Specific cognitive functions and depressive symptoms as predictors of activities of daily living in older adults with heterogeneous cognitive backgrounds

Abstract

Cognitive functioning influences activities of daily living (ADL). However, studies reporting the association between ADL and neuropsychological performance show inconsistent results regarding what specific cognitive domains are related to each specific functional domains. Additionally, whether depressive symptoms are associated with a worse functional performance in older adults is still under explored. We investigated if specific cognitive domains and depressive symptoms would affect different aspects of ADL. Participants were 274 older adults (96 normal aging participants, 85 patients with mild cognitive impairment, and 93 patients probable with mild Alzheimer’s disease dementia) with low formal education (∼4 years). Measures of ADL included three complexity levels: Self-care, Instrumental-Domestic, and Instrumental-Complex. The specific cognitive functions were evaluated through a factorial strategy resulting in four cognitive domains: Executive Functions, Language/Semantic Memory, Episodic Memory, and Visuospatial Abilities. The Geriatric Depression Scale measured depressive symptoms. Multiple linear regression analysis showed executive functions and episodic memory as significant predictors of Instrumental-Domestic ADL, and executive functions, episodic memory and language/semantic memory as predictors of Instrumental-Complex ADL (22 and 28% of explained variance, respectively). Ordinal regression analysis showed the influence of specific cognitive functions and depressive symptoms on each one of the instrumental ADL. We observed a heterogeneous pattern of association with explained variance ranging from 22 to 38%. Different instrumental ADL had specific cognitive predictors and depressive symptoms were predictive of ADL involving social contact. Our results suggest a specific pattern of influence depending on the specific instrumental daily living activity.

Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer’s disease dementia: association with activities of daily living

“…of instrumental ADL changes have been documented, 3,4 there are relatively few established predictors of basic ADL decline in MCI-AD. Our results may have important implications for patient follow-up and for the prediction of more severe functional deficits in MCI and dementia.…”

“…The present study is part of the first author's doctoral dissertation, the results of which have been published elsewhere. 3,11,12 Functional status was reported by each participant's caregivers during an interview conducted as part of the neuropsychological assessment, using the General Activities of Daily Living Scale (GADL). 12 This measure involves sub-scores of basic ADLs (self-care) and instrumental ADLs (domestic and complex).…”

“…2 Cross-sectional and longitudinal studies suggest that cognitive decline (the main difference between normal aging and MCI) precedes functional decline (the main difference between MCI and AD). [3][4][5] This pattern is associated with the main biomarkers of AD and moderated by several factors, including cognitive reserve. 6 Motor impairment may emerge as a phenotype of cognitive decline.…”

Relações entre saúde mental e falhas cognitivas no dia a dia: papel dos sintomas internalizantes e externalizantes

“…Já a associação dos sintomas internalizantes com queixas cognitivas é menos intuitiva, uma vez que os sintomas desse tipo em geral se relacionam ao humor e à regulação emocional. Contudo, vários estudos sugerem que sintomas internalizantes se associam ao funcionamento cognitivo, quer em termos de autorrelato 4 ou de avaliação cognitiva por meio de testes 7 . Embora esses dois aspectos anteriores estejam bem documentados na literatura, a comparação de um grupo misto, tanto com sintomas internalizantes quanto externalizantes, é raramente estudada.…”

“…De forma geral, sintomas típicos dos transtornos mentais mais comuns podem ser agrupados em dois grandes grupos: internalizantes -disforia, anedonia, retraimento social, ansiedade e sintomas somáticos -e externalizantes -impulsividade, uso de substâncias, hiperatividade, desatenção e agressividade 6 . Ambos os sintomas podem influenciar o funcionamento cognitivo e seus reflexos no dia a dia 7,8 . Os sintomas de disforia e anedonia são considerados critérios diagnósticos centrais ao transtorno depressivo maior, enquanto outros sintomas internalizantes são considerados critérios secundários.…”