Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-23T00:26:20.501Z Has data issue: false hasContentIssue false

Educational level as a protective factor against the influence of depressive symptoms on cognition in older adults: implications for functional independence during a 10-year follow-up

Published online by Cambridge University Press:  25 March 2021

Irene Cano-López*
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
Marta Aliño
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
Aránzazu Duque
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
Paula Martínez
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
Mercedes Almela
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain Department of Cognitive Neuropsychology, Tilburg School of Social and Behavioural Sciences, Tilburg, the Netherlands
María J. García-Rubio
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
Sara Puig-Perez
Affiliation:
Research Group in Psychology and Quality of Life (PsiCal), Valencian International University, Valencia, Spain
*
Correspondence should be addressed to: Dr. Irene Cano-López, Valencian International University, C/Pintor Sorolla, 21, 46002, Valencia, Spain. Phone: +34 961924950. Email: [email protected].

Abstract

Objectives:

To examine whether the educational level moderates the relationship between baseline depressive symptoms and cognitive functioning at 5- and 10-year follow-ups in older adults, considering the association between cognitive functioning and difficulty with activities of daily living (ADL).

Design:

Using a prospective design, a path analysis was performed.

Setting:

In-home, face-to-face interviews and self-administered questionnaires, within the National Social Life, Health, and Aging Project.

Participants:

In total, 1,461 participants (mean age = 66.62) were followed up from Wave 1 (baseline) to Wave 2 (at 5 years) and Wave 3 (at 10 years).

Measurements:

Depressive symptoms were assessed at baseline. Cognitive functioning and difficulty with ADL were assessed at baseline and at 5 and 10 years.

Results:

Educational level moderates the relationship between depressive symptoms and cognitive functioning at 5 years (β = 0.07, SE = 0.03, p = 0.04, Cohen’s f2 = 0.02), being depressive symptoms related to poor cognitive functioning only at low educational levels. Cognitive functioning predicts difficulty with ADL at 5 and 10 years (β = −0.08, SE = 0.03, p = 0.008, Cohen’s f2 = 0.01; β = −0.09, SE = 0.03, p = 0.006, Cohen’s f2 = 0.02). The proposed model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, 90% CI 0.0001–0.03, SRMR = 0.004, and χ2(8) = 7.16, p = 0.52).

Conclusions:

Cognitive reserve may act as a protective factor against the effect of depressive symptoms on cognition in older adults, which, in turn, is relevant to their functional independence.

Type
Original Research Article
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

+

These authors are equal contributors.

References

Aiken, L. S. and West, S. G. (1991). Multiple Regression: Testing and Interpreting Interactions. California: Sage.Google Scholar
Alvarado-Esquivel, C., Hernández-Alvarado, A. B., Tapia-Rodríguez, R. O., Guerrero-Iturbe, Á., Rodríguez-Corral, K. and Martínez, S. E. (2004). Prevalence of dementia and Alzheimer’s disease in elders of nursing homes and a senior center of Durango City, Mexico. BMC Psychiatry, 4, 3. doi: 10.1186/1471-244x-4-3 CrossRefGoogle Scholar
Avila, R., Moscoso, M. A. A., Ribeiz, S., Arrais, J., Jaluul, O. and Bottino, C. M. (2009). Influence of education and depressive symptoms on cognitive function in the elderly. International Psychogeriatrics, 21, 560567. doi: 10.1017/S1041610209008928 CrossRefGoogle ScholarPubMed
Becker, J. T. et al. (2009). Depressed mood is not a risk factor for incident dementia in a community-based cohort. The American Journal of Geriatric Psychiatry, 17, 653663. doi: 10.1097/JGP.0b013e3181aad1fe CrossRefGoogle ScholarPubMed
Bhalla, R. K. et al. (2005). Does education moderate neuropsychological impairment in late-life depression? International Journal of Geriatric Psychiatry, 20, 413417. doi: 10.1002/gps.1296 CrossRefGoogle ScholarPubMed
Blazer, D. G. and Hybels, C. F. (2005). Origins of depression in later life. Psychological Medicine, 35, 12411252. doi: 10.1017/S0033291705004411 CrossRefGoogle ScholarPubMed
Ciesielska, N., Sokolowski, R., Mazur, E., Podhorecka, M., Polak-Szabela, A. and Kedziora-Kornatowska, K. (2016). Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatria Polska, 50, 10391052. doi: 10.12740/PP/45368 CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Comijs, H. C., Jonker, C., Beekman, A. T. and Deeg, D. J. (2001). The association between depressive symptoms and cognitive decline in community-dwelling elderly persons. International Journal of Geriatric Psychiatry, 16, 361367. doi: 10.1002/gps.343 CrossRefGoogle ScholarPubMed
Deckers, K. et al. (2015). Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. International Journal of Geriatric Psychiatry, 30, 234246. doi: 10.1002/gps.4245 CrossRefGoogle Scholar
Dong, Y. and Peng, C. Y. J. (2013). Principled missing data methods for researchers. SpringerPlus, 2, 222. doi: 10.1186/2193-1801-2-222 CrossRefGoogle ScholarPubMed
Elbejjani, M. et al. (2015). Depression, depressive symptoms, and rate of hippocampal atrophy in a longitudinal cohort of older men and women. Psychological Medicine, 15, 19311944. doi: 10.1017/S0033291714003055 CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Fonseca, J. A. S. et al. (2015). Factors that predict cognitive decline in patients with subjective cognitive impairment. International Psychogeriatrics, 27, 16711677. doi: 10.1017/S1041610215000356 CrossRefGoogle ScholarPubMed
Freedman, V. A., Martin, L. G. and Schoeni, R. F. (2002). Recent trends in disability and functioning among older adults in the United States: a systematic review. JAMA, 288, 31373146. doi: 10.1001/jama.288.24.3137 CrossRefGoogle ScholarPubMed
Fuhrer, R., Antonucci, T. C. and Dartigues, J. F. (1992). The co-occurrence of depressive symptoms and cognitive impairment in a French community: are there gender differences? European Archives of Psychiatry and Clinical Neuroscience, 242, 161171. doi: 10.1007/BF02191564 CrossRefGoogle Scholar
Geerlings, M. I. et al. (2000). Depression and risk of cognitive decline and Alzheimer’s disease: Results of two prospective community-based studies in The Netherlands. The British Journal of Psychiatry, 176, 568575. doi: 10.1192/bjp.176.6.568 CrossRefGoogle ScholarPubMed
Giebel, C. M. et al. (2014). Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. International Psychogeriatrics, 26, 12831293. doi: 10.1017/S1041610214000775 CrossRefGoogle ScholarPubMed
Glymour, M. M. and Manly, J. J. (2008). Lifecourse social conditions and racial and ethnic patterns of cognitive aging. Neuropsychology Review, 18, 223254. doi: 10.1007/s11065-008-9064-z CrossRefGoogle ScholarPubMed
Harada, C. N., Natelson Love, M. C. and Triebel, K. L. (2013). Normal cognitive aging. Clinics in Geriatric Medicine, 29, 737752. doi: 10.1016/j.cger.2013.07.002 CrossRefGoogle ScholarPubMed
Hu, L. T. and Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424453. doi: 10.1037/1082-989X.3.4.424 CrossRefGoogle Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219. doi: 10.1037//0022-006x.59.1.12 CrossRefGoogle ScholarPubMed
Johnson, P. O. and Neyman, J. (1936). Tests of certain linear hypotheses and their application to some educational problems. Statistical Research Memoirs, 1, 5793.Google Scholar
Josefsson, M., de Luna, X., Pudas, S., Nilsson, L. G. and Nyberg, L. (2012). Genetic and lifestyle predictors of 15-year longitudinal change in episodic memory. Journal of the American Geriatrics Society, 60, 23082312. doi: 10.1111/jgs.12000 CrossRefGoogle ScholarPubMed
Katz, S. (1983). Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721727. doi: 10.1111/j.1532-5415.1983.tb03391.x CrossRefGoogle ScholarPubMed
Kim, B. J., Liu, L., Nakaoka, S., Jang, S. and Browne, C. (2018). Depression among older Japanese Americans: The impact of functional (ADL & IADL) and cognitive status. Social Work in Health Care, 57, 109125. doi: 10.1080/00981389.2017.1397588 CrossRefGoogle ScholarPubMed
Kohout, F. J., Berkman, L. F., Evans, D. A. and Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179193. doi: 10.1177/089826439300500202 CrossRefGoogle ScholarPubMed
Korczyn, A. D. and Halperin, I. (2009). Depression and dementia. Journal of the Neurological Sciences, 283, 139142. doi: 10.1016/j.jns.2009.02.346 CrossRefGoogle ScholarPubMed
Liu, H., Zhang, Y., Burgard, S. A. and Needham, B. L. (2019). Marital status and cognitive impairment in the united states: evidence from the national health and aging trends study. Annals of Epidemiology, 38, 2834. doi: 10.1016/j.annepidem.2019.08.007 CrossRefGoogle ScholarPubMed
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171179. doi: 10.1056/NEJM199801153380307 CrossRefGoogle ScholarPubMed
Mograbi, D. C., de Assis Faria, C., Fichman, H. C., Paradela, E. M. P. and Lourenço, R. A. (2014). Relationship between activities of daily living and cognitive ability in a sample of older adults with heterogeneous educational level. Annals of Indian Academy of Neurology, 17, 7176. doi: 10.4103/0972-2327.128558 CrossRefGoogle Scholar
O’Shea, D. M., Fieo, R. A., Hamilton, J. L., Zahodne, L. B., Manly, J. J. and Stern, Y. (2015). Examining the association between late-life depressive symptoms, cognitive function, and brain volumes in the context of cognitive reserve. International Journal of Geriatric Psychiatry, 30, 614622. doi: 10.1002/gps.4192 CrossRefGoogle ScholarPubMed
Olinsky, A., Chen, S. and Harlow, L. (2003). The comparative efficacy of imputation methods for missing data in structural equation modeling. European Journal of Operational Research, 151, 5379. doi: 10.1016/S0377-2217(02)00578-7 CrossRefGoogle Scholar
Opdebeeck, C., Matthews, F. E., Wu, Y. T., Woods, R. T., Brayne, C. and Clare, L. (2017). Cognitive reserve as a moderator of the negative association between mood and cognition: evidence from a population-representative cohort. Psychological Medicine, 48, 6171. doi: 10.1017/S003329171700126X CrossRefGoogle ScholarPubMed
Opdebeeck, C., Quinn, C., Nelis, S. M. and Clare, L. (2015). Does cognitive reserve moderate the association between mood and cognition? A systematic review. Reviews in Clinical Gerontology, 25, 181193. doi: 10.1017/S0959259815000155 CrossRefGoogle Scholar
Pálsson, S. et al. (2001). The prevalence of depression in relation to cerebral atrophy and cognitive performance in 70-and 74-year-old women in Gothenburg. The Women’s Health Study. Psychological Medicine, 31, 3949. doi: 10.1017/S0033291799003050 CrossRefGoogle ScholarPubMed
Pálsson, S., Aevarsson, Ó. and Skoog, I. (1999). Depression, cerebral atrophy, cognitive performance and incidence of dementia. The British Journal of Psychiatry, 174, 249253. doi: 10.1192/bjp.174.3.249 CrossRefGoogle ScholarPubMed
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of American Geriatrics Society, 23, 433441. doi: 10.1111/j.1532-5415.1975.tb00927.x CrossRefGoogle Scholar
Preacher, K. J., Curran, P. J. and Bauer, D. J. (2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31, 437448. doi: 10.3102/10769986031004437 CrossRefGoogle Scholar
Preacher, K. J. and Kelley, K. (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 16, 93115. doi: 10.1037/a0022658 CrossRefGoogle ScholarPubMed
R Core Team (2016). R: A Language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/ Google Scholar
Respino, M. et al. (2019). The impact of white matter hyperintensities on the structural connectome in late-life depression: relationship to executive functions. NeuroImage: Clinical, 23, 101852. doi: 10.1016/j.nicl.2019.101852 CrossRefGoogle ScholarPubMed
Richard, E. et al. (2013). Late-life depression, mild cognitive impairment, and dementia. JAMA Neurology, 70, 383389. doi: 10.1001/jamaneurol.2013.603 CrossRefGoogle Scholar
Rosseel, Y. (2012). Lavaan: an R package for structural equation modeling. Journal of Statistical Software, 48, 136. doi: 10.18637/jss.v048.i02 CrossRefGoogle Scholar
Santos, N.C. et al. (2014). Clinical, physical and lifestyle variables and relationship with cognition and mood in aging: a cross-sectional analysis of distinct educational groups. Frontiers in Aging Neuroscience, 6, 115. doi: 10.3389/fnagi.2014.00021 CrossRefGoogle ScholarPubMed
Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98, 1232012322. doi: 10.1073/pnas.231475998 CrossRefGoogle ScholarPubMed
Shankar, A., Hamer, M., McMunn, A. and Steptoe, A. (2013). Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75, 161170. doi: 10.1097/psy.0b013e31827f09cd CrossRefGoogle ScholarPubMed
Shega, J. W. et al. (2014). Measuring cognition: the Chicago cognitive function measure in the national social life, health and aging project, wave 2. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69, S166S176. doi: 10.1093/geronb/gbu106 CrossRefGoogle ScholarPubMed
Siedlecki, K. L., Stern, Y., Reuben, A., Sacco, R. L., Elkind, M. S. and Wright, C. B. (2009). Construct validity of cognitive reserve in a multiethnic cohort: The Northern Manhattan Study. Journal of the International Neuropsychological Society, 15, 558569. doi: 10.1017/S1355617709090857 CrossRefGoogle Scholar
Stern, Y. (2012). Cognitive reserve in ageing and Alzheimer’s disease. The Lancet Neurology, 11, 10061012. doi: 10.1016/S1474-4422(12)70191-6 CrossRefGoogle ScholarPubMed
Tallon, L. A., Manjourides, J., Pun, V. C., Salhi, C. and Suh, H. (2017). Cognitive impacts of ambient air pollution in the National Social Health and Aging Project (NSHAP) cohort. Environment International, 104, 102109. doi: 10.1016/j.envint.2017.03.019 CrossRefGoogle ScholarPubMed
Thompson, W. W., Zack, M. M., Krahn, G. L., Andresen, E. M. and Barile, J. P. (2012). Health-related quality of life among older adults with and without functional limitations. American Journal of Public Health, 102, 496502. doi: 10.2105/AJPH.2011.300500 CrossRefGoogle ScholarPubMed
Vasilopoulos, T., Kotwal, A., Huisingh-Scheetz, M. J., Waite, L. J., McClintock, M. K. and Dale, W. (2014). Comorbidity and chronic conditions in the national social life, health and aging project (NSHAP), wave 2. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 69, S154S165. doi: 10.1093/geronb/gbu025 CrossRefGoogle ScholarPubMed
Waite, L. J. et al. (2019b). National Social Life, Health, and Aging Project (NSHAP): Wave 2 and Partner Data Collection, [United States], 2010-2011. (Inter-university Consortium for Political and Social Research [distributor], 2019-06-19). doi: 10.3886/ICPSR34921.v4 CrossRefGoogle Scholar
Waite, L. J. et al. (2019c). National Social Life, Health and Aging Project (NSHAP): Wave 3, [United States], 2015-2016. (Inter-university Consortium for Political and Social Research [distributor], 2019-03-08). doi: 10.3886/ICPSR36873.v4 CrossRefGoogle Scholar
Waite, L. J., Laumann, E. O., Levinson, W. S., Lindau, S. T. and O’Muircheartaigh, C. A. (2019a). National Social Life, Health, and Aging Project (NSHAP): Wave 1, [United States], 2005-2006. (Inter-university Consortium for Political and Social Research [distributor], 2019-06-12). doi: 10.3886/ICPSR20541.v9 CrossRefGoogle Scholar
Wight, R. G., Aneshensel, C. S. and Seeman, T. E. (2002). Educational attainment, continued learning experience, and cognitive function among older men. Journal of Aging and Health, 14, 211236. doi: 10.1177/089826430201400203 CrossRefGoogle ScholarPubMed
Wilson, R. S., De Leon, C. M., Bennett, D. A., Bienias, J. L. and Evans, D. A. (2004). Depressive symptoms and cognitive decline in a community population of older persons. Journal of Neurology, Neurosurgery & Psychiatry, 75, 126129.Google Scholar
Winblad, B. et al. (2016). Defeating Alzheimer’s disease and other dementias: a priority for European science and society. The Lancet Neurology, 15, 455532. doi: 10.1016/S1474-4422(16)00062-4 CrossRefGoogle ScholarPubMed
World Health Organization (2018). Ageing and health. Fact sheet. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health Google Scholar
Zahodne, L. B., Kraal, A. Z., Zaheed, A. and Sol, K. (2018). Subjective social status predicts late-life memory trajectories through both mental and physical health pathways. Gerontology, 64, 466474. doi: 10.1159/000487304 CrossRefGoogle ScholarPubMed