Depression and the relationship between neurocognition and functional status and decline within ethnoculturally diverse middle and older adults

Abstract

AbstractBackgroundEthnoculturally diverse (e.g., non‐Latinx Black (NLB), Latinx) older adults are up to twice as likely as non‐Latinx White (NLW) older adults to experience depressive symptoms. While the relationship between neurocognition (NC) and functional status (e.g., everyday functioning) in older adults is well‐established, the impact of depression remains unclear in diverse populations. We assessed the influence of depression on the relationship between NC and functional status in a sample of Latinx, NLB, and NLW middle‐aged/older adults.MethodThis cross‐sectional study included 50 NLB, 45 Latinx, and 38 NLW (N = 133) adults (59% female; 39% with HIV; M age = 65.3, SD = 6.69; M ed = 13.9, SD = 3.22) who completed the Beck Depression Inventory‐II (BDI‐II), Activities of Daily Living (ADL) scale, and a comprehensive NC battery. Demographically‐corrected T‐scores were used to compute global NC and domain average T‐scores (global cognition, executive function, learning, memory, verbal fluency). The BDI‐II Total Score (BDI‐tot), Cognitive‐Affective Subscale (BDI‐cog), Functional‐Somatic Subscale (BDI‐som), current functional status (ADL‐tot), and decline over time (ADL‐dec) were computed. A series of hierarchical linear regressions (HLRs; Step 1: BDI‐tot; Step 2: NC global/domain NP T‐scores) were computed to predict ADL‐dec in each ethnocultural group. To assess age effects in this relationship, additional HLRs (Step 1: BDI‐tot, age, BDI‐tot×age and Step 2: NC global T‐score) were computed.ResultBDI‐tot, BDI‐cog, and BDI‐som were significantly correlated with ADL‐dec (r s = .58‐.64, ps<.01) in NLW adults. However, in NLB adults, only BDI‐cog was correlated with ADL‐dec (r = .51, p<.01), while in Latinx adults, both BDI‐tot and BDI‐som were significantly related to ADL‐dec (r s = .38, ps <.05). Within NLB adults, BDI‐tot accounted for 15‐16% of the variance in ADL‐dec (ps<.05), but NC scores did not uniquely contribute to the model/s (ΔR 2 = 0‐.11, ps>.05). Across ethnocultural groups, BDI‐tot×age did not significantly predict ADL‐dec. However, in the NLW group BDI‐tot×age was a significant predictor of ADL‐tot (ΔR 2 = .53, p<.05).ConclusionDepressive symptoms are associated with functional decline, particularly in NLB middle/older adults. Cognitive‐affective symptoms may better predict functional status in middle/older NLB adults, while somatic‐functional symptoms are associated with functional decline in Latinx middle/older adults. Future studies should examine the longitudinal impact of depression on functional status/NC within ethnoculturally diverse older adults.