Executive function (capacity for behavioral self-regulation) and decline predicted mortality in a longitudinal study in Southern Colorado

Amirian, E.; Baxter, Judith; Grigsby, Jim; Curran-Everett, Douglas; Hokanson, John E.; Bryant, Lucinda L.

doi:10.1016/j.jclinepi.2009.06.004

« Previous Next »Journal of Clinical Epidemiology
Volume 63, Issue 3 , Pages 307-314, March 2010

Executive function (capacity for behavioral self-regulation) and decline predicted mortality in a longitudinal study in Southern Colorado

E. Amirian
- Department of Epidemiology, UT-MD Anderson Cancer Center, Houston, TX, USA
Judith Baxter
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado at Denver, Denver, CO, USA
Jim Grigsby
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA
Douglas Curran-Everett
- Division of Biostatistics, National Jewish Medical and Research Center, Denver, CO, USA
John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado at Denver, Denver, CO, USA
Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado at Denver, Denver, CO, USA
- Corresponding author. Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, Denver, 13001 East 17th Place, B119, Aurora, CO 80045, USA; Tel.: (303) 724-4384; fax: (303) 724-4476

Accepted 9 June 2009. published online 28 August 2009.

Abstract

Objective

To assess the relationship between mortality and impairment and decline in a specific executive cognitive function, the capacity for behavioral self-regulation.

Study Design and Setting

This study examined the association between mortality and baseline and 22-month decline in the capacity for behavioral self-regulation, as measured by the Behavioral Dyscontrol Scale, among 1,293 participants of the San Luis Valley Health and Aging Study (SLVHAS), a population-based longitudinal study. The Behavioral Dyscontrol Scale and a measure of overall mental status, the Mini-Mental State Examination, were administered at baseline and follow-up interviews. Cox regression was used to examine baseline and decline in capacity for behavioral self-regulation as possible predictors of mortality.

Results

Baseline Behavioral Dyscontrol Scale score was predictive of mortality, independent of demographics and comorbidity count (hazard ratio [HR]=1.07; 95% confidence interval [CI]: 1.04, 1.09). It remained a significant predictor with further adjustment for Mini-Mental State Examination score. Decline in this specific executive cognitive function was associated with mortality after adjustment for covariates and baseline cognitive scores (HR=1.09; 95% CI: 1.04, 1.13).

Conclusion

Thus, both baseline capacity for behavioral self-regulation and its decline over time predicted mortality in the SLVHAS cohort. These associations may partly be attributed to maintaining the ability for self-care. Understanding how specific forms of impairment contribute to mortality may help identify patients who could benefit from early intervention.

Keywords: Executive cognitive function, Cognitive impairment, Cognitive decline, Mortality, Hispanic, San Luis Valley Health and Aging Study