Simple reaction time and depression in the elderly

Abstract

A measure of simple reaction time was administered to 111 elderly outpatients who were classified as depressed or nondepressed on two measures and as cognitively impaired or unimpaired based on the Mini-Mental State Exam (MMSE). Patients with cognitive impairment had slower reaction times, whether they were depressed or not. These results support previous findings of minimal influence of depression on cognitive measures in the elderly. They also point to the decreased efficiency of information processing in cognitively impaired individuals, with implications for their engaging in potentially hazardous activities.     

Cognitive complaints in elderly depressed and pseudodemented patients

The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.     

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.     

Structural changes in the brain in depression and relationship to symptom recurrence

Depression is an important public health problem affecting about 15% of the general population; however, little is known about possible changes in the brain that might underlie the disorder. Neuroimaging has been a powerful tool to map actual changes in the brain structure of depressed patients that might be directly related to their symptoms of depression. Some imaging studies of brain structure have shown smaller hippocampal volume with the chronicity of depression correlating to a reduction in volume. Although the meaning of these findings is unclear, other studies have shown increased amygdala volume. Studies have found reductions in volume of the frontal cortex, with some studies showing specific reductions in subregions of the frontal cortex, including the orbitofrontal cortex. Findings of an increase in white matter lesions in elderly patients with depression have been replicated and correlated with late-onset depression, as well as impairments in social and cognitive function. These findings point to alterations in a circuit of brain regions hypothesized to include the frontal cortex, hippocampus, amygdala, striatum, and thalamus, that underlie symptoms of depression.     

Coping strategies and cognitive functioning in elderly people from a rural community in Italy

Stressful situations may contribute to pathological states in elderly people facing harmful events. This study investigated the relationships between adopting appropriate coping strategies, transforming circumstances to personal preferences or adjusting personal preferences to situational constraints, and the efficiency of cognitive functioning in an elderly sample of 121 residents drawn from a rural community in southern Italy. They were administered the Mini-Mental State Examination, the Tenacious Goal Pursuit, Flexible Goal Adjustment, and Coping Inventory for Stressful Situations. Intercorrelations of scores suggested that facing stressful situations is somewhat associated with efficient cognitive functioning and coping strategies that ensure a wide range of solutions.     

Neuropsychometric correlates of the Mini-Mental State Examination: preliminary data

The present study investigated the neuropsychometric correlates of the Mini-Mental State Examination. 12 consecutive neurological referrals were administered the Mini-Mental State Examination, the Wechsler Memory Scale, and the WAIS--R. Pearson product-moment correlations suggest moderate association between scores on the Mini-Mental State Examination and Wechsler Memory Scale but less robust relationships between scores on the Mini-Mental State Examination and WAIS--R Full Scale, Verbal, and Performance IQs.     

Cognitive,affective and social mechanisms in depression risk: Cognition,hostility, and coping style

Although some research has assessed cognitive variables in individuals at risk for depression, few studies have specifically assessed the role of automatic thinking, and virtually no studies have assessed anger and coping in this group. The current study compared measures of these variables in a high-risk group that was defined on the basis of a previous episode of depression, and a control group comprised of low-risk/never depressed individuals. Even though neither group evidenced depressive symptoms at the time of assessment, group comparisons and regression analyses indicated that high-risk individuals reported more negative automatic thoughts than did low-risk participants and that social support seeking, self-blame, and avoidance emerged as coping predictors of risk as did higher levels of anger and hostility. These data thus suggest patterns of interpersonal, behavioural, and cognitive variables that may characterise depression risk.     

Psychometric properties of the Folstein Mini-Mental State Examination

Criterion-referenced (Livingston) and norm-referenced (Gilmer-Feldt) techniques were used to measure the internal consistency reliability of Folstein's Mini-Mental State Examination (MMSE) on a large sample (N = 418) of elderly medical patients. Two administration and scoring variants of the MMSE Attention and Calculation section (Serial 7s only and WORLD only) were investigated. Livingston reliability coefficients (rs) were calculated for a wide range of cutoff scores. As necessary for the calculation of the Gilmer-Feldt r, a factor analysis showed that the MMSE measures three cognitive domains. Livingston's r for the most widely used MMSE cutoff score of 24 was .803 for Serial 7s and .795 for WORLD. The Gilmer-Feldt internal consistency reliability coefficient was .764 for Serial 7s and .747 for WORLD. Item analysis showed that nearly all of the MMSE items were good discriminators, but 12 were too easy. True score confidence intervals should be applied when interpreting MMSE test scores.     

The Caregivers of Stroke Patients: An Investigation of Factors Associated with Depression

Caregivers of the elderly and infirm are often under more stress and report lower life satisfaction than matched groups of noncaregivers. Forty caregivers of stroke patients (usually a spouse) were interviewed an average of 9 months poststroke to determine the factors associated with poorer caregiver adjustment. Four classes of variables were expected to be related to depression in caregivers: level of functioning of the patient, caregiver perceptions of increased work and burden due to the stroke, the quality of the patient-caregiver relationship, and caregivers' interpretations of their situation. Background characteristics were also measured. As predicted, variables in each class were significantly related to depression. Multiple regression analysis showed three significant independent predictors of caregiver depression. Caregivers are more depressed if the patient is more physically impaired, if caregivers report disharmony in the family, and if they have lesser perceptions of hope Ways to apply these findings to the development of interventions to ameliorate caregiver depression are discussed.     

Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables

Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n = 182) and nonchildbearing (NCB; n = 179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V) x Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V x LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V X LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V x LS interactions support the vulnerability-stress model of postpartum depression.     

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.     

Predictors of self-reported prospective and retrospective memory in a population-based sample of older adults

In this article, the authors examined predictors of self-reported everyday memory failures using the Prospective and Retrospective Questionnaire (PRMQ; Smith, Della Sala, Logie, & Maylor, 2000) in a population-based sample of older adults (age range = 60-90 years; N = 250). The results showed that a higher frequency of reported failures was associated with lower scores on the personality dimension of self-directedness as assessed by the Temperament and Character Inventory (TCI; Cloninger, Dragan, Svrakic, & Przybeck, 1993) and more depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977). However, PRMQ scores showed no relationships with objective memory ability, as reflected by a series of retrospective memory measures and a measure of prospective memory. Neither were the PRMQ scales associated with general cognitive functioning as assessed by the Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1977). Taken together, the results indicate that within the older population, self-reported memory as assessed by the PRMQ may reflect mood-state and personality factors rather than individual differences in memory and cognitive ability.     

Frontal EEG alpha band asymmetry as a predictor of reasoning deficiency in depressed people

Cognitive deficits in depression are mostly apparent in executive functions, especially when integration of information and reasoning is required. In parallel, there are also numerous studies pointing to the frontal alpha band asymmetry as a psychophysiological marker of depression. In this study, we explored the role of frontal alpha asymmetry as a potential factor explaining the cognitive problems accompanying depression. Twenty-six depressed and 26 control participants completed a reasoning task and underwent 5 minutes of electroencephalography recording. In line with the previous studies, depressed people showed difficulties with reasoning but we did not observe the relationship between frontal asymmetry in the alpha band and depression. However, we found that in the depressed group the frontal alpha asymmetry index was characterised by larger variance than in the control group, and it was also a strong predictor of cognitive functioning exclusively in the depressed group. Our results point to the disruption of a psychophysiological balance, reflected in changed frontal alpha asymmetry (into more left-sided frontal asymmetry in the alpha band, reflecting more right-sided cortical activity) as a possible brain correlate of cognitive disturbances present in depressive disorders.     

Learning mnemonics: roles of aging and subtle cognitive impairment

Previously validated methods of memory training were used in conjunction with the Folstein Mini-Mental State Examination (MMSE) to explore the relationship between complexity of learned mnemonic, aging, and subtle cognitive impairment. Subjects were 218 community-dwelling elderly. Treatment included imagery mnemonics for remembering names and faces and lists. There was a significant interaction among age, type of learning task (face-name vs. list), and improvement when controlling for MMSE score. There was also a significant interaction among MMSE score, type of learning task, and improvement when controlling for age. Scores on the more complex list-learning mnemonic were more affected by age and MMSE scores than were scores on the face-name mnemonic. Implications of the findings for cognitive training of the old old and the impaired are discussed.     

A longitudinal study of the psychosocial impact of stroke on primary support persons

We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patient's primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.     

Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents

Past research into the psychological consequences of traumatic events has largely focused on post-traumatic stress disorder (PTSD), although other anxiety disorders and depression are also common in the aftermath of trauma. Little is known about differential predictors of these conditions. The present study investigated the extent to which theoretically derived cognitive variables predict PTSD, phobias and depression after motor vehicle accidents. The cognitive predictors were compared to a set of established, mainly non-cognitive predictors. In addition, we tested how disorder-specific the cognitive predictors are. Participants (n=101) were interviewed within a year after having been injured in a motor vehicle accident. Diagnoses of PTSD, travel phobias and depression, symptom severities and predictor variables were assessed with self-report questionnaires and structured interviews. In multiple regression analyses, the sets of cognitive variables derived from disorder-specific models explained significantly greater proportions of the variance of the symptom severities than the established predictors (PTSD 76% vs. 45%, depression 72% vs. 46% and phobia 66% vs. 40%), and than cognitive variables derived from the models of the other disorders. In addition, the majority of individual cognitive variables showed the expected pattern of differences between diagnostic groups. The results support the hypothesis that disorder-specific sets of cognitive factors contribute to the development and maintenance of PTSD, phobias and depression following traumatic events.     

Neuropsychological correlates of Greek alcoholic patients who report memory disturbances

We studied 40 male and 37 female (M age=63 yr.) Greek alcoholic patients and an equal number of control subjects. Both groups were evaluated with the Mini-Mental State Examination, the Syndrome Short Test, the Verbal Fluency Test (Category & Letter), the Clock Test, and the Digit Span (Forward and Backward from the Wechsler Adult Intelligence Scale-Revised). Alcoholic patients had statistically significant lower scores on MMSE, Verbal Fluency Test, and Digit Span, and higher scores on the Syndrome Short Test, while positive correlations were found among MMSE, Verbal Fluency Test, Clock Test, Digit Span-Backward, and age. These findings point to frontal lobe dysfunction in Greek alcoholic patients which is not different from that shown in patients from diverse ethnic and cultural backgrounds.     

Competence in Everyday Activities as a Predictor of Cognitive Risk and Mortality

This study examined the association of a performance-based measure of everyday functioning with clinically meaningful outcomes. Elderly participants in a prospective study of dementia were assessed at two occasions on the Everyday Problems Test for Cognitively Challenged Elderly (EPCCE), a performance-based measure of everyday functioning. Older adults who remained cognitively intact performed approximately 0.66 SD units higher on the EPCCE at both occasions than elders rated as impaired, when covarying on age, education, gender, and cognitive status. Relative to the nonimpaired participants, decline in EPCCE performance over a 2-year interval was significantly greater for impaired participants and those participants who transitioned from nonimpaired to impaired over the course of the study. Increased risk of mortality was associated with lower baseline scores and decline in EPCCE performance even after controlling for demographic variables and performance on the Mini-Mental State Examination. Given the clinical importance of identifying “at risk” elders for impairment, the findings from this study provide initial evidence for the predictive utility of performance-based measures of everyday functioning.     

Competence in everyday activities as a predictor of cognitive risk and mortality

This study examined the association of a performance-based measure of everyday functioning with clinically meaningful outcomes. Elderly participants in a prospective study of dementia were assessed at two occasions on the Everyday Problems Test for Cognitively Challenged Elderly (EPCCE), a performance-based measure of everyday functioning. Older adults who remained cognitively intact performed approximately 0.66 SD units higher on the EPCCE at both occasions than elders rated as impaired, when covarying on age, education, gender, and cognitive status. Relative to the nonimpaired participants, decline in EPCCE performance over a 2-year interval was significantly greater for impaired participants and those participants who transitioned from nonimpaired to impaired over the course of the study. Increased risk of mortality was associated with lower baseline scores and decline in EPCCE performance even after controlling for demographic variables and performance on the Mini-Mental State Examination. Given the clinical importance of identifying "at risk" elders for impairment, the findings from this study provide initial evidence for the predictive utility of performance-based measures of everyday functioning.     

Cognitive ability predicts objectively measured counterproductive work behaviors

Over the past 2 decades, increasing attention has been directed at the relationship between individual differences and counterproductive work behaviors (CWB). However, most of this research has focused on personality variables as potential predictors of CWB; surprisingly little research has investigated the link between counterproductivity and cognitive ability. This study presents the first focal investigation of the cognitive ability-CWB relationship. The authors measured organizational and interpersonal CWB using organizational records of formally recorded incidents (e.g., destruction of property, physical violence). In a predictive study, for a large sample of law enforcement job applicants, a standardized psychometric test of cognitive ability predicted CWB, whereas educational attainment did not.