Within-person increase in pathological worry predicts future depletion of unique executive functioning domains

Abstract Background Affective neuroscience and scar theories propose that increased excessive worry, the hallmark symptom of generalized anxiety disorder (GAD), predicts future declines in executive functioning (EF). However, the preponderance of cross-sectional designs used to examine between-person chronic worry–EF relationships has blocked progress on understanding their potentially causal within-person associations. Accordingly, this study used bivariate dual latent change score (LCS) models to test whether within-person increased GAD severity might relate to future reduced EF. Methods Community-dwelling adults (N = 2581, 46 years on average, s.d. = 11.40, 54.71% female) were assessed for GAD symptom severity (Composite International Diagnostic Interview-Short Form) across three waves, spaced about 9 years apart. Three aspects of EF [inhibition, set-shifting, and mixing costs (MCs; a measure related to common EF)], were assessed with stop-and-go switch tasks. Participants responded to 20 normal and 20 reverse single-task block trials and 32 mixed-task switch block trials. EF tests were administered at time 2 (T2) and time 3 (T3), but not at time 1 (T1). Results After controlling for T1 depression, LCS models revealed that within-person increased T1 − T2 GAD severity substantially predicted future reduced T2 − T3 inhibition and set-shifting (both indexed by accuracy and latency), and MC (indexed by latency) with moderate-to-large effect sizes (|d| = 0.51–0.96). Conclusions Results largely support scar theories by offering preliminary within-person, naturalistic evidence that heightened excessive worry can negatively predict future distinct aspects of cognitive flexibility. Effectively targeting pathological worry might prevent difficulties arising from executive dysfunction.

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Inflammation Mediates Longitudinal Relations Between Common Psychiatric Disorder Severity and Future Executive Function Impairment

10.31234/osf.io/tx7g2 ◽

2020 ◽

Author(s):

Nur Hani Hani Zainal ◽

Michelle G. Newman

Keyword(s):

Executive Function ◽

Psychiatric Disorder ◽

Structural Equation ◽

Depressive Disorders ◽

Short Form ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Community Dwelling ◽

Equation Modeling ◽

Cross Sectional

Background: Scar models propose that elevated psychiatric disorder severity predisposes people to future decreased executive function (EF) through heightened inflammation. However, most prior research on this topic has been cross-sectional. We thus investigated if increased Time 1 (T1) common psychiatric disorder severity predicted Time 3 (T3) EF decrement via Time 2 (T2) inflammation in two unique samples. Methods: Community- dwelling adults participated in Study 1 (n = 614) and Study 2 (n = 945). Both studies measured T1 common psychiatric disorder severity (Composite International Diagnostic Interview–Short Form major depressive disorder, generalized anxiety disorder, and panic disorder severity scales), T2 inflammation (interleukin-6, C-reactive protein, and fibrinogen blood concentration), and T3 EF (Brief Test of Adult Cognition by Telephone). Structural equation modeling was conducted. Results: Greater T1 diagnostic severity predicted higher T2 inflammation (after 2 months in Study 1: Cohen’s d = 0.84; following 9 years in Study 2: d = 0.82). Moreover, higher T2 inflammation predicted lower T3 EF (after 18 months in Study 1: d = -1.30; following 9 years in Study 2: d = -1.18), with large effect sizes. Further, the mediation paths were significantly moderate-to-large in Study 1 (d = 0.76) and Study 2 (d = 0.69). Socio-demographic, lifestyle, medication use, and physical health variables did not moderate these mediation models. Conclusions: Inflammation may be a mechanism explaining the T1 common psychiatric disorder severity–T3 EF relation. Treatments that target inflammation and/or anxiety or depressive disorders may prevent some individuals from experiencing EF decline.

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Depression and worry symptoms predict future executive functioning impairment via inflammation

Psychological Medicine ◽

10.1017/s0033291721000398 ◽

2021 ◽

pp. 1-11

Author(s):

Nur Hani Zainal ◽

Michelle G. Newman

Keyword(s):

Structural Equation ◽

Short Form ◽

Composite International Diagnostic Interview ◽

Past Research ◽

Serum Levels ◽

Diagnostic Interview ◽

Community Dwelling ◽

Major Depressive ◽

Cross Sectional ◽

Reactive Protein

Abstract Background Scar models posit that heightened anxiety and depression can increase the risk for subsequent reduced executive function (EF) through increased inflammation across months. However, the majority of past research on this subject used cross-sectional designs. We therefore examined if elevated generalized anxiety disorder (GAD), major depressive disorder (MDD), and panic disorder (PD) symptoms forecasted lower EF after 20 months through heightened inflammation. Methods Community-dwelling adults partook in this study (n = 614; MAGE = 51.80 years, 50% females). Time 1 (T1) symptom severity (Composite International Diagnostic Interview – Short Form), T2 (2 months after T1) inflammation serum levels (C-reactive protein, fibrinogen, interleukin-6), and T3 (20 months after T1) EF (Brief Test of Adult Cognition by Telephone) were assessed. Structural equation mediation modeling was performed. Results Greater T1 MDD and GAD (but not PD) severity predicted increased T2 inflammation (Cohen's d = 0.21–1.92). Moreover, heightened T2 inflammation forecasted lower T3 EF (d = −1.98 to −1.87). T2 inflammation explained 25–32% of the negative relations between T1 MDD or GAD and T3 EF. T1 GAD severity predicting T3 EF via T2 inflammation path was stronger among younger (v. older) adults. Direct effects of T1 MDD, GAD, and PD forecasting decreased T3 EF were found (d = −2.02 to −1.92). Results remained when controlling for socio-demographic, physical health, and lifestyle factors. Conclusions Inflammation can function as a mechanism of the T1 MDD or GAD–T3 EF associations. Interventions that successfully treat depression, anxiety, and inflammation-linked disorders may avert EF decrements.

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Several frailty parameters highly prevalent in middle age (50–65) are independent predictors of adverse events

Scientific Reports ◽

10.1038/s41598-021-88410-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lauriane Segaux ◽

Amaury Broussier ◽

Nadia Oubaya ◽

Claire Leissing-Desprez ◽

Marie Laurent ◽

...

Keyword(s):

Adverse Events ◽

Middle Age ◽

Executive Dysfunction ◽

Community Dwelling ◽

Living Alone ◽

Middle Aged ◽

Cross Sectional ◽

Balance Impairment ◽

Logistic Regression Models ◽

Paris Area

AbstractAlthough frailty can arise in middle age, very few studies have investigated frailty before 65 years. Our objectives were to assess the prevalence of frailty parameters in middle-aged individuals and probe the association with future adverse events. We performed cross-sectional and longitudinal analyses of community-dwelling individuals aged 50 to 65 (n = 411, median age: 59.0) having undergone a multidomain geriatric assessment (2010–2015) in an outpatient clinic in the greater Paris area of France (SUCCEED cohort). The primary outcome was a composite measure of adverse events (non-accidental falls, fractures, unplanned hospitalizations, death), recorded in 2016/2017. Multivariable logistic regression models were built to identify independent predictors. Six frailty parameters were highly prevalent (> 20%): low activity (40.1%), exhaustion (31.3%), living alone (28.5%), balance impairment (26.8%), weakness (26.7%), and executive dysfunction (23.2%). Female sex (odds ratio: 2.67 [95% confidence interval: 1.17–6.11]), living alone (2.39 [1.32–4.33]), balance impairment (2.09 [1.16–3.78]), executive dysfunction (2.61, [1.18–5.77]), and exhaustion (2.98 [1.65–5.39]) were independent predictors of adverse events. Many frailty parameters are already altered in middle-aged individuals and are predictive of adverse health events. Our findings highlight a possible need for frailty screening and preventive programs targeting middle-aged individuals.

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The Mediating Effect of Stress Reactivity in the 18-Year Bidirectional Relationship Between Generalized Anxiety and Depression Severity

10.31234/osf.io/27dws ◽

2021 ◽

Author(s):

Kathryn E Barber ◽

Nur Hani Zainal ◽

Michelle G. Newman

Keyword(s):

Structural Equation ◽

Stress Reactivity ◽

Short Form ◽

Emotional Reactions ◽

Community Dwelling ◽

Mediating Effect ◽

Self Report ◽

Anxiety And Depression ◽

Generalized Anxiety ◽

Cross Sectional

Background: Generalized anxiety disorder (GAD) and major depressive disorder (MDD) often precede and predict one another. Stress reactivity theories of psychopathology posit that patterns of heightened emotional reactions to stressors can result in increased vulnerability to the development of anxiety and depression. However, cross-sectional studies on this topic have hindered causal inferences. Method: The present study examined stress reactivity as a potential mediator of the sequential associations between GAD and MDD symptoms in a sample of 3,294 community-dwelling adults. GAD and MDD symptom severity (Composite International Diagnostic Interview-Short Form) was assessed at two time points (T1 and T3), approximately 18 years apart. Stress reactivity (Multidimensional Personality Questionnaire) was measured at T2. Results: Structural equation mediation modeling demonstrated that higher T1 GAD severity positively predicted more severe T3 MDD symptoms via T2 stress reactivity (d = 0.45–0.50). After controlling for T1 GAD, T2 stress reactivity was not a significant mediator in the relationship between higher T1 MDD symptoms and worse T3 GAD symptoms. Direct effects indicated that T1 GAD positively predicted T3 MDD 18 years later, and vice versa (d = 1.29–1.65). Limitations: Stress reactivity was assessed using a self-report measure, limiting conclusions to perceived (vs. behaviorally indexed) stress reactivity. Conclusions: These findings indicate that stress reactivity may be one mechanism through which GAD leads to later MDD over prolonged durations. Overall, our results suggest that targeting stress reactivity in treatments for GAD may reduce the risk of developing subsequent MDD.

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What is the prevalence of untreated depression and death ideation in older people? Data from the Irish Longitudinal Study on Aging

International Psychogeriatrics ◽

10.1017/s104161021700299x ◽

2018 ◽

Vol 30 (9) ◽

pp. 1393-1401 ◽

Cited By ~ 16

Author(s):

Robert Briggs ◽

Katy Tobin ◽

Rose Anne Kenny ◽

Sean P. Kennelly

Keyword(s):

Longitudinal Study ◽

Older People ◽

Depression Scale ◽

Composite International Diagnostic Interview ◽

Population Level ◽

Pharmacological Therapy ◽

Community Dwelling ◽

Late Life Depression ◽

Antipsychotic Therapy ◽

Cross Sectional

ABSTRACTObjective:Late life depression (LLD) confers significant morbidity and mortality but is well recognized that it often goes undetected or untreated. The objective of this study is to quantify the burden of untreated depression and death ideation (DI) at a population level.Design:Cross-sectional study ascertaining the prevalence of, and factors associated with, untreated depression and DI.Setting:This study, embedded within the Irish Longitudinal Study on Ageing, involves over 7,000 community-dwelling people aged ≥50 years.Measurements:Depression was defined as Centre for Epidemiological Studies Depression scale ≥16 indicating current clinically relevant depressive symptoms or Composite International Diagnostic Interview indicative of major depressive episode within the last year. Participants not prescribed antidepressants/antipsychotics were defined as untreated. To define DI, participants were asked “In the last month, have you felt like you would rather be dead?”Results:In total, 12% (839/7,055) met criteria for depression with 29% (241/839) on pharmacological therapy. Those with untreated depression were less likely to endorse symptoms of persistent low mood or worthlessness, but there was no difference in age or general practitioner (GP) visits compared to those on treatment. Over 3% (223/7,055) of participants had DI and less than one-third had visited their GP within the last year.Conclusions:This study demonstrates that two-thirds of depressed older people are not prescribed antidepressant/antipsychotic therapy. It is important to raise awareness of depression among older people and healthcare professionals, with particular focus on the fact that LLD is not an inevitable consequence of ageing and effective treatment is available.

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Life in lockdown: a telephone survey to investigate the impact of COVID-19 lockdown measures on the lives of older people (≥75 years)

Age and Ageing ◽

10.1093/ageing/afaa255 ◽

2020 ◽

Author(s):

Lesley Brown ◽

Rahena Mossabir ◽

Nicola Harrison ◽

Caroline Brundle ◽

Jane Smith ◽

...

Keyword(s):

Older People ◽

Telephone Survey ◽

Negative Impact ◽

Short Form ◽

Health Anxiety ◽

Good Health ◽

Community Dwelling ◽

Activity Levels ◽

Cross Sectional ◽

The Impact

Abstract Background In response to the coronavirus disease 2019 (COVID-19) pandemic, the UK government introduced social distancing measures and identified specific populations at high risk from the virus. People ≥70 were deemed ‘Clinically Vulnerable’. Distancing measures were introduced to reduce the risk of contracting COVID-19. However, these may have a negative impact on older people who are vulnerable to social isolation and may have challenges accessing services and provisions. Objectives To investigate the impact of COVID-19 lockdown measures on the lives of older people. Study design and setting Cross-sectional telephone survey. Participants Community-dwelling older people, 76–97 years. Outcomes Health anxiety; General health (RAND Short-form 36 Survey); Physical activity; Depression (PHQ-8); Anxiety (GAD-2); Loneliness; Access to services; Challenges, concerns and positive experiences. Data analysis Counts (%), means (SDs). Thematic analysis was used to identify themes from open questions. Results n = 142. 52% did not worry about their health; 76% rated their health as ‘good’, ‘very good’ or ‘excellent’; <10% met the criteria indicative of depression (PHQ-8), or anxiety (GAD-2); 42% were less active than before lockdown; and 27% were lonely at least some of the time. Over half of participants identified positive aspects. Conclusions Most participants reported good health with low levels of health anxiety, anxiety and depression. Many were able to identify positive aspects to lockdown and may be better equipped to deal with lockdown than anticipated. Strategies may be required to ameliorate the negative impact of loneliness for a minority of older people, and help some resume previous activity levels and pursuits.

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Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-033661 ◽

2020 ◽

Vol 10 (6) ◽

pp. e033661 ◽

Cited By ~ 2

Author(s):

Ana Rita Sousa-Santos ◽

Cláudia Afonso ◽

Nuno Borges ◽

Alejandro Santos ◽

Patrícia Padrão ◽

...

Keyword(s):

Older Adults ◽

Nutritional Assessment ◽

Multinomial Logistic Regression ◽

Short Form ◽

Mini Nutritional Assessment ◽

Community Dwelling ◽

Secondary Outcome ◽

Physical Frailty ◽

Cross Sectional ◽

European Working

ObjectivesTo investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population.DesignCross-sectional.SettingPortugal.Participants1454 older adults with 65 years or older, from Nutrition UP 65 study.Primary and secondary outcome measuresSarcopenia was identified using the European Working Group on Sarcopenia in Older People 2 guidelines and physical frailty using Fried phenotype. Mini-Nutritional Assessment-Short Form was used to ascertain undernutrition, and obesity was evaluated by body mass index.Results57.3% presented at least one condition, 38.0% were identified with one and 19.3% were identified with two or more conditions. When all preconditions were considered, 95.7% of the older adults presented at least one of these preconditions or conditions. Multinomial logistic regression multivariate analysis revealed that being male (OR 0.61; 95% CI 0.43 to 0.88), being married or in a common-law marriage (OR 0.58; 95% CI 0.40 to 0.84) and having a higher educational level (OR 0.23; 95% CI 0.07 to 0.73) were inversely associated with having two or more conditions, while age >75 years (OR 1.60; 95% CI 1.14 to 2.24), a poor self-perception of health status (OR 5.61; 95% CI 3.50 to 9.01), ≥5 medications (OR 3.11; 95% CI 1.77 to 5.46) and cognitive impairment (OR 1.84; 95% CI 1.37 to 2.48) were directly associated.ConclusionsAlmost three out of five older adults presented at least one of the conditions related to nutritional status, and about one in five had two or more of these occurrences. However, the low coexistence observed between all of these reinforces the need to assess them all individually during the geriatric assessment.

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Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition

Nutrients ◽

10.3390/nu13124239 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4239

Author(s):

Mathuramat Seesen ◽

Wachiranun Sirikul ◽

Jetsada Ruangsuriya ◽

Jiranan Griffiths ◽

Penprapa Siviroj

Keyword(s):

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Community Dwelling ◽

Anthropometric Measurements ◽

Physical Frailty ◽

Early Screening ◽

Cross Sectional ◽

Cognitive Frailty ◽

Age Related

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65–84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried’s criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment–short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18–6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74–0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02–1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99–23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.

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Perseverative responding in Nigerian chronic alcohol and marijuana users

10.31234/osf.io/strav ◽

2019 ◽

Author(s):

Tochukwu Nweze ◽

Cyprian C. Eze ◽

Florian Lange

Keyword(s):

Executive Functioning ◽

Sampling Technique ◽

Marijuana Use ◽

Executive Dysfunction ◽

Wisconsin Card Sorting Test ◽

Control Group ◽

Chronic Alcohol ◽

Set Shifting ◽

Card Sorting ◽

Rule Inference

Chronic consumption of alcohol and marijuana, especially when initiated at an early age, has been implicated in cognitive alterations in the domain of executive functioning. Despite the robustness of this finding in Western populations, its generalizability to other cultural contexts is largely unknown. In this study, we examined whether the regular use of alcohol or marijuana use relates to impaired executive functioning in male students of a Nigerian university. Chronic alcohol users (n = 39), chronic marijuana users (n = 35) and drug-abstinent control participants (n = 40) recruited through snow-ball sampling technique completed a computerized version of the Wisconsin Card Sorting Test (cWCST). As an established measure of executive functioning, the cWCST allows for the simultaneous assessment of three distinct executive processes: set shifting, rule inference, and set maintenance. Results revealed a selective set-shifting deficit in both alcohol and marijuana users. Both groups committed significantly more perseverative errors than the control group, and group differences were significantly stronger on this indicator of set shifting than on indicators of rule inference or set maintenance. Our findings support the generalizability of drug-related deficits in executive functioning and contribute to the characterization of executive dysfunction in non-Western populations. Future longitudinal studies are required to clarify whether executive dysfunction is an antecedent or consequence of alcohol and marijuana use in young Nigerians

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Executive dysfunction following SARS-CoV-2 infection: A cross-sectional examination in a population-representative sample

10.1101/2022.01.01.22268614 ◽

2022 ◽

Author(s):

Peter A Hall ◽

Gang Meng ◽

Anna Hudson ◽

Mohammad Nazmus Sakib ◽

Sara C Hitchman ◽

...

Keyword(s):

Symptom Severity ◽

Executive Dysfunction ◽

Population Based ◽

Community Dwelling ◽

Middle Aged ◽

Observation Study ◽

Cross Sectional ◽

French Speaking ◽

National Cohort ◽

Middle Aged Adults

Objective: To determine whether SRS-CoV-2 infection and COVID-19 symptom severity are associated with executive dysfunction among members of the general population, including those not hospitalized or exposed to intubation. Design: Cross-sectional observation study with data from an ongoing national cohort study of young and middle-aged adults. The Canadian COVID-19 Experiences Project (CCEP) survey involves 1,958 adults with equal representation of vaccinated and vaccine hesitant adults between the ages of 18 and 54 years. Setting: Population-based survey of community dwelling adults, representative of the broader Canadian population. Participants: Men and women between 18 and 54 years of age from English and French speaking provinces. The sample comprised 1,958 adults with a mean age of 37 years (SD=10.4); 60.8% were female. Exposures: SARS-CoV-2 infection with COVID-19 symptoms of any severity, ranging from negligeable to life-threatening infection requiring hospitalization. Primary Outcome: Symptoms of cognitive dysfunction assessed via an abbreviated form of the Barkley Deficits in Executive Functioning Scale (BDEFS). Results: Those who reported a prior SARS-CoV-2 infection regardless of COVID-19 symptom severity (Madj=1.89, SE=0.08, CI: 1.74, 2.04; n=175) reported a significantly higher number of symptoms of executive dysfunction than their non-infected counterparts (Madj=1.63, SE=0.08, CI: 1.47,1.80; n=1,599; β=0.26, p=.001). Among those infected, there was a dose-response relationship between COVID-19 symptom severity and level of executive dysfunction, with moderate (β=0.23, CI: 0.003-0.46) and very/extremely severe (β= 0.69, CI: 0.22-1.16) COVID-19 symptoms being associated with significantly greater dysfunction, compared to asymptomatic. These effects remained reliable and of similar magnitude after removing those who had been received intubation and when controlling for vaccination status. Conclusions: Positive SARS-CoV-2 infection history and COVID-19 symptom severity are associated with executive dysfunction among young and middle-aged adults with no history of medically induced coma.

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