Do cognitive processes predict mental health in individuals with rheumatoid arthritis?

Understanding Cognitive Deficits in People with Arthritis

Cognitive deficits are commonly seen in people with arthritis. However, previous studies focused primarily on small-sized clinical samples. There is a need for cohort-based studies, which are characterized by high generalizability. In addition, these studies mainly focused on attention, memory, and executive function. However, cognition is not a single concept, but includes other cognitive domains, such as verbal fluency and arithmetic abilities. Thus, we aim to explore how arthritis can affect cognitive abilities, including episodic memory, semantic verbal fluency, fluid reasoning, and numerical ability by using a large cohort from the United Kingdom. The main findings were that people with arthritis have significantly lower immediate word recall (t(2257) = -6.40, p < 0.001, Cohen's d = -0.12, 95% C.I. = [-0.16, -0.08]), delayed word recall (t(2257) = -5.60, p < 0.001, Cohen's d = -0.11, 95% C.I. = [-0.14, -0.07]), semantic verbal fluency (t(2257) = -3.03, p < 0.01, Cohen's d = -0.06, 95% C.I. = [-0.10, -0.02]), fluid reasoning (t(2257) = -3.96, p < 0.001, Cohen's d = -0.07, 95% C.I. = [-0.11, -0.04]), and numerical ability (t(2257) = -3.85, p < 0.001, Cohen's d = -0.07, 95% C.I. = [-0.10, -0.03]) compared to what they would expect given their demographics. Interventions are needed to improve cognitive abilities in people with arthritis.

Cognitive Function and Depressive Symptoms among Chinese Adults Aged 40 Years and Above: The Mediating Roles of IADL Disability and Life Satisfaction

The purpose of this study was to investigate the relationship between cognitive function and depressive symptoms among Chinese adults aged 40 years and above, as well as the series of multiple mediating effects of Instrument Activities of Daily Living disability and life satisfaction on this relationship. The data was obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2013-2018), including 6466 adults aged 40 years and above. The mean age of the adults was 57.7 ± 8.5. The SPSS PROCESS macro program was conducted to examine the mediating effects. The results indicated that there was a significant association between cognitive function and depressive symptoms five years later (B = -0.1500, 95%CI: -0.1839, -0.1161), which could also be demonstrated through three mediation pathways: (1) the mediating pathway through IADL disability (B = -0.0247, 95%CI: -0.0332, -0.0171); (2) the mediating pathway through life satisfaction (B = 0.0046, 95%CI: 0.0000, 0.0094); and (3) the chain mediation pathway through IADL disability and life satisfaction (B = -0.0012, 95%CI: -0.0020, -0.0003). Both IADL disability and life satisfaction have been proven to be crucial mediators for the relationship between cognitive function and depressive symptoms five years later. It is necessary to improve individuals' cognitive function and reduce the negative impact of disability on them, which is important to enhance their life satisfaction and prevent depressive symptoms.

Cognitive dysfunction in patients of rheumatoid arthritis

Rheumatoid Arthritis (RA) is a form of arthritis characterized by joint pain, stiffness, swelling and deformity. There has been plethora of researches in the area of rheumatoid arthritis which focused on immune system, genetic predisposition and newer treatment modalities. Researchers have also examined the cognitive decline, physical deficits and their interrelationship in patients with RA. Among several psychological aspects depression, anxiety and stress emerge as significant psychological co morbidity. RA is a multifactorial, chronic, inflammatory disease primarily affects physical functioning as well as psychological aspects. Pain, fatigue, duration of disease, disease activity and functional disability are very common in rheumatoid arthritis which is leading cause of psychological distress and functional disability. Various types of neuropsychological battery were used to assess the decline in specific areas like attention, executive functioning, visuo-spatial learning, verbal learning/memory etc. These functions were compared with other type of arthritis disease. Also, various other factors like depression, cardiovascular diseases, other systemic and chronic disease and concomitant drugs intake etc. also affected cognitive functioning in Rheumatoid Arthritis patients. The objective of this review was to identify and explore the rates and types of cognitive impairment in RA. This present review paper systematically examines and summarizes the cognition related decrement in arthritis patients. Multiple research articles between 1990 to 2018 were searched. These reviews were evaluated and synthesized using a narrative and descriptive approach.

The relationship between cognition and depressive symptoms, and factors modifying this association, in Alzheimer's disease: A multivariate multilevel model

OBJECTIVES

To examine whether there was a bidirectional association between cognition and depressive symptoms in Alzheimer's disease (AD), and to explore the role of socio-demographic factors and daily performance in this association.

METHODS

We conducted a longitudinal study of 104 community-dwelling patients with confirmed AD from Taiyuan, China. We assessed cognition and depressive symptoms (dependent variables) with the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale-30 (GDS-30), respectively. Socio-demographic information and daily performance were treated as explanatory variables. A multivariate multilevel model was built to investigate the interrelationship between patients' cognition and depression, as well as the effect of related factors on both outcomes.

RESULTS

MoCA scores were negatively correlated with GDS-30 both at the subject level (correlation coefficient r₃=-0.68, χ²=19.26, P<0.001) and time point level (r₂=-0.35, χ²=35.68, P<0.001) in patients with AD. Multivariate analysis showed several significant factors for cognitive function, including educational level, personality, hobbies, exercise, reading, aluminum utensil use, dietary restriction and hypertension (regression coefficients: 0.60, 0.52, 0.51, 0.48, 0.45, -0.48, 0.67, and -0.74, respectively). Significant factors for depressive symptoms included family status, employment before retirement, homemaking, reading, aluminum utensil use, dietary restriction, and hypertension (regression coefficients: 3.09, -1.33, -1.62, -1.31, 0.96, -1.15, and 1.14, respectively).

CONCLUSION

These findings indicated that cognition was negatively associated with depression in patients with AD, and both were influenced by reading, aluminum utensil use, dietary restriction, and hypertension. Considering patient factors may help to slow the progression of dementia.

Does early caregiving matter? The effects on young caregivers’ adult mental health

Limited information is available on the long-term effects of providing care for adults when caregiving begins in childhood in the United States. The current study provided an examination of the effects of youthful caregiving on the mental health of these persons when adults, and provided a description of their early family relations. Twenty-four individuals, 21 to 58 years old, were given brief phone interviews with semistructured questions about their early caregiving experiences, and then they completed questionnaires on their early caregiving experiences, mental health, and early parent–child relations. To be included, respondents must have provided primary caregiving assistance (i.e., bathing, feeding, etc.) for a parent or adult relative when the caregiver was under 21 years old. Results showed that the sample reported more positive mental health than negative mental health, though 42% had high depressive scores on the total CES-D. Individuals who reported fathers as too protective reported less current positive mental health. Early caregiving is not associated with poor mental health in adulthood for many young caregivers. However, some individuals do appear at risk of depression in adulthood.

Factors related to self-efficacy in persons with scleroderma

PURPOSE

 Scleroderma (SSc) is rare, and few studies have examined self-efficacy in persons with the disease. Self-efficacy is one precursor that has been shown to initiate changes in behaviour when managing chronic disease. The objective of this study was to explore the levels of self-efficacy in persons with SSc, compare self-efficacy in persons with limited or diffuse SSc and determine correlations between self-efficacy, physical function and psychological variables.

METHODS

 Sixty-two participants with SSc completed measures assessing self-efficacy, depression, fatigue, pain, hand function and activity limitations. The mean age of participants was 52.9 years. The mean educational level was 15.8 years. Sixty-seven per cent were married and 87.1% were women. Thirty participants had diffuse SSc, 27 had limited SSc and five were unclassified.

RESULTS

 The only significant differences between the two disease subtypes were in hand function and self-efficacy function subscale scores. Total self-efficacy scores significantly correlated with marital status, employment, self-reported health, depression, functional ability, fatigue, pain and hand function. Similarly, self-efficacy function scale scores correlated significantly with employment, self-reported health, functional ability, pain and hand function. Self-efficacy pain scale scores correlated significantly with fatigability. The self-efficacy other scale scores correlated significantly with depression and fatigability. Participants with higher levels of pain and depression, more fatigue, more general disability and more hand disability had lower self-efficacy.

CONCLUSION

 Self-efficacy correlates with physical function and psychological variables, and could predict how patients manage their health. Self-efficacy may increase through participation in educational programmes focusing on self-management of these variables.

Cognitive-affective assets and vulnerabilities: two factors influencing adaptation to fibromyalgia

This study set to explore whether variables related to cognitive-affective assets would complement measures of psychological vulnerability for the prediction of physical functioning and pain tolerance in 138 women with Fibromyalgia Syndrome (FMS). Depression, anxiety, stress response and negative affect were defined a priori as measures of vulnerability, while pain self-efficacy, internality and positive affect were identified as assets. Confirmatory factor analyses supported the validity of the hypothesised two-factor structure in FMS. A structural equation model (SEM) revealed that the two factors were associated with different outcomes in FMS as predictors. Pain and associated symptoms appeared related to psychological vulnerabilities in FMS patients, whereas physical functioning and tolerance for pain were better predicted by assets. These results are discussed with reference to current theoretical models concerning the role of psychological factors in FMS, and intervention methods designed to improve quality of life and reduce pain in FMS patients.

The relationship of neighborhood climate to perceived social support and mental health in older Hispanic immigrants in Miami, Florida

OBJECTIVE

This study examines the relationship of neighborhood climate (i.e., neighborhood social environment) to perceived social support and mental health outcomes in older Hispanic immigrants.

METHOD

A population-based sample of 273 community-dwelling older Hispanic immigrants (aged 70 to 100) in Miami, Florida, completed self-report measures of neighborhood climate, social support, and psychological distress and performance-based measures of cognitive functioning. Structural equation modeling was used to model the relationship of neighborhood climate to elders' perceived social support and mental health outcomes (i.e., cognitive functioning, psychological distress).

RESULTS

Neighborhood climate had a significant direct relationship to cognitive functioning, after controlling for demographics. By contrast, neighborhood climate had a significant indirect relationship to psychological distress, through its relationship to perceived social support. Moreover, social support mediated the relationship between neighborhood climate and psychological distress.

DISCUSSION

Findings suggest that a more positive neighborhood social environment may be associated with better mental health outcomes in urban, older Hispanic immigrants.

Longitudinal relationships between cognitive functioning and depressive symptoms among Hispanic older adults

This study examines the relationship between cognitive functioning and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between depressive symptoms and cognitive functioning over time and by examining the relationship between these variables among Hispanics, an understudied population at risk of developing depressive symptoms and cognitive impairments. Structural equation modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent cognitive functioning. However, cognitive functioning was related to subsequent depressive symptoms at every time point, such that poorer cognitive functioning was related to higher depressive symptoms. Findings suggest that cognitive declines may predict depressive symptoms in community-dwelling Hispanic older adults.

Disruption of Attention and Working Memory Traces in Individuals with Chronic Pain

BACKGROUND

Research has found that chronic pain disrupts attention and that this disruption can lead to significant functional impairment and decreased quality of life. We conducted the present study to examine how attention and memory are disrupted by chronic pain.

METHODS

Computerized tests of working memory were given to participants with chronic pain along with a neuropsychological test of attention before and after procedures resulting in analgesia.

RESULTS

Two-thirds of participants with chronic pain had scores in the clinically impaired range on attentional tasks. These results were independent of age, education level, sleep disruption, and pain relief. Medication use was also recorded and is reported to account for potential effects of medication on task performance. Those participants with the highest level of impairment had significantly greater difficulties in maintaining a memory trace during a challenging test of working memory.

CONCLUSIONS

These findings point to a specific cognitive mechanism, the maintenance of the memory trace, that is affected by chronic pain during task performance. Cognitive function was not improved by short-term local analgesia.

A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part I)

Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.

Use of memory compensation strategies is related to psychosocial and health indicators

Research has shown that psychosocial and health characteristics may affect older adults' cognitive performance, self-referent beliefs, and general adaptive resilience. Are such characteristics related specifically to older adults' reported efforts to compensate for memory losses? The Memory Compensation Questionnaire (MCQ) measures 5 mechanisms of everyday memory compensation as well as 2 general aspects of compensatory motivation and awareness. Correlates were derived from indicators of specific health conditions, subjective health ratings, personality, well-being, and memory self-efficacy (MSE). All measures were administered to a cross-sectional sample of 528 healthy older adults between 55 and 94 years of age from the Victoria Longitudinal Study. Specific health composites (i.e., infirmities, respiratory illness), several personality dimensions (e.g., agreeableness, neuroticism), negative affect, and low MSE were associated with more frequent use of everyday memory compensation strategies. Linking healthy older adults' cognitive resilience with individual characteristics is an important contribution to emerging conceptions of adaptation and success in late life.

Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis

This article provides an overview of the emerging literature on biopsychosocial assessment and treatment for two of the most common forms of arthritis: osteoarthritis and rheumatoid arthritis. The article is divided into 3 parts. In the 1st part, the basic elements of the biopsychosocial approach to assessing and treating persons having arthritis is described. In the 2nd part, the authors evaluate studies of biopsychosocial approaches to the assessment of arthritis pain and disability. Six research areas are reviewed: learned helplessness, depression, stress, pain coping, self-efficacy, and the social context of arthritis. The 3rd part of the article reviews studies that testing the efficacy of biopsychosocial treatment approaches for persons having osteoarthritis and rheumatoid arthritis.

The relationship of pain and depression to cognitive function in rheumatoid arthritis patients

The purpose of this study was to assess the hypothesis that pain and depression negatively impact the cognitive functioning of individuals with rheumatoid arthritis (RA). One hundred twenty-one community-dwelling RA patients (ages 34-84) completed a battery of cognitive tasks and multiple measures of pain and depression. Structural equation modeling techniques were used to assess the relative contributions of pain, depression, and age to cognitive performance. Individuals who performed poorly on cognitive tasks reported more pain and depression and were older than those individuals who performed well on cognitive tasks. Moreover, high levels of pain were associated with depression. Further analyses revealed that depression mediated the relationship between pain and cognition. That is, when depression was entered into the analyses, the previously significant effects of pain on cognition were no longer found. Interestingly, depression still mediated the pain-cognition relationship even after controlling for age. These findings suggest the importance of both pain and depression for understanding cognitive function in RA and may have important implications for treating this disease.

Test of a nursing intervention to promote adjustment to fibromyalgia

PURPOSE

This was a test to detect whether a 4-week cognitive behavioral nursing program was effective in increasing adjustment to fibromyalgia (FM) and if the treatment effect would last over time.

DESIGN

This was a control and treatment group experimental longitudinal study with outcome measures obtained at pretest and every 3 months for 1 year.

SAMPLE

A sample of 71 subjects continued their participation throughout the first year of the study.

FINDINGS

Treatment subjects had improved posttreatment adjustment and symptom severity compared to control subjects. When subjects with high pretest psychosocial distress (n = 5) were removed from the analysis, these findings were statistically significant.

IMPLICATIONS FOR NURSING PRACTICE

The article can provide direction for developing new comprehensive nursing intervention for patients seen with orthopaedic problems. The intervention schedule may help nurses expand their use of interventions for FM patients. Orthopaedic nurses are especially suited for this challenge.

Cognitive dysfunction in fibromyalgia

Fibromyalgia is a puzzling syndrome of widespread musculoskeletal pain. In addition to pain, patients with fibromyalgia frequently report that cognitive function, memory, and mental alertness have declined. A small body of literature suggests that there is cognitive dysfunction in fibromyalgia. This article addresses several questions that physicians may have regarding cognitive function in their patients. These questions concern the types of cognitive tasks that are problematic for patients with fibromyalgia, the role of psychological factors such as depression and anxiety, the role of physical factors such as pain and fatigue, the nature of patients' perceptions of their cognitive abilities, and whether patients can be tested for cognitive dysfunction. Critical areas for further investigation are highlighted.