Cognitive Impairment and Preferences for Current Health
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).
Conclusions: 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.
Author: Joseph T King, Joel Tsevat and Mark S Roberts
Credits/Source: Health and Quality of Life Outcomes 2009, 7:1
Published on: 2009-01-09
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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