Association of Global Cognitive Function With Psychological Distress and Adherence to Public Health Recommendations During the Coronavirus Disease 2019 Pandemic: The Women's Health Initiative.

Abstract

BackgroundThe association of cognitive function with symptoms of psychological distress during the coronavirus 2019 (COVID-19) pandemic or adherence to COVID-19 protective health behaviors is not well understood.MethodsWe examined 2,890 older women from the Women’s Health Initiative cohort. Pre-pandemic (i.e., within 12 months prior to pandemic onset) and peri-pandemic global cognitive function scores were assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Anxiety, stress, and depressive symptom severity during the pandemic were assessed using validated questionnaires. We examined adherence to protective behaviors that included safe hygiene, social distancing, mask wearing, and staying home. Multivariable models were adjusted for age, race, ethnicity, education, region of residence, alcohol intake, and comorbidities.ResultsEvery five-point lower pre-pandemic TICS-m score was associated with 0.33-point mean higher (95% CI, 0.20,0.45) perceived stress, and 0.20-point mean higher (95% CI, 0.07,0.32) depressive symptom severity during the pandemic. Higher depressive symptom severity, but not anxiety or perceived stress, was associated with a 0.69-point (95% CI, -1.13, -0.25) mean decline in TICS-m from the pre- to peri-pandemic period. Every five-point lower peri-pandemic TICS-m score was associated with 12% lower odds (OR, 0.88; 95% CI, 0.80,0.97) of practicing safe hygiene.ConclusionsAmong older women, we observed that: 1) lower pre-pandemic global cognitive function was associated with higher stress and depressive symptom severity during the pandemic; 2) higher depressive symptom severity during the pandemic was associated with cognitive decline; and 3) lower global cognitive function during the pandemic was associated with lower odds of practicing safe hygiene.