Network analysis for studying the dynamics of affective symptoms and treatment adherence in APOE‐ɛ4 carriers with subjective cognitive decline following a multimodal intervention: Preliminary findings from the PENSA Study

Abstract

AbstractBackgroundThe co‐occurrence of subjective cognitive decline (SCD) and anxiety critically increases the risk of developing mild cognitive impairment and dementia. Understanding the influence of life style changes on affective symptoms in individuals with SCD can help implementing successful multimodal interventions that benefit both cognitive and mental health. We studied the interaction between affective symptoms and treatment adherence over time in individuals meeting SCD‐Plus criteria and being APOE‐ ɛ4 carriers that were following a multimodal intervention in the framework of the PENSA Study.MethodWe report preliminary analyses of intensive longitudinal data (ILD) weekly collected for 20 weeks in 11 participants (Figure 1). Ecological momentary assessments (EMAs) were used to evaluate anxiety, depression, mood, Mediterranean diet (MedDiet) adherence and participation in social activities. Physical activity and sleep were measured with an activity tracker. Multilevel vector autoregressive models were used to obtain the full set of interactions.ResultThe mean response rate for EMAs was 89.6% (min‐max 80‐100%). There were within‐person temporal relationships between several variables as shown in Figure 2. Physical activity had a positive forward influence on sleep (β=0.32, P=0.016). In turn, higher hours of sleep predicted higher adherence to the MedDiet (β=0.28, P=0.034) and lower anxiety levels (β=‐0.302, P=0.005). Also, higher anxiety predicted negative mood states (β=‐0.12, P=0.012) and lower number of social activities (β=‐0.27, P=0.013), being such relationship bidirectional (β=‐0.19, P=0.005). Finally, the between‐person network (Figure 3) indicated that some variables co‐varied across persons. Individuals with high average minutes of physical activity tended to be more socially active (r=0.36) and those more socially active presented lower anxiety and depression symptoms (r=‐0.24). Finally, those that slept more hours presented more positive mood states (r=0.67).ConclusionThese preliminary findings suggest that social life, quality of sleep and physical activity could be critical to improve affective symptoms. Our findings also support the feasibility and value of ILD collection to better understand the effect of life style changes on cognitive and mental health at the individual and population levels. Finally, monitoring the mental health in ongoing clinical trials is important to understand the impact of the COVID‐19 pandemic on study outcomes.