Specific cognitive functions and depressive symptoms as predictors of activities of daily living in older adults with heterogeneous cognitive backgrounds

The relation between cognitive functioning and activities of daily living in normal aging, mild cognitive impairment, and dementia: a meta-analysis

Literature suggests that dementia and, more generally, cognitive impairment affect the capacity to carry out activities of daily living (ADL) in aging. However, it is important to decipher the weight of specific cognitive domains and neurodegenerative profiles mainly related to ADL difficulties. A meta-analysis was conducted to investigate the nature and strength of the association between cognitive functioning and ADL in healthy older adults, mild cognitive impairment (MCI), and dementia. A comprehensive search of the PubMed, PsycINFO (PROQUEST), and Scopus databases for cross-sectional or longitudinal studies up until December 2022. Our meta-analytic results revealed that: overall, instrumental ADL (IADL) showed a significant association with executive functioning, in particular, abstraction ability/concept formation, set-shifting, and processing speed/complex attention/working memory, regardless of type of participants (i.e., healthy older adults, MCI, and dementia); whereas ADL (both basic ADL, BADL, and IADL) significantly correlated with global cognitive functioning and long-term verbal memory, with a moderator effect of clinical condition (e.g., increasing ES based on the level of cognitive impairment). Moreover, visuospatial and language abilities significantly correlated with ADL, mainly when performance-based tasks were used for ADL assessment. These findings emphasize the importance of neuropsychological assessment in aging to early identify people most at risk of functional decline and shed light on the need to consider specific cognitive abilities in rehabilitation programs.

Moderating role of depression in the association between leisure activity and cognitive function among the disabled older people

Background

This study delves into the complex interaction between leisure activities and cognitive function in older people with disabilities, with a particular emphasis on the moderating influence of depression. Despite the well-documented cognitive benefits of leisure activities among the older people, the intricate relationship between depression and the association between leisure activities and cognitive function in this specific demographic has been rarely reported.

Methods

Drawing on data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study meticulously examined a cohort of 713 participants aged 65-89 years. We constructed a moderation model to examine the impact of leisure activity on cognitive function in older people with disabilities, with depression levels as a moderating variable.

Results

We found a positive association between engagement in leisure activities and cognitive function, highlighting the potential cognitive advantages associated with leisure engagement among disabled older people. However, the present analysis also reveals a significant moderation effect of depression on this relationship, shedding light on the nuanced nature of this association. Specifically, elevated levels of depression emerge as a critical moderator, attenuating the otherwise favorable impact of leisure activities on cognitive function among older people contending with disabilities.

Conclusion

In conclusion, the findings provide a compelling rationale for tailored interventions that comprehensively target both leisure activity engagement and concurrent depression management, effectively fostering improvements in cognitive function among the cohort of disabled older people.

Cognitive dysfunction in patients with childhood-onset systemic lupus erythematosus may impact treatment

BACKGROUND

Cognitive dysfunction (CD) is a widespread manifestation in adult systemic lupus erythematosus (SLE) patients, but this subject is rarely examined in patients with childhood-onset SLE (cSLE). This study aimed to assess the frequency of CD, its associations with lupus clinical manifestations and its impact on the health-related quality of life (HRQL) in young adult cSLE patients.

METHODS

We evaluated 39 cSLE patients older than 18 years. They underwent a rheumatologic evaluation and extensive neuropsychological assessment, encompassing all cognitive domains described by the American College of Rheumatology. HRQL was assessed with the WHOOQOL-BREEF, General Activities of Daily Living Scale (GADL) and Systemic Lupus Erythematosus-specific quality-of-life instrument (SLEQOL). The activity of SLE was evaluated with the modified sle disease activity index (sledai-2k).

RESULTS

Impairment in at least one cognitive domain was found in 35 (87.2%) patients. The most compromised domains were attention (64.1%), memory (46.2%), and executive functions (38.5%). Patients with cognitive impairment were older, had more accumulated damage and had worse socioeconomic status. Regarding the association between cognitive dysfunction and HRQL, memory impairment was correlated with worse environmental perception and a worse relationship with the treatment.

CONCLUSION

In this study, the frequency of CD in cSLE patients was as high as that in the adult SLE population. CD can significantly impact the response of cSLE patients to treatment, justifying preventive measures in the care of this population.

Memory impairment and its associated risk and protective factors among older adults in Indonesia

AIMS

This study aimed to evaluate the association between memory impairment and its risk and protective factors, focusing on demographic and health-related variables among older adults in Indonesia.

METHOD

The data analyzed were the Indonesian Family Life Survey-5 (IFLS-5) using cross-sectional variables of 4236 older adults aged 60 years and over included in the 2015 round. Memory impairment was assessed by immediate word list recall from the Telephone Interview for Cognitive Status (TICS). Sociodemographic factors and multiple health variables were included as predictors. Data were analyzed using frequency analyses bivariate and stepwise logistic regression tests.

RESULT

Among 4236 older adults, 49.7% were male and 50.3% were female. Stepwise backward analyses showed that memory impairment was independently associated with older age, being female, or not in a union (unmarried, separated, divorced, or widowed), having obtained low levels of education, living in a rural area, reporting low life satisfaction, low social capital, higher dependency, and having clinical depression. Only moderate (but not high or low) physical activity levels were associated with a lower risk. Being underweight increased the risk, but being overweight/obese (as assessed by BMI) protective factors for a lower immediate recall score.

CONCLUSION

Increasing education and continued engagement of older adults in psychosocial activities, including moderate physical activity, improving mental health, preventing weight loss, and maintaining functional ability to decrease dependency, are associated with increased episodic memory, especially in non-married and older women in rural areas of Indonesia.

Association of Regional Cortical Network Atrophy With Progression to Dementia in Patients With Primary Progressive Aphasia

BACKGROUND AND OBJECTIVES

Patients with primary progressive aphasia (PPA) have gradually progressive language deficits during the initial phase of the illness. As the underlying neurodegenerative disease progresses, patients with PPA start losing independent functioning due to the development of nonlanguage cognitive or behavioral symptoms. The timeline of this progression from the mild cognitive impairment stage to the dementia stage of PPA is variable across patients. In this study, in a sample of patients with PPA, we measured the magnitude of cortical atrophy within functional networks believed to subserve diverse cognitive and affective functions. The objective of the study was to evaluate the utility of this measure as a predictor of time to subsequent progression to dementia in PPA.

METHODS

Patients with PPA with largely independent daily function were recruited through the Massachusetts General Hospital Frontotemporal Disorders Unit. All patients underwent an MRI scan at baseline. Cortical atrophy was then estimated relative to a group of amyloid-negative cognitively normal control participants. For each patient, we measured the time between the baseline visit and the subsequent visit at which dementia progression was documented or last observation. Simple and multivariable Cox regression models were used to examine the relationship between cortical atrophy and the likelihood of progression to dementia.

RESULTS

Forty-nine patients with PPA (mean age = 66.39 ± 8.36 years, 59.2% females) and 25 controls (mean age = 67.43 ± 4.84 years, 48% females) were included in the data analysis. Greater baseline atrophy in not only the left language network (hazard ratio = 1.47, 95% CI = 1.17-1.84) but also in the frontoparietal control (1.75, 1.25-2.44), salience (1.63, 1.25-2.13), default mode (1.55, 1.19-2.01), and ventral frontotemporal (1.41, 1.16-1.71) networks was associated with a higher risk of progression to dementia. A multivariable model identified contributions of the left frontoparietal control (1.94, 1.09-3.48) and ventral frontotemporal (1.61, 1.09-2.39) networks in predicting dementia progression, with no additional variance explained by the language network (0.75, 0.43-1.31).

DISCUSSION

These results suggest that baseline atrophy in cortical networks subserving nonlanguage cognitive and affective functions is an important predictor of progression to dementia in PPA. This measure should be included in precision medicine models of prognosis in PPA.

Memory performance mediates the relationship between depression and independence in instrumental activities of daily living among community-dwelling older adults: Evidence from the China Family Panel Study

Our objective was to examine the link between depression and independence in the instrumental activities of daily living (IADLs) and to explore the mediating role of memory performance through a cross-sectional analysis of a nationally representative sample of community-dwelling older adults in China. In total, 3730 respondents age ≥ 60 (51.7% males) from the 2020 survey of the China Family Panel Study (CFPS) constituted the study sample. Their depressive symptoms, memory performance, and independence in the IADLs were measured. Based on the descriptive statistics, bivariate correlation analysis and bootstrapping mediation analysis were conducted. As hypothesized, independence in the IADLs was negatively related to depression, while it was positively associated with memory performance. Moreover, after controlling for demographic factors, memory performance was demonstrated to be a partial mediator between depression and independence in the IADLs. These findings support the development of clinical interventions which prevent disability or maintain the physical functioning of older adults through alleviating depression and enhancing memory performance.

The impact of grandchild care on depressive symptoms of grandparents in China: The mediating effects of generational support from children

Objectives

Despite extensive studies about the direct effect of grandchild care on caregiver depression in China, understanding of its internal influencing mechanism has been limited. After controlling for socioeconomic factors, this study investigated whether the experience of caring for grandchildren had a long-term impact on the depression levels of grandparents, either directly or indirectly through generational support from adult children.

Methods

The subjects of this study were a total of 9,219 adults over 45 who participated in the China Health and Retirement Longitudinal Surveys in 2015 and 2018. We adopted a lag-behind variable to examine the impact of grandchild care on depressive symptoms of grandparents. The proposed mediation model was analyzed using bootstrap modeling, and the KHB method was conducted further to examine differences in the effects of generational support.

Results

The experience of caring for grandchildren had a significant negative correlation with the depression level of Chinese grandparents. Moreover, children's support significantly mediated the impact of parenting experience on grandparents' depression. Significantly, instrumental support mediated the effect to the greatest extent, while emotional support from children contributed the least. The intermediary effect has urban-rural heterogeneity.

Conclusion

These findings indicated that grandchild care significantly inhibited the depression level of Chinese grandparents through increased intergenerational support from adult children. The implications of the study's findings were discussed.

The efficiency of activities of daily living (ADLs) skills in late adulthood: A mediational approach

The term "Activities of Daily Living" (ADLs) refers to a set of fundamental tasks (i.e., toileting, bathing, personal care, eating, grooming, and getting dressed) considered necessary for living and being autonomous in everyday life. Although in the clinical setting ADLs efficiency is a marker to diagnose dementia, limited evidence on the mechanism implicating muscular function and cognitive alterations in ADLs skills in late adulthood exists. This study primarily intended to determine the extent to which executive functions mediate between muscular strength, as assessed through handgrip strength (HGS) measurement, and ADLs skills of older community-dwellers. A further goal was to explore the impact of gender and cognitive status on ADLs and HGS scores, using education as a covariate. Three hundred and thirty-four older participants, 199 females and 135 males (Mage = 77.5 years, SD = 5.6 years, age range = 63-93 years) completed a battery of tests assessing ADLs, HGS, and executive functions. The results showed that 34-56% of the variance in the ADLs condition was explained by HGS and executive functioning. Furthermore, cognitively healthy participants exhibited better ADLs skills, whereas cognitively impaired individuals, both males and females, exhibited poorer HGS efficiency. In conclusion, in clinical settings, the concurrent evaluation of ADLs skills, motor, and higher-order cognitive processes should be encouraged to detect individuals needing a person-tailored intervention to boost their quality of life.

Multiple Cognitive and Behavioral Factors Link Association Between Brain Structure and Functional Impairment of Daily Instrumental Activities in Older Adults

OBJECTIVE

Functional impairment in daily activity is a cornerstone in distinguishing the clinical progression of dementia. Multiple indicators based on neuroimaging and neuropsychological instruments are used to assess the levels of impairment and disease severity; however, it remains unclear how multivariate patterns of predictors uniquely predict the functional ability and how the relative importance of various predictors differs.

METHOD

In this study, 881 older adults with subjective cognitive complaints, mild cognitive impairment (MCI), and dementia with Alzheimer's type completed brain structural magnetic resonance imaging (MRI), neuropsychological assessment, and a survey of instrumental activities of daily living (IADL). We utilized the partial least square (PLS) method to identify latent components that are predictive of IADL.

RESULTS

The result showed distinct brain components (gray matter density of cerebellar, medial temporal, subcortical, limbic, and default network regions) and cognitive-behavioral components (general cognitive abilities, processing speed, and executive function, episodic memory, and neuropsychiatric symptoms) were predictive of IADL. Subsequent path analysis showed that the effect of brain structural components on IADL was largely mediated by cognitive and behavioral components. When comparing hierarchical regression models, the brain structural measures minimally added the explanatory power of cognitive and behavioral measures on IADL.

CONCLUSION

Our finding suggests that cerebellar structure and orbitofrontal cortex, alongside with medial temporal lobe, play an important role in the maintenance of functional status in older adults with or without dementia. Moreover, the significance of brain structural volume affects real-life functional activities via disruptions in multiple cognitive and behavioral functions.

Effects of sulforaphane intake on processing speed and negative moods in healthy older adults: Evidence from a randomized controlled trial

Background

Recent studies have reported that sulforaphane (SFN) intake with cognitive training had positive effects on cognitive functions. However, it is still unknown whether SFN intake alone has beneficial effects on cognition as well as mood. We investigated whether a SFN intake intervention improved cognitive performance and mood states in healthy older adults.

Methods

In a 12-week, double-blinded, randomized controlled trial (RCT), we randomly assigned 144 older adults to a SFN group or a placebo group. We asked the participants to take a supplement (SFN or placebo) for 12 weeks. We measured several cognitive functions, mood states, and biomarkers before and after the intervention period.

Results

The SFN group showed improvement in processing speed and a decrease in negative mood compared to the placebo group. In addition, the SFN group exhibited a higher SFN-N-acetyl-L-cysteine (NAC) level compared to the placebo group. However, there were no significant results in other biomarkers of oxidant stress, inflammation, or neural plasticity.

Discussion

These results indicate that nutrition interventions using SFN can have positive effects on cognitive functioning and mood in healthy older adults.

Instrumental Activities of Daily Living by Subjective and Objective Measures: The Impact of Depression and Personality

Objective

Previous research shows that depression and personality are independently associated with self- and informant-reports of the ability to perform instrumental activities of daily living (IADLs). However, less is known about the association between depression and personality and performance-based measures of IADLs. We aimed to determine how depression and personality predict self-and informant-reports of IADL compared to performance-based measures of IADLs in a sample of older adults with normal cognition (NC) and Mild Cognitive Impairment (MCI).

Methods

Participants consisted of 385 older adults with NC (n = 235), or a diagnosis of MCI (n = 150), aged between 76 and 99-years from the Sydney Memory and Ageing Study. Participants underwent comprehensive neuropsychological and clinical assessments to determine global cognition and clinical diagnoses. Personality traits were measured by the NEO Five-Factor Inventory (NEO-FFI) and depression by the Geriatric Depression Scale (GDS). Subjective IADLs were self- and informant-reported Bayer Activities of Daily Living (B-ADL) scales and objective IADL was the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). Linear regressions examined the relationship between depression and personality and the three types of IADL measures, controlling for all covariates and global cognition.

Results

Participant-reported IADL, although associated with global cognition, was more strongly associated with GDS and NEO-FFI scores (conscientiousness and neuroticism). Informant-reported IADL was strongly associated with both global cognition and participants' GDS scores. STAM scores were not associated with participants' GDS or NEO-FFI scores; instead, they were predicted by demographics and global cognition.

Conclusion

These results suggest that performance-based measures of IADL may provide more objective and reliable insight into an individual's underlying functional ability and are less impacted by the participants' mood and personality compared to subjectively reported IADL. We argue that performance-based IADL measures are preferable when trying to accurately assess everyday functional ability and its relationship to cognitive status. Where performance-based measures are not available (e.g., in some clinical settings), informant ratings should be sought as they are less influenced by the participant's personality and mood compared to self-reports.

Association Between Mediterranean Diet and Functional Status in Older Adults: A Longitudinal Study Based on the Washington Heights-Inwood Columbia Aging Project

BACKGROUND

Current evidence on the association between Mediterranean diet (MeDi) intake and activities of daily living (ADL) is limited and inconsistent in older adults.

METHODS

This study included 1 696 participants aged ≥65 years in the Washington Heights-Inwood Community Aging Project study. The MeDi score was calculated based on data collected from the Willett's semiquantitative food frequency questionnaire. The multivariable-adjusted Cox regression model was applied to examine the association of MeDi score with risks of disability in basic (BADL) and instrumental ADL (IADL), as well as the overall ADL (B-IADL).

RESULTS

Eight hundred and thirty-two participants with incident ADL disability were identified over a median follow-up of 5.39 years. The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (hazard ratio = 0.95, 95% confidence interval = 0.91-0.99, p = .018) in a model adjusted for age, sex, race/ethnicity, educational level, and dietary calories intake but was no longer significant after additionally adjusted for multiple comorbidities and physical activities (0.97 [0.93, 1.01], p = .121). The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (0.92 [0.85, 1.00], p = .043) and BADL (0.90 [0.82, 0.99], p = .030) in non-Hispanic Whites, but not in non-Hispanic Blacks and Hispanics (p > .05 for all).

CONCLUSIONS

Higher MeDi score was associated with decreased risk of ADL disability, particularly in non-Hispanic Whites.

Subjective executive dysfunction in patients with primary brain tumors and their informants: relationships with neurocognitive, psychological, and daily functioning

OBJECTIVE

We assessed agreement between patient- and informant-report on the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A) in patients with primary brain tumors (PBT) and differences on BRIEF-A in neurocognitive (intact v. impaired), psychological (asymptomatic v. distressed), and functional (independent v. dependent) categories using both patient- and informant-report.

METHOD

PBT patients (n = 102) completed neuropsychological evaluations including the BRIEF-A, clinical interview, neurocognitive tests, and mood questionnaires. Correlations between the BRIEF-A and Informant (n = 39) were conducted. Differences in patient and informant BRIEF-A indices were investigated across five classifications: neurocognitive functioning, psychological functioning, medication management, appointment management, and finance management.

RESULTS

Patient and informant BRIEF were correlated. There was no difference on BRIEF-A or Informant indices for intact v. impaired neurocognitive status. Higher BRIEF-A and Informant indices were observed among psychologically distressed v. asymptomatic patients. Results showed higher BRIEF indices among those requiring assistance with medication, appointments, and finances.

CONCLUSIONS

Patients and informants agreed in their reports of executive function (EF). These reports, while not different in neurocognitive classification, were different in psychological functioning and in those needing assistance with instrumental activities of daily living (IADL). Patient- and informant-reported EF may provide important data regarding psychological and IADL functioning in this population.

Cognitive impairment in the HTLV-1 infection: a comparative study associated with functional performance

Human T cell leukemia virus type-I (HTLV-1) infection courses with a myelopathy, the tropical spastic paraparesis (HAM/TSP). In a case-control study, we compared the neuropsychological profile and functional characteristics in two case HTLV-1-infected groups (asymptomatic and with HAM/TSP) with a control group negative for HTLV-1. Subjects were paired for age, sex, and educational features. The case group differed from control group in neuropsychological measures such as in episodic memory recall, executive functions, and fine motor dexterity measure. Individuals with HAM/TSP have more depressive symptoms and worst performance in activities of daily living (ADL) presenting a less functionality. In multivariate models, the fine motor performance, the executive functioning, the recognition memory, and the depressive symptoms explained part of the variance in functionality. Those findings may contribute to understand of everyday life impairments and limitations of HTLV-1-infected population and to organize the rehabilitation. Once more, based in neuropsychological and functional data, we can reaffirm that HTLV-1 is never a benign condition, but sometimes it is only in a stage coursing with less symptoms.

Insomnia and Daily Function in Older Adults With Asthma

The current study examined the prevalence of insomnia and its relationship with daily function in older adults with asthma. Data on 278 older adults with asthma (aged ≥60 years) from the 2005-2008 National Health and Nutrition Examination Survey were analyzed. Insomnia was present in 40% of the study sample and was associated with a greater number of activities of daily living (ADL) and instrumental ADL (IADL) limitations. In multivariate analyses accounting for covariates including depressive symptoms, insomnia was not associated with having at least two ADL/IADL limitations. However, those with co-occurring insomnia and depressive symptoms were more likely to have at least two ADL/IADL limitations compared to those with either condition singly. Insomnia in the presence of depressive symptoms may impede one's ability to perform ADL/IADL. Current findings suggest that assessment and treatment of insomnia and depression in older adults with asthma may be important for maintaining active, independent living. [Journal of Gerontological Nursing, 46(11), 28-36.].

Activities of daily living and working memory in pediatric attention-deficit/hyperactivity disorder (ADHD)

Most children with ADHD have impaired working memory abilities. These working memory deficits predict impairments in activities of daily living (ADLs) for adults with ADHD. However, our understanding of the relation between pediatric ADHD and ADLs is limited. Thus, this study aimed to examine (1) the extent to which pediatric ADHD is associated with ADL difficulties; and if so (2) the extent to which these difficulties are related to their well-documented working memory difficulties and/or core ADHD inattentive and hyperactive/impulsive symptom domains. A well-characterized, clinically evaluated sample of 141 children ages 8-13 years (M = 10.36, SD = 1.46; 51 girls; 70% White/non-Hispanic) were administered a battery of well-validated working memory tests and assessed for ADHD symptoms (teacher-ratings) and ADL difficulties (parent-ratings); cross-informant reports were used to control for mono-informant bias. Children with ADHD exhibited medium magnitude difficulties with ADLs (d = 0.61, p < .005, 38% impaired). Results of the bias-corrected, bootstrapped conditional effects model indicated that lower working memory predicted reduced performance of age-expected ADLs (β =0.28) and greater ADHD inattentive (β = -0.40) and hyperactive/impulsive symptoms (β = -0.16). Greater inattentive, but not hyperactive/impulsive, symptoms predicted greater ADL difficulties (β = -0.36) even after controlling for working memory. Interestingly, working memory exerted a significant indirect effect on ADLs via inattentive (indirect effect: β = 0.15, effect ratio = .54) but not hyperactive/impulsive symptoms. These findings implicate ADHD inattentive symptoms as a potential mechanism underlying ADL difficulties for children with ADHD, both independently and via working memory's role in regulating attention.

Depression, social support, executive functioning, functionality, and quality of life in institutionalized elderly people

Aim

Our aim was to study the executive functioning, functionality, and quality of life of institutionalized old aged persons and to determine the potential roles of self-reported depression and satisfaction with social support on these domains.

Method

The sample comprised 36 volunteers (13 males and 23 females) aged between 71 and 94 years. The measures used consisted of well-established battery of neuropsychological tests. A comparative study was performed.

Results

Participants with depressive symptoms shown impaired executive functioning. Cognitive flexibility, functionality in instrumental activities of daily living, and quality of life are more affected in participants with higher levels of depression that also report higher levels of satisfaction with social support.

Conclusion

This result is intriguing and may highlight the relevance of considering not only depression, but also factors related to social isolation and loneliness in the explanation of cognitive performance, functionality, and quality of life.

Relationship between executive dysfunction and neuropsychiatric symptoms and impaired instrumental activities of daily living among patients with very mild Alzheimer's disease

OBJECTIVES

Patients with Alzheimer's disease (AD) experience a gradual loss in their ability to perform instrumental activities of daily living (IADLs) from the early stage. A better understanding of the possible factors associated with IADL decline is important for the development of effective rehabilitation and support programs for patients with AD. Thus, we examined the relationships between comprehensive cognitive functions and neuropsychiatric symptoms and IADLs in patients with very mild AD.

METHODS

In total, 230 outpatients with probable AD were recruited from the Memory Clinic at Kumamoto University Hospital between May 2007 and October 2016. All patients scored ≥21 points on the Mini-Mental State Examination at the first assessment. Relationships between the subdomains of the Lawton IADL scale and neuropsychological/neuropsychiatric tests were examined by multiple regression analysis. All analyses were performed separately in men and women.

RESULTS

In female patients, scores on the Frontal Assessment Battery were significantly associated with telephone use ability, shopping, and ability to handle finances. Apathy scores in the Neuropsychiatric Inventory (NPI) were associated with telephone use ability, housekeeping, responsibility for own medications, and ability to handle finances. NPI agitation scores were associated with food preparation and housekeeping. Geriatric Depression Scale scores were associated with telephone use ability and ability to handle finances. In male patients, only NPI apathy scores were associated with telephone use ability.

CONCLUSIONS

These results suggest the importance of properly assessing executive function, depression, and apathy at interventions for impaired IADLs among female patients with very mild AD.

Predictors of Quality of Life among Older People with Mild Cognitive Impairment Attending Urban Primary Care Clinics

OBJECTIVES

To study the prevalence of Mild Cognitive Impairment (MCI) among older people attending primary care clinics and its predictors of QOL.

METHODS

A cross-sectional study was conducted at two primary care clinics in Kuala Lumpur, Malaysia, recruiting 271 participants by utilizing the universal sampling method. Every patient who attended both the clinics during the study period and met the inclusion and exclusion criteria were approached and briefed about the study. Patients who gave consent were recruited as study participants. Information on sociodemographic, medical condition, and lifestyle behaviors were obtained. The Montreal Cognitive Assessment (MoCA) was used to screen for MCI at a score < 23. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was used to evaluate QOL.

RESULTS

Prevalence of MCI was 27.3%. Lower QOL scores were found in the physical (67.3 ± 1.4), psychological (67.3 ± 1.4), social (66.9 ± 1.6) and environmental (71.3 ± 1.3) domains among participants with MCI. Among them, predictors of QOL were depression in the physical domain, age and stroke in the psychological domain, presence of other types of disorders in the social domain and diabetes and stroke in the environmental domain.

CONCLUSIONS

MCI was prevalent among study participants and were associated with poorer QOL in all domains of QOL. A better understanding of predictors of QOL in older people with MCI is deemed important.

CLINICAL IMPLICATION

Routine cognitive screening at primary care clinics will facilitate early recognition of MCI and facilitates referral to memory clinics for further assessment and treatment.

Impress of intergenerational emotional support on the depression in non-cohabiting parents

BACKGROUND

Mental health is one of the important dimensions of health, while depression is an important indicator of mental health evaluation.

AIM

To investigate the association between intergenerational emotional support and depression of non-cohabiting parents (≥ 45 years old) in China.

METHODS

We used the fourth wave data from the China Health and Retirement Longitudinal Study (2015). The data was made up of ten main modules, the associated two datasets, and five constructed datasets. The first step is to select the corresponding module data according to the purpose of this study. Moreover, the data of the six modules are integrated by the unique ID code and we choose depression and non-cohabiting items as the selection conditions. 4810 samples were selected, which mainly included data on intergenerational emotional support and the individual scores on depressive symptoms.

RESULTS

The average age of 4810 respondents was (60.56 ± 14.613) years old. Females were accounted for more than half of the samples (52.6%). 74.0% respondents from rural areas and approximately 63.3% of the participants had a chronic disease. The mean value of the CESD-10 score was 13.06 (SD5.225). Both faces to face and phone contacts were protective factors on depression symptoms in the mid-aged and seniors in China (P < 0.05). In terms of the frequency of face to face contact, the more frequently you met your parents, the lower your parents' depressive score was. Also, phone contact variable results are displayed as a positive correlation completely between inter-generational contacts from children and depressive symptoms in non-cohabiting parents in China. Children’s education level and income level were also reducing the risk of depression in non-cohabiting parents. However, gender, children’s numerous, chronic disease and chronic disease number were the risk factors.

CONCLUSION

Intergenerational emotional support is associated with depressive symptoms in non-cohabiting parents in China. However, the relationship was also affected by other variables.

A metacognitive intervention model to promote independence among individuals with autism spectrum disorder: Implementation on a shopping task in the community

Adolescents with autism spectrum disorder show low independence levels and difficulty performing complex daily activities. The many intervention approaches for these individuals include deconstructing complex activities into basic components, processing and practicing tasks, and developing compensation strategies. The aim of this study was to examine the effectiveness of a short-term metacognitive intervention combined with virtual supermarket practice to improve the independent implementation of a shopping task among adolescents with autism spectrum disorder. The study included 56 adolescents with autism spectrum disorder, of whom 33 performed the metacognitive intervention and 23 served as controls. Outcome measures included assessments of cognitive and metacognitive functions and a performance-based evaluation of a shopping task in the natural environment. Compared to the control group, the intervention group experienced significant improvement in accuracy and efficiency while performing a shopping task. In addition, the executive functions domain was found to be the main predictor of accuracy and efficiency in performing the shopping task. These findings indicate the short-term metacognitive intervention, reinforced by a technology-based training programme, may effectively enhance the independent execution of a shopping task by adolescents with autism spectrum disorder and expand their potential participation in the community.

Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0

Objective: This study evaluated: (a) associations between long-term care residents' mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders. Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments. Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. Among residents affirming recent pain, those with dementia or SMI diagnoses were twice as likely to obtain no treatment for their pain and significantly less likely to receive as-needed pain medication and non-pharmacological pain treatments than were other residents. Those with either depressive disorder or PTSD were more likely, and those with SUD less likely, to obtain scheduled pain medication. In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning. Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.

The efficacy of cognitive interventions on the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia: protocol for a systematic review and meta-analysis

BACKGROUND

Cognitive changes associated with mild cognitive impairment or mild dementia can lead to difficulties in completing instrumental activities of daily living. The ability to live independently at home and in the community is often compromised due to the inability to complete these activities. Cognitive interventions have been reported as beneficial in maintaining or improving cognitive functions among this group of adults. However, the effectiveness of different types of cognitive interventions on the performance of instrumental activities of daily living in older adults with mild cognitive impairment and mild dementia is not well established. The aim of this paper is to develop a protocol for a systematic review and meta-analysis to investigate the effectiveness of cognitive interventions in maintaining or improving the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia.

METHODS

Randomised control studies which investigate the effectiveness of cognitive interventions on the performance in instrumental activities of daily living for older adults with mild cognitive impairment and mild dementia will be sought. A systematic search will be conducted in five databases: CINAHL, MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. The search strategy was developed with assistance from a health science librarian. Two independent reviewers will perform the study selection and data extraction. Quality assessment will be implemented using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis of the findings will be used to report outcomes of all included studies. If appropriate, a meta-analysis will combine the results of individual studies.

DISCUSSION

This systematic review and meta-analysis will determine the effectiveness of cognitive interventions in maintaining or improving the performance of IADL in individuals with MCI or mild dementia. It is anticipated that the results will inform rehabilitation professionals of the most effective cognitive interventions to be implemented into clinical practice. It will potentially provide substantial benefit to both the persons with MCI or dementia and the health care system by keeping more people out of full-time care and allowing those in full-time care to require less intensive support.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016042364.

Neuropsychological predictors of health and safety abilities in dementia

The Independent Living Scales Health and Safety (ILS HS) scale is commonly used by neuropsychologists when evaluating older adults' instrumental activities of daily living (IADLs). However, there is a minimal amount of research on its use in dementia populations and, specifically, its relationship to other neuropsychological measures. The present study investigated relationships between the ILS HS scale and measures of cognition and depression. The study utilized archival data from a sample (N = 142) of older adults (mean age = 77.85) diagnosed with dementia, who were evaluated at Saint Louis University Medical Center and administered the ILS HS scale as part of a larger clinical neuropsychological evaluation. Multiple regression analyses demonstrated that up to 37% of the variance in ILS HS performance was accounted for by demographic variables, premorbid intelligence, and cognitive functioning (e.g., global cognition, delayed verbal recall, and executive functioning), and regression models demonstrated medium to large effect sizes. Depression and self- or informant-reported IADLs were unrelated to the ILS HS scale. Results suggest that older adults' ability to function in health and safety-related situations requires a range of cognitive abilities. Performance on these measures may help guide clinical decision making regarding independent living and treatment planning.

Intact verbal fluency abilities in the Broad Autism Phenotype

This study attempted to replicate the findings of Camodeca and Voelker (2016), who demonstrated that controlled processing weaknesses were evident in the Broad Autism Phenotype (BAP), and that these weaknesses were predictive of real-world pragmatic language problems. One hundred eighty-two undergraduates completed the Delis-Kaplan Executive Function System Verbal Fluency (D-KEFS-VF) test and the Broad Autism Phenotype Questionnaire (BAPQ). Results were partially replicated. Contrary to the previous study, the BAP group (n = 31) did not demonstrate comparative weaknesses in controlled processing, nor were controlled processing abilities predictive of BAPQ Pragmatic Language score. Similar to the previous study, controlled processing did not predict pragmatic language abilities for Non-BAP (n = 151) subjects. For each group, letter fluency score predicted 2nd 15″ interval score (controlled processing abilities); automatic processing (1st 15″ interval) did not. Results suggest that verbal fluency skills in the BAP are similar to controls, and that controlled processing does not account for significant variance in real-world social language in the BAP.

Clinical Utility of Select Neuropsychological Assessment Battery Tests in Predicting Functional Abilities in Dementia

OBJECTIVE

Neuropsychological test performance can provide insight into functional abilities in patients with dementia, particularly in the absence of an informant. The relationship between neuropsychological measures and instrumental activities of daily living (IADLs) is unclear due to hetereogeneity in cognitive domains assessed and neuropsychological tests administered. Practical and ecologically valid performance-based measures of IADLs are also limited. The Neuropsychological Assessment Battery (NAB) is uniquely positioned to provide a dual-purpose assessment of cognitive and IADL function, as it includes Daily Living tests that simulate real-world functional tasks. We examined the utility of select NAB tests in predicting informant-reported IADLs in mild cognitive impairment and dementia.

METHODS

The sample of 327 participants included 128 normal controls, 97 individuals with mild cognitive impairment, and 102 individuals with Alzheimer's disease dementia from the Boston University Alzheimer's Disease Center research registry. Informants completed the Lawton Brody Instrumental Activities of Daily Living Scale, and study participants were administered selected NAB tests that were complementary to the existing protocol.

RESULTS

ROC curves showed strongest prediction of IADL (AUC > 0.90) for memory measures (List Learning delayed recall and Daily Living Memory delayed recall) and Daily Living Driving Scenes. At a predetermined level of specificity (95%), List Learning delayed recall (71%) and Daily Living Memory delayed recall (88%) were the most sensitive. The Daily Living Memory and Driving Scenes tests strongly predicted IADL status, and the other Daily Living tests contributed unique variance.

CONCLUSIONS

NAB memory measures and Daily Living Tests may have clinical utility in detecting informant-rated functional impairment in dementia.

Directional associations between memory impairment and depressive symptoms: data from a longitudinal sample and meta-analysis

BACKGROUND

Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis.

METHODS

A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model.

RESULTS

In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms.

CONCLUSIONS

These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed.

Ocimum basilicum improve chronic stress-induced neurodegenerative changes in mice hippocampus

Alzheimer's disease (AD), one of the progressive neurodegenerative diseases might be associated with exposure to stress and altered living conditions. This study aimed to evaluate the effectiveness of Ocimum basilicum (OB) essential oils in improving the neurodegenerative-like changes induced in mice after exposed to chronic unpredictable mild stress (CUMS). Forty male Swiss albino mice divided into four groups (n = 10); the control, CUMS, CUMS + Fluoxetine, CUMS + OB were used. Behavioral tests, serum corticosterone level, hippocampus protein level of the glucocorticoid receptors (GRs) and brain-dreived neurotropic factor (BDNF) were determined after exposure to CUMS. Hippocampus was histopathologically examined. Data were analyzed using statistical package for the social sciences (SPSS) and P value of less than 0.05 was considered significant. OB diminished the depression manifestation as well as impaired short term memory observed in the mice after exposure to the CUMS as evidenced by the forced swimming and elevated plus maze test. OB also up-regulated the serum corticosterone level, hippocampal protein level of the glucocorticoid receptor and the brain-derived neurotropic factor and reduced the neurodegenerative and atrophic changes induced in the hippocampus after exposure to CUMS. Essential oils of OB alleviated the memory impairment and hippocampal neurodegenerative changes induced by exposure to the chronic unpredictable stress indicating that it is the time to test its effectiveness on patients suffering from Alzheimer disease.

Relações entre saúde mental e falhas cognitivas no dia a dia: papel dos sintomas internalizantes e externalizantes

RESUMO Objetivo Falhas cognitivas são erros cometidos no dia a dia como perda de compromissos, falta de palavras ao conversar, dificuldades de memorizar o que é lido, erros de orientação, entre outros. Sintomas psiquiátricos internalizantes e externalizantes podem contribuir para a ocorrência de falhas cognitivas. O presente estudo objetiva avaliar como sintomas internalizantes e externalizantes contribuem para a ocorrência de falhas cognitivas no dia a dia. Métodos Foram avaliados 366 voluntários utilizando o Questionário de Falhas Cognitivas (CFQ) e as escalas Self-Reporting Questionnaire-20 (SRQ-20), como medida de sintomas internalizantes, e Adult Self-Report Scale (ASRS-18), como medida de sintomas externalizantes. Os participantes foram classificados com base nos pontos de corte da SRQ-20 e ASRS-18 para a criação de quatro grupos: hígido, internalizante, externalizante e misto. Comparamos os grupos por meio de ANOVA e testamos a associação das variáveis estudadas por meio de correlações. Resultados Todas as escalas apresentaram correlações fortes entre si (r > 0,500, p < 0,001). A comparação dos grupos sugere que participantes com escores clínicos de sintomas internalizantes e externalizantes apresentam mais falhas quando comparados ao grupo hígido (d = 0,86 e d = 1,00), mas não apresentam diferenças entre si (d = 0,21). Participantes do grupo misto apresentaram mais falhas que o grupo hígido (d = 2,01), internalizante (d = 1,31) e externalizante (d = 1,05). Conclusão Tanto sintomas internalizantes quanto externalizantes contribuem para a ocorrência de falhas cognitivas no dia a dia. Observamos ainda um efeito aditivo de ambos os sintomas.

Sensitivity of the Mini-Mental State Examination, Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination III to everyday activity impairments in dementia: an exploratory study

OBJECTIVE

The Mini-Mental State Examination (MMSE) is one of the most frequently used cognitive measures for dementia severity and linked to deficits in everyday functioning. Recently, the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination III (ACE-III) increasingly substitute for the MMSE. However, there are no specific cutoffs in the ACE-III for mild dementia. The objectives of this exploratory study were to assess the sensitivity of each scale to everyday functioning and to examine the cutoffs between mild and moderate dementia on the ACE-III.

METHODS

People with mild dementia completed the MMSE, MoCA and ACE-III, whilst informal carers completed the Revised Interview for Deteriorations in Daily Living Activities for Dementia to rate their relative's initiative and performance of instrumental activities of daily living and the Katz activities of daily living scale. Data were analysed using correlation analysis, raw score comparisons, Cohen's kappa and receiver operating characteristics analysis.

RESULTS

Thirty-three dyads completed the measures. The ACE-III was the most sensitive tool for everyday functioning performance, whilst its language subscale was specifically related to initiation of activities. The most suitable cutoff on the ACE-III between mild and moderate dementia was 61.

CONCLUSIONS

Findings suggest the ACE-III more efficiently identifies everyday functional impairments. Further research is required to confirm these exploratory analyses of the cutoff between mild and moderate dementia on the ACE-III. Both functional impairment and stage of dementia are needed in the diagnostic process and in the clinical assessment of people with dementia. Copyright © 2016 John Wiley & Sons, Ltd.

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

BACKGROUND

Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.

METHODS AND FINDINGS

The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65-93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840-.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805-.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978-1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759-.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.

CONCLUSIONS

This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

Relations between Concurrent Longitudinal Changes in Cognition, Depressive Symptoms, Self-Rated Health and Everyday Function in Normally Aging Octogenarians

Ability to predict and prevent incipient functional decline in older adults may help prolong independence. Cognition is related to everyday function and easily administered, sensitive cognitive tests may help identify at-risk individuals. Factors like depressive symptoms and self-rated health are also associated with functional ability and may be as important as cognition. The purpose of this study was to investigate the relationship between concurrent longitudinal changes in cognition, depression, self-rated health and everyday function in a well-defined cohort of healthy 85 year olds that were followed-up at the age of 90 in the Elderly in Linköping Screening Assessment 85 study. Regression analyses were used to determine if cognitive decline as assessed by global (the Mini-Mental State Examination) and domain specific (the Cognitive Assessment Battery, CAB) cognitive tests predicted functional decline in the context of changes in depressive symptoms and self-rated health. Results showed deterioration in most variables and as many as 83% of these community-dwelling elders experienced functional difficulties at the age of 90. Slowing-down of processing speed as assessed by the Symbol Digits Modality Test (included in the CAB) accounted for 14% of the variance in functional decline. Worsening self-rated health accounted for an additional 6%, but no other variables reached significance. These results are discussed with an eye to possible preventive interventions that may prolong independence for the steadily growing number of normally aging old-old citizens.

Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer's disease dementia: association with activities of daily living

OBJECTIVE

Cognitive impairment is a hallmark of mild cognitive impairment (MCI) and Alzheimer's disease dementia (AD). Although the cognitive profile of these patients and its association with activities of daily living (ADLs) is well documented, few studies have assessed deficits in fine motor dexterity and their association with ADL performance. The objective of this research paper is to evaluate fine motor dexterity performance among MCI and AD patients and to investigate its association with different aspects of ADLs.

METHODS

We assessed normal aging controls, patients with multiple- and single-domain amnestic MCI (aMCI), and patients with mild AD. Fine motor dexterity was measured with the Nine-Hole Peg Test and cognitive functioning by the Mattis Dementia Rating Scale. We analyzed the data using general linear models.

RESULTS

Patients with AD or multiple-domain aMCI had slower motor responses when compared to controls. AD patients were slower than those with single-domain aMCI. We found associations between cognition and instrumental ADLs, and between fine motor dexterity and self-care ADLs.

CONCLUSION

We observed progressive slowing of fine motor dexterity along the normal aging-MCI-AD spectrum, which was associated with autonomy in self-care ADLs.

A Reanalysis of Cognitive-Functional Performance in Older Adults: Investigating the Interaction Between Normal Aging, Mild Cognitive Impairment, Mild Alzheimer's Disease Dementia, and Depression

Depressive symptoms are associated with cognitive-functional impairment in normal aging older adults (NA). However, less is known about this effect on people with mild Cognitive Impairment (MCI) and mild Alzheimer's disease dementia (AD). We investigated this relationship along with the NA-MCI-AD continuum by reanalyzing a previously published dataset. Participants (N = 274) underwent comprehensive neuropsychological assessment including measures of Executive Function, Language/Semantic Memory, Episodic Memory, Visuospatial Abilities, Activities of Daily Living (ADL), and the Geriatric Depression Scale. MANOVA, logistic regression and chi-square tests were performed to assess the association between depression and cognitive-functional performance in each group. In the NA group, depressed participants had a lower performance compared to non-depressed participants in all cognitive and functional domains. However, the same pattern was not observed in the MCI group or in AD. The results suggest a progressive loss of association between depression and worse cognitive-functional performance along the NA-MCI-AD continuum.