The Independent Contributions of Cognitive Impairment and Neuropsychiatric Symptoms to Everyday Function in Older Adults

Abstract

The everyday functional capacities of older adults are determined by multiple factors. The primary goal of the present study was to evaluate whether apathy and depression have unique influences on degree of functional impairment, independent of the effects of specific cognitive impairments. Participants included 344 older adults (199 normals, 87 with MCI, 58 with dementia). The Everyday Cognition (ECog) scales were used to measure both global and domain-specific functional abilities. Neuropsychiatric symptoms of depression and apathy were measured by the Neuropsychiatric Inventory (NPI), and specific neuropsychological domains measured included episodic memory and executive functioning. Results indicated that worse memory and executive function, as well as greater depression and apathy, were all independent and additive determinants of poorer functional abilities. Apathy had a slightly more restricted effect than the other variables across the specific functional domains assessed. Secondary analysis suggested that neuropsychiatric symptoms may be more strongly associated with everyday function within cognitively normal and MCI groups, while cognitive impairment is more strongly associated with everyday function in dementia. Thus, a somewhat different set of factors may be associated with functional status across various clinical groups.

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

“…With the exception of one study 3 showing that apathy increases disability risk, most researchers have focused on depressive symptoms in this population. Depressive symptoms have been widely associated with frailty and disability in cross-sectional, 20,22–24,58,59 and to a lesser extent, longitudinal, 60,61 studies of healthy older adults. Although, studies have identified a lack of correlation between apathy and depression as well as disease specific differences in neuropathology.…”

Human immunodeficiency virus has similar effects on brain volumetrics and cognition in males and females

“…Evidence of residual impairments in executive function is highly problematic given the importance of these cognitive skills for effective implementation of activities of daily living. Executive function predicts adherence to HIV medications, driving abilities, financial management and related high-level instrumental activities of daily living (Rog et al 2014; Thames et al 2013; Cattie et al 2012; Boyle et al 2002, 2003; Tomaszewski et al 2009; Scott et al 2011). The chronic nature of executive deficits and the importance of these skills to successfully engage in critical aspects of daily living underscores the need for interventions to improve executive skills among HIV+ individuals already on treatment.…”

Deficits in Everyday Function Differ in AD and FTD

“…17 In a similar sample, we have shown that neuropsychological measures of memory were independently associated with each of the ECog domains, executive functioning was independently related to the everyday executive domains of the ECog, and spatial ability was uniquely related to the ECog Visuospatial domain. 31 However, the neuropsychological determinants of the ECog domains may be different in different patient populations. Finally, we have previously demonstrated that all of the ECog domains are significantly associated with both apathy and depression, independently of the cognition.…”