IADL Functions, Cognitive Deficits, and Severity of Depression: A Preliminary Study

doi:10.1097/00019442-200503000-00010

The American Journal of Geriatric Psychiatry

Volume 13, Issue 3, March 2005, Pages 244-249

https://doi.org/10.1097/00019442-200503000-00010 Get rights and content

Objective

Despite the documented association of cognitive dysfunction with impairment in instrumental activities of daily living (IADLs) in geriatric depression, the relationship among deficits in distinct IADLs with severity of depression and specific cognitive impairments remains to be clarified. The authors examined the relationship of depression severity and the cognitive domains of attention, initiation/perseveration, construction, conceptualization, and memory to nine distinct IADLs.

Methods

The subjects were 105 nondemented elderly patients but with impairment in at least one IADL and a history or presence of major depression. Impairment in IADLs and severity of depression were assessed with the Philadelphia Multilevel Assessment Instrument (MAI) and the 24-item Hamilton Depression Rating Scale (Ham-D), respectively. Cognitive dysfunction was assessed with the Mini-Mental State Exam (MMSE) and the Mattis Dementia Rating Scale (DRS).

Results

Six IADLs were influenced by impairment in at least one of the cognitive domains. Abnormal scores in initiation/perseveration, an aspect of executive dysfunction, was the cognitive impairment affecting most IADLs; it interfered with the ability to shop for groceries, prepare meals, take medicine, and manage money. Impairment in initiation/perseveration had a most prominent effect in the presence of depressive symptoms and affected shopping for groceries and preparing meals. Lack of interest and motivation, part of the depressive syndrome, compounded by behavioral abnormalities resulting from executive dysfunction, may account for this interaction.

Conclusions

These relationships may provide the background for developing interventions targeting functional deficits associated with specific cognitive dysfunctions and depression.

Section snippets

METHODS

The subjects were consecutively recruited psychiatric outpatients and inpatients by the Longitudinal Study of Late-Life Depression. They were included if they were age 60 years or older, had an impairment in at least one IADL (score below 3 on at least one IADL subscale of the Multilevel Assessment Instrument [MAI-IADL]),¹³ and had a history or presence of major depression (by SCID and DSM-IV criteria). The reason for including subjects with either history or presence of major depression was to

RESULTS

We studied a total of 105 disabled elderly subjects without dementia and with a history or presence of unipolar major depression. The sample was predominantly Caucasian (97%). They experienced varying degrees of depression severity and had a wide range of medical burden (Table 1). The female-to-male ratio was 2.1 to 1. Women and men had comparable Total IADL scores (t_[103] = 0.57; p = 0.645).

For the analysis of specific IADL functions, each IADL was classified as impaired (score <3) or

DISCUSSION

The principal finding of this preliminary study is that depression severity and impairment in specific cognitive domains alone or in the presence of depression are associated with impairment in seven out of eight IADL functions. Specifically, six of the nine IADLs were influenced by impairment on at least one of the cognitive domains. Abnormal score in initiation/perseveration, an aspect of executive dysfunction, was the cognitive impairment affecting most IADLs; it interfered with the ability

References (22)

GJ Kennedy
The dynamics of depression and disability
Am J Geriatr Psychiatry
(2001)
GS Alexopoulos et al.
Comorbidity of late-life depression: an opportunity for research on mechanisms and treatment
Biol Psychiatry
(2002)
EJ Lenze et al.
The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research
Am J Geriatr Psychiatry
(2001)
ML Bruce
Psychosocial risk factors for depressive disorders in late life
Biol Psychiatry
(2002)
P Laukkanen et al.
Health and functional capacity as predictors of community dwelling among elderly people
J Clin Epidemiol
(2000)
DC Steffens et al.
Disability in geriatric depression
Am J Geriatr Psychiatry
(1999)
DN Kiosses et al.
Executive dysfunction and disability in elderly patients with major depression
Am J Geriatr Psychiatry
(2001)
MF Folstein et al.
“Mini-Mental State:” a practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975)
MD Miller et al.
Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale
Psychiatry Res
(1992)
CF Reynolds et al.
Chronic depression in the elderly: approaches for prevention
Drugs Aging
(2001)

M Ganguli et al.

Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression

Arch Gen Psychiatry

(2002)

Cited by (110)

The association between functional disability and depressive symptoms among older adults: Findings from the China Health and Retirement Longitudinal Study (CHARLS)
2024, Journal of Affective Disorders
Previous research has shown that depressive symptoms in older adults was associated with functional disability, including basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). However, little is known about the impact of different patterns of functional disability and new-onset functional disability on subsequent depressive symptoms.
To determine the effect of various patterns of functional disability and new-onset functional disability on depressive symptoms among Chinese older adults aged 60 years and above.
The study included 3242 older adults from the China Health and Retirement Longitudinal Study (CHARLS), which was conducted from 2011 to 2018. Cox proportional hazards models were used to investigate the associations between patterns of functional disability and depressive symptoms. The associations were also examined in the population with new-onset functional disability.
During 15,321 person-years of follow-up, 946 depressive symptoms occurred. The hazard ratios (HRs) of depressive symptoms were 1.29 (95 % confidence intervals [CI]: 1.05–1.58) for IADLs disability, 1.22 (95 % CI: 0.75–1.55) for BADLs disability, and 1.78 (95 % CI: 1.41–2.22) for both IADLs and BADLs disabilities. In the analysis of new-onset functional disability, the HRs were 1.50 (95 % CI: 1.06–2.13) for onset IADLs disability, 1.28 (95 % CI: 0.85–1.91) for onset BADLs disability, and 1.69 (95 % CI: 1.03–2.76) for both onset BADLs and IADLs disabilities.
Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale, which has limitations in diagnosing clinical depression.
Functional disability increases the risk of depressive symptoms, particularly impaired IADLs function. Psychological care for older adults with functional disability should be strengthened.
Hoarding Symptoms in Late Life Depression are Associated With Greater Executive Dysfunction and Disability and Poorer Response to Depression Treatment
2024, American Journal of Geriatric Psychiatry
Late life depression (LLD) and hoarding disorder (HD) are common in older adults and characterized by executive dysfunction and disability. We aimed to determine the frequency of co-occurring HD in LLD and examine hoarding severity as an additional contributor to executive dysfunction, disability, and response to psychotherapy for LLD.
Cross-sectional.
Outpatient psychiatry program.
Eighty-three community-dwelling adults ages 65–90 with LLD.
Problem-solving therapy.
Measures of executive function, disability, depression, and hoarding severity were completed at post-treatment. Pearson's chi-squared tests evaluated group differences in rates of cognitive impairment, disability, and depression treatment response between participants with HD (LLD+HD) and LLD only. Separate linear regressions assessed associations between hoarding severity and executive function, disability, and psychotherapy response. Covariates included age, education, gender, and depression severity.
30.1% (25/83) of LLD participants met HD criteria. Relative to LLD, LLD+HD participants demonstrated greater impairment rates on measures of executive function (Letter-Number-Sequencing, X²(1)=4.0, p = 0.045; Stroop-Interference, X²(1) = 4.8, p = 0.028). Greater hoarding severity was associated with poorer executive functioning performance (Letter-Number-Sequencing (t[70] = −2.1, β = −0.05, p = 0.044), Digit-Span (t[71] = −2.4, β = −0.07, p = 0.019), Letter-Fluency (t[ 71] = −2.8, β = −0.24, p = 0.006)). Rates of disability were significantly higher for LLD+HD (88.0%) than LLD (62.3%), (X²[1] = 5.41, p = 0.020) and higher hoarding severity was related to greater disability (t[72] = 2.97, β = 0.13, p = 0.004). Depression treatment response rates were significantly lower for LLD+HD (24.0%) compared to LLD (48.3%), X²(1) = 4.26, p = 0.039, and HD status predicted psychotherapy response, t(67) = −2.15, β = −15.6, p = 0.035.
We found 30.1% co-occurrence of HD in LLD, which was accompanied by greater executive dysfunction, disability, and poorer response to depression treatment. Results underscore the need for increased screening of hoarding behaviors in LLD and tailored interventions for this LLD+HD group.
Predicting functional dependency using machine learning among a middle-aged and older Chinese population
2023, Archives of Gerontology and Geriatrics
To develop prediction models for assessing functional dependency in a middle-aged and older Chinese population.
Adults ≥45 years old from the China Health and Retirement Longitudinal Study (CHARLS) and without functional dependency at baseline were included. Functional dependency was defined as needing any help in any basic activities of daily living (ADL) or instrumental activities of daily living (IADL). The outcomes were overall functional dependency, ADL and IADL dependency. Stacked ensemble models were constructed based on five selected machine learning models. Models were trained and tested in the 2011–2015 cohort, and were externally validated in the 2015–2018 cohort. SHapley Additive exPlanations (SHAP) was utilized to quantify the significance of predictors.
In the training cohort, a total of 6,297 participants were included at baseline, 1,893 developed functional dependency during the follow-up period. The stacked ensemble model achieved the best performance in terms of discrimination ability for predicting overall functional dependency, ADL and IADL dependency, with AUCs of 0.750, 0.690 and 0.748, respectively; in external validation cohort, the corresponding AUCs were 0.725, 0.719 and 0.727, respectively. A compact model was further developed and maintained similar predictive performance.
The stacked ensemble approach can serve as a useful tool for identifying the risk of functional dependency in a large Chinese population. For ADL dependency, arthritis, age, self-report health, and waist circumference were identified as highly significant predictors. Conversely, cognitive function, age, living in rural areas, and performance in chair stand test emerged as highly ranked predictors for IADL dependency.
The effectiveness of repeated intravenous ketamine on subjective and objective psychosocial function in patients with treatment-resistant depression and suicidal ideation
2022, Journal of Affective Disorders
Citation Excerpt :
Functional outcomes generally correlated, but not totally parallel with mood symptom severity, while cognitive function appears to affect general functioning independently of depressive symptoms, as well some studies found an interaction between cognition and depression severity on functional outcomes (Kiosses and Alexopoulos, 2005; Paelecke-Habermann et al., 2005; Knight and Baune, 2018; McInerney et al., 2020). Adults with MDD and cognitive deficits often present with more severe depression, less favourable response to treatment, course and outcome (Kiosses and Alexopoulos, 2005; Paelecke-Habermann et al., 2005; Knight and Baune, 2018; McInerney et al., 2020). There is a need to identify strategies in MDD/TRD that can meaningfully improve cognitive measures (McIntyre et al., 2019).
Ketamine has rapid and robust antidepressant effects in adults with treatment-resistant depression (TRD), while its effects on functional outcomes have not been sufficiently evaluated. The aim was to evaluate the efficacy of ketamine treatment on both subjective and objective functioning, and to explore whether improvements in depressive symptom and cognition mediated changes in functioning.
Adults (n=111) with TRD and/or suicidality received six infusions of ketamine (0.5mg/kg, thrice-weekly). Depression symptoms were assessed with the Montgomery–Asberg Depression Rating Scale (MADRS) at baseline, day 13 and day 26. Cognitive domains, including processing speed, working memory, visual learning and verbal learning were measured with the MATRICS Consensus Cognitive Battery, and subjective and objective functioning were measured with the Sheehan Disability Scale (SDS) and the Global Assessment of Functioning (GAF) at the same time-points.
Significant improvement was observed in SDS total score (effect size [ES]=-1.563) and GAF score (ES=1.700) during the 26-day observation. Results from path analysis indicated that reductions of the total MADRS score and improvements in processing speed aggregately significantly mediated the reductions of SDS total score (total indirect effect coef=-3.993, 95%CI [-4.9, -3.2], direct effect coef=-1.374, 95%CI [-2.4, -0.4]) as well as the increases of GAF score (total indirect effect coef=6.022, 95%CI [4.5, 7.8], direct effect coef=3.987, 95%CI [2.1, 5.8]).
Six infusions of ketamine was associated with improvements in functional outcomes in adults with TRD and/or suicidality. Depressive symptoms severity and processing speed performance were significant partial mediators of objective and subjective functioning improvements.
Brain-based mechanisms of late-life depression: Implications for novel interventions
2021, Seminars in Cell and Developmental Biology
Late-life depression (LLD) is a particularly debilitating illness. Older adults suffering from depression commonly experience poor outcomes in response to antidepressant treatments, medical comorbidities, and declines in daily functioning. This review aims to further our understanding of the brain network dysfunctions underlying LLD that contribute to disrupted cognitive and affective processes and corresponding clinical manifestations. We provide an overview of a network model of LLD that integrates the salience network, the default mode network (DMN) and the executive control network (ECN). We discuss the brain-based structural and functional mechanisms of LLD with an emphasis on their link to clinical subtypes that often fail to respond to available treatments. Understanding the brain networks that underlie these disrupted processes can inform the development of targeted interventions for LLD. We propose behavioral, cognitive, or computational approaches to identifying novel, personalized interventions that may more effectively target the key cognitive and affective symptoms of LLD.
On the nature of objective and perceived cognitive impairments in depressive symptoms and real-world functioning in young adults
2020, Psychiatry Research
Cognitive impairments in depression contribute to disability. According to prevailing cognitive theories, one's perception related to cognitive ability can cause and maintain depression, and related outcomes. Here, we investigate the degree to which perceived cognitive impairment predicts functional impairment above and beyond objective neurocognition. A sample of young adults (n = 123) completed a battery of tests measuring objective cognitive ability, perceived cognitive function (e.g., Perceived Deficits Questionnaire), disability (e.g., World Health Organization Disability Assessment Schedule) and depressive symptoms (Beck Depression Inventory-2). Hierarchical multiple regression analyses tested the incremental variance that perceived cognitive impairment accounts for above and beyond neuropsychological test measures and disability related to depression. Results show that perceived cognitive impairment accounts for significant incremental variance in depressive symptoms beyond neuropsychological test scores; disability measures were significantly associated with depressive symptoms, as was perceived cognitive impairment. Individuals with depression and related disorders are more likely to report cognitive impairments and experience diminished cognitive ability - relative to healthy controls - regardless of objective impairments, highlighting the importance of considering, measuring, and treating this perceived cognitive impairment, that is, Cognitive Impairment Bias (Dhillon and Zakzanis, 2019).

View all citing articles on Scopus

: This work was supported by National Institute of Mental Health grants P30 MH068638, R37 MH51842, R01 MH65653, T32 MH19132, and a NARSAD Young Investigator Award.

View full text

Regular Research ArticlesIADL Functions, Cognitive Deficits, and Severity of Depression: A Preliminary Study

Objective

Methods

Results

Conclusions

Section snippets

METHODS

RESULTS

DISCUSSION

Am J Geriatr Psychiatry

Biol Psychiatry

Am J Geriatr Psychiatry

Biol Psychiatry

J Clin Epidemiol

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

J Psychiatr Res

Psychiatry Res

Chronic depression in the elderly: approaches for prevention

Drugs Aging

Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression

Arch Gen Psychiatry

Regular Research Articles
IADL Functions, Cognitive Deficits, and Severity of Depression: A Preliminary Study