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24 Associations Between Positive Psychological Factors and Neurocognitive Functioning in Older Adults
- Jacqueline E Maye, Colin A Depp, Ellen E Lee, Ho-Cheol Kim, Dilip V Jeste, Elizabeth W Twamley
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 337
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Objective:
Psychological wellness and strong cognitive skills are both important to successful aging. Although there are well-established relationships between psychiatric illness (e.g., depression, anxiety, PTSD) and cognitive dysfunction, few studies have focused on the relationships between positive psychological factors and neurocognitive function in older adults. Our goal was to explore associations between these two sets of measures in older adults.
Participants and Methods:Participants (n=111) were part of a longitudinal study of biopsychosocial functioning in independently living older adult residents of a Continuing Care Senior Housing Community. Participants were administered a cognitive screening test (Montreal Cognitive Assessment; MoCA), a comprehensive neuropsychological battery, and a set of published self-report scales measuring positive emotional and psychological function. Neuropsychological scores were appropriately normed, and composite scores were calculated for the following domains: language (Boston Naming Test, Delis-Kaplan Executive Function System [D-KEFS] Verbal Fluency), attention/working memory (Wechsler Adult Intelligence Scale-IV [WAIS-IV] Digit Span, DKEFS Visual Scanning), learning and delayed recall (Brief Visuospatial Memory Test-Revised, Hopkins Verbal Learning Test-Revised), processing speed (WAIS-IV Coding, D-KEFS Trails Number and Letter Sequencing, D-KEFS Color-Word Interference Test Color and Word Naming), and executive function (D-KEFS Color-Word Inhibition and Inhibition/Switching, DKEFS Letter/Number Switching). Self-Report scales included the Perceived Stress Scale, Center for Epidemiological Studies in Depression Scale, Emotional Support Scale, Connor-Davidson Resilience Scale, Coping Humor and Self-Efficacy Scales, Personal Mastery Scale, Meaning in Life Scale, Self-Rated Successful Aging, Satisfaction with Life, Cognitive Failures Questionnaire, and Lifetime Orientation Test-Revised. Due to the large number of psychological functioning measures, dimension reduction was undertaken via principal component analysis, resulting in a two-factor solution. Bivariate Pearson correlations were then computed between the two factor scores and each neurocognitive variable.
Results:Factor 1 consisted of variables reflecting Positive Subjective Functioning. A higher score on Factor 1 (indicating higher self-rating of successful aging, fewer perceived cognitive failures, fewer reported depressive symptoms, less perceived stress/anxiety, more perceived emotional support, more satisfaction with life, more meaningfulness in life, and more search for meaning in life) was associated with better attention/working memory (r=0.226, p=0.049) and executive function (r=0.242, p=0.035). Factor 2 consisted of variables that reflected Positive Coping Skills. A higher score on Factor 2 (indicating more happiness, higher optimism, greater resilience, higher sense of personal mastery, more use of humor as a coping strategy, and greater coping self-efficacy) was associated with better performance on tests of language (r=0.325, p=0.004), learning (r=0.313, p=0.006) and delayed recall (r=0.241, p=0.035) of visual and verbal information, and better MoCA performance (r=0.440, p<0.001). Neither factor was associated with processing speed.
Conclusions:Higher levels of subjective functioning and positive outlook/coping skills were associated with better neuropsychological performance. Given that late life is a time of risk for cognitive decline, future research should consider the influence of positive psychological functioning on neurocognitive outcomes and vice versa, as these relationships may have neurobiological and therapeutic implications for overall function in later life.
2 Neuropsychological Predictors of Posttraumatic Stress Disorder and Depressive Symptom Improvement in Compensatory Cognitive Training for Veterans with a History of Mild Traumatic Brain Injury
- Amber V Keller, Jillian M.R. Clark, Jacqueline E Maye, Amy J Jak, Maya E O’Neil, Rhonda M Williams, Aaron P Turner, Kathleen F Pagulayan, Elizabeth W Twamley
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 515-517
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Objective:
Mild traumatic brain injury (mTBI), depression, and posttraumatic stress disorder (PTSD) are a notable triad in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) Veterans. With the comorbidity of depression and PTSD in Veterans with mTBI histories, and their role in exacerbating cognitive and emotional dysfunction, interventions addressing cognitive and psychiatric functioning are critical. Compensatory Cognitive Training (CCT) is associated with improvements in areas such as prospective memory, attention, and executive functioning and has also yielded small-to-medium treatment effects on PTSD and depressive symptom severity. Identifying predictors of psychiatric symptom change following CCT would further inform the interventional approach. We sought to examine neuropsychological predictors of PTSD and depressive symptom improvement in Veterans with a history of mTBI who received CCT.
Participants and Methods:37 OEF/OIF/OND Veterans with mTBI history and cognitive complaints received 10-weekly 120-minute CCT group sessions as part of a clinical trial. Participants completed a baseline neuropsychological assessment including tests of premorbid functioning, attention/working memory, processing speed, verbal learning/memory, and executive functioning, and completed psychiatric symptom measures (PTSD Checklist-Military Version; Beck Depression Inventory-II) at baseline, post-treatment, and 5-week follow-up. Paired samples t-tests were used to examine statistically significant change in PTSD (total and symptom cluster scores) and depressive symptom scores over time. Pearson correlations were calculated between neuropsychological scores and PTSD and depressive symptom change scores at post-treatment and follow-up. Neuropsychological measures identified as significantly correlated with psychiatric symptom change scores (p^.05) were entered as independent variables in separate multiple linear regression analyses to predict symptom change at post-treatment and follow-up.
Results:Over 50% of CCT participants had clinically meaningful improvement in depressive symptoms (>17.5% score reduction) and over 20% had clinically meaningful improvement in PTSD symptoms (>10-point improvement) at post-treatment and follow-up. Examination of PTSD symptom cluster scores (re-experiencing, avoidance/numbing, and arousal) revealed a statistically significant improvement in avoidance/numbing at follow-up. Bivariate correlations indicated that worse baseline performance on D-KEFS Category Fluency was moderately associated with PTSD symptom improvement at post-treatment. Worse performance on both D-KEFS Category Fluency and Category Switching Accuracy was associated with improvement in depressive symptoms at post-treatment and follow-up. Worse performance on D-KEFS Trail Making Test Switching was associated with improvement in depressive symptoms at follow-up. Subsequent regression analyses revealed worse processing speed and worse aspects of executive functioning at baseline significantly predicted depressive symptom improvement at post-treatment and follow-up.
Conclusions:Worse baseline performances on tests of processing speed and aspects of executive functioning were significantly associated with improvements in PTSD and depressive symptoms during the trial. Our results suggest that cognitive training may bolster skills that are helpful for PTSD and depressive symptom reduction and that those with worse baseline functioning may benefit more from treatment because they have more room to improve. Although CCT is not a primary treatment for PTSD or depressive symptoms, our results support consideration of including CCT in hybrid treatment approaches. Further research should examine these relationships in larger samples.
67 Examination of Neuropsychological Functioning and Current Suicidal Ideation and Suicide Attempt History in Individuals with Severe Mental Illness
- Amber V. Keller, Emma M. Parrish, Samantha A. Chalker, Elizabeth W. Twamley, Amy E. Pinkham, Philip D. Harvey, Colin A. Depp
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 851-852
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Objective:
Suicide risk among individuals with psychosis is elevated compared to the general population (e.g., higher rates of suicide attempts [SA] and completions, more severe lethality of means). Importantly, suicidal ideation (SI) seems to be more predictive of near-term and lifetime SAs in people with psychosis than in the general population. Yet, many randomized controlled trials in psychosis have excluded individuals with suicidality. Additionally, research suggests better cognitive and functional abilities are associated with greater suicide risk in psychotic disorders, which is dissimilar to the general population, but studies examining the link between cognition and suicidality are scarce. Because neuropsychological abilities can affect how individuals are able to attend to their environment, solve problems, and inhibit behaviors, further work is needed to consider how they may contribute to suicide risk in people with psychotic disorders. We sought to examine associations between neuropsychological performance and current SI and SA history in a large sample of individuals with psychosis.
Participants and Methods:176 participants with diagnoses of schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features completed clinical interviews, a neuropsychological assessment (MATRICS Consensus Cognitive Battery subtests), and psychiatric symptom measures (Positive and Negative Syndrome Scale [PANSS]; Montgomery-Asberg Depression Rating Scale [MADRS]. First, participants were divided into groups based on their current endorsement of SI in the past month on the Colombia Suicide Severity Rating scale (C-SSRS): those with current SI (SI+; n=86) and without current SI (SI-; n=90). We also examined lifetime history of SA (n=114) vs. absence of lifetime SA (n=62). Separate t-tests, chi-square tests, and logistic regressions were used to examine associations between neuropsychological performance and the two dichotomous outcome variables (current SI; history of SA).
Results:The SI groups did not differ on diagnosis, demographics (e.g., age, gender, race, ethnicity, years of education, premorbid functioning), or on positive and negative symptoms. The SI+ group reported more severe depressive symptoms (t(169)= -5.90, p<.001) and had significantly worse performance on working memory tests than the SI- group (t(173)=2.28, p=.024). Logistic regression revealed that working memory performance uniquely predicted current SI+ group membership above and beyond depressive symptoms (B= -.040; OR= .96; 95% CI [.93, .99]; p= .034). The SA groups did not significantly differ on demographic variables or on positive/negative symptoms, but those with a history of SA had more severe depressive symptoms (t(169)= -2.80, p=.006) and worse performance on tests of working memory (t(173)=2.16, p=.033) and processing speed (t(166)=2.28, p=.024) than did those without a history of SA. Logistic regression demonstrated that after controlling for depressive symptom severity, working memory and processing speed did not predict unique variance in SA history (p=.25).
Conclusions:Worse working memory performance was associated with SI in the past month in individuals with psychotic disorders. Although our finding is consistent with literature in other psychiatric populations, it conflicts with existing psychosis literature. Thus, a more nuanced examination of how cognition relates to SI/SA in psychosis is warranted to identify and/or develop optimal interventions.
Rates of Cognitive and Functional Impairments in Older Adults Residing in a Continuing Care Senior Housing Community
- Ryan Van Patten, Zanjbeel Mahmood, Tanya T. Nguyen, Jacqueline E. Maye, Ho-Cheol Kim, Dilip V. Jeste, Elizabeth W. Twamley
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- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 1 / January 2022
- Published online by Cambridge University Press:
- 22 March 2021, pp. 62-73
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Objective:
The current cross-sectional study examined cognition and performance-based functional abilities in a continuing care senior housing community (CCSHC) that is comparable to other CCSHCs in the US with respect to residents’ demographic characteristics.
Method:Participants were 110 older adult residents of the independent living unit. We assessed sociodemographics, mental health, neurocognitive functioning, and functional capacity.
Results:Compared to normative samples, participants performed at or above expectations in terms of premorbid functioning, attention span and working memory, processing speed, timed set-shifting, inhibitory control, and confrontation naming. They performed below expectation in verbal fluency and verbal and visual learning and memory, with impairment rates [31.4% (>1 SD below the mean) and 18.49% (>1.5 SD below the mean)] well above the general population (16% and 7%, respectively). Within the cognitive test battery, two tests of delayed memory were most predictive of a global deficit score. Most cognitive test scores correlated with performance-based functional capacity.
Conclusions:Overall, results suggest that a subset of older adults in the independent living sector of CCSHCs are cognitively and functionally impaired and are at risk for future dementia. Results also argue for the inclusion of memory tests in abbreviated screening batteries in this population. We suggest that CCSHCs implement regular cognitive screening procedures to identify and triage those older adults who could benefit from interventions and, potentially, a transition to a higher level of care.
Implementation and evaluation of a community-based treatment for late-life hoarding
- James O. E. Pittman, Eliza J. Davidson, Mary E. Dozier, Brian H. Blanco, Kylie A. Baer, Elizabeth W. Twamley, Tina L. Mayes, David H. Sommerfeld, Tiffany Lagare, Catherine R. Ayers
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- Journal:
- International Psychogeriatrics / Volume 33 / Issue 9 / September 2021
- Published online by Cambridge University Press:
- 05 March 2020, pp. 977-986
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Objectives:
The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST).
Design:This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science.
Setting:Program activities took place in San Diego County, mainly within clients’ homes or community, with some activities in-office.
Participants:Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD.
Intervention:A manualized, mobile protocol that incorporated CREST was utilized.
Measurements:The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation.
Results:Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three.
Conclusion:Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.
Multivariate predictors of social skills performance in middle-aged and older out-patients with schizophrenia spectrum disorders
- D. I. Sitzer, E. W. Twamley, T. L. Patterson, D. V. Jeste
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- Journal:
- Psychological Medicine / Volume 38 / Issue 5 / May 2008
- Published online by Cambridge University Press:
- 06 September 2007, pp. 755-763
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Background
Cognitive impairment and negative symptoms are two of the primary features of schizophrenia associated with poor social functioning. We examined the relationships between clinical characteristics, specific cognitive abilities and social skills performance in middle-aged and older out-patients with schizophrenia and normal comparison subjects.
MethodOne hundred and ninety-four middle-aged and older schizophrenia out-patients and 60 normal comparison subjects were administered a standardized, performance-based measure of social skills using role-plays of various social situations [Social Skills Performance Assessment (SSPA)] and measures of current level of social contact (the Lehman Quality of Life Interview), psychiatric symptom severity [the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HAMD)], insight [the Birchwood Insight Scale (IS)] and cognitive functioning [the Mattis Dementia Rating Scale (DRS)].
ResultsPatients demonstrated worse social skills compared with normal subjects. Better performance on the SSPA was associated with having less severe positive and negative symptoms, fewer social contacts, and better attention, initiation/freedom from perseveration, visuospatial ability, abstraction ability and memory. After controlling for demographic, clinical and insight-related factors, abstraction ability was the strongest predictor of social skills performance, followed by frequency of social contact.
ConclusionsSocial functioning (as measured through direct observation of social skills performance) was related to cognitive ability in out-patients with schizophrenia. Addressing such cognitive impairment may help to improve social functioning and result in greater overall quality of life.