Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations ...of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia).
A total of 5,822 participants (Mage = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates.
In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b = 0.65, 95% confidence interval 95% CI = 0.07, 1.23) and less decline in GCA over time (b = 0.06, 95% CI = 0.001, 0.12). Baseline insomnia was related to better baseline MoCA (b = 1.54, 95% CI = 0.88, 2.21) and less decline in MoCA over time (b = 0.56, 95% CI = 0.20, 0.92). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia.
Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep.
Abstract
Objective
We investigated complexity of work in main occupation in relation to incident cognitive impairment in older Puerto Ricans.
Method
A population-based sample of 1,673 adults age 60+ ...for the Puerto Rican Elderly: Health Conditions (PREHCO) study was used. Cognition was measured at baseline and 4 years later using the Mini-Mental Cabán (MMC), with scoring 1.5 SD below the MMC score adjusted for age, education, gender, and reading ability comprising cognitive impairment. Complexity scores were derived from the 1970 U.S. Census, 1977 and 2000 Dictionary of Occupational Titles, and 2001 O*Net.
Results
Controlling for baseline age, gender, childhood economic hardship, adult money problems, depressive symptoms, and self-reported health, greater scores for most work complexity measures were associated with significantly lower risk of cognitive impairment (ps < .05), with significant odds ratios ranging between 0.74, reflecting 26% reduction in risk for every extra standard deviation of complexity, and 0.81. Controlling for education reduced these effects slightly but also reduced most associations to nonsignificant. The results were stronger for those with less childhood economic hardship or education (ps < .05).
Discussion
Complexity of work may reduce risk of cognitive impairment in Puerto Rican older adults, especially when combined with favorable childhood economic conditions and higher educational attainment.
Informal caregivers are an integral part of end-of-life care for hospice patients with cancer. Although adjustment following loss is highly individual, many caregivers have significant psychological ...distress after the death of a loved one. This study investigated risk factors that may predict psychological distress, which could aid hospice bereavement departments in targeting bereavement services.
Demographic characteristics, patient impairment, caregiver baseline symptoms of depression, and caregiver resources were assessed among 188 cancer patient-caregiver dyads. Regression analyses identified predictors of symptoms of depression, grief, and complicated grief one year following loss.
Over 50% of bereaved caregivers had clinically significant depressive symptoms one year after death of their relative. Caregivers with fewer years of education and more baseline symptoms of depression had significantly worse grief, complicated grief, and depression. Younger patient age was a significant predictor of poorer outcomes for grief and complicated grief; and less patient impairment was a significant predictor of more post-loss symptoms of depression. Lower social support satisfaction was correlated with worse grief and complicated grief but was not a significant multivariate predictor of poorer outcomes.
Despite having access to hospice bereavement services, many former caregivers had high psychological distress one year following loss. Bereavement departments could consider utilizing readily available risk factors to target services to former caregivers who may benefit from bereavement services. Bereavement departments might also consider including brief, standardized screenings of caregiver depression in initial risk assessments. Future studies should investigate evidence-based approaches for assessment and interventions among highly distressed former hospice caregivers.
We aimed to characterize premature aging as an accumulation of deficits in survivors of pediatric cancer compared with community controls and examine associations with host and treatment factors, ...neurocognition, and mortality.
Pediatric cancer survivors (n = 4000, median age = 28.6, interquartile range IQR = 23-35 years; 20 years postdiagnosis: IQR = 15-27), and community participants without a history of cancer serving as controls (n = 638, median age = 32, IQR = 25-40 years) completed clinical assessments and questionnaires and were followed for mortality through April 30, 2020 (mean SD follow-up = 7.0 3.4 years). A deficit accumulation index (DAI) score was calculated from 44 aging-related items including self-reported daily function, psychosocial symptoms, and health conditions. Items were weighted from 0 (absent) to 1 (present and/or most severe), summed and divided by the total yielding a ratio (higher = more deficits). Scores less than 0.20 are robust, and 0.06 is a clinically meaningful difference. Linear regression compared the DAI in survivors and controls with an age*survivor or control interaction. Logistic regression and Cox-proportional hazards estimated the risk of neurocognitive impairment and death. Models were minimally adjusted for age, sex, and race and ethnicity.
The adjusted mean DAI among survivors at age 30 years was 0.16 corresponding to age 63 years in controls (33 years premature aging; β = 0.07, 95% confidence interval CI = 0.06 to 0.08; P < .001). Cranial and abdominal radiation, alkylators, platinum, and neurosurgery were associated with worse DAI (P ≤ .001). Higher scores were associated with increased risk of neurocognitive impairment in all domains (P < .001) and increased risk of death (DAI = 0.20-0.35, hazard ratio = 2.80, 95% CI = 1.97 to 3.98; DAI ≥ 0.35, hazard ratio = 5.08, 95% CI = 3.52 to 7.34).
Pediatric cancer survivors experience clinically significant premature aging. The DAI may be used to identify survivors at greatest risk of poor health outcomes.
Witnessing end-of-life suffering of loved ones is an underappreciated stressor that may affect caregiver bereavement. We interviewed 61 spousal caregivers of hospice patients who died within the past ...6-18 months. Higher rumination about suffering and lower feelings of relief was related to poorer well-being. Rumination by caregivers about end-of-life suffering was an important predictor of depression and complicated grief. Most caregivers viewed the death as at least in part a relief. One important focus of grief support may be to help caregivers find productive ways to avoid rumination and use other forms of coping and to acknowledge feelings of relief.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Questionnaires like the Metamemory in Adulthood Questionnaire (MIA; Dixon, Hultsch, & Hertzog, 1988) have been used to examine longitudinal changes and cross-sectional age differences in multiple ...metamemory facets (e.g., memory self-efficacy). This study used 3 independent cross-sectional samples (N = 1,555; ages 55-85) from the Victoria Longitudinal Study collected in 1986, 1992, and 2000 to evaluate period and cohort effects on 8 MIA scales. Alternative general linear models analyzed age, cohort, and period effects, while subsequently assessing gender differences in metamemory beliefs. Period effects were detected on the MIA Internal Strategy and External Strategy scales; self-reported use of internal strategies decreased while use of external memory aids increased over the historical period. Reliable cohort (generational) differences were found for MIA Change, with the lowest levels of perceived change in individuals born between 1916 and 1925. MIA Task, measuring knowledge about memory, produced small age and cohort effects. Gender differences emerged in metamemory, especially for the Internal Strategy and External Strategy scales (women reporting higher strategy use). Gender differences were also seen for the Capacity, Locus, Anxiety, and Achievement scales, with women reporting higher perceived memory efficacy, control, memory anxiety, and greater motivation to have better memory, respectively. The historical trends in metamemory beliefs should be replicated with other measures and other populations; however, the results generally confirm conclusions from earlier cross-sectional studies regarding age sensitivity of metamemory beliefs from middle age to old age.
Background
Increases in fatigue, depressive symptomatology, and cognitive impairment are common after the initiation of androgen deprivation therapy (ADT) for prostate cancer. To date, no studies ...have examined the potential role of inflammation in the development of these symptoms in ADT recipients. The goal of the current study was to examine circulating markers of inflammation as potential mediators of change in fatigue, depressive symptomatology, and cognitive impairment related to the receipt of ADT.
Methods
Patients treated with ADT for prostate cancer (ADT+; n = 47) were assessed around the time of the initiation of ADT and 6 and 12 months later. An age‐ and education‐matched group of men without a history of cancer (CA–; n = 82) was assessed at comparable time points. Fatigue, depressive symptomatology, and cognitive impairment were assessed with the Fatigue Symptom Inventory, the Center for Epidemiological Studies Depression Scale, and a battery of neuropsychological tests, respectively. Circulating markers of inflammation included interleukin 1 receptor antagonist (IL‐1RA), interleukin 6 (IL‐6), soluble tumor necrosis factor receptor II (sTNF‐RII), and C‐reactive protein (CRP).
Results
Fatigue, depressive symptomatology, and serum IL‐6 increased significantly over time in the ADT+ group versus the CA– group; rates of cognitive impairment also changed significantly between the groups. No significant changes in IL‐1RA, sTNF‐RII, or CRP over time were detected. Treatment‐related increases in IL‐6 were associated with worsening fatigue but not depressive symptomatology or cognitive impairment.
Conclusions
Results of this preliminary study suggest that increases in circulating IL‐6, perhaps due to testosterone inhibition, may play a role in fatigue secondary to receipt of ADT. Additional research is needed to determine whether interventions to reduce circulating inflammation improve fatigue in this population.
Androgen deprivation therapy is associated with increases over time in fatigue, depressive symptomatology, and circulating interleukin 6. Increases in interleukin 6 over time are associated with worsening treatment‐related fatigue but not depressive symptomatology or cognitive impairment.
•No baseline variables moderated the effects of DCS augmentation of CBT for OCD.•Better insight at pre-treatment was associated with more improvement over treatment.•Several baseline variables were ...associated with a decreased likelihood of remission.•Need to adapt existing CBT protocols to personalize treatments.
Over half of children receiving cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) do not fully remit. To improve response rates and enhance extinction learning, d-cycloserine (DCS) has been examined as an augmenting agent of CBT. To direct children with OCD towards treatments with the highest likelihood of success, the current study evaluated the conditions under which DCS augmentation works best (i.e., moderators) and the baseline characteristics associated with outcome, irrespective of treatment type (i.e., predictors).
Data came from a two-site randomized controlled trial (N = 142) in which children received either DCS + CBT (n = 70) or placebo + CBT.
No baseline variables moderated the effects of DCS augmentation on CBT outcome. However, several predictor variables were associated with a decreased likelihood of achieving remission status, including higher family accommodation scores, higher impairment scores, higher depression scores, and higher externalizing scores. Furthermore, better insight at pre-treatment was associated with more improvement longitudinally on a clinician-rated summary measure of illness severity.
The current study did not examine all variables that had previously been shown to moderate or predict treatment outcome (e.g., family history of OCD or cognitive profile).
The absence of significant moderators suggests that baseline factors cannot yet be used to determine who benefits most from DCS. To maximize treatment benefits for children presenting with identified predictors of worse treatment outcome, clinicians might need to adapt existing CBT protocols and administer additional interventions that address patients’ specific problem areas.
This study examined sleep concerns among direct-care workers in long-term care and their perceived need for a sleep intervention. Thirty-five participants reported their sleep concerns and ...willingness to participate in a sleep intervention with preferred delivery forms/content. Multiple sleep characteristics were assessed via ecological momentary assessment and actigraphy for 2 weeks. Eighty percent reported at least one sleep concern with insomnia-related concerns being most prevalent. Those with insomnia-related concerns tended to have long sleep onset latency, frequent awakenings, suboptimal (long) sleep duration, and long naps. Most participants (66%) expressed interest in participating in a sleep intervention either online or in group sessions; interest was higher in those with insomnia-related concerns. Mindfulness strategies were most preferred, followed by cognitive-behavioral therapy and sleep hygiene education. The high prevalence of insomnia-related concerns in direct-care workers needs to be addressed for the well-being of these workers and for the quality of geriatric care delivery.
Objective
Cancer and its treatment are associated with long‐term cognitive deficits. However, most studies of cancer patients have used traditional, office‐based cognitive evaluations instead of ...assessing patients in their daily lives. Recent research in cognitive aging suggests that variability in performance may be a sensitive indicator of cognitive decline. Using ecological momentary assessment (EMA), we examined cognitive variability among breast cancer survivors and evaluated whether ratings of fatigue and depressed mood were associated with cognition.
Methods
Participants were 47 women (M age = 53.3 years) who completed treatment for early stage breast cancer 6 to 36 months previously. Smartphones were preloaded with cognitive tests measuring processing speed, executive functioning, and memory, as well as rating scales for fatigue and depressed mood. Participants were prompted five times per day over a 14‐day period to complete EMA cognitive tasks and fatigue and depressed mood ratings.
Results
Cognitive variability was observed across all three EMA cognitive tasks. Processing speed responses were slower at times that women rated themselves as more fatigued than their average (P < .001). Ratings of depressed mood were not associated with cognition.
Conclusions
This study is the first to report cognitive variability in the daily lives of women treated for breast cancer. Performance was worse on a measure of processing speed at times when a woman rated her fatigue as greater than her own average. The ability to identify moments when cognition is most vulnerable may allow for personalized interventions to be applied at times when they are most needed.
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