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

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.

Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

“…Late-life depression and mild cognitive deficits frequently coexist in older adults (Alexopoulos, 2002;Arve et al, 1999;Bhalla et al, 2009;Butters et al, 2000;Kohler et al, 2010;Nebes et al, 2003;van Ojen et al, 1995;Wang and Blazer, 2015) and are associated with negative outcomes. Depression and cognitive impairment are present in 25% of adults over 85 years old (Alexopoulos, 2002;Arve et al, 1999;Bhalla et al, 2009;Butters et al, 2000;Kohler et al, 2010;Nebes et al, 2003;van Ojen et al, 1995) and contribute to increased medical and psychiatric morbidity and mortality, decreased quality of life, and impairment in social and interpersonal functioning (Alexopoulos et al, 2005;Cacciatore et al, 1998;Ganguli et al, 2002;LaMonica et al, 2019;Lenze et al, 2008;Reynolds et al, 2001;Roberts et al, 2010). Furthermore, depression in older adults with cognitive impairment correlates with more rapid cognitive decline than in cognitive impairment without depression in most (Van der Mussele et al, 2014;Verdelho et al, 2013) but not all (Cooper et al, 2015;Palmer et al, 2010) cohort studies, and is also associated with atrophy in brain regions typically affected in Alzheimer's disease (AD; Lee et al, 2012).…”

Association of social factors and health conditions with capacity and performance

“…Based on the scientific literature on disability, we selected the following self-reported exposures: age (< 38; 38-57; 58-77; and > 78 years old), gender (men/women), level of education (none; incomplete primary education; complete primary; incomplete secondary education; complete secondary; incomplete tertiary education; and complete tertiary), personal income (categorized into quintiles) 12 , and health conditions (hypertension 13 ; arthrosis; chronic respiratory disease 14 ; low back pain (LBP) 14 ; migraine 14 ; anxiety 14 ; dementia 15 ; chronic kidney disease (CKD) 14 ; rheumatic diseases 16 ; and sleep disorders 17 ).…”

Relationship between Multimorbidity and Disability in Elderly Patients with Coexisting Frailty Syndrome

“…Changes caused by aging are correlated with the increased risk of the onset of chronic diseases and the limitation of functional efficiency [ 1 , 2 ]. Older people are also the fastest and most significantly growing social group [ 3 ].…”