndromes: Is There a Link? J Gerontol A Biol Sci Med Sci. 2004;59(8):M818–826.
    1. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–130. doi: 10.1111/1467-9280.t01-1-01430.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–186.
    1. Chan SW, Chiu HF, Chien WT, Goggins W, Thompson D, Hong B. Predictors of change in health-related quality of life among older people with depression: a longitudinal study. Int Psychogeriatr. 2009;21(6):1171–1179. doi: 10.1017/S1041610209990950.
    1. Devlin N, Parkin D, Brown J. Using the EQ-5D as a performance measurement tool in the NHS. 2009.
    1. Cahn-Weiner DA, Boyle PA, Malloy PF. Tests of executive function predict instrumental activities of daily living in community-dwelling older individuals. Appl Neuropsychol. 2002;9(3):187–191. doi: 10.1207/S15324826AN0903_8.
    1. Carlson MC, Fried LP, Xue QL, Bandeen-Roche K, Zeger SL, Brandt J. Association between executive attention and physical functional performance in community-dwelling older women. J Gerontol B Psychol Sci Soc Sci. 1999;54(5):S262–270.
    1. Jefferson AL, Paul RH, Ozonoff A, Cohen RA. Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs) Arch Clin Neuropsychol. 2006;21(4):311–320. doi: 10.1016/j.acn.2006.03.007.
    1. Wlodarczyk JH, Brodaty H, Hawthorne G. The relationship between quality of life, Mini-Mental State Examination, and the Instrumental Activities of Daily Living in patients with Alzheimer's disease. Arch Gerontol Geriatr. 2004;39(1):25–33. doi: 10.1016/j.archger.2003.12.004.
    1. Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ. 1995;311(7003):485.
    1. Marra CA, Esdaile JM, Guh D, Kopec JA, Brazier JE, Koehler BE, Chalmers A, Anis AH. A comparison of four indirect methods of assessing utility values in rheumatoid arthritis. Med Care. 2004;42(11):1125–1131. doi: 10.1097/00005650-200411000-00012.
    1. Peri K, Kerse N, Robinson E, Parsons M, Parsons J, Latham N. Does functionally based activity make a difference to health status and mobility? A randomised controlled trial in residential care facilities (The Promoting Independent Living Study; PILS) Age Ageing. 2008;37(1):57–63. doi: 10.1093/ageing/afm135.
    1. Syddall HE, Martin HJ, Harwood RH, Cooper C, Aihie Sayer A. The SF-36: a simple, effective measure of mobility-disability for epidemiological studies. J Nutr Health Aging. 2009;13(1):57–62. doi: 10.1007/s12603-009-0010-4.
    1. Teixeira LE, Silva KN, Imoto AM, Teixeira TJ, Kayo AH, Montenegro-Rodrigues R, Peccin MS, Trevisani VF. Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial. Osteoporos Int. 2009;21(4):589–96. doi: 10.1007/s00198-009-1002-2.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa