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Disability in older adults across the continuum of cognitive decline: unique contributions of depression, sleep disturbance, cognitive deficits and medical burden

Published online by Cambridge University Press:  04 February 2019

Haley M. LaMonica Open the ORCID record for Haley M. LaMonica [Opens in a new window] ,
Ian B. Hickie ,
Jerome Ip ,
Catriona Ireland ,
Loren Mowszowski ,
Amelia English ,
Nick Glozier  and
Sharon L. Naismith
Haley M. LaMonica
Affiliation:
Healthy Brain Ageing Program, The University of Sydney, Camperdown, NSW, Australia School of Psychology, The University of Sydney, Camperdown, NSW, Australia Central Clinical School, Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Ian B. Hickie
Affiliation:
Central Clinical School, Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Jerome Ip
Affiliation:
Healthy Brain Ageing Program, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Catriona Ireland
Affiliation:
Healthy Brain Ageing Program, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Loren Mowszowski
Affiliation:
Healthy Brain Ageing Program, The University of Sydney, Camperdown, NSW, Australia School of Psychology, The University of Sydney, Camperdown, NSW, Australia Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Amelia English
Affiliation:
Central Clinical School, Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Nick Glozier
Affiliation:
Central Clinical School, Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
Sharon L. Naismith*
Affiliation:
Healthy Brain Ageing Program, The University of Sydney, Camperdown, NSW, Australia School of Psychology, The University of Sydney, Camperdown, NSW, Australia Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
*
Correspondence should be addressed to: Sharon L. Naismith, Healthy Brain Ageing Program, Brain and Mind Centre, School of Psychology, The University of Sydney, 94 Mallet Street, Camperdown, NSW 2050 Australia. Phone: +61 2 9351 0781; Fax: +61 2 9351 0551. Email: [email protected].
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Abstract

Objectives:

Disability in older adults is associated with a need for support in work, education, and community activities, reduced independence, and poorer quality of life. This study examines potential determinants of disability in a clinical sample of older adults across the continuum of cognitive decline, including sociodemographic, medical, psychiatric, and cognitive factors.

Design:

This is a cross-sectional study.

Setting:

Participants were recruited from a specialty clinic for adults “at risk” of or with early dementia (including subjective cognitive complaints, mild cognitive impairment, and early dementia).

Participants:

Four hundred forty-two older adults (mean age = 67.11, SD = 9.33) underwent comprehensive medical, neuropsychological, and mood assessments.

Measurements:

Disability was assessed via the self-report World Health Organization Disability Assessment Schedule 2.0. A stepwise (forward) linear regression model was computed to determine factors that contribute to disability within this group.

Results:

Depressive symptoms were the largest predictor, uniquely explaining 31.8% of the variance. Other contributing factors in the model included younger age, medical burden, and sleep quality, with all factors together accounting for a total of 50.4% of the variance in disability. Cognitive variables did not contribute to the model.

Conclusions:

Depressive symptoms account for a significant portion of the variance in disability, but other factors such as age, medical burden and sleep quality are also important contributors in older adults across the continuum of cognitive decline. The relative association of these variables with disability appears to differ for older (≥65 years) relative to younger (<65 years) participants. Given the relationship between disability and these risk factors, an integrative and multidisciplinary approach to risk reduction will likely be most effective, with potential carry over effects for physical and mental health.

Keywords

disabilitydepressionmild cognitive impairmentdementiasleep
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 11: Issue Theme: Psychiatric Morbidity in Exceptionally Old People , November 2019 , pp. 1611 - 1625
Copyright
© International Psychogeriatric Association 2019 

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4 edn). Washington, DC: American Psychiatric Association.Google Scholar
Arroll, B. et al. (2009). Antidepressants versus placebo for depression in primary care. Cochrane Database of Systematic Reviews, 8, CD007954.Google Scholar
Australian Institute of Health and Welfare (AIHW) (2006). Disability Support Services 2004-2005: National Data on Services Provided under the Commonwealth State/Territory Disability Agreement. Canberra: AIHW.Google Scholar
Bartels, C., Wagner, M., Wolfsgruber, S., Ehrenreich, H., Schneider, A. and Alzheimer’s Disease Neuroimaging Initiative (2018). Impact of SSRI therapy on risk of conversion from mild cognitive impairment to Alzheimer’s dementia in individuals with previous depression. American Journal of Psychiatry, 175, 232–241.CrossRefGoogle ScholarPubMed
Benton, A. L. and Hamsher, K. D. (1978). Multilingual Aphasia Examination Manual. Iowa City: University of Iowa.Google Scholar
Biritwum, R. et al. (2016). Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas, 91, 8–18.CrossRefGoogle ScholarPubMed
Blazer, D. G. (2003). Depression in late life: review and commentary. Journal Gerontology Series A Biological Science Medical Science, 58, M249–M265.CrossRefGoogle ScholarPubMed
Brommelhoff, J. A., Gatz, M., Johansson, B., McArdle, J. J., Fratiglioni, L. and Pedersen, N. L. (2009). Depression as a risk factor or prodromal feature for dementia? Findings in a population-based sample of Swedish twins. Psychological Aging, 24, 373–384.CrossRefGoogle ScholarPubMed
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. and Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefGoogle ScholarPubMed
Cockayne, N. L. et al. (2015). The Beyond Ageing Project Phase 3 - a double blind, selective prevention, randomised, placebo-controlled trial of omega-3 fatty acids and sertraline in an older age cohort at risk for depression: a study protocol for randomized controlled trial. BMC Medicine, 16, 247.Google Scholar
Dillon, C., Serrano, C. M., Castro, D., Leguizamón, P. P., Heisecke, S. L. and Taragano, F. E. (2013). Behavioral symptoms related to cognitive impairment. Neuropsychatric Disease and Treatment, 9, 1443–1455.CrossRefGoogle ScholarPubMed
Dorenlot, P., Harboun, M., Bige, V., Henrard, J. C. and Ankri, J. (2005). Major depression as a risk factor for early institutionalization of dementia patients living in the community. International Journal of Geriatric Psychiatry, 20, 471–478.CrossRefGoogle ScholarPubMed
Espelt, A. et al. (2010). Disability among older people in a southern European city in 2006: trends in gender and socioeconomic inequalities. Journal of Women’s Health, 19, 927–933.CrossRefGoogle Scholar
Gustavson, K. A., Alexopoulos, G. S., Niu, G. C., McCulloch, C., Meade, T. and Areán, P. A. (2016). Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction. The American Journal of Geriatric Psychiatry, 24, 11–17.CrossRefGoogle ScholarPubMed
Hayes, A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach (2 edn). New York: The Guilford Press.Google Scholar
Hindmarch, I., Lehfeld, H., de Jongh, P. and Erzigkeit, H. (1998). The Bayer activities of daily living scale (B-ADL). Dementia and Geriatric Cognitive Disorders, 9, 20–26.CrossRefGoogle Scholar
Holtzer, R. et al. (2005). Depressive symptoms in Alzheimer’s disease: natural course and temporal relation to function and cognitive status. Journal of the American Geriatrics Society, 53, 2083–2089.CrossRefGoogle ScholarPubMed
Kales, H. C., Chen, P., Blow, F. C., Welsh, D. E. and Mellow, A. M. (2005). Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression. The American Journal of Geriatric Psychiatry, 13, 441–449.CrossRefGoogle ScholarPubMed
Kessing, L. V. and Andersen, P. K. (2004). Does the risk of developing dementia increase with the number of episodes of patients with depressive disorder and in patients with bipolar disorder? Journal of Neurology, Neurosurgery and Psychiatry, 75, 1662–1666.CrossRefGoogle ScholarPubMed
Kim, J. M. et al. (2005). Physical health, depression and cognitive function as correlates of disability in an older Korean population. International Journal of Geriatric Psychiatry, 20, 160–167.CrossRefGoogle Scholar
Kinne, S. (2008). Distribution of secondary medical problems, impairments, and participation limitations among adults with disabilities and their relationship to health and other outcomes. Disability and Health Journal, 1, 42–50.CrossRefGoogle ScholarPubMed
Laidlaw, K., Thompson, L. W. and Gallagher-Thompson, D. (2004). Comprehensive conceptualization of cognitive behaviour therapy for late life depression. Behavioural and Cognitive Psychotherapy, 32, 389–399.CrossRefGoogle Scholar
Lockwood, K. A., Alexopoulos, G. S. and van Gorp, W. G. (2002). Executive dysfunction in geriatric depression. American Journal of Psychiatry, 159, 1119–1126.CrossRefGoogle ScholarPubMed
Ludvigsson, M., Bernfort, L., Marcusson, J., Wressle, E. and Milberg, A. (2018). Direct costs of very old persons with subsyndromal depression: a 5-year prospective study. American Journal of Geriatric Psychiatry, 26, 741–751.CrossRefGoogle ScholarPubMed
Mahesh, M. et al. (2016). Disability in Singapore’s elderly population. Annals of the Academy of Medicine, Singapore, 45, 284–296.Google ScholarPubMed
McKeith, I., Taylor, J. P., Thomas, A., Donaghy, P. and Kane, J. (2016). Revisiting DLB diagnosis: a consideration of prodromal DLB and of the diagnostic overlap with Alzheimer’s disease. Journal of Geriatric Psychiatry and Neurology, 29, 249–253.CrossRefGoogle Scholar
McKhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7, 263–269.CrossRefGoogle Scholar
Millán-Calenti, J. C., Maseda, A., Rochette, S., Vázquez, G. A., Sánchez, A. and Lorenzo, T. (2011). Mental and psychological conditions, medical comorbidity and functional limitation: differential associations in older adults with cognitive impairment, depressive symptoms and co-existence of both. International Journal of Geriatric Psychiatry, 26, 1071–1079.CrossRefGoogle Scholar
Miller, M. D. et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237–248.CrossRefGoogle ScholarPubMed
Mirza, S. S. et al. (2016). 10-year trajectories of depressive symptoms and risk of dementia: a population-based study. Lancet Psychiatry, 3, 628–635.CrossRefGoogle ScholarPubMed
Mojtabai, R. and Olfson, M. (2004). Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychological Medicine, 34, 623–634.CrossRefGoogle ScholarPubMed
Mottram, P. G., Wilson, K. and Strobl, J. J. (2006). Antidepressants for depressed elderly. The Cochrane Library, 25, CD003491.Google Scholar
Naismith, S. L., Glozier, N., Burke, D., Carter, P. E., Scott, E. and Hickie, I. B. (2009). Early intervention for cognitive decline: is there a role for multiple medical or behavioural interventions? Early Intervention in Psychiatry, 3, 19–27.CrossRefGoogle ScholarPubMed
Naismith, S. L., Longley, W. A., Scott, E. M. and Hickie, I. B. (2007). Disability in major depression related to self-rated and objectively-measured cognitive deficits: a preliminary study. BMC Psychiatry, 7, 32.CrossRefGoogle ScholarPubMed
Naismith, S. L. et al. (2011a). Sleep disturbance in mild cognitive impairment: differential effects of current and remitted depression. Acta Neuropsychiatrica, 23, 167–172.CrossRefGoogle ScholarPubMed
Naismith, S. L. et al. (2011b). Sleep disturbance relates to neuropsychological functioning in late-life depression. Journal of Affective Disorders, 132, 139–145.CrossRefGoogle ScholarPubMed
Nakakubo, S. et al. (2016). Sleep duration and excessive daytime sleepiness are associated with incidence of disability in community-dwelling older adults. Journal of the American Medical Directors Association, 17, 768. e761–765.CrossRefGoogle ScholarPubMed
National Health Medical Research Council (2009). Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra, ACT: Commonwealth of Australia.Google Scholar
Neary, D. et al. (1998). Frontotemporal lobor degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 1546–1554.CrossRefGoogle Scholar
Norton, S., Matthews, F. E., Barnes, D. E., Yaffe, K. and Brayne, C. (2014). Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurology, 13, 788–794.CrossRefGoogle ScholarPubMed
Orfila, F., Ferrer, M., Lamarca, R., Tebe, C., Domingo-Salvany, A. and Alonso, J. (2006). Gender differences in health-related quality of life among the elderly: the role of objective functional capacity and chronic conditions. Social Science & Medicine, 63, 2367–2380.CrossRefGoogle ScholarPubMed
Park, S. M., Jang, S. N. and Kim, D. H. (2010). Gender differences as factors in successful ageing: a focus on socioeconomi status. Journal of Biosocial Science, 42, 99–111.CrossRefGoogle ScholarPubMed
Reitan, R. M. (1986). Trail Making Test: Manual for Administration and Scoring. Arizona: Reitan Neuropsychology Laboratory.Google Scholar
Rosen, W. G. (1980). Verbal fluency in aging and dementia. Journal of Clinical and Experimental Neuropsychology, 2, 135–146.CrossRefGoogle Scholar
Serfaty, M. A., Haworth, D., Blanchard, M., Buszewicz, M., Murad, S. and King, M. (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Archives of General Psychiatry, 66, 1332–1340.CrossRefGoogle ScholarPubMed
Sexton, C. E. et al. (2012). Exploring the pattern and neural correlates of neuropsychological impairment in late-life depression. Psychological Medicine, 42, 1195–1202.CrossRefGoogle ScholarPubMed
Stenholm, S. et al. (2014). Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study. Journal of Gerontology Series A Biological Science Medical Science, 70, 332–338.CrossRefGoogle ScholarPubMed
Stuck, A. E., Walthert, J. M., Nikolaus, T., Büla, C. J., Hohmann, C. and Beck, J. C. (1999). Risk factors for functional status decline in community-living elderly people: a systematic literature review. Social Science & Medicine, 48, 445–469.CrossRefGoogle ScholarPubMed
Taragano, F. E. et al. (2009). Mild behavioral impairment and risk of dementia. Journal of Clinical Psychiatry, 70, 584–592.CrossRefGoogle Scholar
Taş, Ü. et al. (2007). Incidence and risk factors of disability in the elderly: the Rotterdam Study. Preventive Medicine, 44, 272–278.CrossRefGoogle ScholarPubMed
Unützer, J. (2002). Diagnosis and treatment of older adults with depression in primary care. Biological Psychiatry, 52, 285–292.CrossRefGoogle ScholarPubMed
Unützer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. Journal of the American Medical Association, 288, 2836–2845.CrossRefGoogle ScholarPubMed
Üstün, T. B. (2010). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0. Geneva: World Health Organization.Google Scholar
van Rijn, R. M., Robroek, S. J., Brouwer, S. and Burdorf, A. (2014). Influence of poor health on exit from paid employment: a systematic review. Occupational and Environmental Medicine, 71, 295–301.CrossRefGoogle ScholarPubMed
van’t Veer-Tazelaar, P. J. et al. (2009). Stepped-care prevention of anxiety and depression in late life: a randomized controlld trial. Archives of General Psychiatry, 66, 297–304.CrossRefGoogle Scholar
Wechsler, D. (1997a). Wechsler Adult Intelligence Scale - Third Edition. Administration and Scoring Manual. San Antonio: The Psychological Corporation.Google Scholar
Wechsler, D. (1997b). Wechsler Memory Scale-Third edition. Administration and Scoring Manual. San Antonio: The Psychological Corporation.Google Scholar
Wiese, B. S. (2011). Geriatric depression: the use of antidepressants in the elderly. British Columbia Medical Journal, 53, 341–347.Google Scholar
Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 724–747.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar
World Health Organization (2011). World Report on Disability. Geneva: World Health Organization.Google Scholar
World Health Organization (2013). World Health Statistics 2013. Geneva: World Health Organization.Google Scholar
Yesavage, J. A. and Sheikh, J. I. (1986). 9/Geriatric depression scale (GDS) recent evidence and development of a shorter violence. Clinical Gerontologist, 5, 165–173.CrossRefGoogle Scholar
Zarrabian, M. M., Johnson, M. and Kriellaars, D. (2014). Relationship between sleep, pain, and disability in patients with spinal pathology. Archives of Physical Medicine and Rehabilitation, 95, 1504–1509.CrossRefGoogle ScholarPubMed