Exploring the role of cognitive function in improving health outcomes

Historically, health interventions directed to improving outcomes among large samples/populations have focused primarily on program characteristics rather than patient characteristics that might modulate outcomes.  One potentially critical factor is the cognitive capacity of program recipients.  Although cognitive engagement is a prerequisite for program success, systematic study of cognitive processes known to underlie successful behavioral change are infrequently conducted. As part of a longitudinal randomized trial examining the benefits of health navigation and financial support on health risk behaviors, Medicaid enrollees with co-occurring physical and mental health diagnoses completed a brief telephone cognitive screening battery. Three diagnostic groups were formed: a) Severely Mentally Ill (SMI), b) Chronic Physical Illness (PH) + Behavioral Health Disorder (BH) + SMI, and c) PH + BH (without SMI). Given their conceptual relevance to achieving health goals, the cognitive tests focused on working and episodic memory processes.  This report summarizes performance prior to intervention.  Interestingly, the groups did not differ in their performance on measures of either cognitive domain, although all groups performed poorly across all tests.  The association between objective performance and self-reported cognitive compromise was also examined using the MOS-Cognitive survey. This analysis revealed that higher levels of cognition were associated with lower levels of self-reported impairment. However, the association accounted for relatively little variance. As the project proceeds, we will examine how these measures are related to outcomes and whether successful outcomes (meeting health goals, etc.) are associated with improved cognitive processing.