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Health Qual Life Outcomes. 2009 Jan 9;7:1. doi: 10.1186/1477-7525-7-1.

Cognitive impairment and preferences for current health.

Author information

1
Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut, USA. joseph.kingjr@va.gov

Abstract

BACKGROUND:

We assessed preferences for current health using the visual analogue scale (VAS), standard gamble (SG), time trade-off (TTO), and willingness to pay (WTP) in patients with cerebral aneurysms, a population vulnerable to cognitive deficits related to aneurysm bleeding or treatment.

METHODS:

We measured VAS, SG, TTO, and WTP values for current health in 165 outpatients with cerebral aneurysms. We assessed cognitive impairment with the Mini Mental State Examination (MMSE; scores < 24 = cognitive impairment). We examined the distributions of preference responses stratified by cognitive status, and the relationship between preferences and cognitive impairment, patient characteristics, and aneurysm history.

RESULTS:

Eleven patients (7%) had MMSE scores < 24. The distribution of preferences responses from patients with cognitive impairment had greater variance (SG, 0.39 vs. 0.21, P = 0.001; TTO, 0.36 vs. 0.24, P = 0.017) and altered morphology (VAS, P = 0.012; SG, P = 0.023) compared to the responses of unimpaired patients. There was good correlation between most preference measures for unimpaired patients (VAS:TTO, rho = 0.19, P = 0.018; SG:TTO, rho = 0.36, P < 0.001; SG:WTP, rho = -0.33, P < 0.001) and a trend towards significance with another pairing (VAS:WTP, rho = 0.16, P = 0.054). In subjects with cognitive impairment, there was a significant correlation only between VAS and TTO scores (rho = 0.76, P = 0.023). Separate regression models showed that cognitive impairment was associated with lower preferences on the VAS (beta = -0.12, P = 0.048), SG (beta = -0.23, P = 0.002), and TTO (beta = -0.17, P = 0.035).

CONCLUSION:

Cognitive impairment is associated with lower preferences for current health in patients with cerebral aneurysms. Cognitively impaired patients have poor inter-preference test correlations and different response distributions compared to unimpaired patients.

PMID:
19134191
PMCID:
PMC2633318
DOI:
10.1186/1477-7525-7-1
[Indexed for MEDLINE]
Free PMC Article

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