Skip to main content Accessibility help
×
Home

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

  • Haley M. LaMonica (a1) (a2) (a3) (a4) (a5), Ian B. Hickie (a3) (a5), Jerome Ip (a1) (a5), Catriona Ireland (a1) (a5), Loren Mowszowski (a1) (a2) (a4) (a5), Amelia English (a3) (a5), Nick Glozier (a3) (a5) and Sharon L. Naismith (a1) (a2) (a4) (a5)...

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.

Copyright

Corresponding author

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: sharon.naismith@sydney.edu.au.

References

Hide All
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4 edn). Washington, DC: American Psychiatric Association.
Arroll, B. et al. (2009). Antidepressants versus placebo for depression in primary care. Cochrane Database of Systematic Reviews, 8, CD007954.
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.
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, 232241.
Benton, A. L. and Hamsher, K. D. (1978). Multilingual Aphasia Examination Manual. Iowa City: University of Iowa.
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, 818.
Blazer, D. G. (2003). Depression in late life: review and commentary. Journal Gerontology Series A Biological Science Medical Science, 58, M249M265.
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, 373384.
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, 193213.
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.
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, 14431455.
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, 471478.
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, 927933.
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, 1117.
Hayes, A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach (2 edn). New York: The Guilford Press.
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, 2026.
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, 20832089.
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, 441449.
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, 16621666.
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, 160167.
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, 4250.
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, 389399.
Lockwood, K. A., Alexopoulos, G. S. and van Gorp, W. G. (2002). Executive dysfunction in geriatric depression. American Journal of Psychiatry, 159, 11191126.
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, 741751.
Mahesh, M. et al. (2016). Disability in Singapore’s elderly population. Annals of the Academy of Medicine, Singapore, 45, 284296.
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, 249253.
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, 263269.
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, 10711079.
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, 237248.
Mirza, S. S. et al. (2016). 10-year trajectories of depressive symptoms and risk of dementia: a population-based study. Lancet Psychiatry, 3, 628635.
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, 623634.
Mottram, P. G., Wilson, K. and Strobl, J. J. (2006). Antidepressants for depressed elderly. The Cochrane Library, 25, CD003491.
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, 1927.
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.
Naismith, S. L. et al. (2011a). Sleep disturbance in mild cognitive impairment: differential effects of current and remitted depression. Acta Neuropsychiatrica, 23, 167172.
Naismith, S. L. et al. (2011b). Sleep disturbance relates to neuropsychological functioning in late-life depression. Journal of Affective Disorders, 132, 139145.
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. e761765.
National Health Medical Research Council (2009). Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra, ACT: Commonwealth of Australia.
Neary, D. et al. (1998). Frontotemporal lobor degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 15461554.
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, 788794.
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, 23672380.
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, 99111.
Reitan, R. M. (1986). Trail Making Test: Manual for Administration and Scoring. Arizona: Reitan Neuropsychology Laboratory.
Rosen, W. G. (1980). Verbal fluency in aging and dementia. Journal of Clinical and Experimental Neuropsychology, 2, 135146.
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, 13321340.
Sexton, C. E. et al. (2012). Exploring the pattern and neural correlates of neuropsychological impairment in late-life depression. Psychological Medicine, 42, 11951202.
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, 332338.
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, 445469.
Taragano, F. E. et al. (2009). Mild behavioral impairment and risk of dementia. Journal of Clinical Psychiatry, 70, 584592.
Taş, Ü. et al. (2007). Incidence and risk factors of disability in the elderly: the Rotterdam Study. Preventive Medicine, 44, 272278.
Unützer, J. (2002). Diagnosis and treatment of older adults with depression in primary care. Biological Psychiatry, 52, 285292.
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, 28362845.
Üstün, T. B. (2010). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0. Geneva: World Health Organization.
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, 295301.
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, 297304.
Wechsler, D. (1997a). Wechsler Adult Intelligence Scale - Third Edition. Administration and Scoring Manual. San Antonio: The Psychological Corporation.
Wechsler, D. (1997b). Wechsler Memory Scale-Third edition. Administration and Scoring Manual. San Antonio: The Psychological Corporation.
Wiese, B. S. (2011). Geriatric depression: the use of antidepressants in the elderly. British Columbia Medical Journal, 53, 341347.
Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 724747.
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, 240246.
World Health Organization (2011). World Report on Disability. Geneva: World Health Organization.
World Health Organization (2013). World Health Statistics 2013. Geneva: World Health Organization.
Yesavage, J. A. and Sheikh, J. I. (1986). 9/Geriatric depression scale (GDS) recent evidence and development of a shorter violence. Clinical Gerontologist, 5, 165173.
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, 15041509.

Keywords

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

  • Haley M. LaMonica (a1) (a2) (a3) (a4) (a5), Ian B. Hickie (a3) (a5), Jerome Ip (a1) (a5), Catriona Ireland (a1) (a5), Loren Mowszowski (a1) (a2) (a4) (a5), Amelia English (a3) (a5), Nick Glozier (a3) (a5) and Sharon L. Naismith (a1) (a2) (a4) (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed