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Li Y, Song Y, Sui J, Greiner R, Li XM, Greenshaw AJ, Liu YS, Cao B. Prospective prediction of anxiety onset in the Canadian longitudinal study on aging (CLSA): A machine learning study. J Affect Disord 2024; 357:148-155. [PMID: 38670463 DOI: 10.1016/j.jad.2024.04.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/20/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Anxiety disorders are among the most common mental health disorders in the middle aged and older population. Because older individuals are more likely to have multiple comorbidities or increased frailty, the impact of anxiety disorders on their overall well-being is exacerbated. Early identification of anxiety disorders using machine learning (ML) can potentially mitigate the adverse consequences associated with these disorders. METHODS We applied ML to the data from the Canadian Longitudinal Study on Aging (CLSA) to predict the onset of anxiety disorders approximately three years in the future. We used Shapley value-based methods to determine the top factor for prediction. We also investigated whether anxiety onset can be predicted by baseline depression-related predictors alone. RESULTS Our model was able to predict anxiety onset accurately (Area under the Receiver Operating Characteristic Curve or AUC = 0.814 ± 0.016 (mean ± standard deviation), balanced accuracy = 0.741 ± 0.016, sensitivity = 0.743 ± 0.033, and specificity = 0.738 ± 0.010). The top predictive factors included prior depression or mood disorder diagnosis, high frailty, anxious personality, and low emotional stability. Depression and mood disorders are well known comorbidity of anxiety; however a prior depression or mood disorder diagnosis could not predict anxiety onset without other factors. LIMITATION While our findings underscore the importance of a prior depression diagnosis in predicting anxiety, they also highlight that it alone is inadequate, signifying the necessity to incorporate additional predictors for improved prediction accuracy. CONCLUSION Our study showcases promising prospects for using machine learning to develop personalized prediction models for anxiety onset in middle-aged and older adults using easy-to-access survey data.
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Affiliation(s)
- Yutong Li
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Yipeng Song
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jie Sui
- School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Russell Greiner
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada; Alberta Machine Intelligence Institute, Edmonton, Alberta, Canada
| | - Xin-Min Li
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada.
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2
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Pan RM, Chang HJ, Chi MJ, Wang CY, Chuang YH. The traditional Chinese version of the Geriatric Anxiety Inventory: Psychometric properties and cutoff point for detecting anxiety. Geriatr Nurs 2024; 58:438-445. [PMID: 38908039 DOI: 10.1016/j.gerinurse.2024.06.008] [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] [Received: 02/02/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
The study aimed to translate the Geriatric Anxiety Inventory into traditional Chinese (GAI-TC), examine its psychometric properties, and identify the optimal cutoff point. This research recruited 337 older adults from two community activity centers. Structured questionnaires were used, including demographic information and characteristics, the GAI-TC, and the State-Trait Anxiety Inventory (STAI). Cronbach's α of the GAI-TC was 0.93. The intraclass correlation coefficient was 0.90. The content validity index was 1.0. An exploratory factor analysis revealed that three factors in the GAI-TC, including cognition anxiety, impact of anxiety, and somatic anxiety, explained 59.46 % of the variance. The criterion-related validity showed a significant positive correlation between the GAI-TC and STAI, with an optimal cutoff of 9/10 for detecting anxiety in older persons living in the community. The GAI-TC had good reliability and validity and can provide professionals with a tool for the early identification of anxiety among older adults.
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Affiliation(s)
- Rou-May Pan
- Department of Nursing, National Taiwan University Hospital, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei 100225, Taiwan
| | - Hsiu-Ju Chang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Linong St., Sec. 2, Taipei 112304, Taiwan; College of Nursing, Efficient Smart Care Research Center, National Yang Ming Chiao Tung University,155 Linong St., Sec. 2, Taipei City 112304, Taiwan
| | - Mei-Ju Chi
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wu-Xing St., Taipei 11031, Taiwan; International PhD Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wu-Xing St., Taipei 11031, Taiwan
| | - Chih-Yu Wang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Xing St., Xinyi District, Taipei 11031, Taiwan
| | - Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Xing St., Xinyi District, Taipei 11031, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd, Sec. 3. Wenshan District, Taipei 11696, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd, Sec. 3. Wenshan District, Taipei 11696, Taiwan.
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3
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Pacas Fronza G, Byrne G, Appadurai K, Pachana N, Dissanayaka NNW. Anxiety Symptoms in Australian Memory Clinic Attendees with Cognitive Impairment: Differences Between Self-, Carer-, and Clinician-Report Measures. Clin Gerontol 2024; 47:215-223. [PMID: 37409742 DOI: 10.1080/07317115.2023.2231940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To identify the prevalence of anxiety symptoms using a variety of instruments in an Australian memory clinic sample. METHODS This is an exploratory cross-sectional study using a purposive consecutive series sample of 163 individuals and their carers who attended a Brisbane, Australia, memory clinic in 2012-2015. Descriptive statistics and correlation analyses were performed to explore different approaches to measuring anxiety in the sample, using clinician-rated, self-report and carer-report measures. RESULTS The mean age of participants was 78 years, nearly 53% were females. Over 70% of participants with mild cognitive impairment (MCI) and dementia (n = 163) experienced mild to moderate anxiety per a clinician-rated measure (HAM-A), which moderately correlated with carer-report anxiety (IQAD; rs =.59, p < .001). Only weak correlations of these measures with self-report anxiety (GAI) were detected. CONCLUSIONS Mild to moderate anxiety symptoms were frequent in memory clinic attendees diagnosed with MCI or dementia using the HAM-A, suggesting experiences of subclinical anxiety symptoms. CLINICAL IMPLICATIONS Self- as well as carer-report screening tools should be used in memory clinics in addition to routinely administered neuropsychiatric assessments to support early identification of anxiety symptoms and mapping of available post-diagnostic care pathways for people diagnosed with cognitive impairment.
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Affiliation(s)
- Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Gerard Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Australia
- Academy of Psychiatry, School of Medicine, The University of Queensland, Herston, Australia
| | - Kana Appadurai
- Geriatric and Rehabilitation Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Nancy Pachana
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
| | - Nadeeka N W Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia
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André C, Martineau-Dussault MÈ, Daneault V, Blais H, Frenette S, Lorrain D, Hudon C, Bastien C, Petit D, Lafrenière A, Thompson C, Montplaisir J, Gosselin N, Carrier J. REM sleep is associated with the volume of the cholinergic basal forebrain in aMCI individuals. Alzheimers Res Ther 2023; 15:151. [PMID: 37684650 PMCID: PMC10485959 DOI: 10.1186/s13195-023-01265-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Rapid-eye movement (REM) sleep highly depends on the activity of cholinergic basal forebrain (BF) neurons and is reduced in Alzheimer's disease. Here, we investigated the associations between the volume of BF nuclei and REM sleep characteristics, and the impact of cognitive status on these links, in late middle-aged and older participants. METHODS Thirty-one cognitively healthy controls (66.8 ± 7.2 years old, 13 women) and 31 participants with amnestic Mild Cognitive Impairment (aMCI) (68.3 ± 8.8 years old, 7 women) were included in this cross-sectional study. All participants underwent polysomnography, a comprehensive neuropsychological assessment and Magnetic Resonance Imaging examination. REM sleep characteristics (i.e., percentage, latency and efficiency) were derived from polysomnographic recordings. T1-weighted images were preprocessed using CAT12 and the DARTEL algorithm, and we extracted the gray matter volume of BF regions of interest using a probabilistic atlas implemented in the JuBrain Anatomy Toolbox. Multiple linear regressions were performed between the volume of BF nuclei and REM sleep characteristics controlling for age, sex and total intracranial volume, in the whole cohort and in subgroups stratified by cognitive status. RESULTS In the whole sample, lower REM sleep percentage was significantly associated to lower nucleus basalis of Meynert (Ch4) volume (β = 0.32, p = 0.009). When stratifying the cohort according to cognitive status, lower REM sleep percentage was significantly associated to both lower Ch4 (β = 0.48, p = 0.012) and total BF volumes (β = 0.44, p = 0.014) in aMCI individuals, but not in cognitively unimpaired participants. No significant associations were observed between the volume of the BF and wake after sleep onset or non-REM sleep variables. DISCUSSION These results suggest that REM sleep disturbances may be an early manifestation of the degeneration of the BF cholinergic system before the onset of dementia, especially in participants with mild memory deficits.
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Affiliation(s)
- Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Functional Neuroimaging Unit, University of Montreal Geriatric Institute, 4565 Queen-Mary Road, Montreal, QC, H3W 1W5, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Sonia Frenette
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Dominique Lorrain
- Research Centre On Aging, University Institute of Geriatrics of Sherbrooke, CIUSSS de L'Estrie-CHUS, Sherbrooke, QC, Canada
- Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carol Hudon
- CERVO Research Centre, Québec City, QC, Canada
- School of Psychology, Université Laval, Québec City, QC, Canada
| | - Célyne Bastien
- CERVO Research Centre, Québec City, QC, Canada
- School of Psychology, Université Laval, Québec City, QC, Canada
| | - Dominique Petit
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
| | - Alexandre Lafrenière
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada.
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.
- Functional Neuroimaging Unit, University of Montreal Geriatric Institute, 4565 Queen-Mary Road, Montreal, QC, H3W 1W5, Canada.
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Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, Smith K, Strivens E, Pachana NA. Culturally Appropriate Assessment of Depression and Anxiety in Older Torres Strait Islanders: Limitations and Recommendations. Clin Gerontol 2023; 46:240-252. [PMID: 35694996 DOI: 10.1080/07317115.2022.2086090] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults. METHODS A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region. RESULTS A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region. CONCLUSIONS Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait. CLINICAL IMPLICATIONS • Current mental health screening tools are not applicable for the Torres Strait• More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities.
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Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Services, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, School of Medicine, University of Western Australia, Perth, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Australia
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Martineau-Dussault MÈ, André C, Daneault V, Baril AA, Gagnon K, Blais H, Petit D, Montplaisir JY, Lorrain D, Bastien C, Hudon C, Descoteaux M, Boré A, Theaud G, Thompson C, Legault J, Martinez Villar GE, Lafrenière A, Lafond C, Gilbert D, Carrier J, Gosselin N. Medial temporal lobe and obstructive sleep apnea: Effect of sex, age, cognitive status and free-water. Neuroimage Clin 2022; 36:103235. [PMID: 36272339 PMCID: PMC9668668 DOI: 10.1016/j.nicl.2022.103235] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
Medial temporal structures, namely the hippocampus, the entorhinal cortex and the parahippocampal gyrus, are particularly vulnerable to Alzheimer's disease and hypoxemia. Here, we tested the associations between obstructive sleep apnea (OSA) severity and medial temporal lobe volumes in 114 participants aged 55-86 years (35 % women). We also investigated the impact of sex, age, cognitive status, and free-water fraction correction on these associations. Increased OSA severity was associated with larger hippocampal and entorhinal cortex volumes in women, but not in men. Greater OSA severity also correlated with increased hippocampal volumes in participants with amnestic mild cognitive impairment, but not in cognitively unimpaired participants, regardless of sex. Using free-water corrected volumes eliminated all significant associations with OSA severity. Therefore, the increase in medial temporal subregion volumes may possibly be due to edema. Whether these structural manifestations further progress to neuronal death in non-treated OSA patients should be investigated.
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Affiliation(s)
- Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Centre de recherche de l’Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de l’Île-de-Montréal, Montreal, Canada
| | - Andrée-Ann Baril
- Department of Psychiatry, McGill University, Montreal, Canada,Douglas Mental Health University Institute, CIUSSS de l'Ouest-de-l'Ile-de-Montréal, Montreal, Canada
| | - Katia Gagnon
- Hôpital en santé mentale Rivière-des-Prairies, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychiatry, Université de Montréal, Montreal, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada
| | - Dominique Petit
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychiatry, Université de Montréal, Montreal, Canada
| | - Jacques Y. Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychiatry, Université de Montréal, Montreal, Canada
| | - Dominique Lorrain
- Research Center on Aging, Institut universitaire de gériatrie de Sherbrooke, CIUSSS de l’Estrie, Sherbrooke, Canada,Department of Psychology, Université de Sherbrooke, Sherbrooke, Canada
| | - Célyne Bastien
- CERVO Research Center, Quebec City, Canada,École de psychologie, Université Laval, Quebec City, Canada
| | - Carol Hudon
- CERVO Research Center, Quebec City, Canada,École de psychologie, Université Laval, Quebec City, Canada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Canada,Imeka Solutions Inc, Sherbrooke, Canada
| | - Arnaud Boré
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de l’Île-de-Montréal, Montreal, Canada,Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Canada,Imeka Solutions Inc, Sherbrooke, Canada
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Canada,Imeka Solutions Inc, Sherbrooke, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada
| | - Julie Legault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Guillermo E. Martinez Villar
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Alexandre Lafrenière
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Chantal Lafond
- Department of Medecine, Université de Montréal, Montreal, Canada,Department of Pneumonology, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada
| | - Danielle Gilbert
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada,Department of Radiology, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada,Centre de recherche de l’Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de l’Île-de-Montréal, Montreal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, Canada,Department of Psychology, Université de Montréal, Montreal, Canada,Corresponding author at: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de l’Ile-de-Montréal, 5400 Gouin Blvd. West, Office J-5135, Montreal, Quebec H4J 1C5, Canada.
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7
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Carlucci L, Balestrieri M, Maso E, Marini A, Conte N, Balsamo M. Psychometric properties and diagnostic accuracy of the short form of the geriatric anxiety scale (GAS-10). BMC Geriatr 2021; 21:401. [PMID: 34193082 PMCID: PMC8243753 DOI: 10.1186/s12877-021-02350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anxious symptoms have a negative impact on different aspects of the elderly's quality of life, ranging from the adoption of unhealthy lifestyle behaviours to an increased functional impairment and a greater physical disability. Different brief assessment instruments have been developed as efficacy measures of geriatric anxiety in order to overcome psychometric weaknesses of its long form. Among these, the 10-item Geriatric Anxiety Scale (GAS-10) showed strong psychometric properties in community-dwelling samples. However, its diagnostic accuracy is still unexplored, as well as its discriminative power in clinical samples. METHODS In the present study, we explored the psychometric performance of the GAS-10 in the elderly through Item Response Theory in a sample of 1200 Italian community-dwelling middle-aged and elderly adults (53.8% males, mean age = 65.21 ± 9.19 years). Concurrent validity, as well as diagnostic accuracy, was examined in a non-clinical sample (N = 229; 46.72% males) and clinical sample composed of 35 elderly outpatients (74.28% females) with Generalized Anxiety Disorder (GAD). RESULTS The GAS-10 displayed good internal construct validity, with unidimensional structure and no local dependency, good accuracy, and no signs of Differential Item Functioning (DIF) or measurement bias due to gender, but negligible due to the age. Differences in concurrent validity and diagnostic accuracy among the long form version of the GAS and the GAS-10 were not found significant. The GAS-10 may be more useful than the longer versions in many clinical and research applications, when time constraints or fatigue are issues. CONCLUSION Using the ROC curve, the GAS-10 showed good discriminant validity in categorizing outpatients with GAD disorder, and high anxiety symptoms as measured by the GAS-SF cut-off. The stable cut-off point provided could enhance the clinical usefulness of the GAS-10, which seems to be a promising valid and reliable tool for maximize diagnostic accuracy of geriatric anxiety symptoms.
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Affiliation(s)
- Leonardo Carlucci
- Department of Psychological Sciences, Health and Territory, "G. d'Annunzio" University of Chieti-Pescara, via dei Vestini, 31 66100, Chieti, Italy.
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elisa Maso
- Psychiatric Clinic, Healthcare and University Integrated Trust, Udine, Italy
| | - Alessia Marini
- Department of Psychological Sciences, Health and Territory, "G. d'Annunzio" University of Chieti-Pescara, via dei Vestini, 31 66100, Chieti, Italy
| | - Nadia Conte
- Department of Psychological Sciences, Health and Territory, "G. d'Annunzio" University of Chieti-Pescara, via dei Vestini, 31 66100, Chieti, Italy
| | - Michela Balsamo
- Department of Psychological Sciences, Health and Territory, "G. d'Annunzio" University of Chieti-Pescara, via dei Vestini, 31 66100, Chieti, Italy
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Luo F, Ye M, Lv T, Hu B, Chen J, Yan J, Wang A, Chen F, He Z, Ding Z, Zhang J, Qian C, Liu Z. Efficacy of Cognitive Behavioral Therapy on Mood Disorders, Sleep, Fatigue, and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:793804. [PMID: 34966313 PMCID: PMC8710613 DOI: 10.3389/fpsyt.2021.793804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 02/06/2023] Open
Abstract
Objective: The aim of this study was to perform a quantitative analysis to evaluate the efficacy of cognitive behavioral therapy (CBT) on mood disorders, sleep, fatigue, and its impact on quality of life (QOL) in Parkinson's Disease (PD). Methods: We searched for randomized controlled trials in three electronic databases. Fourteen studies, including 507 patients with PD, met the inclusion criteria. We determined the pooled efficacy by standard mean differences and 95% confidence intervals, using I 2 to reveal heterogeneity. Results: The result showed CBT had a significant effect on depression [-0.93 (95%CI, -1.19 to -0.67, P < 0.001)] and anxiety [-0.76 (95%CI, -0.97 to -0.55, P < 0.001)]. Moderate effect sizes were noted with sleep disorders [-0.45 (95% CI, -0.70 to -0.20, P = 0.0004)]. There was no evident impact of CBT on fatigue or QOL. We found an intervention period >8 weeks was advantageous compared with <8 weeks, and CBT implemented in non-group was more effective than in group. Between the delivery methods, no significant difference was found. Conclusion: We found that CBT in patients with PD was an efficacious therapy for some non-motor symptoms in PD, but not efficacious for fatigue and QOL. These results suggest that CBT results in significant improvement in PD and should be used as a conventional clinical intervention.
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Affiliation(s)
- Fangyi Luo
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center, Medical College of Shaoxing University, Shaoxing, China.,Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Mengfei Ye
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center, Medical College of Shaoxing University, Shaoxing, China
| | - Tingting Lv
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Baiqi Hu
- Department of Neurology, Shaoxing Hospital, China Medical University, Shaoxing, China
| | - Jiaqi Chen
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Junwei Yan
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Anzhe Wang
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Feng Chen
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Ziyi He
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Zhinan Ding
- Laboratory of Forensic Toxicology, Judicial Identification Center of Shaoxing University, Shaoxing, China
| | - Jian Zhang
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China
| | - Chao Qian
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center, Medical College of Shaoxing University, Shaoxing, China
| | - Zheng Liu
- Department of Behavioral Neurosciences, Science Research Center of Medical College, Shaoxing University, Shaoxing, China.,Laboratory of Forensic Toxicology, Judicial Identification Center of Shaoxing University, Shaoxing, China
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Khine WWT, Voong ML, Ng TKS, Feng L, Rane GA, Kumar AP, Kua EH, Mahendran R, Mahendran R, Lee YK. Mental awareness improved mild cognitive impairment and modulated gut microbiome. Aging (Albany NY) 2020; 12:24371-24393. [PMID: 33318317 PMCID: PMC7762482 DOI: 10.18632/aging.202277] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
There is ample scientific and clinical evidence of the effects of gut microbiota on the brain but no definitive evidence that the brain can affect changes in gut microbiota under the bi-directional gut-brain axis concept. As there is no pharmacotherapeutic intervention for the early stages of cognitive decline, research has focused on cognitive stimulation in reversing or slowing the impairment. Elderly patients diagnosed with mild cognitive impairment underwent a randomized-control trial of mindful awareness practice. Neuropsychological assessments, inflammatory markers, and gut microbiota profiles were tested. Here, we report that their cognitive impairment was improved and associated with changes in gut bacterial profile. A cognition-score-dependent-abundance was observed in Ruminococcus vs Recognition Trials (RT), Digit Span Backward (DSB), Semantic Fluency Span (SFS) and Memory Domain (MD); Coprococcus vs DSB, Color Trails Test 2 (CTT2) and Block Design (BD); Parabacteroides vs DSB and SFS; Fusobacterium vs DSB and CTT2; Enterobacteriaceae vs BD and SFS; Ruminococcaceae vs DSB; Phascolarctobacterium vs MD. The study showed for the first-time, alteration in the cognitive capacity leading to the corresponding changes in microbiota profiles. This strongly suggests that signals from the different segments of brain could dictate directly or indirectly the abundances of specific gut microbes.
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Affiliation(s)
- Wei Wei Thwe Khine
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore.,Functional Foods Forum, Faculty of Medicine, University of Turku, Turku 20014, Finland
| | - Miao Lian Voong
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore
| | - Ted Kheng Siang Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore
| | - Grishma Avinash Rane
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
| | - Alan Prem Kumar
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.,Medical Sciences Cluster, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore
| | - Ratha Mahendran
- Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yuan-Kun Lee
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore.,Department of Surgery, National University Hospital, Singapore 119228, Singapore
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Abstract
The Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) are self-reported scales used internationally to assess anxiety symptoms in older adults. In this study, we conducted the first critical comprehensive review of these scales' psychometric properties. We rated the quality of 31 relevant studies with the COSMIN checklist. Both the GAI and GAI-SF showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with generalized anxiety measures; lowest with instruments relating to somatic symptoms. We detected substantial overlap with depression measures. While there was no consensus on the GAI's factorial structure, we found the short version to be unidimensional. Although we found good sensitivity and specificity for detecting anxiety, cut-off scores varied. The GAI and GAI-SF are relevant instruments showing satisfactory psychometric properties; to broaden their use, however, some psychometric properties warrant closer examination. This review calls attention to weaknesses in the methodological quality of the studies.
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11
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Bandari R, Heravi-Karimooi M, Miremadi M, Mohebbi L, Montazeri A. The Iranian version of geriatric anxiety inventory (GAI-P): a validation study. Health Qual Life Outcomes 2019; 17:118. [PMID: 31296228 PMCID: PMC6624870 DOI: 10.1186/s12955-019-1176-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 06/06/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Anxiety is one of the most common mental health problems experienced by the elderly that affects quality of life. This study aimed to assess the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-P) in order to provide a valid instrument for measuring anxiety in this population. METHODS Forward-backward translation was used to translate the Geriatric Anxiety Inventory from English into Persian and was tested by 10 elderly to assess its face validity. Then a sample of elderly people attending health centers in Dezful, Iran completed the questionnaire. Validity was assessed using both exploratory and confirmatory factors analysis, known-groups comparison (abused and non-abused elderly) also was administered. The internal consistency of the instrument was assessed using Kuder-Richardson 20 coefficients (KR-20). Afterwards, the reliability and validity through assessing the correlation between the Persian version of the GAI-P and the SF-36, were measured. RESULTS In all 720 elderly completed the questionnaire. Of these data from 420 elderly were used for exploratory factor analysis and the data from the remaining 300 elderly were used for confirmatory factor analysis. The exploratory factor analysis showed a three-factor solution (cognitive, arousal and somatic) for the questionnaire that jointly explained 59.48% of the overall variance observed. The confirmatory factor analysis supported the three-factor solution and the second-order latent factor model. The findings indicated a positive and significant correlation between the two measures lending support to its concurrent validity (r = 0.67, p < .001).Ultimately, the Geriatric Anxiety Inventory was found to have a favorable internal consistency. CONCLUSION This study confirmed that the GAI-P is a valid measure of anxiety in elderly population and now can be used in geriatric studies in Iran.
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Affiliation(s)
- Razieh Bandari
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Majideh Heravi-Karimooi
- Elderly Care Research Center, College of Nursing & Midwifery, Shahed University, Tehran, Iran
| | - Mojgan Miremadi
- Faculty of Nursing Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Mohebbi
- Department of Health, Dezful University of Medical Sciences, Dezful, Iran
| | - Ali Montazeri
- Population Health Group Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
- Faculty of Humanity Sciences, University of Science & Culture ACECR, Tehran, Iran
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Bakkane Bendixen A, Engedal K, Selbaek G, Benth JŠ, Hartberg CB. Anxiety symptom levels are persistent in older adults with a mental disorder: A 33-month follow-up study. Int J Geriatr Psychiatry 2019; 34:601-608. [PMID: 30609143 DOI: 10.1002/gps.5058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/20/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Anxiety symptoms are common in old age and have been suggested as risk factors for development of cognitive impairment and mortality. The objective of the present study was to investigate whether anxiety symptoms among older adults with a mental health diagnosis are persistent, and severity of anxiety predicts cognitive decline and mortality. METHODS We collected data from 201 patients referred to specialist mental health service in a department of geriatric psychiatry. Of these, 150 were reexamined after 33 months, while 51 patients died before follow-up. Mean age (SD) at baseline among the patients that were reexamined was 73.4 (7.3) years, and 67% were women. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety symptoms at baseline and follow-up. We investigated whether higher GAI scores at baseline were associated with persistence of anxiety. Associations with cognitive decline or mortality were also explored. The associations were estimated by use of trajectory analysis and regression models. RESULTS Seventy-four percentages had the same level of anxiety symptoms, and 29% had a high level of anxiety at baseline and follow-up. GAI score at baseline was not associated with cognitive decline or mortality at 33-month follow-up. CONCLUSION In a longitudinal study of anxiety symptoms among older adults in specialist mental health services, we demonstrate persistent high or low levels of anxiety symptoms. Anxiety trajectories over time were not predicted by patient characteristics. Also the level of anxiety cannot be used as predictor for future cognitive decline or mortality in a clinical population.
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Affiliation(s)
- Anette Bakkane Bendixen
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.,Vestfold Hospital Trust, Norwegian National Advisory Unit on Aging and Health, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Aging and Health, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Selbaek
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Aging and Health, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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13
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Miranda-Castillo C, Contreras D, Garay K, Martínez P, León-Campos MO, Farhang M, Morán J, Fernández-Fernández V. Validation of the Geriatric Anxiety Inventory in Chilean older people. Arch Gerontol Geriatr 2019; 83:81-85. [PMID: 30974400 DOI: 10.1016/j.archger.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Currently in Chile there is a lack of validated tools for measuring anxiety in the elderly population. Considering this, the purpose of this study was to validate the Geriatric Anxiety Inventory (GAI) in the country. METHOD An analysis of the psychometric properties of the GAI was carried out, using a non-clinical sample of 301 older adults in the Metropolitan and Valparaíso regions of Chile. Older people were asked about anxiety, rumination, depression, well-being and sociodemographic data. RESULTS An excellent internal reliability was obtained with a Cronbach score of 0.931. An adequate convergent validity was observed with the Depression scales (CES-D) (Rho = 0.549, p < .01), Rumination (RSS) (Rho = 0.618; p < 0.01) and Experiential avoiding (Rho = 0.485; p < 0.01). On the other hand, the discriminant validity of the psychological well-being scale presented a negative correlation of Rho = -0.699 (p < 0.01). Finally, and Exploratory Factor Analysis was made, revealing a one-dimensional model of the instrument. CONCLUSION The Geriatric Anxiety Inventory has very good psychometric properties measuring anxiety in elderly people, being an adequate instrument for the screening of anxiety on this population.
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Affiliation(s)
- Claudia Miranda-Castillo
- Universidad Andres Bello, Faculty of Nursing, Sazié 2212, Santiago, Chile; Millennium Institute for Research in Depression and Personality, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile.
| | - Daniel Contreras
- School of Psychology, Universidad de Valparaíso, Av. Brasil 2140, Valparaíso, Chile
| | - Karin Garay
- School of Psychology, Universidad de Valparaíso, Av. Brasil 2140, Valparaíso, Chile
| | - Paula Martínez
- School of Psychology, Universidad de Valparaíso, Av. Brasil 2140, Valparaíso, Chile
| | - María O León-Campos
- Millennium Institute for Research in Depression and Personality, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Maryam Farhang
- Millennium Institute for Research in Depression and Personality, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Javier Morán
- Millennium Institute for Research in Depression and Personality, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile; School of Psychology, Universidad de Valparaíso, Av. Brasil 2140, Valparaíso, Chile
| | - Virginia Fernández-Fernández
- Psychology of Personality, Evaluation and Psychological Treatment Department, Faculty of Psychology, UNED, C/ Juan del Rosal 10, 28040, Madrid, Spain
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Hills D, Hills S, Robinson T, Northam H, Hungerford C. General practice nurse-led screening for anxiety in later life in Australian primary care settings. Australas J Ageing 2019; 38:e121-e126. [PMID: 30828952 DOI: 10.1111/ajag.12637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/02/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the feasibility of general practice nurse (GPN)-led screening for clinically significant symptoms of anxiety (CSSA) in older people and to estimate the prevalence of CSSA. METHODS General practice nurse-led screening for CSSA was undertaken in eight general practices by integrating the five-item Geriatric Anxiety Inventory-Short Form (GAI-SF) into the annual 75 years and older health assessment (75+ HA). Prevalence rates were calculated, and field notes were analysed. RESULTS Over 30 months, 736 patients were screened for CSSA, with a detected prevalence rate of 20.1%. The application of the GAI-SF into the 75+ HA was feasible and readily accepted by patients. CONCLUSIONS The five-item GAI-SF is an age-appropriate screening tool for CSSA in general practice settings. Further research is warranted, particularly in relation to the development and implementation of evidence-informed, general practice-based interventions for CSSA that can be effectively delivered to meet the needs of older people.
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Affiliation(s)
- Danny Hills
- Federation University Australia, Ballarat, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
| | | | | | - Holly Northam
- University of Canberra, Bruce, Australian Capital Territory, Australia
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Hills D, Hills S, Robinson T, Hungerford C. Mental Health Nurses Supporting the Routine Assessment of Anxiety of Older People in Primary Care Settings: Insights from an Australian Study. Issues Ment Health Nurs 2019; 40:118-123. [PMID: 30605357 DOI: 10.1080/01612840.2018.1517285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Anxiety in older age is a worldwide problem and co-associated with other mental health problems, physical health conditions, disability, reduced quality of life and increased healthcare utilisation. Yet the symptoms of anxiety are often unrecognised in older people, challenging early diagnosis and increasing the risk of older people developing more chronic and disabling illness. This article reports on research led by mental health nurses and a primary care nurse that supported primary care practitioners to undertake a routine assessment of anxiety in older people in Australia. The Geriatric Anxiety Inventory-Short Form was incorporated into the annual, in-depth 75 years and older, health assessment that is undertaken in primary care settings and funded by Australia's Medicare. An initial feasibility study demonstrated good acceptance levels of the routine assessment by the primary care practitioners. These findings suggest fertile ground for the everyday use of the routine assessment in primary care settings in Australia, with transferability internationally in low-, middle- and high-income global communities. Mental health nurses can play a key role in supporting primary care nurses to recognise and respond to anxiety in older people. Illness prevention and health promotion activities are low cost and have the potential to make a difference worldwide to the health of people across the lifespan.
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Affiliation(s)
- Danny Hills
- a Federation University , Melbourne , NSW , Australia
| | - Sharon Hills
- b Integrated Medical Practice , Melbourne , NSW , Australia
| | | | - Catherine Hungerford
- d School of Nursing, Midwifery, and Indigenous Health, Faculty of Science , Charles Sturt University , Wagga Wagga , NSW , Australia
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Modified Mindfulness-Based Cognitive Therapy for Depressive Symptoms in Parkinson's Disease: a Pilot Trial. Behav Cogn Psychother 2019; 47:446-461. [DOI: 10.1017/s135246581800070x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliable improvement in anxiety after modified MBCT than after waitlist. Significantly more waitlist participants had reliable deterioration in symptoms of anxiety and depression than those completing modified MBCT. Most participants stayed engaged in modified MBCT, with only three drop-outs. Discussion: This proof-of-concept study demonstrates the potential efficacy of modified MBCT as a treatment for depressive symptoms in Parkinson's disease and suggests further research is warranted.
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Bakkane Bendixen A, Engedal K, Selbæk G, Hartberg CB. Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality. Dement Geriatr Cogn Disord 2018; 45:180-189. [PMID: 29860257 DOI: 10.1159/000488480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/12/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Anxiety symptoms are common in older adults with depression, but whether severe anxiety is associated with poorer outcomes of depression is unknown. The objective of the present study was to examine the association between severity of anxiety and severity of depression and physical illness, suicidality, and physical and cognitive functioning in older adults with depression. METHODS We included 218 older adults with diagnoses of a depressive disorder according to the ICD-10 criteria; their mean age (SD) was 75.6 (7.2), and 67.0% were women. The Geriatric Anxiety Inventory (GAI) was used to measure the severity of anxiety symptoms. The Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess the severity of depression. We obtained information on the level of functioning with the Physical Self-Maintenance Scale (PSMS) by Lawton and Brody and on cognition with the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). Physical health was determined based on information regarding falls and weight loss and an assessment of each patient's general medical condition. The treating physician evaluated current suicidality in a comprehensive and standardized way. RESULTS Higher GAI scores were significantly associated with scores on the MADRS (β = 0.233, p = 0.002) and suicidality (β = 0.206, p = 0.006). Levels of physical or cognitive functioning were not associated with the GAI score. CONCLUSION The severity of anxiety symptoms was associated with the severity of depression and suicidality in older adults with depressive disorders. The results could indicate a need to focus greater attention on the treatment of anxiety and suicidality in older patients with depression.
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Affiliation(s)
- Anette Bakkane Bendixen
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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Bakkane Bendixen A, Hartberg CB, Selbæk G, Engedal K. Symptoms of Anxiety in Older Adults with Depression, Dementia, or Psychosis: A Principal Component Analysis of the Geriatric Anxiety Inventory. Dement Geriatr Cogn Disord 2018; 42:310-322. [PMID: 27811466 DOI: 10.1159/000452272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS The primary aim of this study was to examine anxiety symptoms as measured by the Geriatric Anxiety Inventory (GAI) in older patients with depression, dementia, or psychotic disorders. The secondary aim was to conduct a principal component analysis (PCA) of the GAI and to examine whether its subscales differ between the 3 disorders. METHODS We included data from 428 patients who were admitted to a department of geriatric psychiatry and examined according to a standardized protocol. The GAI was used to measure current anxiety symptoms. RESULTS The GAI symptoms occurred more frequently in the group with depression than in the other 2 groups. The PCA of the GAI with oblimin rotation resulted in a 2-component solution, labelled as "worries" (explained variance 46.3%, Cronbach's α 0.92) and "physical symptoms" (explained variance 7.1%, Cronbach's α 0.85). CONCLUSION The results indicate that in old age, anxiety is especially prevalent in depression. The 2-component solution indicates that the GAI measures 2 different aspects of anxiety with different symptomatology.
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Champagne A, Landreville P, Gosselin P, Carmichael PH. Psychometric properties of the French Canadian version of the Geriatric Anxiety Inventory. Aging Ment Health 2018; 22:40-45. [PMID: 27656951 DOI: 10.1080/13607863.2016.1226767] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Geriatric Anxiety Inventory (GAI) and a short form of this instrument (GAI-SF) were developed to assess the severity of anxiety symptoms in older adults in order to compensate for the lack of validated screening tools adapted to the elderly population. This study examined the psychometric properties of the French Canadian version of the GAI, in its complete (GAI-FC) and short form (GAI-FC-SF). METHOD A total of 331 community-dwelling seniors between 65 and 92 years old participated in this study. RESULTS Both the GAI-FC and the GAI-FC-SF have sound psychometric properties with, respectively, a high internal consistency (α = .94 and .83), an adequate convergent validity (r = .50 to .86 with instruments known to evaluate constructs similar to the GAI or related to anxiety), a good test-retest reliability (r = .89 and .85), in addition to a single-factor structure. CONCLUSIONS The results support the use of both the GAI-FC and the GAI-FC-SF. The GAI-FC-SF seems to be an interesting alternative to the GAI-FC as a screening tool when time available for assessment is limited.
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Affiliation(s)
| | - Philippe Landreville
- a School of Psychology , Université Laval , Québec , Canada.,b Centre d'Excellence sur le Vieillissement , CHU de Quebec Research Center , Québec , Canada
| | - Patrick Gosselin
- c Department of Psychology , Université de Sherbrooke , Sherbrooke , Canada.,d Axis Adult Capacity Development , Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS) , Sherbrooke , Canada
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20
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Abstract
BACKGROUND Due to previously reported mixed findings, there is a need for further empirical research on the factorial structure of the commonly used Geriatric Anxiety Inventory (GAI). Therefore, the psychometric properties of the GAI and its short form version (GAI-SF) were evaluated in a psychogeriatric mixed in-and-out patient sample (n = 543). METHODS Unidimensionality was tested using a bifactor analysis. Rasch modeling was used to assess scale properties. Sex, cognitive functioning and depressive symptoms were tested for differential item functioning (DIF). RESULTS The bifactor analysis identified an essential unidimensional (general) factor structure but also specific local factors. The general factor comprises all the 20 items as one factor, and the results showed that the variance in the general and specific factors (subscale) scores is best explained by the single general factor. These findings were demonstrated for both versions of the GAI. Furthermore, the Rasch models identified extensive item overlap, indicating redundant items in the full version of the GAI. The GAI-SF also seems to extract much of the same information as the full form. Test scores and items have the same meaning for older adults across different demographic status. CONCLUSION The findings support the use of a total sum score for both GAI and GAI-SF. Notably, when using the GAI-SF, no information is lost, in comparison with the full scale, thus, supporting the option of choosing the short form (version) when considered most appropriate in demanding clinical contexts.
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Abstract
OBJECTIVES Our aims were to explore prevalence of anxiety among patients admitted to departments of geriatric psychiatry for treatment of various diagnoses and to examine how often anxiety was registered as a previous or ongoing diagnosis. METHOD In all, 473 patients admitted to one of five departments of geriatric psychiatry were included in a quality register and examined according to a standardized protocol. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety during the first week after admission. Diagnoses were made at discharge. RESULTS Using a cutoff on the GAI of 8/9, the prevalence of anxiety for the following diagnostic groups was depression 65.3%, psychosis 28%, dementia 38.8% and mania 33.3%. Of 24 patients with a primary diagnosis of anxiety, 66.7% scored above 8 on the GAI. Of 236 patients with a GAI score above 8, only 22 (9.3%) were reported to have a comorbid anxiety disorder by the treating psychiatrist. In a multiple regression analysis, we found that the severity of depression (beta 0.585, p < 0.001), being female (beta 0.096, p 0.028) and the use of antipsychotic drugs (beta 0.129, p 0.006) and anxiolytic drugs (beta 0.129, p 0.005) were associated with a higher GAI score. CONCLUSION Anxiety is common in geriatric psychiatric patients, regardless of the primary diagnosis. Our findings suggest that anxiety is often a hidden comorbidity in various psychiatric disorders. A high score on the GAI was associated with the severity of depression, female gender and the use of antipsychotic and anxiolytic drugs.
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Affiliation(s)
- Anette Bakkane Bendixen
- a Department of Geriatric Psychiatry , Diakonhjemmet Hospital, University of Oslo , Oslo , Norway
| | - Knut Engedal
- b Norwegian Advisory Unit of Aging and Health , Vestfold Hospital Trust, Toensberg, University of Oslo , Oslo , Norway
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Stanley MA, Wilson N, Shrestha S, Amspoker AB, Armento M, Cummings JP, Evans-Hudnall G, Wagener P, Kunik ME. Calmer Life: A Culturally Tailored Intervention for Anxiety in Underserved Older Adults. Am J Geriatr Psychiatry 2016; 24:648-658. [PMID: 27426212 DOI: 10.1016/j.jagp.2016.03.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/02/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the feasibility of the Calmer Life and Enhanced Community Care interventions delivered by community and expert providers and test their preliminary effectiveness on worry, generalized anxiety disorder (GAD) severity, anxiety, depression, sleep, health-related quality of life, and satisfaction. DESIGN Small randomized trial, with measurements at baseline and 3 months. SETTING Underserved, low-income, mostly minority communities in Houston, TX. PARTICIPANTS Forty underserved adults 50 years and older, with significant worry and principal or coprincipal GAD or anxiety disorder not otherwise specified. INTERVENTION Combination of person-centered, flexible skills training to reduce worry; resource counseling to target unmet basic needs; and facilitation of communication with primary care providers developed through a community-academic partnership with social service and faith-based organizations. Religion/spirituality may be incorporated. PRIMARY OUTCOMES worry (Penn State Worry Questionnaire-Abbreviated), GAD severity (GAD-7), anxiety (Geriatric Anxiety Inventory-Short Form). SECONDARY OUTCOMES depression (Patient Health Questionnaire-8 and Geriatric Depression Scale-Short Form), sleep (Insomnia Severity Index), health-related quality of life (12-item Medical Outcomes Study Short Form), satisfaction (Client Satisfaction Questionnaire and exit interviews). RESULTS Provider training was valid; mean ratings for community providers were well above average, with none less than adequate. Reach was excellent. Participants receiving the Calmer Life intervention had greater improvement in GAD severity and depression than those receiving Enhanced Community Care. Satisfaction with both treatments was equivalent. CONCLUSIONS A larger comparative-effectiveness trial needs to examine outcomes following the Calmer Life intervention relative to standard community-based care and to evaluate more fully issues of implementation potential.
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Affiliation(s)
- Melinda A Stanley
- Houston VA HSR&D Center for Quality, Effectiveness, and Safety, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA; South Central Mental Illness Research, Education, and Clinical Center, USA.
| | - Nancy Wilson
- Houston VA HSR&D Center for Quality, Effectiveness, and Safety, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Srijana Shrestha
- Baylor College of Medicine, Houston, TX, USA; University of St. Thomas (SS), Houston, TX, USA
| | - Amber B Amspoker
- Houston VA HSR&D Center for Quality, Effectiveness, and Safety, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | | | | | - Gina Evans-Hudnall
- Houston VA HSR&D Center for Quality, Effectiveness, and Safety, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Paula Wagener
- Houston VA HSR&D Center for Quality, Effectiveness, and Safety, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Quality, Effectiveness, and Safety, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA; South Central Mental Illness Research, Education, and Clinical Center, USA
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23
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A Comparison of Single-Session Positive Reappraisal, Cognitive Restructuring and Supportive Counselling for Older Adults with Type 2 Diabetes. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9737-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Johnco C, Wuthrich VM, Rapee RM. THE IMPACT OF LATE-LIFE ANXIETY AND DEPRESSION ON COGNITIVE FLEXIBILITY AND COGNITIVE RESTRUCTURING SKILL ACQUISITION. Depress Anxiety 2015; 32:754-62. [PMID: 26014612 DOI: 10.1002/da.22375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Studies examining treatment moderators and mediators in late-life anxiety and depression are sparse. Executive functioning skills decrease with age, and are poorer in the context of anxiety and depression. One of the key cognitive behavioral therapy techniques for anxiety and depression is cognitive restructuring (CR), which teaches people to identify and dispute maladaptive thoughts. There is evidence that cognitive flexibility (CF), one aspect of executive functioning, has a negative impact on CR skill acquisition in nonclinical older adults, and this warrants extension in a clinical sample. METHOD This study assessed CR skill acquisition in a clinical sample of 47 older adults with anxiety and depression and 53 nonclinical controls during an experimental paradigm, and investigated the influence of CF on this relationship. A battery of neuropsychological tests assessing CF were administered and CR was learned during a brief intervention. RESULTS The clinical sample showed poorer CF on some measures, as well as poorer CR quality and efficacy (reduction in subjective distress). CF partially mediated the relationship between clinical status and CR quality, and between clinical status and CR efficacy. CONCLUSION These results provide preliminary evidence that older adults with anxiety and depression are worse at learning and benefiting from CR with a brief intervention and this is partially due to having poorer CF skills. These findings warrant further examination in a treatment context to assess whether CR skill acquisition improves over treatment.
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Affiliation(s)
- Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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25
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Abstract
BACKGROUND The Geriatric Anxiety Inventory (GAI) is a recently developed scale aiming to evaluate symptoms of anxiety in later life. This 20-item scale uses dichotomous answers highlighting non-somatic anxiety complaints of elderly people. The present study aimed to evaluate the psychometric properties of the Brazilian Portuguese version GAI (GAI-BR) in a sample from community and outpatient psychogeriatric clinic. METHODS A mixed convenience sample of 72 subjects was recruited for answering the research protocol. The interview procedures were structured with questionnaires about sociodemographic data, clinical health status, anxiety, and depression previously validated instruments, Mini-Mental State Examination, Mini International Neuropsychiatric Interview, and GAI-BR. Twenty-two percent of the sample were interviewed twice for test-retest reliability. For internal consistency analyses, the Cronbach's α test was applied. The Spearman correlation test was applied to evaluate the test-retest GAI-BR reliability. A ROC (receiver operating characteristic) curve study was made to estimate the GAI-BR area under curve, cut-off points, sensitivity, and specificity for the Generalized Anxiety Disorder diagnosis. RESULTS The GAI-BR version showed high internal consistency (Cronbach's α = 0.91) and strong and significant test-retest reliability (ρ = 0.85, p < 0.001). It also showed moderate and significant correlation with the Beck Anxiety Inventory (ρ = 0.68, p < 0.001) and the State-Trait Anxiety Inventory (ρ = 0.61, p < 0.001) showing evidence of concurrent validation. The cut-off point of 13 estimated by ROC curve analyses showed sensitivity of 83.3% and specificity of 84.6% to detect Generalized Anxiety Disorder (DSM-IV). CONCLUSION GAI-BR has demonstrated very good psychometric properties and can be a reliable instrument to measure anxiety in Brazilian elderly people.
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26
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Johnco C, Wuthrich VM, Rapee RM. The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behav Res Ther 2014; 57:55-64. [PMID: 24828838 DOI: 10.1016/j.brat.2014.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/04/2014] [Accepted: 04/16/2014] [Indexed: 12/12/2022]
Abstract
There is some evidence that cognitive flexibility negatively impacts cognitive restructuring skill acquisition with brief training; however, there is little understanding of how this relates to learning cognitive restructuring over the course of a therapy program, and how it relates to overall treatment outcome. This study assessed the impact of cognitive flexibility on cognitive restructuring skill acquisition following group CBT, and on treatment outcome, along with changes in cognitive flexibility over treatment. 44 older participants with anxiety and depression completed self-report and neuropsychological tests of cognitive flexibility and a clinical interview at pre and post-treatment. Qualitative and quantitative measures of cognitive restructuring were completed at post-treatment. Pre-treatment cognitive flexibility was not related to the quality of cognitive restructuring at post-treatment or overall treatment outcome. However, it did predict reduction in subjective units of distress from using cognitive restructuring and therapist ratings of cognitive restructuring ability at post-treatment. Few participants showed changes in cognitive flexibility over treatment. Those with poorer cognitive flexibility may not find cognitive restructuring as useful to alleviate emotional distress as those with better cognitive flexibility. However, those with poorer cognitive flexibility can still benefit from standardised CBT, even if their use of cognitive restructuring is less effective.
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Affiliation(s)
- C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - V M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - R M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
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Assessment of anxiety in long-term care: examination of the Geriatric Anxiety Inventory (GAI) and its short form. Int Psychogeriatr 2013; 25:1533-42. [PMID: 23782768 DOI: 10.1017/s1041610213000847] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accurate assessment of anxiety in later life is critical, as anxiety among older adults is associated with social and functional impairment and poorer quality of life. The Geriatric Anxiety Inventory (GAI) and the GAI-Short Form (GAI-SF) were designed to detect anxiety symptoms among community-dwelling older adults, but the usefulness of the GAI and GAI-SF in long-term care is unknown. The present study examined the psychometric properties of the GAI and GAI-SF among residents at a long-term care facility. METHODS Seventy-five nursing home residents completed the GAI and measures of depression, executive functioning, and adaptive functioning. The mean age of residents was 69.60 years (SD = 10.76). Psychiatric diagnoses included dementia, psychotic disorders, mood disorders, anxiety disorders, substance abuse, sleep disorders, and mental retardation. RESULTS Internal consistency of the GAI was good (α = 0.92) and the GAI-SF was adequate (α = 0.73). GAI and GAI-SF scores were moderately correlated with depression scores, and weakly correlated with adaptive functioning scores and executive functioning scores, suggesting discriminant validity. Logistic regression analyses were conducted with GAI and GAI-SF scores predicting an anxiety disorders diagnosis. Results provided support for the predictive validity of the GAI and GAI-SF. Sensitivity, specificity, and the percentage of individuals correctly classified at various cut-off scores were also calculated. CONCLUSIONS Both the GAI and GAI-SF appear to be useful tools for assessing anxiety among nursing home residents with psychological disorders. The GAI-SF may be a viable replacement for the GAI as a screener for anxiety in long-term care.
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Johnco C, Wuthrich VM, Rapee RM. The role of cognitive flexibility in cognitive restructuring skill acquisition among older adults. J Anxiety Disord 2013; 27:576-84. [PMID: 23253357 DOI: 10.1016/j.janxdis.2012.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
Cognitive flexibility is one aspect of executive functioning that encompasses the ability to produce diverse ideas, consider response alternatives, and modify behaviors to manage changing circumstances. These processes are likely to be important for implementing cognitive restructuring. The present study investigated the impact of cognitive flexibility on older adults' ability to learn cognitive restructuring. Neuropsychological measures of cognitive flexibility were administered to 40 normal community-dwelling older adult volunteers and their ability to implement cognitive restructuring was coded and analyzed. Results indicated that the majority of participants showed good cognitive restructuring skill acquisition with brief training. The multiple regression analysis suggested that those with poorer cognitive flexibility on neuropsychological testing demonstrated poorer quality cognitive restructuring. In particular, perseverative thinking styles appear to negatively impact the ability to learn cognitive restructuring. Further research is needed to clarify whether older adults with poor cognitive flexibility can improve their cognitive restructuring skills with repetition over treatment or whether alternative skills should be considered.
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Affiliation(s)
- C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
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29
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Abstract
BACKGROUND Anxiety in persons with dementia has received little attention despite its severe consequences. In this observational cross-sectional study, we investigated the frequency of anxiety and associations between anxiety and socio-demographic and clinical variables in an outpatient sample with first-time diagnosed mild dementia. METHODS The study sample (n = 169) comprised participants recruited from clinics in geriatric medicine and old age psychiatry for a longitudinal dementia study. Symptoms of anxiety were rated by a caregiver on the Neuropsychiatric Inventory (NPI) and by the patient on the anxiety tension item on the Montgomery and Åsberg Depression Rating Scale. Measures of caregiver stress, dementia-related impairment (Clinical Dementia Rating (CDR) scale), and cognitive functioning were also included. RESULTS According to caregiver reports, 19.5% had clinically significant anxiety and an additional 22.5% had subclinical anxiety. Half of the patients reported experiencing anxiety from time to time. Patients with Lewy-body dementia reported anxiety more often compared to patients with Alzheimer's disease. Anxiety was associated with depression, higher caregiver stress, and more dementia-related impairment, but not with cognitive test performance. Caregiver stress and higher CDR score increased the odds for anxiety significantly, even when controlling for depression. CONCLUSION Anxiety is common in patients with mild dementia, and seems to be associated not so much with cognitive test performance than with caregiver distress and the patient's ability to function in daily life. Anxiety should be taken into account when assessing dementia, as well as screened for when examining patients with known dementia.
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