Leilani Feliciano

The bidirectional relationship of depression and diabetes: a systematic review.

Depression and diabetes are both serious chronic conditions common in Western cultures. These conditions impart a significant burden on the patients and society. Depression is often comorbid with chronic illness, and past research has found an increased prevalence of depressive symptoms in patients with Type 2 Diabetes Mellitus (T2DM). However, the exact nature and direction of this relationship are unknown. Depression is often thought to be a consequence of diabetes, perhaps due to the burden of chronic illness. Research has also suggested that depression may be a risk factor for development of diabetes, in part due to biochemical changes in depression and in part because of a reduction of health care behaviors in individuals with depression. This paper reviews the literature behind both lines of investigation and includes special diagnostic and clinical considerations for at risk populations. We discuss clinical implications, limitations of current research, and areas of interest for future research.

Utility of the SLUMS as a Cognitive Screening Tool Among a Nonveteran Sample of Older Adults

OBJECTIVES To investigate the concurrent validity of the Saint Louis University Mental Status examination (SLUMS) by comparing the ability of the Mini-Mental State Examination (MMSE) and the SLUMS to predict performance on standard neuropsychological measures of memory and executive functioning. DESIGN Cross-sectional. SETTING University-based research clinic. PARTICIPANTS Community-dwelling adults (N = 170) age 60 years and older (Mage = 73.08; SD = 8.18). MEASUREMENTS The Trail Making Test (TMT), Rey Auditory Verbal Learning Test, Wisconsin Card Sorting Test (WCST), MMSE, and SLUMS. RESULTS The distributional properties of the SLUMS and the MMSE were directly compared. The SLUMS showed statistically a smaller mean, lower rank scores, and less skewness than the MMSE. Comparisons of the correlations of the screening tests with the neuropsychological measures indicated that the SLUMS demonstrated stronger relationships with the TMT compared with the MMSE. Multiple regression analyses were conducted to determine the ability of the SLUMS and the MMSE to predict scores on common neuropsychological tests after controlling for demographic variables. Results demonstrated that the SLUMS significantly predicted performance across all measures over the MMSE and demographic variables, with the exception of the WCSTs perseverative errors. However, the MMSE does not add to the prediction of neuropsychological functioning over the SLUMS. CONCLUSION Although the SLUMS and the MMSE are strongly correlated, the SLUMS significantly adds to the prediction of neuropsychological measures beyond the MMSE scores. Our findings suggest that the SLUMS may be an appropriate measure to use as a screening tool among older adults and may have fewer ceiling effects than the MMSE.

The Sensitivity and Specificity of Cognitive Screening Instruments to Detect Cognitive Impairment in Older Adults With Severe Psychiatric Illness

Background: Older adults with severe psychiatric illness are often treated at community mental health centers (CMHCs) and these individuals commonly have numerous risk factors for cognitive impairment (CI). Brief cognitive screening instruments are frequently used to evaluate cognitive functioning in CMHCs, but the validity of these measures for detecting CI has not been adequately evaluated in this patient population. Objectives: To determine the sensitivity and specificity of 2 cognitive screening measures (the Mini-Mental Status Examination [MMSE] and the Stroop Color and Word Test [SCWT]) for detecting CI in a sample of older adults with severe psychiatric illness. Methods: Data were collected from 52 older adults receiving services at a CMHC. Diagnosis of CI was made by a neuropsychologist. Sensitivity and specificity coefficients for 2 cutoff scores for the MMSE and the SCWT were calculated. Results: A cutoff score of 25 on the MMSE yielded a sensitivity of 43.3% and a specificity of 90.4% for detecting CI, whereas a cutoff score of 21 yielded sensitivity of 13.1% and 100% specificity. Using an age- and education-corrected scaled score (SS) on the SCWT falling at or below 7 as the criterion the SCWT had 88.8% sensitivity and 36.8% specificity, whereas a cutoff score of 5 or below yielded sensitivity of 59.2% and specificity of 57.8%. Conclusions: Overall, the MMSE was found to be the more clinically useful cognitive screening tool for use in CMHC. Yet, because of the poor sensitivity of the MMSE for detecting CI in this patient population, alternative screening methods should be explored.

Applications of Preference Assessment Procedures in Depression and Agitation Management in Elders with Dementia

Low levels of engagement with leisure activities are commonly seen in older adults with dementia and may lead to decreased social contact, depressed affect, and agitated behaviors. Adults with dementia often have difficulty choosing activities when asked directly about preferences due to cognitive decline, which makes it more difficult to increase their engagement levels. However, simply presenting leisure items without prior knowledge of preferences may be inefficient and may not yield desired results. Long-term care staff need more structured and efficient ways to determine individual preferences, and preference assessments (structured choice-making opportunities) may offer a solution. Preference assessments have been used to identify effective reinforcers both for individuals with developmental disabilities and for older adults with dementia and can provide staff with a brief method for identifying enjoyable activities. This study examines the utility of using stimuli (identified from preference assessments) in behavioral management protocols with 11 elders (mean age = 85.6 years) with dementia in a long-term care setting. Behavioral outcomes of depression and agitation were evaluated at baseline and throughout the intervention. Results indicated positive improvement in behavioral symptoms in 8 of 11 participants. The utility of using preferred items in behavioral management protocols was supported for reducing agitated behaviors but was only partially supported for decreasing depressive symptoms in individuals with dementia.

Concurrent Validity of the Cognitive Assessment of Minnesota in Older Adults with and without Depressive Symptoms.

Cognitive impairment represents a common mental health problem in community-dwelling and institutionalized older adults, and the prevalence increases with age. Multidisciplinary teams are often asked to assess cognitive and functional impairment in this population. The Cognitive Assessment of Minnesota was created by occupational therapists for this purpose and is frequently used, but has not been extensively validated. This study examined the performance of the CAM and compared it to the MMSE with 113 outpatient clinic patients over the age of 60. Subgroups were established based on scores on a depression inventory to determine if the presence of depressed mood altered the relationship between the measures. Both measures demonstrated good internal consistency. The overall correlation between the two measures was high, statistically significant and remained high regardless of depression status. We offer recommendations about the utility of each measure in screening cognitive functioning for older adults.

Comorbidity of depressive symptoms among primary care patients with diabetes in a federally qualified health center

Depression is frequently comorbid with diabetes; however, less is known about this comorbidity in socially disadvantaged populations. This cross-sectional study examined depressive symptomatology among 424 patients with prediabetes or type 2 diabetes mellitus at a federally qualified health center. Prevalence of clinically significant depressive symptoms was assessed using the World Health Organization Five-Item Well-Being Index. The majority (67.7%) endorsed depressive symptoms, with greater prevalence among middle-aged adults (45–64 years) than younger or older counterparts. More women than men endorsed depressive symptoms. Findings suggest the need for routine depression screening in both prediabetes and type 2 diabetes mellitus, particularly among middle-aged and low-income individuals.

Finding your way home: A systematic investigation of shadowboxes on room recognition in memory care.

Dementia care residents frequently experience difficulty locating their bedrooms, which creates challenges for both residents and staff. Previous research suggests that hanging items outside individual bedrooms can help facilitate room finding. This project involved a multiphase study designed to systematically investigate whether recognition and personal relevance of showcased items facilitates better room finding. Participants (n = 6) included older adults (Mage = 89.67, SD = 3.20) with moderate to severe cognitive impairment living in dementia care communities; data collection was terminated before evaluation of the intervention was possible with 1 participant due to adverse health events. Accuracy of room selection was measured through direct observation in a baseline condition (i.e., empty shadow box), then participants were randomly assigned to either personalized (i.e., well-recognized pictures, names, and items) or landmark (i.e., distinctive but not self-referent items) experimental conditions. Nonconcurrent multiple baseline across participants single-subject research methodology was used to empirically evaluate the intervention. Significant improvements in room finding were observed for 50% of participants across experimental conditions. The results suggest that distinctive landmark properties of shadow boxes are critical in improving room finding and that landmarks alone (without personal identifiers) are sufficient for some people. Anecdotal evidence suggests that personalization of boxes is preferred by families and staff and is more congruent with person-centered care.

Preference assessments in older adults with dementia.

As cognitive impairment progresses, individuals with dementia gradually decline in activity engagement due to difficulties initiating leisure activities independently and effectively communicating their preferences. Low activity engagement has negative implications for mood and quality of life. To address this difficulty, preference assessments (PA) can be effectively used to determine the likes and dislikes of individuals with dementia. The present study assessed the utility of PA and the stability of preferences over time (i.e., 1 and 6 months after initial assessment) in a sample of older adults with dementia (Mage = 82.25 years, SD = 6.52 years). Results supported the use of PA as an assessment procedure to assess preferences for items or leisure activities in adults with moderate to severe dementia. The majority of participants exhibited stable patterns of preference over 1 to 6 months with correlation coefficients exceeding rs = .50, suggesting that preferences may remain stable for some individuals with dementia. Research and clinical implications of the use of PA in this population are discussed.

Recognition of Self-Referent Stimuli in People With Dementia: Names and Pictures as Prosthetic Memory Aids

Individuals with dementia have difficulty distinguishing their personal items and spaces from others, which creates problems in long-term care (LTC). Prosthetic memory aids may help facilitate recognition. This study assessed which self-referent stimuli were best recognized by individuals with dementia. LTC residents with dementia (n = 27) were shown arrays of three stimuli and asked to select the picture/name that featured them. Stimulus arrays included photographs from young adulthood, middle adulthood, current age, and their printed name. Most participants (95%) completed the assessment and recognized at least one stimulus type above chance levels. Participants recognized printed names most accurately (M = 89%). Current photographs were recognized least (M = 64%). Printed names and early adulthood photographs facilitate self-recognition in individuals with dementia.

Increasing Nutritional Adherence in an African American Woman With Type 2 Diabetes

Chronic diseases such as type 2 diabetes mellitus (T2DM) are increasingly common and costly, imparting debilitating economic and health effects. This case presents the use of an individualized behavioral intervention for diabetes management in a 61-year-old African American woman with T2DM. The intervention was delivered over five home-based treatment sessions and two follow-up probes that focused on nutrition. At the end of treatment, the participant exhibited improved nutrition and dietary habits (i.e., increased intake of fruits and vegetables; eating more, smaller meals throughout the day), which maintained through follow-up. In addition, she demonstrated generalization of treatment effects, as evidenced by the application of treatment strategies to other areas of her health (i.e., exercise and blood glucose testing). This case study highlights how psychological treatment emphasizing behavioral techniques can be effectively applied to manage medical conditions and mitigate future complications and comorbidities.