Daily associations between affect and cognitive performance in older adults with depression and cognitive impairment: a series of seven single-subject studies in the Netherlands

Alieke Tieks,Richard C Oude Voshaar,Marij Zuidersma

doi:10.1186/s12877-022-02797-y

Alieke Tieks, Richard C Oude Voshaar + Show 1 more

Open Access

https://doi.org/10.1186/s12877-022-02797-y

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Abstract

BackgroundComorbidity between depression and cognitive impairment is common in older adults, increases the disease burden disproportionally, and leads to diagnostic uncertainty. Insight into individual daily associations between affect and cognitive performance may help in personalizing diagnosis and treatment decisions. Our objective was to get insight into the daily associations between affect and cognitive performance within individual older adults.MethodsIn this single-subject study seven older adults with both depression and cognitive impairment filled in electronic diaries daily for 62-93 consecutive days evaluating positive affect (PA), negative affect (NA), working memory (WM) and visual learning (VL). Time-series analyses using vector autoregressive modelling, Granger causality tests and cumulative orthogonalized impulse response function analyses were performed for each individual separately.ResultsIn one patient higher NA was associated with better WM the next day. For another patient days with higher NA and lower PA were days with worse WM. For a third patient better VL was associated with lower NA and higher PA the next day. No associations were found for four patients.ConclusionsThese results highlight heterogeneity in the daily associations between affect and cognitive performance and stress the relevance of single-subject studies. These studies may be an important step towards personalized diagnosis and treatment in old age psychiatry.

Highlights

Patients with both depression and cognitive impairment form a vulnerable patient group, as the combination of depression and cognitive impairment has been associated with a poorer response to antidepressant medication [1, Tieks et al BMC Geriatrics (2022) 22:1332], an increased risk of functional dependence [3], and an increased risk of subsequently developing dementia [4, 5]
While cognitive impairment is generally seen as a first manifestation of an underlying cognitive disorder [6], cognitive impairment in the context of depression may reflect a psychological reaction to cognitive decline [7, 8] or a contemporaneous consequence of the depressive state [9,10,11]
Inclusion criteria were 1) ≥60 years old, 2) major depressive disorder according to the DSM-IV criteria or a score of ≥4 on the Geriatric Depression Scale (GDS), and 3) mild cognitive impairment (MCI) or mild dementia diagnosed by the multidisciplinary team of a memory clinic, or a Mini Mental State Examination (MMSE) [24] score of

Summary

Introduction

Patients with both depression and cognitive impairment form a vulnerable patient group, as the combination of depression and cognitive impairment has been associated with a poorer response to antidepressant medication [1, Tieks et al BMC Geriatrics (2022) 22:1332], an increased risk of functional dependence [3], and an increased risk of subsequently developing dementia [4, 5]. Affect may influence cognitive performance the day, as poor mood states may induce negative next-day effects on cognition, for example through a low level of physical activity [16] or a disturbed sleep [17, 18]. These findings suggest that cognitive impairment is a consequence of the affective state. Experiencing a decline in one’s cognitive performance or being confronted with cognitive limitations can evoke worse affective states which may persist the day(s) In these circumstances, treatment could be focused on acceptance and adjustment to the cognitive impairments [19]. Our objective was to get insight into the daily associations between affect and cognitive performance within individual older adults

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