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Executive function and attentional bias as serial mediators in the relationship between frailty and depressive symptoms among older inpatients: A cross‐sectional study
Abstract
Aims and objectives:
To examine the serial mediating effect of executive function and attentional bias in the relationship between frailty and depressive symptoms.
Background:
Although the role of frailty in predicting depression has been well documented, the underlying mechanisms remain unclear.
Design:
A cross-sectional study was conducted with 667 older inpatients aged 60-90 years in the internal medicine wards of a hospital in China.
Methods:
Attentional bias, frailty and depressive symptoms were assessed using the Attention to Positive and Negative Information Scale, the Physical Frailty Phenotype and the 5-item Geriatric Depression Scale. Executive function was measured using 3 tests, including digital backward, category Verbal Fluency Test and Trail Making Test. The study followed the STROBE guideline.
Results:
The latent profile analysis (LPA) identified four patterns of attentional bias, namely "no positive bias & no negative bias" (class 1, 9.3%), "minor positive bias & no negative bias" (class 2, 48.0%), "major positive bias & minor negative bias" (class 3, 25.6%) and "major positive bias & no negative bias" (class 4, 17.1%). Regression analysis found that frailty was associated with depressive symptoms. Frailty was also negatively associated with executive function, which was a protective factor for attentional bias class 1, 2 and 3 with reference to class 4. Attentional bias class 1 and 2 but not class 3 was associated with depressive symptoms with reference to class 4. The joint significance test confirmed executive function and attentional bias as serial mediators linking frailty to depressive symptoms.
Discussion:
Unlike robust older adults who have the age-related positivity effect, frail older adults have attentional bias deficits due to executive dysfunction, and consequently experience clinically relevant depressive symptoms.
Relevance to clinical practice:
Healthcare providers should take executive function training and attentional bias regulation into consideration to reduce the detrimental effects of frailty on emotional well-being.
... Study populations were drawn from a wide range of clinical environments. Eight studies assessed the prevalence of frailty across all inpatient wards [31,37,38,41,43,45,54,55]. The remaining studies focussed on one or more specific environments, with internal medical wards being the most commonly surveyed (n = 13) [28,30,32,33,36,39,42,44,47,48,50,51,53], followed by geriatrics (n = 8) Systematic review and meta-analysis of the prevalence of frailty and pre-frailty [29,30,34,35,46,49,52,56], cardiology (n = 2) [30,42], general surgery (n = 4) [33,42,44,50] and intensive care (n = 1) [40]. ...
... However, some of these exclusions may have led to selection bias and an underestimation of the prevalence of frailty. They were terminal illnesses [30,33,35,46,47,51], cancer [35,46,55], cognitive impairment [31,33,35,36,38,41,42,48,52,54,56], mobility problems [33, 35, 39, 41, 43, 47-49, 52, 54, 55] and impairments of hearing or vision [33,35,36,42,49,51,56]. For further information regarding the risk of bias amongst included studies, see Appendix 4. This systematic review had a number of limitations. ...
... However, some of these exclusions may have led to selection bias and an underestimation of the prevalence of frailty. They were terminal illnesses [30,33,35,46,47,51], cancer [35,46,55], cognitive impairment [31,33,35,36,38,41,42,48,52,54,56], mobility problems [33, 35, 39, 41, 43, 47-49, 52, 54, 55] and impairments of hearing or vision [33,35,36,42,49,51,56]. For further information regarding the risk of bias amongst included studies, see Appendix 4. This systematic review had a number of limitations. ...
Background
As populations age, low- and middle-income countries (LMICs) are rapidly adapting hospital services to meet the needs of older populations. This systematic review aimed to establish the prevalence of frailty and pre-frailty amongst older people admitted to hospital in LMICs, and to compare levels with existing estimates for high-income settings.
Methods
Databases Medline, Embase, CINAHL and PsychInfo were searched, and results were manually screened by two researchers. Included studies were cross-sectional or cohort design and reported data from hospital inpatients, aged ≥60 years, in LMICs, using validated methods for identifying frailty. Risk of bias was assessed by two researchers using the Joanna Briggs Institute checklist. Where possible, results were synthesised using meta-analysis.
Results
Twenty-nine studies were included, all reporting data from middle-income countries. Physical frailty tools were the most common, with Fried’s phenotype and the FRAIL Scale being the most often used methods of assessment. The pooled estimate of the prevalence of frailty was 39.1% [95% confidence interval (CI) 31.9–46.6%] comprising data from 23 311 older inpatients. For pre-frailty, prevalence was 40.0% (95% CI 25.1–51.4%) from 6954 individuals.
Discussion
Due to the paucity of eligible studies and their geographical distribution, these pooled estimates are only representative of the burden of frailty in select middle-income settings (particularly China). Future research should seek to establish the prevalence of frailty in hospitals in low-income countries, and to assess clinical outcomes by frailty status, in order to develop bespoke clinical tools and to aid the planning of future geriatric services.
... Latent profile analysis is a person-centered statistical approach that is commonly used to reveal heterogeneous groups of people with common patterns of external or internal behavior [24]. A cross-sectional study assessed attentional biases by self-report inventories in 667 inpatients of 60-90 years from a hospital in China and revealed four distinct profiles of positive and negative attentional biases with latent profile analysis [13]. The four profiles consisted of "no positive and negative bias" which included 9.3% of participants, "minor positive bias & no negative bias" (48.0%), "major positive bias & minor negative bias" (25.6%), and "major positive bias & no negative bias" (17.1%). ...
... Additionally, the results also added that the majority of children had moderate or high attention to positive stimuli during the COVID-19 pandemic. These results were inconsistent with the findings from a previous study by Ji et al. [13], which revealed four profiles of attentional biases in adults by the APNIS: "no positive and negative bias" group (9.3%), "minor positive bias & no negative bias" group (48.0%), "major positive bias & minor negative bias" (25.6%), and "major positive bias & no negative bias" (17.1%). While both studies provided evidence that the fewest number of individuals showed zero to low negative and positive attentional biases in adults and children. ...
... This evidence supported that the majority of children had moderate to high levels of attentional biases during the COVID-19 pandemic. It should also be noted that for both the previous study by Ji et al. [13] on adults and the current study on children, the profile of high negative and positive attentional biases was not revealed, suggesting that these children hardly show strong attentional bias towards both negative and positive stimuli, even during the COVID-19 pandemic. ...
Background
It is unknown how the patterns of negative and positive attentional biases in children predict fear of COVID-19, anxiety symptoms, and depression symptoms during the COVID-19 pandemic. The study identified profiles of negative and positive attentional biases in children and examined their association with emotional symptoms during the COVID-19 pandemic.
Method
264 children (girls: 53.8% and boys: 46.2%) of 9–10 years born in Hong Kong or mainland China from a primary school in Shenzhen, People’s Republic of China were involved in a two-wave longitudinal study. Children completed the COVID-19 Fear Scale, the Revised Child Anxiety and Depression Scale, and the Attention to Positive and Negative Information Scale to measure fear of COVID-19, anxiety and depression symptoms, and negative and positive attentional biases in classrooms. After six months, they completed the second assessment of fear of COVID-19, anxiety symptoms, and depression symptoms in classrooms. Latent profile analysis was conducted to reveal distinct profiles of attentional biases in children. A series of repeated MANOVA was performed to examine the association of profiles of attentional biases to fear of COVID-19, anxiety symptoms, and depression symptoms across 6 months.
Results
Three profiles of negative and positive attentional biases were revealed in children. Children with a “moderate positive and high negative attentional biases” profile had significantly higher fear of the COVID-19 pandemic, anxiety symptoms, and depression symptoms than children with a “high positive and moderate negative attentional biases” profile. Children with a “low positive and negative attentional biases” profile were not significantly different in fear of COVID-19, anxiety symptoms, and depression symptoms than those with the other two profiles.
Conclusions
Patterns of negative and positive attentional biases were related to emotional symptoms during the COVID-19 pandemic. It might be important to consider children's overall patterns of negative and positive attentional biases to identify children at risk of higher emotional symptoms.
... Latent pro le analysis is a person-centered statistical approach that is commonly used to reveal heterogeneous groups of people with common patterns of external or internal behavior (Perzow, Bray, Wadsworth, Young, & Hankin, 2021). A cross-sectional study assessed attentional biases by self-report inventories in inpatients of 60 to 90 years and revealed four distinct pro les of positive and negative attentional biases with latent pro le analysis (Ji et al., 2022). The four pro les consisted of "no positive and negative bias" which included 9.3% of participants, "minor positive bias & no negative bias" (48.0%), "major positive bias & minor negative bias" (25.6%), and "major positive bias & no negative bias" (17.1%). ...
... These results were inconsistent with the ndings from a previous study by Ji et al. (2022), which revealed four pro les of attentional biases in adults by the APNIS: "no positive and negative bias" group (9.3%), "minor positive bias & no negative bias" group (48.0%), "major positive bias & minor negative bias" (25.6%), and "major positive bias & no negative bias" (17.1%). While both studies provided evidence that the fewest number of individuals showed zero to low negative and positive attentional biases in adults and children. ...
... This evidence supported that the majority of children had moderate to high levels of attentional biases during the COVID-19 pandemic. It should also be noted that for both the previous study by Ji et al. (2022) on adults and the current study on children, the pro le of high negative and positive attentional biases was not revealed, suggesting that these children hardly show strong attentional bias towards both negative and positive stimuli. ...
Background. It is unknown how the patterns of negative and positive attentional biases in children predict fear of COVID-19, anxiety, and depression during the COVID-19 pandemic. The study identified profiles of negative and positive attentional biases in children and examined their association with emotional symptoms during the COVID-19 pandemic.
Method. 322 children were involved in a two-wave longitudinal study. Children completed the self-report assessment of fear of COVID-19, anxiety, depression, and attention to positive and negative information in classrooms. After six months, they completed the second assessment of fear of COVID-19, anxiety, and depression in classrooms.
Results. Higher fear of COVID-19 was related to higher anxiety and depression throughout the assessment period. Three profiles of negative and positive attentional biases were revealed in children. Children with a “moderate positive and high negative attentional biases” profile had significantly higher fear of COVID-19 pandemic, anxiety, and depression than children with a “high positive and moderate negative attentional biases” profile. Children with a “low positive and negative attentional biases” profile were not significantly different in fear of COVID-19, anxiety, and depression than those with the other two profiles.
Conclusions. Patterns of negative and positive attentional biases were related to emotional symptoms during the COVID-19 pandemic. It might be important to consider children's overall patterns of negative and positive attentional biases to identify children at risk of higher emotional symptoms.
This study examines how financial management practices and competitive advantage affect loan performance of microfinance institutions (MFIs) in Ghana's Ashanti Region. The research employs a cross-sectional design with a sample of 85 Ashanti Region MFIs, following Krejcie and Morgan's guidelines for sample selection. Employing a positivist approach with quantitative analysis, primary data comes from closed-ended questionnaires given to Credit Directors, Credit Department, and Risk Managers, selected randomly from staff lists. Results reveal financial management practices significantly impact loan performance and competitive advantage. However, competitive advantage, under controlled conditions, does not significantly predict loan performance. This highlights financial management's crucial role in shaping loan performance and competitive advantage in MFIs. The study suggests that sustaining growth requires Ghana's Central Bank to enforce adherence to standards for liquidity management. This research adds a fresh perspective to understanding financial management practices, competitive advantage, and loan performance in Sub-Saharan Africa's MFIs. K E Y W O R D S competitive advantage, financial management practices, loan performance, MFIs in Ghana, microfinance institutions, Resource-Based Theory
Background. Attention to Positive and Negative Information Scale (APNIS) is a commonly used scale to measure attentional biases in adults. However, no research has validated the use of APNIS in primary school children and investigated the association between attentional biases and fear of COVID-19 among them.
Method. Two samples of early adolescents were involved in the current research. The first sample consisted of 122 children from a primary school who completed the Chinese version of the APNIS (CAPNIS) in the classrooms. Sample two included 321 children who completed the CAPNIS, Revised Child Anxiety and Depression Scale (RCADS), Attentional Control Scale (ACS), and Fear of COVID-19 scale (FCS) in the classrooms at the first assessment. They completed FCS again after 6 months at the second assessment.
Results.The study revealed a CAPNIS with acceptable to good psychometric properties. Higher negative attentional bias, but not positive attentional bias predicted higher fear of COVID-19 after 6 months, controlling for fear of COVID-19, anxiety, and depression symptoms at the first assessment.
Conclusions. The findings supported that the CAPNIS might be used to predict the development of fear related to the pandemic.
Socioemotional selectivity theory claims that the perception of time plays a fundamental role in the selection and pursuit of social goals. According to the theory, social motives fall into 1 of 2 general categories—those related to the acquisition of knowledge and those related to the regulation of emotion. When time is perceived as open-ended, knowledge-related goals are prioritized. In contrast, when time is perceived as limited, emotional goals assume primacy. The inextricable association between time left in life and chronological age ensures age-related differences in social goals. Nonetheless, the authors show that the perception of time is malleable, and social goals change in both younger and older people when time constraints are imposed. The authors argue that time perception is integral to human motivation and suggest potential implications for multiple subdisciplines and research interests in social, developmental, cultural, cognitive, and clinical psychology.
Background: Although numerous studies have suggested that the gradually increasing selective preference for positive information over negative information in older adults depends on cognitive control processes, few have reported the characteristics of different attention stages in the emotional processing of older individuals. The present study used a real-time eye-tracking technique to disentangle the attentional engagement and disengagement processes involved in age-related positivity effect (PE).
Methods: Eye movement data from a spatial-cueing task were obtained for 32 older and 32 younger healthy participants. The spatial-cueing task with varied cognitive loads appeared to be an effective way to explore the role of cognitive control during the attention engagement and disengagement stages of emotion processing.
Results: Compared with younger adults, older participants showed more positive gaze preferences when cognitive resources were sufficient for face processing at the attention engagement stage. However, the age-related PE was not observed at the attention disengagement stage because older adults had more difficulty disengaging from fearful faces than did the younger adults due to the consumption of attention by the explicit target judgment.
Conclusion: The present study highlights how cognitive control moderates positive gaze preferences at different attention processing stages. These findings may have far-reaching implications for understanding, preventing, and intervening in unsuccessful aging and, thus, in promoting active and healthy aging.
The relationship between cognitive function and frailty among older adults is a growing area of research due to the implications of cognitive and physical decline for functional independence in late life. Multiple studies demonstrate a meaningful relationship between these two factors, which together may constitute increased risk of negative health outcomes for older adults. The current analysis was conducted to 1) systematically review current evidence for differences in cognitive performance based on frailty status among older adults and provide quantitative evidence for the magnitude of this effect, and 2) assess the influence of demographic and methodological variables on this effect. The preregistered protocol (CRD42018087138) included a search of EBSCOhost, Pubmed, and Embase online databases and reference lists to identify cross-sectional studies comparing frail and non-frail or robust older adults (60+) on cognitive performance. In total, 42 effects were retrieved from 38 studies, expressed as Hedges’ g, and pooled based on a random-effects model. Results indicated an overall significant, negative effect of frailty status on cognitive function among tests of global cognitive function (g = 0.734: 95% CI = 0.601-0.867) and individual cognitive domains (g = 0.439: 95% CI = 0.342–0.535). Age, frailty assessment used, and cognitive status of the sample did not significantly moderate the overall effect. Post-hoc moderator analysis revealed that difference in mean age of frail and robust groups significantly moderated the overall effect (R² = 0.38, β = .0974, 95% CI = 0.0537-0.141). Implications for future research are discussed.
Background:
Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this.
Objective:
This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness.
Methods:
Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: ("attention bias" OR "cognitive bias" OR "approach bias" OR "avoidance bias" OR "interpretative bias") AND ("Internet" OR "Web" OR "Online"). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported.
Results:
Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD.
Conclusions:
This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions.
International registered report identifier (irrid):
RR1-10.2196/10427.
Objectives:
To determine whether there are age differences in positive and negative repetitive thought (i.e., rumination).
Method:
Young adults (ages 19-39; N = 114) and Older Adults (ages 60-85; N = 88) completed measures of negative and positive rumination. Bayesian analyses were used to determine whether age differences were present for both negative (young > old) and positive (old > young) rumination.
Results:
There was extremely strong evidence for age differences in negative rumination, with lower scores in older adults. In contrast, the evidence was in favor of the null hypothesis for positive rumination.
Discussion:
Age-related positivity is better characterized as decreased dwelling on the meaning of negative moods, rather than increased attention to positive ones.
Background
Following treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. When Attention bias modification training (ABM) leads to more positive emotional biases, associated changes in clinical symptoms have been reported. A broader and more transparent picture of the true advantage of ABM based on larger and more stringent clinical trials have been requested. The current study evaluates the early effect of two weeks ABM training on blinded clinician-rated and self-reported residual symptoms, and whether changes towards more positive attentional biases (AB) would be associated with symptom reduction.
Method
A total of 321 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training.
Results
ABM training led to significantly greater decrease in clinician-rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards relatively more positive stimuli for participants that also showed greater symptom reduction.
Conclusion
The current study demonstrates that ABM produces early changes in blinded clinician-rated depressive symptoms and that changes in AB is linked to changes in symptoms. ABM may have practical potential in the treatment of residual depression.
Trial registration
ClinicalTrials.gov ID: NCT02658682 (retrospectively registered in January 2016).
Electronic supplementary material
The online version of this article (10.1186/s12888-019-2105-8) contains supplementary material, which is available to authorized users.
Introduction
The 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting).
Methods and analysis
Individual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Ethics and dissemination
The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy.
PROSPERO registration number
CRD42018104329.
Background
Different study designs and population size may require different sample size for logistic regression. This study aims to propose sample size guidelines for logistic regression based on observational studies with large population.
Methods
We estimated the minimum sample size required based on evaluation from real clinical data to evaluate the accuracy between statistics derived and the actual parameters. Nagelkerke r-squared and coefficients derived were compared with their respective parameters.
Results
With a minimum sample size of 500, results showed that the differences between the sample estimates and the population was sufficiently small. Based on an audit from a medium size of population, the differences were within ± 0.5 for coefficients and ± 0.02 for Nagelkerke r-squared. Meanwhile for large population, the differences are within ± 1.0 for coefficients and ± 0.02 for Nagelkerke r-squared.
Conclusions
For observational studies with large population size that involve logistic regression in the analysis, taking a minimum sample size of 500 is necessary to derive the statistics that represent the parameters. The other recommended rules of thumb are EPV of 50 and formula; n = 100 + 50i where i refers to number of independent variables in the final model.
Background/objectives:
The Trail-Making Test (TMT), which is commonly used to measure executive function, consists of two components (TMT-A and TMTB). There is a lack of normative TMT data for Chinese elderly adults. This study aimed to evaluate the validity of the TMT in screening for cognitive impairment.
Design:
2,294 Chinese-speaking adults aged 50 to 85: 1,026 with normal cognition (NC), 462 with mild cognitive impairment (MCI), 108 with Alzheimer's disease (AD), 113 with vascular mild cognitive impairment (VaMCI), 121 with vascular dementia (VaD), 282 with uncertain types of dementia, and 15 with mixed dementia. Receiver operating characteristic curve analysis was performed to test the ability of TMT scores to differentiate between NC and cognitive impairment.
Results:
Age, education, and sex were significantly associated with TMT completion time. The TMT-A exhibited sensitivity of 77.8% and specificity of 92.0% with cut-off value of 98.5 seconds for discriminating AD from NC. The TMT-B had sensitivity of 83.3% and specificity of 91.8% with a cut-off value of 188.5 seconds for discriminating AD from NC. The TMT-A had sensitivity of 85.7% and specificity of 81.6% for discriminating NC from VaD with a cut-off value of 77.5 seconds, and the TMT-s had sensitivity of 81.6% and specificity of 83.9% with a cut-off value of 147.5 seconds. The TMT had less sensitivity distinguishing MCI from NC.
Conclusion:
The Chinese version of the TMT is reliable for detecting AD or VaD but poor at distinguishing MCI from NC.
The prevailing model for working memory proposes the existence of a “central executive” responsible for coordinating and prioritizing incoming information from sensory and association cortices. The Digit Span task is commonly used by clinicians to parse attentional and executive components of working memory; however, the interrelatedness of these constructs in the context of advanced age and neurodegenerative disease remains an area of active investigation. The current study details a procedure and rationale for the use of latent class analysis, a data-driven, person-centered method, in the investigation of older adults and dementia. Class analysis of digit span performance in older adults (n = 874) drawn from a specialty clinic revealed four classes with distinct performance across task subcomponents. In three of the classes, attentional and executive elements demonstrated similar performance. The fourth class and implications of class structure are discussed in the context of aging.
Objective:
Early and preferential targeting of limbic structures by Alzheimer disease (AD)-related pathology suggests emotion dysregulation may serve as a marker of AD risk. We studied emotional verbal memory in two groups at risk for AD, amnestic mild cognitive impairment (aMCI) and late-onset depression (LOD), to test the hypothesis that aMCI and LOD would be characterized by a negative bias in emotional memory, whereas cognitively normal (CN) adults would show the "positivity effect" associated with healthy aging.
Methods:
Participants completed a novel test of emotional verbal memory, the Emotional Verbal Learning Test (EVeLT), consisting of a 15-item list of words with positive, negative, or neutral valence. Recall as a function of group and valence was analyzed using mixed analysis of variance. Spearman's rho was used to examine associations between EVeLT, mood, and executive function. MCI and CN participants had no current or past history of mood or anxiety disorders. aMCI participants met neuropsychological criteria for single-domain aMCI (sd-aMCI). LOD developed their first episode of depression at ≥60 years of age.
Results:
CN adults recalled more positive words, whereas sd-aMCI and LOD adults recalled more negative, relative to neutral, words on the EVeLT. Positive emotional memory and negative attitudes regarding self were inversely correlated in CN adults.
Conclusion:
sd-aMCI and LOD groups show negative emotional memory biases, consistent with our hypothesis that emotion dysregulation is a signature of AD risk.
Background: Little is known about the cognitive signature of bipolar disorder (BD) in elderly brains. The neuropsychological features of depressive elderly with early-onset BD are largely unknown. This issue is relevant because cognitive impairment can produce an additional impact on the already compromised functionality of elderly with BD. The aim of this study is to assess executive functions (EFs) in the depressive phase of elderly outpatients with early-onset BD.
Methods: Forty-nine elderly outpatients with early-onset BD were assessed with several neuropsychological tests for EF in the depressive phase of the disorder.
Results: Executive dysfunction is very common in old age bipolar depression. Thirteen patients (26.5%) had a pseudodementia presentation. The worst performances were observed in the following tests: Trail Making B, Stroop Test 3, Backward Digit Span and Wisconsin Card Sorting Test.
Conclusion: Executive dysfunction profile in elderly BD is complex and heterogeneous, but most cases display difficulties in working memory, inhibitory control, mental flexibility, and information processing speed. The performance of elderly with bipolar depression in executive assessment can be divided into two main categories: (1) Single EF domain impairment; and (2) Multiple EF domain impairment with or without a pseudodementia syndrome. Executive dysfunction in old age bipolar depression may be explained by lack of sufficient mental energy to run those cognitive processes that require larger amounts of effort to be performed.
Attentional bias and self-referential schemas have been observed in numerous cross-sectional studies of depressed adults and are theorised to maintain negative mood. However, few longitudinal studies have examined whether maladaptive cognition predicts the course of depressive symptoms. Fifty-seven adults with elevated depression symptoms were assessed for negative attentional bias using a dot-probe task with eye-tracking and self-referential schemas using a self-referent encoding task. Participants subsequently completed five weekly depression symptom assessments. Participants with more negative self-referential schemas had higher baseline depression symptoms (r = .55). However, participants who spent more time attending to negative words showed greater symptom worsening over time (r = .42). The findings for negative self-referential schemas replicate past research, while the findings for negative attention bias represent the first evidence showing that attentional biases predict naturalistic symptom course. This work suggests that negative attention biases maintain depression symptoms and represent an important treatment target for neurocognitive therapeutics.
Background:
Attention bias modification (ABM) training has been suggested to effectively reduce depressive symptoms, and may be useful in the prevention of the illness in individuals with subthreshold symptoms, yet little is known about the spontaneous brain activity changes associated with ABM training.
Method:
Resting-state functional MRI was used to explore the effects of ABM training on subthreshold depression (SubD) and corresponding spontaneous brain activity changes. Participants were 41 young women with SubD and 26 matched non-depressed controls. Participants with SubD were randomized to receive either ABM or placebo training during 28 sessions across 4 weeks. Non-depressed controls were assessed before training only. Attentional bias, depressive severity, and spontaneous brain activity before and after training were assessed in both training groups.
Results:
Findings revealed that compared to active control training, ABM training significantly decreased depression symptoms, and increased attention for positive stimuli. Resting-state data found that ABM training significantly reduced amplitude of low-frequency fluctuations (ALFF) of the right anterior insula (AI) and right middle frontal gyrus which showed greater ALFF than non-depressed controls before training; Functional connectivity strength between right AI and the right frontoinsular and right supramarginal gyrus were significantly decreased after training within the ABM group; moreover, the improvement of depression symptoms following ABM significantly correlated with the connectivity strength reductions between right AI and right frontoinsular and right supramarginal gyrus.
Conclusion:
These results suggest that ABM has the potential to reshape the abnormal patterns of spontaneous brain activity in relevant neural circuits associated with depression.
The purpose of this study was to examine in which way adding more indicators or a covariate influences the performance of latent class analysis (LCA). We varied the sample size (100 ≤ N ≤ 2000), number, and quality of binary indicators (between 4 and 12 indicators with conditional response probabilities of [0.3, 0.7], [0.2, 0.8], or [0.1, 0.9]), and the strength of covariate effects (zero, small, medium, large) in a Monte Carlo simulation study of 2- and 3-class models. The results suggested that in general, a larger sample size, more indicators, a higher quality of indicators, and a larger covariate effect lead to more converged and proper replications, as well as fewer boundary parameter estimates and less parameter bias. Furthermore, interactions among these study factors demonstrated how using more or higher quality indicators, as well as larger covariate effect size, could sometimes compensate for small sample size. Including a covariate appeared to be generally beneficial, although the covariate parameters themselves showed relatively large bias. Our results provide useful information for practitioners designing an LCA study in terms of highlighting the factors that lead to better or worse performance of LCA.
Recently, the focus in gerontology has expanded from trying to avoid age-related decline to also trying to promote optimal aging. One key component of optimal aging is maintaining or even enhancing emotional well-being over the life span (Baltes & Baltes 1990; Lawton, 2001; Rowe & Kahn, 1987). The traditional stereo-type of old age depicts a period of evitable and continuous loss, with decreased subjective well-being. However, although negative life events tend to become more frequent and cognitive function and health tend to decline as people get older, emotional well-being does not appear to be compromised by the aging process. In fact, accumulating evidence indicates that healthy emotional aging— characterized by an overall enhancement of emotional experience across the life span—is part of normal human development (see Carstensen, Mikels, & Mather, of aging must explain this phenomenon. How is it that older adults have such emotionally gratifying lives in the face of significant losses? In this chapter, we attempt to explain the surprising robustness of emotional well-being in aging by integrating perspectives from cognition, emotion, and neuroscientific research. First, we review evidence that emotional well-being improves with age and discuss how age-related changes in goals motivate older adults to pursue emotionally gratifying experiences. Next, we present behav-ioral evidence that older adults use cognitive control to enhance their current emotional states. Then we use research findings from cognitive neuroscience to outline the requirements of implementing emotion regulation–focused strate-gies. We then evaluate older adults' capacity to exert cognitive control given the trajectory of cognitive and brain function in aging. Finally, we present findings indicating that older adults use cognitive resources to regulate emotion. In this chapter, we argue that older adults use strategic control processes to achieve their emotional goals within the limitations of age-related changes to neural structures. The intersection of neurological function and affective goals in aging indicates that cognitive function—particularly executive function—is a critical factor in promoting emotional well-being in late life. Our theoretical framework emphasizes older adults' power in determining their own emotional destiny. Cognitive control allows people to direct attention and memory in ways that help satisfy emotional needs. Using cognitive control as an emotion regu-lation tool becomes increasingly useful with advancing age as emotional well-being takes on more importance to those with more limited futures.
In contrast to long-held axioms of old age as a time of "doom and gloom," mounting evidence indicates an age-related positivity effect in attention and memory. However, several studies report inconsistent findings that raise critical questions about the effect's reliability, robustness, and potential moderators. To address these questions, we conducted a systematic meta-analysis of 100 empirical studies of the positivity effect (N = 7,129). Results indicate that the positivity effect is reliable and moderated by theoretically implicated methodological and sample characteristics. The positivity effect is larger in studies that do not constrain (vs. constrain) cognitive processing-reflecting older adults' natural information processing preferences-and in studies incorporating wider (vs. narrower) age comparisons. Analyses indicated that older adults show a significant information processing bias toward positive versus negative information, whereas younger adults show the opposite pattern. We discuss implications of these findings for theoretical perspectives on emotion-cognition interactions across the adult life span and suggest future research directions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
The present study tested the interplay between mood and attentional deployment by examining attention to positive (i.e., happy faces) and negative (i.e., angry and sad faces) stimuli in response to experimental inductions of sad and happy mood. Participants underwent a negative, neutral, or positive mood induction procedure (MIP) which was followed by an assessment of their attentional deployment to emotional faces using eye-tracking technology. Faces were selected from the Karolinska Directed Emotional Faces (KDEF) database (Lundqvist, Flykt, & Öhman, 1998). In the positive MIP condition, analyses revealed a mood-congruent relation between positive mood and greater attentional deployment to happy faces. In the negative MIP condition, however, analyses revealed a mood-incongruent relation between increased negative mood and greater attentional deployment to happy faces. Furthermore, attentional deployment to happy faces after the negative MIP predicted participants' mood recovery at the end of the experimental session. These results suggest that attentional processing of positive information may play a role in mood repair, which may have important clinical implications. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
We hypothesized individual differences in the tendency to attend to, think about, and focus on positive (or negative) information. A scale measuring these individual differences was constructed and its validity and reliability were examined in three studies. Attention to positive information was related to positive affectivity, extraversion, BAS, optimism. Attention to negative information was related to negative affectivity, neuroticism, BIS, and optimism (inversely). Validity was partially confirmed by a person perception task: individuals high in attention to positive information perceived the character in a story as happy. Attention to positive information was a partial mediator of the relation between extraversion and positive affect and attention to negative information was a partial mediator of the relation between neuroticism and negative affect.
In a three-path mediational model, two mediators intervene in a series between an independent and a dependent variable. Methods of testing for mediation in such a model are generalized from the more often used single-mediator model. Six such methods are introduced and compared in a Monte Carlo study in terms of their Type I error, power, and coverage. Based on its results, the joint significance test is preferred when only a hypothesis test is of interest. The percentile bootstrap and bias-corrected bootstrap are preferred when a confidence interval on the mediated effect is desired, with the latter having more power but also slightly inflated Type I error in some conditions.
The present study tested whether the relationships among resilience, life satisfaction, and depression could be explained by positive views toward the self, the world, and the future (positive cognitive triad). Structural equation modeling and mediation analyses were conducted based on 1,419 college students in Hong Kong. The model of positive cognitive triad as mediator between resilience and well-being fit the data (comparative fit index = .94, Tucker-Lewis index = .93, root-mean-square error of approximation = .08). Findings showed resilience to be significantly related to positive cognitions about the self, the world, and the future. Individuals who had higher level of resilience held significantly more positive cognitions and reported significantly higher levels of life satisfaction and lower levels of depression. The utility of the positive cognitive triad as the mechanism through which resilience enhances well-being was supported. Applications in cultivating resilience and positive cognitions in counseling services are discussed.
Empirical studies have frequently linked negative attentional biases with attentional dysfunction and negative moods; however, far less research has focused on how attentional deployment can be an adaptive strategy that regulates emotional experience. The authors argue that attention may be an invaluable tool for promoting emotion regulation. Accordingly, they present evidence that selective attention to positive information reflects emotion regulation and that regulating attention is a critical component of the emotion regulatory process. Furthermore, attentional regulation can be successfully trained through repeated practice. The authors ultimately propose a model of attention training methodologies integrating attention-dependent emotion regulation strategies with attention networks. Although additional interdisciplinary research is needed to bolster these nascent findings, meditative practices appear to be among the most effective training methodologies in enhancing emotional well-being. Further exploration of the positive and therapeutic qualities of attention warrants the empirical attention of social and personality psychologists.
Older adults show positive preferences in their gaze toward emotional faces, and such preferences appear to be activated when older adults are in bad moods. This suggests that age-related gaze preferences serve a mood regulatory role, but whether they actually function to improve mood over time has yet to be tested. We investigated links between fixation and mood change in younger and older adults, as well as the moderating role of attentional functioning. AgexFixationxAttentional Functioning interactions emerged such that older adults with better executive functioning were able to resist mood declines by showing positive gaze preferences. Implications for the function of age-related positive gaze preferences are discussed.
To evaluate the reliability and validity of the Faces Pain Scale Revised (FPS-R), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) for pain assessment in Chinese elders who have had surgery.
A descriptive correlational design with repeated measures was used. A convenience sample of 180 Chinese elders (age range 65 to 95 years) undergoing scheduled surgery at a university-affiliated hospital was recruited.
On the day before surgery, recalled pain and anticipated postoperative pain intensity were rated by patients with three scales presented in randomized order, and then cognitive function was measured. On the first 3 postoperative days, participants completed the three scales in random order to assess current, worst, and least pain on each day. On the 3rd postoperative day, single retrospective ratings on worst, least, and average pain over the 3 days for each scale were also obtained and scale preferences were investigated.
The failure rates for all three scales were extremely low. The intraclass correlation coefficients across current, worst, and least pain on each postoperative day were consistently high (0.949 to 0.965), and all scales at each rating were strongly correlated (r=.833 to .962). Pain scores significantly decreased during the 3 postoperative days and all three scales were found to be sensitive in evaluating patient-controlled analgesia (PCA) efficacy. The scale mostly preferred was the IPT (54.7%), followed by the FPS-R (28.5%) and the NRS (15.6%). No significant differences were noted in participant preference by age and cognitive status, but preference for the IPT and the FPS-R were significantly related to gender and education level.
Although all three scales show good reliability, validity, and sensitivity for assessing postoperative pain intensity in Chinese elders, the IPT appears to be a better choice based on patient preference.
The FPS-R, the NRS, and the IPT can be used confidently to assess postoperative pain in Chinese surgical elders.
Socioemotional selectivity theory claims that the perception of time plays a fundamental role in the selection and pursuit of social goals. According to the theory, social motives fall into 1 of 2 general categories--those related to the acquisition of knowledge and those related to the regulation of emotion. When time is perceived as open-ended, knowledge-related goals are prioritized. In contrast, when time is perceived as limited, emotional goals assume primacy. The inextricable association between time left in life and chronological age ensures age-related differences in social goals. Nonetheless, the authors show that the perception of time is malleable, and social goals change in both younger and older people when time constraints are imposed. The authors argue that time perception is integral to human motivation and suggest potential implications for multiple subdisciplines and research interests in social, developmental, cultural, cognitive, and clinical psychology.
Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.
Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).
This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0-5 or 0-10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale-Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5-12 years. In the third phase, a clinical sample of pediatric inpatients aged 4-12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0-10), and conforms closely to a linear interval scale.
As people get older, they experience fewer negative emotions. Strategic processes in older adults' emotional attention and memory might play a role in this variation with age. Older adults show more emotionally gratifying memory distortion for past choices and autobiographical information than younger adults do. In addition, when shown stimuli that vary in affective valence, positive items account for a larger proportion of older adults' subsequent memories than those of younger adults. This positivity effect in older adults' memories seems to be due to their greater focus on emotion regulation and to be implemented by cognitive control mechanisms that enhance positive and diminish negative information. These findings suggest that both cognitive abilities and motivation contribute to older adults' improved emotion regulation.
The present study revealed that older adults recruit cognitive control processes to strengthen positive and diminish negative information in memory. In Experiment 1, older adults engaged in more elaborative processing when retrieving positive memories than they did when retrieving negative memories. In Experiment 2, older adults who did well on tasks involving cognitive control were more likely than those doing poorly to favor positive pictures in memory. In Experiment 3, older adults who were distracted during memory encoding no longer favored positive over negative pictures in their later recall, revealing that older adults use cognitive resources to implement emotional goals during encoding. In contrast, younger adults showed no signs of using cognitive control to make their memories more positive, indicating that, for them, emotion regulation goals are not chronically activated.
Previous findings reveal that older adults favor positive over negative stimuli in both memory and attention (for a review, see Mather & Carstensen, 2005). This study used eye tracking to investigate the role of cognitive control in older adults' selective visual attention. Younger and older adults viewed emotional-neutral and emotional-emotional pairs of faces and pictures while their gaze patterns were recorded under full or divided attention conditions. Replicating previous eye-tracking findings, older adults allocated less of their visual attention to negative stimuli in negative-neutral stimulus pairings in the full attention condition than younger adults did. However, as predicted by a cognitive-control-based account of the positivity effect in older adults' information processing tendencies (Mather & Knight, 2005), older adults' tendency to avoid negative stimuli was reversed in the divided attention condition. Compared with younger adults, older adults' limited attentional resources were more likely to be drawn to negative stimuli when they were distracted. These findings indicate that emotional goals can have unintended consequences when cognitive control mechanisms are not fully available.
Objective: Aging is associated with decline in executive function that may lead to reduced dual-task performance. Regular exercise has been recommended for promoting or maintaining mental and physical health in older adults, yet only a fraction of older adults exercise regularly. Exergame training may have the potential to enhance exercise adherence. Therefore, the aim of this study was to examine the effects of exergame-based dual-task training on executive function and dual-task performance in community-dwelling older adults. Materials and Methods: This was a single-blinded, randomized-controlled trial. Twenty community-dwelling older adults were recruited and randomly assigned to one of two groups. All participants completed 36 trainings, including three 60-minute sessions/week over 12 weeks. Participants in the experimental group received exergame-based dual-task training, while those in the control group received home-based multicomponent exercise training. Measures of executive function, dual-task performance, and community walking ability were assessed before and after the intervention. Results: Significant group × time interactions (P = 0.000-0.027) with large effects were found in all selected outcome measures. Compared with the control group, the experimental group improved significantly in measures of general executive function (P = 0.014), inhibitory control (P = 0.037), cognitive dual-task performance (P < 0.001), and community walking ability (P = 0.002). Enhanced general executive function was highly correlated with either improved motor dual-task performance (r = 0.674) or improved cognitive dual-task performance (r = -0.701). Conclusion: These results suggested that exergame-based dual-task training improved both executive function and dual-task performance in older people. These positive effects could be transferred to enhance community walking ability. Clinical Trial Registration number: ACTRN 12617000095369.
Recently, the interactive stepping exercise (ISE) was developed on the basis of square stepping exercise. The aim of this study was to examine the feasibility and effectiveness of ISE on executive function and gait variability among community-dwelling older adults. Fourteen participants were recruited and randomly assigned to the experimental group (n=7) or control group (n=7) and received ISE or home exercise program, respectively, three times a week for 12 weeks. The outcomes included retention rate, attendance rate, Trail Making Test, and dual-task walking. The results showed that participants had high retention and attendance rate for the ISE intervention. Moreover, significant improvement in the part A of Trail Making Test and stride length variability during cognitive dual-task walking after 12-week ISE intervention. The current results suggested that ISE is a feasible and effective intervention on executive function and gait variability in community-dwelling older adults.
Learning objectives:
After participating in this activity, learners should be better able to:• Identify risk factors for late-life depression• Evaluate strategies to prevent late-life depression ABSTRACT: Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.
Background:
Little is known about the validity of the Norwegian versions of the Geriatric Depression Scale-5 (GDS-5) and the Hospital Anxiety and Depression Scale-D (HADS-D). The aim of this study was therefor to validate the two assessment tools in a population of home-dwelling persons of 60 years of age and above.
Methods:
A sample of 194 home-dwelling old adults with and without depressive symptoms were recruited. The participants were examined for depressive symptoms (GDS-5, HADS-D) and cognitive impairment. Sociodemographic information was collected. The participants underwent a blinded diagnostic evaluation for a depressive episode according to the diagnostic criteria of ICD-10.
Results:
In all, 56 (28.9%) participants fulfilled criteria for a depressive episode according to ICD-10. The Receiver Operating Characteristics analyses of HAD-D and GDS-5 using the diagnostic criteria of ICD-10 for depression as gold standard was performed. For GDS-5 the Areal under the Curve was 0.81 and for HAD-D 0.75. The cut-off points of the measures that produced the highest accuracies were ≥2 for GDS-5 with a sensitivity of 73.2% and a specificity of 73.2% and ≥4 for HADS-D with a sensitivity of 70.3% and a specificity of 69.6%.
Limitations:
A larger sample would have given the opportunity for analyzing home dwelling old adults with and without home health care separately. The participants were talked through the self-filling questionnaires. The procedure could have influenced the participants' answers.
Conclusion:
GDS-5 and HADS-D are useful screening tools for old adults, but only fairly good to identify depression according to criteria of ICD-10.
Objective
Verbal fluency is a common neuropsychological test that is impaired in dementia. We test whether verbal fluency is a prospective risk factor for incident dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia.
Methods
Participants (N=18,189) from the Health and Retirement Study were administered a standard test of verbal fluency and were assessed for cognitive status every two years between baseline and six years follow‐up.
Results
Every standard deviation increase in verbal fluency was associated with an approximately 60% reduced risk of incident dementia, an approximately 25% reduced risk of incident CIND, and an approximately 25% reduced risk of conversion from CIND to dementia. These associations were independent of age, gender, education, race, ethnicity, and APOE risk status. The associations were slightly weaker (but still significant) for African‐Americans and individuals with lower education. There was no interaction between verbal fluency and APOE risk status.
Conclusion
Verbal fluency is an easily‐administered task that is predictive of incident cognitive impairment.
The MMSE is used to screen for cognitive impairment and estimate dementia severity. In clinical settings, conventional cut-off scores have been used to distinguish between dementia stages. However, these scores have not been validated for different populations. This study maps scores from the modified version of the MMSE to dementia stages delineated by the Diagnostic and Statistical Manual of Mental Disorders-3rd revised edition (DSM-III-R), the Clinical Dementia Rating (CDR) and Functional Assessment Staging Test (FAST). We used cross-sectional data from a tertiary hospital memory clinic. Subjects were stratified into “primary education and below” (PE) or “secondary education and above” (SE). Receiving operating characteristic (ROC) analyses and Cohen's κ were performed to determine MMSE cut-off scores for dementia stages. Our derived cut-off scores were lower compared to the conventional scores. Scores also differed between subjects of different education levels. MMSE cut-off scores were 19, 15, and 9 for CDR stages 1, 2, and 3 respectively in PE subjects, and 23, 17, and 10 for SE subjects. Cut-off scores were comparable for staging by DSM-III-R Criteria and FAST. There is a need for locally derived stage-specific MMSE cut-off scores for the Asian population adjusted for education.
Cognitive science has been instrumental in advancing our understanding of the onset, maintenance, and treatment of depression. Research conducted over the last 50 years supports the proposition that depression and risk for depression are characterized by the operation of negative biases, and often by a lack of positive biases, in self-referential processing, interpretation, attention, and memory, as well as the use of maladaptive cognitive emotion regulation strategies. There is also evidence to suggest that deficits in cognitive control over mood-congruent material underlie these cognitive processes. Specifically, research indicates that difficulty inhibiting and disengaging from negative material in working memory: (1) increases the use of maladaptive emotion regulation strategies (e.g., rumination), decreases the use of adaptive emotion regulation strategies (e.g., reappraisal), and potentially impedes flexible selection and implementation of emotion regulation strategies; (2) is associated with negative biases in attention; and (3) contributes to negative biases in long-term memory. Moreover, studies suggest that these cognitive processes exacerbate and sustain the negative mood that typifies depressive episodes. In this review, we present evidence in support of this conceptualization of depression and discuss implications of research findings for theory and practice. Finally, we advance directions for future research.
Pain and frailty are both prevalent and have severe health impacts among older adults. We conducted a cross-sectional observational study to examine the association between pain and frailty, and depression as a mediator and its interaction with pain on frailty among 1788 Chinese community-dwelling older adults. Physical frailty, pain intensity and depressive symptoms were assessed using the Frailty Phenotype, the revised Faces Pain Scale (FPS-R), and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that both pain (OR = 1.61; 95% CI: 1.32, 1.97) and depressive symptoms (OR = 4.67; 95% CI: 3.36, 6.50) were positively associated with physical frailty (OR = 1.61; 95% CI: 1.32, 1.97), and depressive symptoms were associated with pain (OR = 1.94; 95% CI: 1.15, 3.39), attenuating the association between pain and physical frailty by 56.1%. Furthermore, older adults with both pain and depressive symptoms (OR = 8.13; 95% CI: 5.27, 12.53) had a higher risk of physical frailty than, those with pain (OR = 1.41; 95% CI: 1.14, 1.76) or depressive symptoms (OR = 3.63; 95% CI: 2.25, 5.85) alone. The relative excess risk of interaction (RERI), the attributable proportion due to interaction (AP) and the synergy index (S) were 4.08, 0.50, and 2.34, respectively. These findings suggest that the positive association of pain with frailty is persistent and partially mediated by depression, and comorbid depression and pain has an additive interaction on physical frailty. It has an implication of multidisciplinary care for frail older adults with pain.
Negative bias in cognition is closely associated with susceptibility to recurrent episodes of depression. Given the high recurrence rate of depression, previous studies have focused on the attentive level in late-life depression (LLD), but depression relapse is difficult to detect as a lower chief complaint in elderly people. Facial expression mismatch negativity (EMMN) is a tool that can measure cognitive bias in pre-attentive processing. In this study, we sought to explore the cognitive bias in pre-attentive emotional information processing in LLD. Thirty patients with remitted LLD and 30 non-depressed, age- and gender-matched normal controls (NC) were enrolled in this study. Automatic emotional processing was elicited by using an expression-related oddball paradigm in all participants. There were no significant differences in N170 amplitude and latency between remitted LLD and NC. Compared with NC subjects, patients with remitted LLD demonstrated an attenuated mean amplitude of positive and negative EMMN, whereas the mean amplitude of negative EMMN in remitted LLD was much larger than that of positive EMMN. Our findings suggest that although basic processing of facial expressions is intact in remitted LLD, automatic processing of facial expressions in remitted LLD is impaired with a negative bias in cognition. Further investigation of the contributions of negative bias in EMMN to susceptibility to recurrence of LLD is warranted.
Aim:
Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta-analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty.
Methods:
Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders.
Results:
From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07-47.10, I(2)=94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66-7.35, k=11), also after adjusting for potential confounders (OR=2.64; 95%CI: 1.59-4.37, I(2)=55%, k=4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00-55.30, I(2)=97%). People with depression were at increased odds of having frailty (OR=4.07, 95%CI 1.93-8.55, k=8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95-7.08, I(2)=98%, k=4), whilst in two studies frailty increased the risk of incident depression with an OR=1.90 (95%CI 1.55-2.32, I(2)=0%).
Conclusion:
This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.
Savoring is the ability to be mindful of positive experiences and to be aware of and regulate positive feelings about these experiences. Previous research has found that savoring interventions can be effective at improving well-being of younger adults, but findings have not been extended to older populations. This pilot study examined the effects of a 1-week savoring intervention on older adults’ psychological resilience and well-being (i.e., depressive symptoms and happiness). Participants, 111 adults ages 60 or over, completed measures of resilience, depressive symptoms, and happiness pre- and postintervention as well as 1 month and 3 months after the intervention. Analyses revealed that participants who completed the savoring intervention with high fidelity also reported improvements in resilience, depressive symptoms, and happiness over time. These findings suggest that the savoring intervention has the potential to enhance older adults’ resilience and psychological well-being.
Physical frailty has been recognized as a clinical syndrome resulting from declines in various physiological systems; however, the role of the central nervous system in the pathophysiology of frailty remains unclear. The I-Lan Longitudinal Aging Study randomly sampled community-dwelling people aged 50 or older for a brain magnetic resonance imaging study. All participants were assessed for frailty status (robust, prefrail, and frail) based on the presence of five frailty components: slow walking speed, muscle weakness, low physical activity, exhaustion and weight loss (Fried criteria). Gray matter volume (GMV) changes associated with frailty status and individual frailty components were examined. Overall, 456 participants (64.0 ± 8.5 years, 47.6% women) were included in this study. The prefrail (n = 178, 39.0%) and frail (n = 19, 4.2%) subjects were grouped for analysis. The prefrail-frail group showed reduced GMV, compared to the robust group (n = 259, 56.8%), in the cerebellum, hippocampi, middle frontal gyri, and several other cerebral regions (corrected P < 0.05). Each frailty component was associated with GMV changes in functionally related brain areas. Hierarchical cluster analysis categorized these components into three subsets. Motor-related components, including weakness, low activity, and slowness, comprised one subset with a common cerebellar involvement. Exhaustion and weight loss were the other two subsets without cerebellar changes. To conclude, physical frailty is associated with a decreased reserve in specific brain regions, especially cerebellum. Further longitudinal studies are needed to explore if the cerebellum- and noncerebellum-based frailty components reflect a distinctive future risk for developing frailty. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc.
© 2015 Wiley Periodicals, Inc.
To identify salient characteristics of frailty that increase risk of death in depressed elders.
Data were from the Nordic Research on Ageing Study from research sites in Denmark, Sweden, and Finland. Participants were 1,027 adults aged 75 years (436 men and 591 women). Time of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988 and 1991).
Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models including all four frailty characteristics showed slow gait speed (hazard ratio: 1.84; 95% confidence interval: 1.05-3.21) and fatigue (hazard ratio: 1.94; 95% confidence interval: 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics in the simultaneous model was associated with death in depressed men. In women, the effect of impaired gait speed on mortality rates nearly doubled when depression was present (nondepressed women: no gait impairment = 26%; slow gait = 40%; depressed women: no gait impairment = 32%; slow gait = 58%). A similar pattern was observed for fatigue.
The confluence of specific characteristics of frailty (fatigue and slow gait speed) and depressive illness is associated with an increased risk of death in older adults; this association is particularly strong in older depressed women. Future research should investigate whether multimodal interventions targeting depressive illness, mobility deficits, and fatigue can decrease mortality and improve quality of life in older depressed individuals with characteristics of the syndrome of frailty.
Growth mixture modeling (GMM) is a method for identifying multiple unobserved sub-populations, describing longitudinal change within each unobserved sub-population, and examining differences in change among unobserved sub-populations. We provide a practical primer that may be useful for researchers beginning to incorporate GMM analysis into their research. We briefly review basic elements of the standard latent basis growth curve model, introduce GMM as an extension of multiple-group growth modeling, and describe a four-step approach to conducting a GMM analysis. Example data from a cortisol stress-response paradigm are used to illustrate the suggested procedures.
The development of the Posttraumatic Growth Inventory, an instrument for assessing positive outcomes reported by persons who have experienced traumatic events, is described. This 21-item scale includes factors of New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation of Life. Women tend to report more benefits than do men, and persons who have experienced traumatic events report more positive change than do persons who have not experienced extraordinary events. The Posttraumatic Growth Inventory is modestly related to optimism and extraversion. The scale appears to have utility in determining how successful individuals, coping with the aftermath of trauma, are in reconstructing or strengthening their perceptions of self, others, and the meaning of events.
Using reliable outcome measures is a necessity for the occupational therapy profession in enabling valid assessments of clients. Although Cronbach's alpha is the most widely applied index of internal consistency reliability, there are misconceptions about its use and interpretation. This paper aims to guide assessment developers in paediatric occupational therapy, as well as practitioners who are evaluating outcome measures in using and interpreting the Cronbach's alpha estimates appropriately. This will enable them to decide on the tools' clinical value and incorporate them into their practice with children.
Previously published papers reporting on internal consistency issues of outcome measures in paediatric occupational therapy were searched through the Allied and Complementary Medicine database. These papers were used as a basis to discuss possible reasons for reporting of low internal consistency.
The analysis demonstrates that Cronbach's alpha reports are not always interpreted in a sound way. The paper emphasises that one should be cautious about judging estimates of internal consistency. Low size of the coefficient alpha might not always indicate problems with the construction of the tool; whereas large sizes do not always suggest adequate reliability. Instead, these reports might be related to the data characteristics of the construct.
In judging an outcome measure's internal consistency, researchers and practitioners in occupational therapy should report and consider the nature of data, the scale's length and width, the linearity and the normality of response distribution, the central response tendency, the sample response variability and the sample size.
Emotion dysregulation is associated with midlife major depressive disorder and is predictive of relapse, but its role in understanding the neurobiology of late-life depression (LLD) is unknown. The current pilot study investigated emotional processing in LLD.
Depressed patients (N = 11, 7 women, mean age = 73 +/- 8.4 years) and healthy comparison subjects (HCs; N = 11, 8 women, mean age = 75+/- 6.9 years) completed two tasks in which they viewed a series of faces with happy, sad, fearful,or neutral expressions and were instructed to make nonaffective judgements of faces or label the expression.
HCs showed longer response latencies to making judgements of all emotional expressions relative to neutral faces. In contrast, response latencies did not vary by emotion in LLDs. LLDs were also less accurate in correctly labeling neutral faces.
These preliminary findings suggest that LLD is associated with alterations in emotional processing,which are distinct from the mood-congruent cognitive biases observed in younger depressed cohorts.
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
To develop and test the effectiveness of a 5-item version of the Geriatric Depression Scale (GDS) in screening for depression in a frail community-dwelling older population.
A cross-sectional study.
A geriatric outpatient clinic at the Sepulveda VA Medical Center, Sepulveda, California.
A total of 74 frail outpatients (98.6% male, mean age 74.6) enrolled in an ongoing trial.
Subjects had a comprehensive geriatric assessment that included a structured clinical evaluation for depression with geropsychiatric consultation. A 5-item version of the GDS was created from the 15-item GDS by selecting the items with the highest Pearson chi2 correlation with clinical diagnosis of depression. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for the 15-item GDS and the new 5-item scale.
Subjects had a mean GDS score of 6.2 (range 0-15). Clinical evaluation found that 46% of subjects were depressed. The depressed and not depressed groups were similar with regard to demographics, mental status, educational level, and number of chronic medical conditions. Using clinical evaluation as the gold standard for depression, the 5-item GDS (compared with the 15-item GDS results shown in parentheses) had a sensitivity of .97 (.94), specificity of .85 (.83), positive predictive value of .85 (.82), negative predictive value of .97 (.94), and accuracy of .90 (.88) for predicting depression. Significant agreement was found between depression diagnosis and the 5-item GDS (kappa = 0.81). Multiple other short forms were tested, and are discussed. The mean administration times for the 5- and 15-item GDS were .9 and 2.7 minutes, respectively.
The 5-item GDS was as effective as the 15-item GDS for depression screening in this population, with a marked reduction in administration time. If validated elsewhere, it may prove to be a preferred screening test for depression.
Comparison of consistency and validity of Fried frailty phenotype, Frail scale and Edmonton frailty scale for frailty screening among community‐dwelling older adults
- J. Han
- J. Wang
- B. Xie
- Y. Wang