Depression in Older Adults 12 Months After Traumatic Brain Injury: A TRACK-TBI Study.

OBJECTIVE: To investigate depression at 12 months after traumatic brain injury (TBI) in older adults compared with younger adults. DESIGN: Prospective longitudinal cohort study of persons with medically documented mild, moderate, and severe TBI at 12 months postinjury. SETTING: Eighteen participating Level 1 trauma centers in the United States. PARTICIPANTS: Participants with TBI (N=1505) and primary outcome data at 12-month follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient Health Questionnaire-9 (PHQ-9). RESULTS: PHQ-9 total scores were significantly lower for older adults (age≥65y; M=3.2) compared with younger adults (age<65y; M=5.0; B=-1.63, P<.001), indicating fewer depressive symptoms in older adults. Age did not interact with education, sex, race/ethnicity, psychiatric history, substance use, or Glasgow Coma Scale severity to affect PHQ-9 scores. Of the 29% of older adults who endorsed symptoms consistent with depression, 14% were classified as minor depression and 15% as major depression. The odds of older adults falling in the major depression vs no depression group were significantly lower (decreased by 56%) compared with younger adults (odds ratio=0.44, P=.001). CONCLUSIONS: At 12 months post-TBI, older adults endorse lower depressive symptoms than their younger counterparts and are less likely to experience major depression; however, over one-fourth of older adults endorsed symptoms consistent with depression, warranting evaluation and treatment.

Utilization of the Patient Competency Rating Scale in an epileptic and non-epileptic veteran population.

Differentiating between epilepsy and psychogenic non-epileptic events (PNEE) can be difficult given similar presentations. PNEE is often misdiagnosed, resulting in unwarranted treatment with anti-epileptic drugs (AED). While the gold standard for differentiating PNEE from epilepsy is video EEG (VEGG) monitoring, self-reported symptomology has also been shown to discriminate between epilepsy and PNEE with high accuracy, particularly in cases where VEEG is difficult to obtain or when there are no observed events during extended monitoring. The Patient Competency Rating Scale (PCRS) was developed to measure the extent to which individuals are able to function in four domains: activities of daily living, emotional, interpersonal, and cognitive competency. Factor analyses validated the underlying factor structure of the PCRS in this seizure disorder sample. Follow-up MANOVA revealed group differences such that those diagnosed with PNEE reported less competence in all areas of functioning as compared to those diagnosed with epilepsy, with the largest difference being emotional competency. Secondary factor analyses were conducted for each diagnostic category. Two items related strongly to emotional competency loaded equally across the factors for those diagnosed with PNEE, indicating that emotional control is highly correlated with all areas of perceived competence for those with PNEE in this sample and may be considered as an intervention target. This was the first study to validate the use of the PCRS for a seizure disorder sample and to examine group differences in self-reported competency between those diagnosed with epilepsy and PNEE.

Stroke Symptoms With Absence of Recognized Stroke Are Associated With Cognitive Impairment and Depressive Symptoms in Older Adults With Diabetes.

Self-reported stroke symptoms may represent unrecognized cerebrovascular events leading to poorer cognitive and mental health. We examined relationships between stroke symptoms, cognitive impairment, and depressive symptoms in a high-risk sample: 247 adults aged ≥65 with diabetes. Stroke symptoms were assessed using the Questionnaire for Verifying Stroke-free Status, cognitive impairment was measured with the modified Telephone Interview for Cognitive Status, and depressive symptoms were measured using the 15-item Geriatric Depression Scale. In 206 participants without history of stroke/transient ischemic attack, 27.7% reported stroke symptoms, with sudden loss of comprehension most frequently reported (11.7%). Having >1 versus 0 stroke symptoms was associated with greater odds of cognitive impairment (odds ratio = 3.04, 95% confidence interval 1.15-8.05) and more depressive symptoms (b= 2.60,P< .001) while controlling for age, race, gender, education, diabetes duration, diabetes severity, and cardiovascular comorbidities. Better recognition and treatment of cerebrovascular problems in older adults with diabetes may lead to improved cognition and mental health.

Social anxiety and social cognition: the influence of sex.

Current theoretical models predict a negative relationship between social anxiety and performance on measures of social cognition, yet there appears to be relatively little research that directly examines this relationship and the potential interaction of sex. Two samples of undergraduates self-reporting either a high (n=27; 59% female) or low (n=29; 62% female) level of social anxiety on the abbreviated Social Phobia and Anxiety Inventory completed two social cognition measures: the Reading the Mind in the Eyes Test (Eyes Test) and The Awareness of Social Inference Test-Parts 2 and 3). A multivariate analysis of variance revealed a significant group by sex interaction on overall social cognition performance. Follow-up analyses indicated that males with high and low levels of social anxiety did not differ on any of the social cognition measures. In contrast, females with high social anxiety performed significantly better on the Eyes Test and the TASIT-Part 3 than females with low social anxiety. Contrary to expectations, results of this study suggest that females with high social anxiety may exhibit better-developed social cognition abilities than those with low social anxiety. These preliminary results have clinical implications in the treatment of individuals with social phobia.

The relationship of cognitive change over time to the self-reported Ascertain Dementia 8-item Questionnaire in a general population.

OBJECTIVE: The aim of the study was to examine the relationship between longitudinally assessed cognitive functioning and self-reported dementia status using the Ascertain Dementia 8-item questionnaire (AD8) in a national population-based sample. METHODS: The analysis included 14,453 participants from the REasons for Geographic and Racial Differences in Stroke study. A validated cutoff of ≥2 symptoms endorsed on the AD8 (administered 10 years after enrollment) represented positive AD8 status. Incident cognitive impairment was defined as change from intact to impaired status in the Six-Item Screener score, and cognitive decline was defined by trajectories of Letter "F" Fluency from the Montreal Cognitive Assessment, and Animal Fluency, Word List Learning, and Word List Delayed recall, all from the Consortium to Establish a Registry for Alzheimer's Disease battery. Logistic regression models controlled for demographics, health variables, and depressive symptoms. RESULTS: Sensitivity and specificity of the AD8 to detect incident cognitive impairment were 45.2% and 78.4%, respectively. Incident cognitive impairment and a one-word decline in WLL increased the odds of self-reported positive AD8 by 96% (95% CI: 1.68-2.28) and 27% (95% CI: 1.17-1.37), respectively. There was a strong association between high depression risk and self-reported positive AD8 in sensitivity analyses. CONCLUSIONS: Incident cognitive impairment and high depression risk were the strongest predictors of self-reported positive AD8 in this population-based sample. Our results inform the utility of the AD8 as a self-report measure in a large, national sample that avoids selection biases inherent in clinic-based studies. The AD8 is screening measure and should not be used to diagnose dementia clinically.

Cognitive Processing Speed Is Strongly Related to Driving Skills, Financial Abilities, and Other Instrumental Activities of Daily Living in Persons With Mild Cognitive Impairment and Mild Dementia.

BACKGROUND: Cognitive processing speed is important for performing everyday activities in persons with mild cognitive impairment (MCI). However, its role in daily function has not been examined while simultaneously accounting for contributions of Alzheimer's disease (AD) risk biomarkers. We examine the relationships of processing speed and genetic and neuroimaging biomarkers to composites of daily function, mobility, and driving. METHOD: We used baseline data from 103 participants on the MCI/mild dementia spectrum from the Applying Programs to Preserve Skills trial. Linear regression models examined relationships of processing speed, structural magnetic resonance imaging (MRI), and genetic risk alleles for AD to composites of performance-based instrumental activities of daily living (IADLs), community mobility, and on-road driving evaluations. RESULTS: In multivariable models, processing speed and the brain MRI neurodegeneration biomarker Spatial Pattern of Abnormality for Recognition of Early Alzheimer's disease (SPARE-AD) were significantly associated with functional and mobility composite performance. Better processing speed and younger age were associated with on-road driving ratings. Genetic risk markers, left hippocampal atrophy, and white matter lesion volumes were not significant correlates of these abilities. Processing speed had a strong positive association with IADL function (p < .001), mobility (p < .001), and driving (p = .002). CONCLUSIONS: Cognitive processing speed is strongly and consistently associated with critical daily functions in persons with MCI in models including genetic and neuroimaging biomarkers of AD risk. SPARE-AD scores also significantly correlate with IADL performance and mobility. Results highlight the central role of processing speed in everyday task performance among persons with MCI/mild dementia.

The relationship of longitudinal cognitive change to self-reported IADL in a general population.

This study examined the relationship between cognitive change and instrumental activities of daily living (IADL) in a large, national, population-based sample. Cognitive change was assessed via verbal fluency, word list learning (WLL), and word list delayed recall (WLD). Incident cognitive impairment was defined by change in Six-Item Screener (SIS) status over a period of 10 years. Impaired IADL was defined as self-reported difficulty or needing assistance performing any IADL at Year 10. A one-word decrease in WLL over a 10-year span increased the odds of impaired IADL by 16% (95% CI 1.08-1.24) and incident cognitive impairment increased the odds of impaired IADL by 59% (95% CI 1.36-1.85) when adjusting for demographic factors, health-related behaviors, vascular risk factors and disease, and depressive symptoms. Cognitive change most strongly predicted impairment in managing finances (OR 2.47, 95% CI 2.04-3.00) and driving (OR 2.06, 95% CI 1.73-2.44).

Olfactory ability in normal pressure hydrocephalus as compared to Alzheimer's disease and healthy controls.

OBJECTIVES: Normal pressure hydrocephalus (NPH) is a treatable neurological disorder that appears in older adults, lacks specific diagnostic criteria, and resembles symptoms seen in Alzheimer's disease (AD). Presently, differentiating NPH from AD in the early stages of symptom presentation remains difficult. This study established whether olfactory testing may be useful in this regard. In addition, we determined whether olfactory function of NPH patients differed before and after extended lumbar drainage (ELD), as well as six months after surgical implantation of a ventriculoperitoneal (VP) shunt. PATIENTS AND METHODS: Twenty-two NPH patients (mean age=77.6yrs), 14 age- and gender-matched healthy controls (mean age=79.9yrs), and 7 AD patients (mean age=75.5yrs) were administered the 40-item University of Pennsylvania Smell Identification Test (UPSIT). Eighteen of the 22 NPH patients were also tested following ELD and 8 patients were tested six months following implantation of VP shunt. RESULTS: Prior to ELD, patients with NPH scored significantly higher on the UPSIT than those with AD [respective means (SDs)=26.9 (7.1) & 14.1 (4.7)]. While the mean NPH score was significantly below that of the matched controls [control mean (SD)=32.7 (6.7)], their test scores were nonetheless within the general normal range, as determined from published normative data (48th percentile). The UPSIT scores did not differ significantly among the three longitudinal time points in the NPH patients. CONCLUSION: Olfactory testing may be useful in differentiating between patients with NPH and patients with AD. Odor identification test scores of NPH patients are not influenced by the release of intracranial pressure via ELD or six months following implantation of a VP shunt.