Fibromyalgia status and depressive symptoms are linked to body mass index and physical performance in mid to late life.

Fibromyalgia (FM) is a chronic pain condition that is frequently accompanied by comorbid conditions, including depression. Depression is associated with reduced physical functioning and health, disproportionately affecting middle-aged and older adults with FM. This study examined associations between FM status and depressive symptoms with body mass index (BMI) and several physical performance indicators among middle-aged and older adults. Participants included 239 community-dwelling middle-aged and older adults with or without FM. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II), BMI was objectively assessed, and physical performance was measured using the Fullerton Advanced Balance scale, 6-minute walk test, 30-second chair stand, and 8-foot up and go test. A path model using structural equation modeling yielded good fit and revealed that, compared to pain-free adult controls, participants with FM reported more depressive symptoms, which were in turn associated with reduced physical performance across all indicators except BMI, after adjusting for age and symptom severity. Findings suggest that individuals with FM demonstrate disproportionately higher depressive symptoms compared to non-FM controls, which may diminish physical performance after accounting for age and symptom severity. This study supports FM status and depressive symptoms as important considerations when evaluating the health and disability risk of aging adults.

The role of pain intensity and depressive symptoms in the relationship between sleep quality and postural control among middle-aged and older adults with Fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) is a chronic pain condition often accompanied by sleep problems and depression that are each associated with reduced physical ability including postural control. Research supports a sequential association between pain intensity and depression in FM, and poor sleep quality may play a key role in this relationship. This study aimed to verify a serial pattern of associations among sleep quality, pain intensity, and depressive symptoms and quantify these effects on objective postural control. DESIGN: Community-residing adults diagnosed with FM (n = 155; Mage = 61.08, SD = 7.70; 93% female; 79% White) were included in this cross-sectional study. MAIN OUTCOMES: Participants self-rated sleep quality (restorative sleep, sleep waking, and sleep latency), pain intensity, and depressive symptoms, and the Fullerton Advanced Balance (FAB) scale and 8-Foot Up and Go Test (8FUPGT) measured objective postural control. RESULTS: Findings indicated that the serial association between pain intensity and depressive symptoms fully mediated the relationship between sleep quality and both FAB (95% CI [-.125, -.013]), and 8FUPGT (95% CI [.002, .033]) performance. CONCLUSION: Findings highlight the serial association of pain intensity and depressive symptoms with objective postural control performance and the potential for sleep and depression interventions that may maximize functional outcomes in FM.

Distress as a mediator for pain and activities of daily living in older adults with fibromyalgia.

Introduction: Pain, distress, and activities of daily living impact the lives of those with chronic pain. This study investigated distress (depressive symptoms, anxiety) on the relationship between pain (intensity and pain interference) and activities of daily living in individuals with fibromyalgia while controlling for age. Methods: The current cross-sectional investigation focused on data from 123 men and women with fibromyalgia. Pain intensity, pain interference and anxiety were measured on 0-10 Likert type scales from the National Fibromyalgia Assessment Questionnaire. Depressive symptoms were assessed using the Beck Depression Inventory II. Activities of daily living (basic, instrumental) were measured with the Physical Activity Inventory Scale. Results: It was hypothesized that the relationships between pain intensity and pain interference and activities of daily living in individuals with fibromyalgia would be mediated by the construct of distress while controlling for age. Mediation significantly occurred in both models as predicted. However, those who were older reported lower levels of pain intensity and distress than their younger counterparts, which may be related to time since diagnosis or other factors. Discussion: Results of this study suggest that individuals with chronic pain conditions would benefit from treatment options which address distress, specifically depressive symptoms and anxiety.

Pain intensity and physical performance among individuals with fibromyalgia in mid-to-late life: The influence of depressive symptoms.

This study investigated the mediating role of depressive symptoms among 147 middle-aged and older adults with FM in the relationship between pain intensity and 4 objective measures of physical performance: Fullerton Advanced Balance scale (FAB), 6-Minute Walk Test (6MWT), 30-Second Chair Stand (30SCS), and 8-Foot Up and Go Test (8FUPGT). Asymptotic mediation analyses revealed that depressive symptoms fully mediated the relationship between pain intensity and FAB (95% CI [-0.40, -0.10]) and 8FUPGT (CI [0.02, 0.11]) and partially mediated the relationship to 6MWT (CI [-9.15, -2.20]) and 30SCS (CI [-0.29, -0.06]). Findings support the evaluation of co-morbid depression in FM.

Impact of Affect Balance on Cognitive and Physical Function in Adults With and Without Fibromyalgia.

OBJECTIVE: To identify the potential benefits of heightened levels of affect balance in older adults with and without chronic pain on various cognitive domains, physical performance, and perceived cognitive and physical health. METHOD: Ninety-one older adults, some with and some without fibromyalgia (FM) participated. Objective tests included cognitive (immediate and delayed recall, delayed recognition-CERAD 10-item word list) and physical measures (Fullerton Advanced Balance Scale; lower body strength-30-s chair stand; gait velocity-30-ft. walk). Self-report measures were problems with forgetting, activities of daily living (perceived function), and affect (Positive and Negative Affect Scale [PANAS]). Affect balance was calculated as positive minus negative affect from the PANAS. RESULTS: Hierarchical regression analyses revealed that-regardless of FM status-higher affect balance was associated with better episodic memory performance (immediate recall, delayed recognition), better balance, enhanced lower body strength (more chair stands), and healthier gait (30-ft. walk), as well as less forgetfulness and better perceived functional health. CONCLUSION: Increased affect balance was associated with better objective and subjective health in older adults both without and with chronic pain. Positive psychology treatments which increase affect balance are easy to administer, cost effective, and may add an important, additional treatment modality for maintaining health in normal aging adults as well as those with chronic pain. CLINICAL RELEVANCE: In order to help patients with healthy aging, nurses need to be aware of the potential long-term effect of emotional state on overall function and be able to counsel patients regarding potential treatments to enhance positive global emotions such as resilience.

Blood pressure as a predictor of everyday cognitive function in aging adults with and without fibromyalgia.

Objective : Both hypotension and hypertension are related to poorer cognitive performance in older adults. However, little attention has been paid to everyday problem solving, a real-world indicator of functionality and independence among aging individuals. Research also suggests that chronic pain may affect the relationship between blood pressure (BP) and cognition. This study examined the relationship between BP and everyday problem solving in older adults with and without fibromyalgia (FM), a chronic pain condition. Method : The study included 99 participants with an FM diagnosis (Mage = 59.95) and 88 healthy older adults (Mage = 68.01). Results : Multiple regression analyses revealed that systolic BP and pulse pressure, but not diastolic BP, were significant predictors of everyday problem solving after controlling for executive function. FM status did not moderate this relationship. Conclusion : These findings indicate that BP is an important factor in functional and cognitive health, especially among aging adults.

Aging well: Processing speed inhibition and working memory related to balance and aerobic endurance.

AIM: The present study explored whether certain physical performance measures could be linked to specific cognitive domains in healthy older adults. METHOD: A total of 50 adults (mean age 69.5 years, SD 8.1) were evaluated on physical performance using measures of balance (Fullerton Advanced Balance Scale), functional mobility (8-ft up-and-go), lower body strength (30-s chair stand), gait (30-ft walk velocity) and aerobic endurance (6-min walk). Cognitive measures included Stroop Color-Word Test, Digit Span Backward, Trail Making Tests, Everyday Problems Test, Digit Symbol Substitution and a Brown-Peterson test. Principal component analyses reduced cognition to domains of processing speed, inhibition and working memory. RESULTS: Hierarchical regression analyses were carried out with age and each physical measure as potential predictors of the three cognitive domains. The balance scale and 6-min walk were specifically associated with processing speed, inhibition and working memory. CONCLUSIONS: Better dynamic balance and aerobic endurance predicted enhanced processing speed, inhibition and working memory in older adults, with these last two domains considered components of executive function. Geriatr Gerontol Int 2017; 17: 108-115.

Heterogeneity in fibromyalgia based upon cognitive and physical performance and psychological symptomology.

PURPOSE: This study sought to investigate the existence of subgroups within a fibromyalgia (FM) sample based on physical and cognitive performance measures, as well as self-report psychological measures. A multisystem disorder characterized by widespread musculoskeletal pain and co-morbid conditions, FM can lead to declines in cognitive functioning and difficulty with psychological health. DATA SOURCES: Community participants (n = 57 women) recruited from support groups and university center databases provided documentation of having met the criteria for diagnosis of FM. Measures included validated performance and self-report instruments. Analysis was completed using hierarchical cluster analysis; a four cluster solution was chosen for its level of interpretability. The resulting model identified four distinct subgroups based upon patterns of performance and symptomology. Significant group differences were found on pain, fatigue, stiffness, and level of physical activity. CONCLUSIONS: Study results support the existence of subgroups among the FM population based on levels of cognitive and physical performance and psychological symptoms. IMPLICATIONS FOR PRACTICE: Nurse practitioners aware of potential subgroups within FM should be better prepared to recommend treatment options for patients that target subgroup characteristics (e.g., high vs. low levels of psychological symptoms).

Genetic and experiential influences on behavior: Twins reunited at seventy-eight years.

Twins living in different countries offer opportunities to explore associations between observed differences and experiential effects. This report compared the life histories, cognitive abilities, personality traits, psychomotor skills, medical characteristics, job satisfaction, social support and social relations of dizygotic (DZ) female twins reunited at 78, the world's longest separated set. The twins' advanced age also enabled a study of how co-twin differences in aging may be associated with current behavioral and social differences. Consistent with previous studies, these dizygotic reared apart (DZA) twins showed discordance across some, but not all, traits. Their different rearing situations and life histories may explain current differences in their responses to meeting their twin. This case highlights the importance of both genetic and rearing factors on behavior, but does not allow firm conclusions regarding the extent to which these sources explain individual developmental differences. However, such data contribute to the growing number of cross-culturally separated twins, generating novel hypotheses that may be assessed using larger samples.

Interhemispheric collaboration during digit and dot number-matching in younger and older adults.

Digit and dot number-matching stimuli were used to replicate findings reported for younger adults by Patel and Hellige (2007) and to explore whether performance would differ for younger versus older participants. Participants were to make numerical matches of digits only, dots only, and digits and dots mixed conditions to determine whether reaction time (RT), percentage error, and efficiency scores that combine latency and accuracy for match trials were better on within- versus across-hemisphere trials. Sixty-six younger and 42 older participants were screened with the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale. They performed the three experimental conditions and were assessed with Digit Span Forward and Backward subscales from the Wechsler Adult Intelligence Scale-III. Results for younger adults demonstrated a within-hemisphere advantage for the Digits and Mixed conditions and an across-hemisphere advantage for the Dots condition, consistent with previous literature. Older participants showed a stronger within-hemisphere advantage for the Digits condition compared with younger participants and no advantage for within- or across-hemisphere processing for the Mixed condition when RT was considered, but they performed similarly to younger adults when efficiency scores were used and showed a relative across-hemisphere advantage for the Dots condition. Although RT suggests age-related differences in how information is distributed across the hemispheres of the brain, more comprehensive efficiency scores indicate that younger and older adults appear to use similar strategies in the coordination of interhemispheric transfer of information. MMSE scores regardless of age were related to type of task but not to across- versus within-hemisphere performance.

Cognitive performance in women aged 50 years and older with and without fibromyalgia.

OBJECTIVES: Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years). METHOD: Measures included explicit memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test). RESULTS: Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding). DISCUSSION: Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.

Positive associations between physical and cognitive performance measures in fibromyalgia.

OBJECTIVE: To investigate the associations between perceived physical function (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: Exercise testing laboratory in Southern California. PARTICIPANTS: Community-residing ambulatory adults meeting the American College of Rheumatology 1990 criteria for FM (N=68; mean age, 59.5y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function scale, Senior Fitness Test (3 items), Fullerton Advanced Balance scale, 30-foot walk, Trail Making Test parts A and B, Digit Symbol Substitution Test, a composite score of these 3 cognitive measures, attention/executive function composite, processing speed composite, problem solving, inhibition, and episodic memory composite. RESULTS: Hierarchical regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assessments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition. CONCLUSIONS: Researchers should continue to investigate the relationship between physical and cognitive function in both clinical and nonclinical populations, as well as explore changes across time. Because physical activity has been associated with neural improvements, further research may identify whether particular mechanisms, such as neurogenesis, synaptogenesis, or changes in inflammatory marker levels, are involved.

Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial.

BACKGROUND: Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people. METHODS: A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60-95 years (mean age 74.9 ± 7.7 years; 53% <$12000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area. RESULTS: Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41218/UK £24868 per unit). No intervention effect was found for cognitive functioning outcome measures. CONCLUSIONS: A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people. Trial Registration clinicaltrials.gov identifier: NCT0078634.

Experiences with electronic health records: early adopters in long-term care facilities.

BACKGROUND: : Electronic health records (EHRs) are becoming a required technology across the health care sector. Long-term care (LTC) facilities have lagged other settings in adopting health information technologies but represent an area where significant care coordination benefits might be realized. Nevertheless, managers face many of the same challenges implementing EHRs that exist in other environments when implementing enterprise-wide systems. PURPOSES: : This study was conducted to provide a description of the early users' experiences with EHRs in LTC facilities. METHODOLOGY: : Semistructured interviews were conducted. The 10 sites were all the "freestanding" LTC facilities using an EHR as of July 2008 in Texas. The interview respondents included administrators, nursing managers, nurses, certified nurse aides, and other system users. Semistructured interviews across multiple stakeholders were used to assess constructs critical to EHR adoption and implementation. FINDINGS: : The LTC facility employees who work with EHR systems on a daily basis were positive about their experiences. In particular, operational improvements were achieved through increased access to resident information, cost avoidance, increased documentation accuracy, and implementation of evidence-based practices. PRACTICE IMPLICATIONS: : Overall, administrators believed that the systems improved care quality and employee satisfaction and were cost effective and that the EHR made a positive return on investment. Electronic documentation led to both increases in charge capture related to resource utilization group documentation, significant savings in pharmacy waste, and reductions in nursing overtime as medical record management became more automated. Quality improvement came from computer-aided monitoring of the certified nurse aide's attendance to residents' activities of daily living.

Do fall predictors in middle aged and older adults predict fall status in persons 50+ with fibromyalgia? An exploratory study.

We explored potential predictors of fall status in 70 community-dwelling persons > or =50 years of age with fibromyalgia (FM). Over 40% of the sample reported one or more falls in the year prior to the study. A logistic regression model using 10 variables known to predict falls in middle aged and older persons predicted 45% of the variance in fall status. Three variables offered significant independent contributions to the overall model predicting fall status: perception of postural instability, balance performance, and executive function processing speed. The results support prior work in both nonclinical and clinical populations of middle aged and older adults indicating that falls are associated with multiple risk factors. Prospective designs with larger samples are needed to (a) validate and extend these findings, and (b) identify risk factors related to fall status that are unique to persons with FM.

Exploring interhemispheric collaboration in older compared to younger adults.

Physical and Name Identity letter-matching tasks were used to explore differences in interhemispheric collaboration in younger and older adults. To determine whether other factors might also be related to across/within-hemisphere processing or visual field asymmetries, neuropsychological tests measuring frontal/executive functioning were administered, and comparisons were made for participants split into low and high efficiency groups based on performance on the letter-matching tasks. A Task by Across/Within interaction was found for both groups, but with a stronger within-hemisphere advantage for the Physical Task and a weaker across-hemisphere advantage for the Name Task for older participants. More efficient groups and better performers on several neuropsychological tasks showed a reduced across-hemisphere advantage for the Name Identity task. Findings suggest that computational complexity, specific task demands, and perhaps trade-offs between age-related changes in gray and white matter all contribute to whether processing loads are distributed across or within hemispheres as we age.

Physical performance as a predictor of attention and processing speed in fibromyalgia.

UNLABELLED: Cherry BJ, Weiss J, Barakat BK, Rutledge DN, Jones CJ. Physical performance as a predictor of attention and processing speed in fibromyalgia. OBJECTIVE: To explore the associations between physical (both self-report and objective measures) and cognitive function for persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: An exercise testing laboratory in southern California. PARTICIPANTS: Community-residing and functionally independent (not wheelchair-bound) adults meeting the American College of Rheumatology 1990 criteria for FM (N=51) with a mean age of 54 years and no history of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function Scale, Fibromyalgia Impact Questionnaire, adapted Trail Making Test parts A (TMT-A) and B (TMT-B), Digit Symbol Substitution Test, a composite index of TMT-A, TMT-B, and Digit Symbol Substitution Test combined, and physical performance assessments. RESULTS: Hierarchical regression analyses indicated that better objective physical performance predicted increased cognitive function for TMT-A and the composite cognitive score after controlling for age and symptom burden. That is, as the physical performance level decreased, cognitive performance levels decreased. CONCLUSIONS: Findings suggest that research is needed to determine whether patterns of physical activity participation, through their effects on physical fitness and performance, can enhance cognitive performance in persons with FM. Physiologic changes in specific brain regions in FM (eg, hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.

Cognitive dysfunctions associated with PTSD: evidence from World War II prisoners of war.

The authors aim to delineate cognitive dysfunction associated with posttraumatic stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD patients only when they have comorbid psychiatric diagnoses.

Impaired hemispheric communication in schizophrenia: a study using the consonant-vowel-consonant task.

The ability of the left and right hemispheres to interact and cooperate in the processing of information is important for normal brain functioning. Some investigators have suggested that this cooperation in functioning occurs through a process called "metacontrol." Because studies have suggested that patients with schizophrenia may have problems with interhemispheric interaction, we considered that it could be informative to study such patients from the viewpoint of interhemispheric cooperation, and more specifically that of metacontrol. To do this we utilized an assessment procedure called the consonant-vowel-consonant (CVC) task, in which nonsense three-letter combinations (trigrams) are presented vertically to the left, right and both visual fields. The pattern of errors can be used to determine the type of processing the hemispheres use under the different conditions of presentation. Previous studies have shown that when trigram information is presented to both hemispheres, the left hemisphere appears to switch into a mode that more resembles right hemisphere processing, and we wished to determine if evidence for this switch in the mode of processing also occurred in a sample of patients with schizophrenia. To determine the specificity of any findings to schizophrenia, we also studied a group of patients with bipolar disorder. For the control and bipolar groups, our results showed the typical finding of superior processing in the right visual field (left hemisphere) over the left visual field, with presentation to both visual fields demonstrating a qualitative error pattern resembling that of the left visual field (right hemisphere). Patients with schizophrenia, however, did not demonstrate this switching into a right hemisphere mode upon bilateral presentation of the trigrams and instead seemed to show no switching, or actually switching into more of a left hemisphere mode. Our results suggest that patients with schizophrenia (but not bipolar disorder) may have abnormalities in the cooperative processing of information when it is presented to both hemispheres, and that this disturbance may reflect problems with metacontrol of hemispheric processing.

Lateralized cognitive dysfunction and psychotic symptoms in schizophrenia.

Our understanding of hemispheric asymmetries in schizophrenia can be attributed to extensive neuropsychological and neuroimaging research on this topic; however, it has yet to be determined whether lateralized cognitive dysfunction represents a single core trait in schizophrenia or whether the lateralized impairments are domain specific. To test whether lateralized deficits are core features in schizophrenia we examined performance across a wide range of lateralized cognitive domains including attention, fluency, recognition memory, perception, and arousal. We also examined the relationship between lateralized impairments and psychotic and affective symptoms to determine whether abnormal hemispheric asymmetries were possibly state-related. The sample consisted of 43 subjects with schizophrenia and 66 normal healthy comparison subjects without psychiatric illness. Schizophrenia subjects exhibited abnormal right hemisphere performance on a test of recognition memory and abnormal left hemisphere performance on a measure of arousal. These findings suggest that lateralized cognitive disturbances in schizophrenia do not represent a single core lateralized deficit. Regarding the symptom analyses, severity of positive symptoms was related to right hemisphere cognitive impairment (including fluency and recognition memory), whereas severity of negative symptoms was related to left hemisphere cognitive impairment (including fluency). Overall, our findings suggest that lateralized dysfunction can occur in both hemispheres in schizophrenia, and that the positive psychotic symptoms may relate more to right hemisphere impairment, whereas negative psychotic symptoms may related more to left hemisphere impairment.