Project

Relationship between cognitive impairment, symptoms of depression and functional loss in normal and pathological aging

Goal: The presence of cognitive impairment and depressive symptoms in older adults are commonly associated with functional outcomes, such as activities of daily living (ADL) performance. The loss of autonomy in their execution leads to functional limitations or disability. Cognitive disorders more common in old age, such as mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) involve progressive impairment of cognitive resources, reducing the patient’s competencies to cope with environmental pressures. In this context, this work aims to investigate the contribution of different aspects of cognition and the presence of functional outcomes for depressive symptoms in older adults.

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Jonas Jardim de Paula
added a research item
METHODS Sixty-eight elderlies were paired in terms of age and gender and were equally distributed into depressed and nondepressed groups, according to their score on the Beck Depression Questionnaire. The participants performed the Grooved Pegboard Test placing and withdrawing pegs while execution time and error rate were measured. RESULTS This investigation revealed that depressive symptoms exert a broad effect upon motor control, although that the symptom intensity, as well as the interaction between aging and depression intensity, were exclusively correlated with withdrawal task, suggesting that there is a greater effect upon motor acts with higher frontal lobe requirements. CONCLUSION The discrimination of motor control aspects provides a valuable contribution for the understanding of the underlying neurophysiology of the interaction between aging and depression as it represents an indirect measure of cerebral dysfunction. Further, these findings may still have clinical implications, as they can promote more rational approaches to the elaboration of preventive measures that help maintain the functional capability of depressed elderlies.
Jonas Jardim de Paula
added a research item
Objective: To propose and evaluate the psychometric properties of a multidimensional measure of activities of daily living (ADLs) based on the Katz and Lawton indices for Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods: In this study, 85 patients with MCI and 93 with AD, stratified by age (≤ 74 years, > 74 years), completed the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale, and their caregivers completed scales for ADLs. Construct validity (factor analysis), reliability (internal consistency), and criterion-related validity (receiver operating characteristic analysis and logistic regression) were assessed. Results: Three factors of ADL (self-care, domestic activities, and complex activities) were identified and used for item reorganization and for the creation of a new inventory, called the General Activities of Daily Living Scale (GADL). The components showed good internal consistency (> 0.800) and moderate (younger participants) or high (older participants) accuracy for the distinction between MCI and AD. An additive effect was found between the GADL complex ADLs and global ADLs with the MMSE for the correct classification of younger patients. Conclusion: The GADL showed evidence of validity and reliability for the Brazilian elderly population. It may also play an important role in the differential diagnosis of MCI and AD.
Jonas Jardim de Paula
added 2 research items
Cognitive functioning influences activities of daily living (ADL). However, studies reporting the association between ADL and neuropsychological performance show inconsistent results regarding what specific cognitive domains are related to each specific functional domains. Additionally, whether depressive symptoms are associated with a worse functional performance in older adults is still under explored. We investigated if specific cognitive domains and depressive symptoms would affect different aspects of ADL. Participants were 274 older adults (96 normal aging participants, 85 patients with mild cognitive impairment, and 93 patients probable with mild Alzheimer's disease dementia) with low formal education (∼4 years). Measures of ADL included three complexity levels: Self-care, Instrumental-Domestic, and Instrumental-Complex. The specific cognitive functions were evaluated through a factorial strategy resulting in four cognitive domains: Executive Functions, Language/Semantic Memory, Episodic Memory, and Visuospatial Abilities. The Geriatric Depression Scale measured depressive symptoms. Multiple linear regression analysis showed executive functions and episodic memory as significant predictors of Instrumental-Domestic ADL, and executive functions, episodic memory and language/semantic memory as predictors of Instrumental-Complex ADL (22 and 28% of explained variance, respectively). Ordinal regression analysis showed the influence of specific cognitive functions and depressive symptoms on each one of the instrumental ADL. We observed a heterogeneous pattern of association with explained variance ranging from 22 to 38%. Different instrumental ADL had specific cognitive predictors and depressive symptoms were predictive of ADL involving social contact. Our results suggest a specific pattern of influence depending on the specific instrumental daily living activity.
Jonas Jardim de Paula
added a research item
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.
Jonas Jardim de Paula
added a research item
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.
Jonas Jardim de Paula
added a project goal
The presence of cognitive impairment and depressive symptoms in older adults are commonly associated with functional outcomes, such as activities of daily living (ADL) performance. The loss of autonomy in their execution leads to functional limitations or disability. Cognitive disorders more common in old age, such as mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) involve progressive impairment of cognitive resources, reducing the patient’s competencies to cope with environmental pressures. In this context, this work aims to investigate the contribution of different aspects of cognition and the presence of functional outcomes for depressive symptoms in older adults.