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Duff K, Dixon A, Embree L. A Closer Look at Practice Effects in Mild Cognitive Impairment and Alzheimer's Disease. Arch Clin Neuropsychol 2024; 39:1-10. [PMID: 37323010 PMCID: PMC10802223 DOI: 10.1093/arclin/acad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
Practice effects have become a potentially important variable regarding the diagnosis, prognosis, and treatment recommendations in mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, the understanding of these short-term changes in test scores remains unclear. The current observational study sought to examine variables that influence the magnitude of short-term practice effects in MCI and AD, including demographic information, cognitive performance, daily functioning, and medical comorbidities. One hundred sixty-six older adults classified as cognitively intact, amnestic MCI, or mild AD were tested twice across 1 week with a brief battery of neuropsychological tests. Correlational and regression analyses examined the relationship of practice effects with demographic and clinical variables. Results indicated that practice effects were minimally related to demographic variables and medical comorbidities, but they were significantly related to cognitive variables, depressive symptoms, and daily functioning. These findings expand our understanding of practice effects in MCI and AD, and they may allow a better appreciation of how they could affect clinical care and research.
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Affiliation(s)
- Kevin Duff
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Center for Alzheimer’s Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City UT, USA
| | - Ava Dixon
- Center for Alzheimer’s Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City UT, USA
| | - Lindsay Embree
- Center for Alzheimer’s Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City UT, USA
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Gamm S, Ummel D, Vasil N, Grenier S. Getting Insight to the Lived Emotional Experience of People with Alzheimer's Disease Shortly After Diagnosis: A Phenomenological Approach. J Alzheimers Dis 2024; 99:1129-1145. [PMID: 38788071 DOI: 10.3233/jad-231403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background A diagnosis of Alzheimer's disease (AD) is a crucial moment in an individual's existence and represents a major life change that often results in psychological distress, diminish of perceived quality of life, and loss of independence. It is important to better understand the emotional experience of people with dementia to intervene according to their specific needs. Objective The aim of the research was to get insight to the emotional experience of people with AD shortly after its discovery and the consequences thereof. Methods A qualitative exploratory design was engaged, and in-depth interviews were conducted with ten French-speaking participants over 70 years recently diagnosed. Interviews were guided by Heideggerian phenomenology about movements in the worldview of individuals. The transcribed data was subjected to interpretative phenomenological analysis. Results Following the diagnosis, participants experienced either shock or denial. Emotions felt were unpleasant and disturbing for most of them. Especially when participants were confronted with news concerning the illness, they experienced incomprehension. They engaged in an oscillatory motion of connection and disconnection to establish new meanings of their worldview. Thinking about the past seemed to diminish their worries, to reinforce the possibility to fulfil a significant place in their existence and to maintain their autonomy. Conclusions When participants could express their emotional experience and their concerns, they regained a sense of control in their life that seemed du reduce their distress. With this insight, intervention could be adapted to the specific needs of people with AD to enhance their self-determination and quality of life.
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Affiliation(s)
- Simone Gamm
- University of Montréal, Montréal, QC, Canada
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
| | | | - Nancy Vasil
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
| | - Sébastien Grenier
- University of Montréal, Montréal, QC, Canada
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
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Chen J, Gan L, Tuersun Y, Xiong M, Sun J, Zhang C, Li H. Social Participation: A Strategy to Manage Depression in Disabled Populations. J Aging Soc Policy 2023:1-17. [PMID: 37699113 DOI: 10.1080/08959420.2023.2255492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/05/2022] [Indexed: 09/14/2023]
Abstract
This study aimed to investigate whether social participation (SP) can decrease depressive symptom severity in disabled older adults. A total of 5,937 disabled participants (4877, 1970, 219, and 8 participants responding 1, 2, 3, 4 times, respectively), obtained from the China Health and Retirement Longitudinal Study, were enrolled in our analysis. Based on pooled Ordinary Least Square regressions, SP was associated with decreased depressive symptom severity, and this association was significant in recreational activities and interacting with friends. For brain-disabled respondents, the association was not significant. SP is effective in decreasing depressive symptom severity in disabled older populations. Diversified activities and targeted interventions should be applied to specified older disabled populations to prevent depression.
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Affiliation(s)
- Jiangyun Chen
- School of Health Management of Southern Medical University, Guangzhou, Guangdong, China
- ACACIA Labs of SMU Institute for Global Health (SIGH) and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, Guangdong, China
- Institute for Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Gan
- School of Health Management of Southern Medical University, Guangzhou, Guangdong, China
- Institute for Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Yusupujiang Tuersun
- School of Health Management of Southern Medical University, Guangzhou, Guangdong, China
- Institute for Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Man Xiong
- School of Health Management of Southern Medical University, Guangzhou, Guangdong, China
- Institute for Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
| | - Chichen Zhang
- School of Health Management of Southern Medical University, Guangzhou, Guangdong, China
- Institute for Health Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
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Lin P, LaMonica HM, Naismith SL, Mowszowski L. Identifying subtle functional change in individuals with mild cognitive impairment: development and validation of the Healthy Brain Ageing - Functional Assessment Questionnaire. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:536-554. [PMID: 35345965 DOI: 10.1080/13825585.2022.2057910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/21/2022] [Indexed: 05/10/2023]
Abstract
Accumulating research suggests that individuals with Mild Cognitive Impairment (MCI) experience subtle functional changes, but that available functional assessment tools are insensitive to this. To address this gap, we describe the development and validation of the self-report, "Healthy Brain Ageing Functional Assessment Questionnaire" (HBA-FAQ). We examined the factor structure and psychometric properties of the HBA-FAQ in 503 participants with normal cognition, subjective cognitive decline (SCD), MCI or dementia. Our results found the HBA-FAQ to have good reliability, validity and stronger discriminative ability between healthy control participants and those with SCD (0.734, p = .001), MCI (0.666, p = .012) and dementia (0.798, p < .001) compared to a widely-used instrumental activities of daily living screener. In conclusion, the HBA-FAQ is a valid, reliable self-report tool, providing an efficient and sensitive approach to identifying subtle changes in daily functioning in older people at risk of dementia.
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Affiliation(s)
- Pinghsiu Lin
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
| | - Haley M LaMonica
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- Translational Research Collective, The University of Sydney, Nsw, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Nsw, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
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Szymkowicz SM, Ryan C, Elson DM, Kang H, Taylor WD. Cognitive phenotypes in late-life depression. Int Psychogeriatr 2023; 35:193-205. [PMID: 35766159 PMCID: PMC9797624 DOI: 10.1017/s1041610222000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify cognitive phenotypes in late-life depression (LLD) and describe relationships with sociodemographic and clinical characteristics. DESIGN Observational cohort study. SETTING Baseline data from participants recruited via clinical referrals and community advertisements who enrolled in two separate studies. PARTICIPANTS Non-demented adults with LLD (n = 120; mean age = 66.73 ± 5.35 years) and non-depressed elders (n = 56; mean age = 67.95 ± 6.34 years). MEASUREMENTS All completed a neuropsychological battery, and individual cognitive test scores were standardized across the entire sample without correcting for demographics. Five empirically derived cognitive domain composites were created, and cluster analytic approaches (hierarchical, k-means) were independently conducted to classify cognitive patterns in the depressed cohort only. Baseline sociodemographic and clinical characteristics were then compared across groups. RESULTS A three-cluster solution best reflected the data, including "High Normal" (n = 47), "Reduced Normal" (n = 35), and "Low Executive Function" (n = 37) groups. The "High Normal" group was younger, more educated, predominantly Caucasian, and had fewer vascular risk factors and higher Mini-Mental Status Examination compared to "Low Executive Function" group. No differences were observed on other sociodemographic or clinical characteristics. Exploration of the "High Normal" group found two subgroups that only differed in attention/working memory performance and length of the current depressive episode. CONCLUSIONS Three cognitive phenotypes in LLD were identified that slightly differed in sociodemographic and disease-specific variables, but not in the quality of specific symptoms reported. Future work on these cognitive phenotypes will examine relationships to treatment response, vulnerability to cognitive decline, and neuroimaging markers to help disentangle the heterogeneity seen in this patient population.
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Affiliation(s)
- Sarah M. Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claire Ryan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Damian M. Elson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
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Barreto MCA, Cartes-Velásquez R, Campos V, Araújo LF, Castro SSD. Association of social factors and health conditions with capacity and performance. Rev Saude Publica 2022; 56:62. [PMID: 35766791 PMCID: PMC9239428 DOI: 10.11606/s1518-8787.2022056004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.
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Affiliation(s)
- Marina Carvalho Arruda Barreto
- Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, Ceará, Brasil
| | | | - Valeria Campos
- Universidad Autónoma de Chile. Escuela de Salud Pública. Santiago de Chile, Chile
| | - Larissa Fortunato Araújo
- Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, Ceará, Brasil
| | - Shamyr Sulyvan de Castro
- Universidade Federal do Ceará. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Fortaleza, Ceará, Brasil
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Jędrzejczyk M, Foryś W, Czapla M, Uchmanowicz I. Relationship between Multimorbidity and Disability in Elderly Patients with Coexisting Frailty Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063461. [PMID: 35329148 PMCID: PMC8950513 DOI: 10.3390/ijerph19063461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022]
Abstract
Background: Multimorbidity is a common problem worldwide. It carries the risk of reduced quality of life, disability, frequent hospitalizations, and death. The present study was designed to assess the relationships that exist between multimorbidity and disability in elderly patients. Methods: The study included 100 patients and was conducted between October 2020 and January 2021. Inclusion criteria included age >65 years, presence of a minimum of two comorbidities in the subject, and consent to participate in the study. Standardized survey instruments such as Tilburg Frailty Indicator (TFI), Charlson Comorbidities Index (CCI), Assessment of Basic Activities of Daily Living—Katz Scale (ADL), and Assessment of Complex Activities of Daily Living—Lawton Scale (IADL) were used in the study. Results: The majority of the subjects (92) had a frailty syndrome (TFI). A small group of respondents (8%) suffered from severe comorbidities (CCI). Among the subjects surveyed, 71% maintained full function in performing simple activities of daily living (ADL), while 29% demonstrated moderate disability on the scale. Full independence in performing complex activities of daily living (IADL) was present in 33% of the respondents, and 67% were partially independent. Independence in complex activities of daily living (IADL) was significantly higher in patients with fewer comorbidities. The severity of comorbidities (CCI) had a significant effect on the decrease in the level of independence (ADL and IADL). Independence in performing complex activities (IADL) was worse among older patients. Conclusions: An increase in the number of comorbidities contributes to a decrease in the level of performance of complex activities of daily living. The severity of comorbidities significantly reduces the level of independence of the subjects in simple and complex activities of daily living. In patients with a higher level of independence in performing simple and complex activities, the co-occurrence of frailty syndrome was less severe. As the age of the subjects increases, the frequency in which they show moderate dependence on third parties in performing complex activities of daily living increases.
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Affiliation(s)
- Maria Jędrzejczyk
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland; (M.J.); (I.U.)
| | - Weronika Foryś
- Harvard Division of Continuing Education, Harvard University, Cambridge, MA 02138-3722, USA;
| | - Michał Czapla
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Faculty of Nursing, Group in Research in Care (GRUPAC), University of La Rioja, 26006 Logroño, Spain
- Correspondence:
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland; (M.J.); (I.U.)
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
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Palmer JR, Duffy SL, Meares S, Pye J, Calamante F, Cespedes M, Hickie IB, Naismith SL. Rest-activity functioning is related to white matter microarchitecture and modifiable risk factors in older adults at-risk for dementia. Sleep 2021; 44:6082819. [PMID: 33428761 DOI: 10.1093/sleep/zsab007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Growing evidence demonstrates pronounced alterations in rest-activity functioning in older adults at-risk for dementia. White matter degeneration, poor cardiometabolic functioning, and depression have also been linked to a greater risk of decline; however, limited studies have examined the white matter in relation to rest-activity functioning in at-risk older adults. METHODS We investigated associations between nonparametric actigraphy measures and white matter microarchitecture using whole-brain fixel-based analysis of diffusion-weighted imaging in older adults (aged 50 years or older) at-risk for cognitive decline and dementia. The fixel-based metrics assessed were fiber density, fiber cross-section, and combined fiber-density, and cross-section. Interactions between rest-activity functioning and known clinical risk factors, specifically body mass index (BMI), vascular risk factors, depressive symptoms and self-reported exercise, and their association with white matter properties were then investigated. RESULTS Sixty-seven older adults were included (mean = 65.78 years, SD = 7.89). Lower relative amplitude, poorer 24-h synchronization and earlier onset of the least active 5-h period were associated with reductions in markers of white matter atrophy in widespread regions, including cortico-subcortical and cortical association pathways. Preliminary evidence was also found indicating more pronounced white matter alterations in those with lower amplitude and higher BMI (β = 0.25, 95% CI [0.05, 0.46]), poorer 24-h synchronization and more vascular risk factors (β = 0.17, 95% CI [-0.02, 0.36]) and earlier onset of inactivity and greater depressive symptoms (β = 0.17, 95% CI [0.03, 0.30]). CONCLUSIONS These findings highlight the complex interplay between rest-activity rhythms, white matter, and clinical risk factors in individuals at-risk for dementia that should be considered in future studies.
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Affiliation(s)
- Jake R Palmer
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Shantel L Duffy
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration, Sydney, NSW, Australia
| | - Susanne Meares
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jonathon Pye
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Fernando Calamante
- Sydney Imaging and School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, NSW, Australia
| | - Marcela Cespedes
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD, Australia
| | - Ian B Hickie
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration, Sydney, NSW, Australia
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Xiao J, Shi Z, Fang Y. Association Between Disability Trajectory and Health Care Service Utilization Among Older Adults in China. J Am Med Dir Assoc 2021; 22:2169-2176.e4. [PMID: 33577828 DOI: 10.1016/j.jamda.2020.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/21/2020] [Accepted: 12/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to identify the heterogeneous disability trajectories among older Chinese adults and examine the association between disability trajectories and health care service utilization. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS A community-based study including older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey. METHODS Disability was assessed by the difficulties in activities of daily living and instrumental activities of daily living between 2002 and 2018. Health care utilization was measured by the expenditures on outpatient and inpatient services in 2018. Growth mixture modeling was conducted to estimate heterogeneous disability trajectories. A 2-part model was used to analyze the association of disability trajectories and health care utilization. Covariates were included based on Andersen's behavioral model. RESULTS Three classes of disability trajectories were identified: the progressive (7.9%), late-onset (13.7%), and normal classes (78.4%). Older adults who followed the late-onset trajectory of disability were more likely to use inpatient services compared with the normal class (odds ratio = 1.47, P < .010), after controlling potential confounders. Compared with the normal class, the progressive class on average spent US$145.94 more annually (45.2% higher) on outpatient services (P < .010) and $738.99 more annually (72.6% higher) on inpatient services (P < .001); the late-onset class reported higher annual expenditures on outpatient and inpatient services of $215.94 (66.9% higher) and $1405.00 (138.0% higher), respectively (all P < .001). CONCLUSIONS AND IMPLICATIONS Heterogeneous disability trajectories exhibited distinct health care service utilization patterns among older Chinese adults. Older adults affected by late-onset disability incurred the highest health care needs. These findings provide valuable policy-relevant evidence for reducing health care burden among older adults.
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Affiliation(s)
- Jian Xiao
- School of Public Health, Xiamen University, Xiamen, China
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.
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Subjective cognitive complaints and permanent work disability: a prospective cohort study. Int Arch Occup Environ Health 2021; 94:901-910. [PMID: 33462663 PMCID: PMC8238735 DOI: 10.1007/s00420-020-01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Work disability (WD) is a medico-legal concept that refers to disability benefits (DB) granted due to diseases. We assessed whether subjective cognitive complaints (SCC)-presenting as self-rated difficulties of concentration, memory, clear thinking, and decision making-predict permanent WD in knowledge-intensive occupations. METHODS In this prospective cohort study with up to 7-year follow-up, we combined the SCC questionnaire results with reliable registry data on the DBs of 7161 professional/managerial employees (46% females). We excluded employees who were on long-term sickness absence (SA) or had received a DB at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome variable was a granted DB. The cumulative incidence function illustrates the difference between SCC categories, and the Fine-Gray model estimates the predictors of WD during the 8-year follow-up. RESULTS The annual incidence of DB was 0.15% in the entire cohort: 0.18% among the females, and 0.12% among the males (p = 0.795). The most common primary reasons for permanent WD were mental (36%) and musculoskeletal (20%) disorders. SCC predicted DB in both genders when controlling for age and prior SA. Hazard ratios were 2.9 with a 95% confidence interval 1.4-6.0 for the females and 3.7 (1.8-7.9) for the males. CONCLUSION Subjective cognitive complaints predict permanent WD in knowledge-intensive occupations. This finding has implications for supporting work ability and preventing work disability among employees with cognitively demanding tasks.
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Increase in Number of Depression Symptoms Over Time is Related to Worse Cognitive Outcomes in Older Adults With Type 2 Diabetes. Am J Geriatr Psychiatry 2021; 29:1-11. [PMID: 33127316 PMCID: PMC7771631 DOI: 10.1016/j.jagp.2020.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Older adults with type 2 diabetes (T2D) are at increased risk for depression, cognitive decline, and dementia compared to those without T2D. Little is known about the association of simultaneous changes in depression symptoms and cognitive decline over time. METHODS Subjects (n=1021; mean age 71.6 [SD=4.6]; 41.2% female) were initially cognitively normal participants of the Israel Diabetes and Cognitive Decline study who underwent evaluations of depression and cognition approximately every 18 months. Cognitive tests were summarized into four cognitive domains: episodic memory, attention/working memory, executive functions, and semantic categorization. The average of the z-scores of the four domains defined global cognition. Depression symptoms were assessed using the Geriatric Depression Scale, 15-item version. We fit a random coefficients model of changes in depression and in cognitive functions, adjusting for baseline sociodemographic and cardiovascular variables. RESULTS Higher number of depression symptoms at baseline was significantly associated with lower baseline cognitive scores in global cognition (estimate = -0.1175, SE = 0.021, DF = 1,014, t = -5.59; p < 0.001), executive functions (estimate = -0.186, SE = 0.036, DF = 1,013, t = -5.15; p = <0.001), semantic categorization (estimate = -0.155, SE = 0.029, DF = 1,008, t = -5.3; p < 0.001), and episodic memory (estimate = -0.08165, SE = 0.027, DF = 1,035, t = -2.92; p = 0.0036), but not with rate of decline in any cognitive domain. During follow-up, a larger increase in number of depression symptoms, was associated with worse cognitive outcomes in global cognition (estimate = -0.1053, SE = 0.027, DF = 1,612, t = -3.77; p = 0.0002), semantic categorization (estimate = -0.123, SE = 0.036, DF = 1,583, t = -3.36; p = 0.0008), and in episodic memory (estimate = -0.165, SE = 0.055, DF = 1,622, t = -3.02; p = 0.003), but the size of this effect was constant over time. CONCLUSION In elderly with T2D, increase in depression symptoms over time is associated with parallel cognitive decline, indicating that the natural course of the two conditions progresses concurrently and suggesting common underlying mechanisms".
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Pihlajamäki M, Arola H, Ahveninen H, Ollikainen J, Korhonen M, Nummi T, Uitti J, Taimela S. Subjective cognitive complaints and sickness absence: A prospective cohort study of 7059 employees in primarily knowledge-intensive occupations. Prev Med Rep 2020; 19:101103. [PMID: 32420012 PMCID: PMC7218151 DOI: 10.1016/j.pmedr.2020.101103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/08/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022] Open
Abstract
Subjective cognitive complaints predict sickness absence. Age and prior absence also predict sickness absence in an additive fashion. Maintenance of resources is important in knowledge-intensive occupations.
Knowledge-intensive work requires capabilities like monitoring multiple sources of information, prioritizing between competing tasks, switching between tasks, and resisting distraction from the primary task(s). We assessed whether subjective cognitive complaints (SCC), presenting as self-rated problems with difficulties of concentration, memory, clear thinking and decision making predict sickness absence (SA) in knowledge-intensive occupations. We combined SCC questionnaire results with reliable registry data on SA of 7743 professional/managerial employees (47% female). We excluded employees who were not active in working life, on long-term SA, and those on a work disability benefit at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome measure was the accumulated SA days during a 12-month follow-up. We used a hurdle model to analyse the SA data. SCC predicted the number of SA days during the 12-month follow-up. The ratio of the means of SA days was higher than 2.8 as compared to the reference group, irrespective of gender, with the lowest limit of 95% confidence interval 2.2. In the Hurdle model, SCC, SA days prior to the questionnaire, and age were additive predictors of the likelihood of SA and accumulated SA days, if any. Subjective cognitive complaints predict sickness absence in knowledge-intensive occupations, irrespective of gender, age, or general health. This finding has implications for supporting work ability (productivity) among employees with cognitively demanding tasks.
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Affiliation(s)
- Minna Pihlajamäki
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Heikki Arola
- Terveystalo, Jaakonkatu 3b, 00100 Helsinki, Finland
| | | | - Jyrki Ollikainen
- Faculty of Information Technology and Communication Sciences, Tampere University, Finland
| | - Mikko Korhonen
- Faculty of Information Technology and Communication Sciences, Tampere University, Finland
| | - Tapio Nummi
- Faculty of Information Technology and Communication Sciences, Tampere University, Finland
| | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Simo Taimela
- Clinicum, Department of Orthopedics and Traumatology, University of Helsinki, Finland.,Evalua International, PO Box 35, FIN-02661 Espoo, Finland
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13
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Kanellopoulos D, Rosenberg P, Ravdin LD, Maldonado D, Jamil N, Quinn C, Kiosses DN. Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits. Int Psychogeriatr 2020; 32:485-493. [PMID: 31910916 PMCID: PMC7165030 DOI: 10.1017/s1041610219001716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Antidepressants have limited efficacy in older adults with depression and cognitive impairment, and psychosocial interventions for this population have been inadequately investigated. Problem Adaptation Therapy (PATH) is a psychosocial intervention for older adults with major depression, cognitive impairment, and disability. DESIGN This study tests the efficacy of PATH versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in reducing depression (Montgamery Asberg Depression Rating Scale [MADRS]) and disability (World Health Organization Disability Assessments Schedule-II [WHODAS-II]) and improving cognitive outcomes (Mini Mental State Examination [MMSE]) over 24 weeks (12 weeks of treatment and 12-week post-treatment follow-up). SETTING Participants were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry. Both interventions and all research assessments were conducted at home. PARTICIPANTS Thirty-five older adults (age ≥ 65 years) with major depression and cognitive impairment no dementia (CIND). INTERVENTIONS PATH aims to increase emotion regulation by incorporating a problem-solving approach, teaching compensatory strategies, and inviting caregiver participation. Supportive Therapy aims to facilitate the expression of affect, as well as promote empathy. MEASUREMENTS Depression was measured using the MADRS, disability using the WHODAS-II, and cognition using the MMSE. RESULTS PATH participants showed significantly greater reduction in MADRS total score (7.04 points at 24 weeks, treatment group by time interaction: F[1,24.4] = 7.61, p = 0.0108), greater improvement in MMSE total score (2.30 points at 24 weeks, treatment group by time interaction: F[1,39.8] = 13.31, p = 0.0008), and greater improvement in WHODAS-II total score (2.95 points at 24 weeks, treatment group by time interaction: F[1,89] = 4.93, p = 0.0290) than ST-CI participants over the 24-week period. CONCLUSIONS PATH participants had better depression, cognitive, and disability outcomes than ST-CI participants over 6 months. PATH may provide relief to depressed older adults with CIND who currently have limited treatment options.
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Affiliation(s)
- Dora Kanellopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa D Ravdin
- Department of Neurology & Neuroscience, Weill Cornell Medicine, New York, NY, USA
| | - Dalynah Maldonado
- Department of Medicine/Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nimra Jamil
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Crystal Quinn
- The Graduate Center, City University of New York, New York, NY, USA
| | - Dimitris N Kiosses
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
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14
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Stickley A, Leinsalu M, DeVylder JE, Inoue Y, Koyanagi A. Sleep problems and depression among 237 023 community-dwelling adults in 46 low- and middle-income countries. Sci Rep 2019; 9:12011. [PMID: 31427590 PMCID: PMC6700183 DOI: 10.1038/s41598-019-48334-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/31/2019] [Indexed: 01/24/2023] Open
Abstract
Sleep problems are considered a core symptom of depression. However, there is little information about the comorbidity of sleep problems and depression in low- and middle-income countries (LMICs), and whether sleep problems with depression confer additional risk for decrements in health compared to sleep problems alone. This study thus examined the association between sleep problems and depression and whether sleep problems with depression are associated with an increased risk for poorer health in 46 LMICs. Cross-sectional, community-based data from 237 023 adults aged ≥18 years from the World Health Survey (WHS) 2002–2004 were analyzed. Information on sleep problems (severe/extreme) and International Classification of Diseases 10th Revision depression/depression subtypes was collected. Multivariable logistic (binary and multinomial) and linear regression analyses were performed. Sleep problems were associated with subsyndromal depression (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.84–2.70), brief depressive episode (OR = 2.48, 95% CI = 2.09–2.95) and depressive episode (OR = 3.61, 95% CI = 3.24–4.03). Sleep problems with depression (vs. sleep problems alone) conferred additional risk for anxiety, perceived stress and decrements in health in the domains of mobility, self-care, pain, cognition, and interpersonal activities. Clinicians should be aware that the co-occurrence of sleep problems and depression is associated with a variety of adverse health outcomes in LMICs. Detecting this co-occurrence may be important for treatment planning.
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Affiliation(s)
- Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, 141 89, Sweden. .,Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8553, Japan.
| | - Mall Leinsalu
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, 141 89, Sweden.,Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, New York City, NY, USA
| | - Yosuke Inoue
- Carolina Population Center, The University of North Carolina at Chapel Hill, 123 West Franklin St, Chapel Hill, NC, 27516, USA
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain.,ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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