Reliability of proxy response on mental health indices for aged, community-dwelling women

The correspondence between respondent and proxy response was evaluated on 4 mental health measures (Affect Balance Scale, Center for Epidemiological Studies Depression Scale, Mental Status Questionnaire, and Mini-Mental State Examination) with a sample of 538 respondent-proxy pairs. Results indicated that respondent and proxy responses were strongly associated, particularly for the cognitive measures. This association was found even for respondents classified as depressed or cognitively impaired. Although there was evidence of proxy bias, with proxies underrating affective status and overrating cognitive status, the magnitude of the bias proved small for all scales but the Mental Status Questionnaire. Examination of response comparability by proxy characteristics showed that choice of proxy affected agreement and bias. Implications of these findings for survey research are discussed.     

MEMORY AND COGNITIVE ABILITIES IN UNIVERSITY PROFESSORS:

Abstract— Professors from the University of California at Berkeley were administered a 90-min test battery of cognitive performance that included measures of reaction time, paired-associate learning, working memory, and prose recall. Age effects among the professors were observed on tests of reaction time, paired-associate memory, and some aspects of working memory. Age effects were not observed on measures of proactive interference and prose recall, though age-related declines are generally observed in standard groups of elderly individuals. The findings suggest that age-related decrements in certain cognitive functions may be mitigated in intelligent, cognitively active individuals     

Dual-task effects of simulated lane navigation and story recall in older adults with and without memory impairment

ABSTRACT

While driving is a complex task, it becomes relatively automatic over time although unfamiliar situations require increased cognitive effort. Much research has examined driving risk in cognitively impaired elders and found little effect. This study assessed whether mildly memory impaired elders made disproportionate errors in driving or story recall, under simultaneous simulated driving and story recall. Forty-six healthy (61% women; mean age = 76.4) and 15 memory impaired (66% women, mean age = 79.4) elders participated. Cognitive status was determined by neuropsychological performance. Results showed that during dual-task conditions, participants stayed in lane more, and recalled stories more poorly, than when they did the tasks separately. Follow-up analysis revealed that verbatim recall, in particular, was reduced while driving for healthy participants. While memory impaired participants performed more poorly than healthy controls on both tasks, cognitive status was not associated with greater dual-task costs when driving and story recall were combined.     

Spatial navigation deficits in amnestic mild cognitive impairment with neuropsychiatric comorbidity

Aims: To find out whether neuropsychiatric comorbidity (comMCI) influences spatial navigation performance in amnestic mild cognitive impairment (aMCI).

Methods: We recruited aMCI patients with (n = 21) and without (n = 21) neuropsychiatric comorbidity or alcohol abuse, matched for global cognitive impairment and cognitively healthy elderly participants (HE, n = 22). They completed the Mini-Mental State Examination and a virtual Hidden Goal Task in egocentric, allocentric, and delayed recall subtests.

Results: In allocentric navigation, aMCI and comMCI performed significantly worse than HE and similarly to each other. Although aMCI performed significantly worse at egocentric navigation than HE, they performed significantly better than patients with comMCI.

Conclusions: Despite the growing burden of dementia and the prevalence of neuropsychiatric symptoms in the elderly population, comMCI remains under-studied. Since trials often assess “pure” aMCI, we may underestimate patients’ navigation and other deficits. This finding emphasizes the importance of taking account of the cognitive effects of psychiatric disorders in aMCI.     

Frontal Lobe Function and Pain in the Elderly

We review the literature on pain and aging and conclude that evidence supports a hypothesis that right frontal cortex contributes to the mediation of the chronic pain experience in elderly persons with chronic pain syndromes. Evidence for the right frontal pain hypothesis comes from clinical, neurocognitive, and neuroimaging studies, which implicate right inferior and orbitofrontal cortex in (1) the persistent pain experience, (2) negative emotional states, (3) retrieval of negative emotional and autobiographical memories, (4) regulation of autonomic arousal, and (5) regulation of attentional and pain functions of the anterior cingulate region. Right frontal dysfunction is also implicated in the effects of cognitive aging. If right frontal neurocognitive systems are affected in cognitively impaired elderly, and if (by hypothesis) the right frontal cortex also plays a major role in the experience of chronic pain, then cognitively impaired elderly with right frontal dysfunction should be protected to some extent from persistent pain syndromes. Available evidence supports this proposition.     

Evaluation of the effects a caregiver training programme has on the cognitive and functional maintenance of the elderly / Valoración de los efectos de un programa de formación de cuidadores sobre el mantenimiento cognitivo y funcional de ancianos

Abstract

With the increase in the elderly population comes a need to ensure they remain cognitively and functionally stable for as long as possible. Achieving this through a caregiver training programme based on the Person Centred Care (PCC) approach has been suggested. On this basis, the purpose of this study has been to evaluate the effectiveness of a caregiver training programme on the cognitive and functional maintenance of the elderly. The study sample comprised 56 elderly people and 14 caregivers, who were assessed using the MMSE, Clifton, Barthel, EuroQol, RMBPC (elderly) and SSFQ (caregivers) measurement scales. The results at intergroup level show significant differences in the pre-treatment assessment: the control group had higher scores for MMSE, Barthel, EuroQol and RMPBC scales, but that difference disappeared as scores for the treatment group increased. At an intragroup level, increases in scores were observed in the MMSE, Clifton and EuroQol scales for the treatment group and decreases in the Clifton, EuroQol and Barthel scales for the control group. From these results we can conclude that a caregiver training programme based on a PCC approach produces cognitive and functional benefits in the elderly. In addition, caregivers in the treatment group felt more competent, confident and satisfied with their work.     

Cognitively impaired older adults exhibit comparable difficulties on naturalistic and laboratory prospective memory tasks

Prospective memory, or remembering future intentions, is critical for independent living for all ages, but especially older adults. Previous laboratory research has found that cognitively impaired older adults may have particular difficulties with prospective memory, but previous studies have not examined whether these difficulties occur in everyday life. In normal ageing, a dissociation between settings has been observed, with older adults selectively impaired in laboratory (but not naturalistic) contexts. Consequently, in the present study 15 cognitively impaired older adults were compared to demographically matched controls on laboratory and naturalistic measures of prospective memory. The results indicated that the cognitively impaired group performed more poorly on both measures, with the magnitude of the deficit comparable across setting. These results indicate that for older adults who present with cognitive impairment prospective memory deficits observed in laboratory settings may be a valid indicator of difficulties experienced executing delayed intentions in everyday life. Copyright © 2008 John Wiley & Sons, Ltd.     

Degree of cognitive impairment and the dissociation of implicit and explicit memory

One group of normal elderly adults and two groups of cognitively impaired elderly adults were compared on an implicit and an explicit memory task. Degree of impairment affected explicit memory; the mildly and moderately impaired elderly adults demonstrated significantly reduced recognition performance. Degree of impairment also affected implicit memory priming performance, particularly for low frequency items, as measured by a word completion task. Explicit memory performance declined for both cognitively impaired groups, but implicit memory performance was sensitive to the degree or severity of impairment, causing a decline in performance only in the moderately impaired group.     

Transference in Psychotherapy with Schizophrenic Patients

Three current approaches to the group therapy of the cognitively intact, depressed elderly are reviewed. Examination of the strengths and limitations of these three models—self psychology, developmental considerations such as reminiscing and life review, and cognitive—behavioral therapies—points in the direction of the usefulness of an integrated model. The main objectives of an integrated approach include: stabilization of the individual's sense of self, establishment of interpersonal competence, and enhanced mastery over the affects of depression and demoralization. Clinical illustrations are provided to demonstrate the practical considerations in this model of group therapy.     

Selective reminding procedure in depression and dementia

Patients with mild dementia of the Alzheimer's type (DAT), patients with major depression, and normal elderly control subjects were administered a verbal learning task using the selective reminding procedure. Depressed patients were impaired on total recall and the proportion of items retained from one trial to the next without reminding and did not benefit from imagery in retaining items over consecutive trials. The DAT patients were impaired on all measures derived from the test, including storage and recognition memory. With the exception of the ability to benefit from imagery, all of the measures distinguished depressed and mild DAT patients. These findings are consistent with deficient encoding in DAT and performance deficits as a function of effortful cognitive processing in depression.     

How cognitive is psychomotor slowing in depression? evidence from a meta-analysis

Abstract

The current meta-analysis explores the hypothesis that many of the apparently specific deficits that depressed subjects show on speeded cognitive tasks are actually the result of general (i.e., task-independent) slowing. Results of three analyses provided strong support for this hypothesis. the reaction times (RTs) of the depressed groups were consistently slower than those of the control groups. Moreover, the degree of cognitive slowing was approximately the same regardless of the task or condition. Regression analyses revealed a proportional relation between the RTs of the two depressed and control groups, suggesting that depression slows sensory/motor and cognitive processes to approximately the same degree. the regression-based approach used in the present analyses has implications for the study of other neurological disorders and also may have important applications in the assessment of both general and specific cognitive deficits in individual patients.     

The indirect effect of cognitive reserve on the relationship between age and cognition in pathological ageing: A cross-sectional retrospective study in an unselected and consecutively enrolled sample

Cognitive reserve (CR) allows individuals to maintain cognitive functionality even in the presence of pathologies. The compensation hypothesis suggests that CR plays an indirect role between age and cognitive decline, contrasting the negative effect of ageing on cognition. We test this hypothesis in an unselected and consecutively enrolled sample of memory clinic attendees (n = 134) who completed the CR Index questionnaire and three neuropsychological tests assessing global cognition (MMSE, FAB, CDT). Participants were divided into two groups based on standard diagnostic criteria (DSM-5): those who were cognitively impaired (n = 92) and those who were preserved (n = 42). A principal component analysis was used to extract a composite measure of global cognitive functioning from the three neuropsychological tests, and mediation analysis was used to examine the relationship between CR, age and global cognitive functioning in the two groups. Results revealed that: (i) age had a significant direct negative effect on the global cognitive score in both groups; (ii) the three socio-behavioural proxies of CR together suppress the direct negative relationship between age and global cognitive score in cognitively impaired patients but not in cognitively preserved participants. This study confirms the association between CR, age and cognition and allows us to validate its role in a population with cognitive impairment and extend findings to a low-to-middle educated population. These results hold important implications for public health and wellness promotion, emphasising the beneficial role of maintaining healthy and active physical, cognitive and social lifestyles.     

Health numeracy and cognitive decline in advanced age

ABSTRACT

The study aimed at investigating health numeracy in cognitively well performing healthy participants aged from 50 to 95 years as well as in participants with cognitive impairment, but no dementia (CIND). In cognitively well performing participants (n = 401), demographic variables and cognitive abilities (executive functions, reading comprehension, mental calculation, vocabulary) were associated with health numeracy. Older age, lower education, female gender as well as lower cognitive functions predicted low health numeracy. The effect of older age was partly mediated by executive functions and calculation abilities. Participants with CIND (n = 51) performed significantly lower than healthy controls in health numeracy. The findings suggest that cognitively well performing old individuals have difficulties in understanding health-related numerical information. The risk of misunderstanding health-related numerical information is increased in persons with CIND. As these population groups are frequently involved in health care decisions, particular attention has to be paid to providing numerical information in comprehensible form.     

Cognitive impairment in the early phase of multiple sclerosis and its relationship with mood, demographic and clinical variables

Our aim was to study cognitive performance in the early phase of MS. In addition, we studied whether depression, demographic and clinical variables differentiate cognitively impaired patients from non-impaired patients. A group of 52 MS-RR patients with mild level of neurological disability and 51 healthy controls were administered a comprehensive neuropsychological battery. The MS group performed significantly worse on several measures of attention and processing speed and visuoperceptive/visuoconstructive tasks. Verbal memory is characterized by working memory deficits, whereas the visual memory impairment is attributable to deficits in acquisition and consolidation/recuperation. Results shows that cognitive impairment is evident even in MS patients in the early course of their disease. Depression scores were higher in cognitively impaired patients as compared with unimpaired patients. The effect of educational level suggests that higher education delays the onset of cognitive decline.     

Performance in normal subjects on a novel battery of driving-related sensory-motor and cognitive tests

Currently, there is no international standard for the assessment of fitness to drive for cognitively or physically impaired persons. A computerized battery of driving-related sensory-motor and cognitive tests (SMCTests) has been developed, comprising tests of visuoperception, visuomotor ability, complex attention, visual search, decision making, impulse control, planning, and divided attention. Construct validity analysis was conducted in 60 normal, healthy subjects and showed that, overall, the novel cognitive tests assessed cognitive functions similar to a set of standard neuropsychological tests. The novel tests were found to have greater perceived face validity for predicting on-road driving ability than was found in the equivalent standard tests. Test—retest stability and reliability of SMCTests measures, as well as correlations between SMCTests and on-road driving, were determined in a subset of 12 subjects. The majority of test measures were stable and reliable across two sessions, and significant correlations were found between on-road driving scores and measures from ballistic movement, footbrake reaction, hand-control reaction, and complex attention. The substantial face validity, construct validity, stability, and reliability of SMCTests, together with the battery’s level of correlation with on-road driving in normal subjects, strengthen our confidence in the ability of SMCTests to detect and identify sensory-motor and cognitive deficits related to unsafe driving and increased risk of accidents.     

Influence of depression on verbal fluency performance

Abstract

Neuropsychologists are often faced with the challenge of assessing older adults who exhibit both cognitive deficits and symptoms of depression. This study examined factors associated with diminished fluency in elderly adults. Three groups were tested: 54 community elderly, 35 institutionalized elderly, and 40 young adults using the Controlled Oral Word Association test. Significant incremental contributions to performance on verbal fluency included age, education, depression, and the interaction term for depression and functional impairment. Diminished verbal fluency was associated with depression among older adults who were not functionally impaired. the results suggest that variables other than cerebral integrity must be taken into consideration when interpreting older adults' performance on fluency tests.     

Cognitive Vulnerability to Persistent Depression

Abstract

The account of cognitive vulnerability to depression offered by Beck's cognitive model is summarised. As this account currently lacks consistent empirical support, an alternative, related, account is presented. This proposes that, once a person is initially depressed, an important factor that determines whether their depression remains mild or transient, or becomes more severe and persistent, is the nature of the negative cognitive processes and constructs that become active and accessible in the depressed state. These interact with the nature of environmental difficulties, available social support, and biological factors, to determine whether a depression-maintaining cognitive-affective vicious cycle will be set up.

Results from studies specifically designed to test predictions from this account have yielded positive results. Findings consistent with the hypothesis have also been obtained in other prospective studies which have shown that cognitive measures, administered in the depressed state, predict the future course of depression independently of initial levels of depression.

The hypothesis is elaborated to incorporate the demonstrated relationship of elevated neuroticism to risk and persistence of depression. Recent views on the nature of sex differences in rates of depression, and on the relationship of attributional style to depression are also compatible with the hypothesis. It is concluded that the hypothesis has encouraging preliminary support.

SUMMARY

Two broad aspects of cognitive vulnerability to depression can be distinguished. The first is the tendency to evaluate certain types of life event in ways which will produce intense rather than mild depression. This is the aspect of vulnerability on which Beck's cognitive model appears to concentrate. There are considerable difficulties in assessing this aspect of Beck's model and it is not consistently supported by comparison of recovered depressed patients with control groups.

The second aspect of cognitive vulnerability relates to the cognitive processes and constructs that become active and accessible once a person is in a state of depression. Within this approach, vulnerability to onset and vulnerability to persistence of depression can be roughly distinguished, depending on whether the focus is on the period when the depression has been present for only a brief period, or is mild, or whether depression has already existed for some time and reached at least moderate severity. The account presented here proposes that a crucial factor determining whether an initially mild or transient depressed state remains mild or soon disappears, or becomes more severe and persistent, is whether a vicious cycle based on a reciprocally reinforcing relationship between depressed mood and negative cognitive processing can become established. The probability that this cycle will become established is, in turn, a function of a complex interaction between the environmental difficulties facing a person, the support available to them, their biological state, and the nature of the cognitive processes and constructs that are active and accessible in the depressed state. The kind of cognitive process and constructs that are most active and accessible in the depressed state will be a function both of the patterns of cognitive processing that are characteristic of the person in their normal mood state (such as those related to neuroticism), and of the patterns of cognitive processing that become active in the depressed state. It is on these latter that the differential activation hypothesis concentrates. It suggests that individual differences in the cognitive processes and constructs that become active and accessible in the depressed' state can make an important contribution to whether an initial state of depression becomes more intense, or fades away, and whether, once established, depression of moderate severity persists a long time or a short time. In particular, it is proposed that processes and constructs related to global negative characterological evaluations of the self or that, in other ways, lead to interpretations of experience as highly aversive and uncontrollable are likely to act to intensify and maintain depression.

Two investigations specifically designed to test predictions from the differential activation hypothesis yielded positive results. Further supportive evidence is available from a number of other studies which have examined the relationship between cognitive measures, administered in the depressed state, and the future course of depression. Such studies haverecurringly found that persistence or return of depression is associated with initially high scores on measures of negative cognition, and this association remains when the effects of initial depression level are partialled out.

In addition to this encouraging preliminary empirical support, the differential activation hypothesis has the further attraction that it can incorporate into this account the well established finding that neuroticism is associated with risk of becoming depressed, and of depression persisting. Further, it is quite consistent with recent proposals related to sex differences in rates of depression, and to the relationship of attributional style to depression.     

Investigating the acute effect of an aerobic dance exercise program on neuro-cognitive function in the elderly

ObjectiveThe present study investigated the types of aerobic dance programs that positively impact cognition, such as executive function, in elderly people.DesignRandomized controlled trial.MethodThe study compared the effects of acute aerobic dance exercise on cognitive performance using two 40-min aerobic dance programs. Thirty-four elderly participants, aged 65–75 years, were randomly assigned into either free (N = 17) or combination (N = 17) style workout groups. The free style (FR) workout consisted of several patterns of movement, while the combination style (CB) workout consisted of similar patterns of movement to FR, but the patterns were joined to form a long choreographic routine. Both dance programs were controlled to be the same in exercise intensity, approximately 40% heart rate reserve. Reaction time and correct rates were measured using a task-switching reaction time test to evaluate executive cognitive performance immediately before and after the 40-min dance exercise.ResultsA two-way (dance program × pre-post dance exercise) repeated-measures analysis of variance for switch reaction time increase (switch cost) demonstrated a significant interaction (p = .006), showing that the switch cost in the CB group became smaller after the dance exercise than before (p = .009).ConclusionThe results suggest that the executive cognitive network was facilitated in a CB dance workout that has a dual-task nature and induces movement (task) interference with unexpected movement changes.     

An Attempt to Predict Change in Mood in Response to Velten-Like Mood Induction Procedures

College student subjects were rated high or low in cognitive and behavioral depression proneness, based on their scores on a screening battery that included the Automatic Thoughts Questionnaire (Hollon & Kendall, 1980), the Dysfunctional Attitude Scale (Weissman, 1979), the Intemality-Extemality Scale (Rotter, 1966), the Pleasant Events Schedule and the Unpleasant Events Schedule (Lewinsohn & Amenson, 1978). The students were subsequently exposed to one of two different Velten-like depressive mood inductions, one based on Beck's (1974) model of depression, and the other based on Lewinsohn's (1974) model. We hypothesized that subjects who scored higher on the cognitive measures would tend to become more depressed when exposed to the Beck statements and that those who scored higher on the behavioral measures would tend to become more depressed when exposed to the Lewinsohn statements. The hypothesis was not supported. Instead, pre-existing cognitively or behaviorally defined depression proneness appeared to be unrelated to subjects' susceptibility to one or the other model of depression as defined by the two mood inductions. However, the inductions themselves were found to produce a significant lowering of mood, and both inductions were equally effective in lowering mood.     

Extending Neuropsychological Assessments into the Primary Mental Ability Space

ABSTRACT

A battery of 17 neuropsychological tests (including the CERAD battery) and 17 psychometric ability tests were administered to a sample of 499 participants of the Seattle Longitudinal study who had been given the psychometric ability tests seven and 14 years earlier. The neuropsychological tests were projected into a 5-factor psychometric ability space by means of extension analysis. The concurrent regressions of the neuropsychology tests on the psychometric ability tests were then used to estimate neuropsychology test scores from the psychometric ability tests administered in 1984, 1991 and 1998. Neuropsychologists then rated the study participants as either normal, suspect or cognitively impaired in 1998. Changes in estimated test scores were computed over seven and fourteen years. Significant odds ratios between normal and cognitively impaired groups were found for all neuropsychological tests over the proximal period and for most tests over the 14-year period. Similar findings occurred for the odds ratios between the normal and suspect groups for the most proximal 7-year changes.