Mathew Niti

Criterion-based validity and reliability of the Geriatric Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older adults

Background: Few studies have evaluated the validation of 15-item Geriatric Depression Scale (GDS-15) in a heterogeneous population with different age, ethnicity and comorbidities of elderly users of social services in the community. Aims: To assess the criterion validity and reliability of the GDS-15 and its equivalence across different gender, age groups, ethnicity and different comorbidities in community living elderly and nursing homes residents. Method: A validation sample of non-demented 4253 elderly (age ≥ 60 years), who regularly use community based care corner, senior activity center, day care center, sheltered homes and nursing homes were interviewed using the GDS-15. Structured clinical interview (SCID) was used to make DSM-IV diagnosis of major depressive disorder (MDD). Results: The overall sensitivity and specificity were 0.97 and 0.95, respectively (area under curve, AUC was 0.98). The overall Cronbachs alpha was 0.80, and intraclass coefficient of test-–retest reliability over 2 weeks was 0.83 and inter-rater reliability was 0.94 (intra-class) and 0.99 (Cohens kappa). Although some items in the GDS-15 appeared to be biased by gender, age and ethnicity, there were no clinically significant differences in test performance among different age, gender, ethnicity and comorbidities at cutoff of 4/5. Conclusions: The GDS-15 was a reliable and valid screening for MDD across different age, gender, ethnicity and chronic illness status in the community and social service setting.

Prevalence and Correlates of Functional Disability in Multiethnic Elderly Singaporeans

Objectives: To make comparative estimates of prevalence of late‐life functional disability, examine sociodemographic and health correlates, investigate sex and ethnic differences, and estimate population attributable risk of modifiable risk factors.

Continued work employment and volunteerism and mental well-being of older adults: Singapore longitudinal ageing studies

OBJECTIVE to examine the effect of late life engagement in continued work involvement or volunteer activities during retirement on mental well-being. METHODS two waves of data from the Singapore Longitudinal Ageing Studies were analyzed for 2,716 Singaporeans aged 55 or above at baseline and 1,754 at 2-year follow-up. Trained research nurses interviewed participants (non-volunteering retiree, volunteering retiree, and working seniors) on mental health status (geriatric depression scale, Mini Mental State Examination, positive mental wellbeing and life satisfaction). RESULTS about 88% of seniors were retired (78% non-volunteering, 10% volunteering) and 12% were still working in paid employment or business. At baseline and 2 year follow up, and regardless of physical health status, volunteering retirees and working seniors gave significantly better MMSE cognitive performance scores, fewer depressive symptoms, and better mental well-being and life satisfaction than non-volunteering retirees. CONCLUSION the results of this study suggest that continued work involvement or volunteerism provides opportunities for social interaction and engagement and may be associated with enhanced mental well-being. Future research should clarify which specific aspects of volunteerism are related to long-term mental well-being.

Co-morbid association of depression and COPD: a population-based study.

OBJECTIVES Depression occurs commonly among patients with COPD, but the independent association of depression and COPD and the effect of depression on COPD outcomes are not well established. METHOD A population sample of 2402 Chinese aged >or=55 with and without COPD (characteristic symptoms of chronic cough, sputum or breathlessness and airflow obstruction and FEV(1)/FVC<0.70) was assessed on Geriatric Depression Scale (score>or=5), dependence on basic activities of daily living (ADL), SF-12 health status, smoking and medication behaviour. RESULTS The 189 respondents with COPD showed higher depressive symptoms prevalence (22.8%) than 2213 respondents without COPD (12.4%); multivariate odd ratio (OR) was 1.86; 95% CI, 1.25-2.75 after controlling for confounding risk factors. In multivariate analyses of respondents with COPD, those who were depressed (N=43), compared to those who were not (N=146), were more likely to report ADL disability (OR=2.89, p=0.049) poor or fair self-reported health (OR=3.35, p=0.004), poor SF-12 PCS scores (OR=2.35, p=0.041) and SF-12 MCS scores (OR=4.17, p<0.001). CONCLUSION Depressive symptoms were associated with COPD independent of known risk factors. In COPD participants, depressive symptoms were associated with worse health and functional status and self-management.

Folate, Vitamin B12, Homocysteine, and Depressive Symptoms in a Population Sample of Older Chinese Adults

OBJECTIVES: To investigate the independent associations between folate, B12, and homocysteine levels and depressive symptoms in older adults.

Metabolic Syndrome and Cognitive Decline in Chinese Older Adults: Results From the Singapore Longitudinal Ageing Studies

OBJECTIVE To determine the association of the metabolic syndrome (MS) with cognitive decline in a Chinese older population. METHODS In a prospective cohort study of 1,352 community-living Chinese older adults without cognitive impairment (Mini Mental State Examination, MMSE <24) and without cardiovascular disease and stroke, the authors assessed baseline MS (defined according to International Diabetic Federation Criteria). Cognitive decline was predefined as at least 2-point drop in MMSE score at follow-up 1-2 years after baseline assessment. RESULTS MS was present in 26.3% of the participants at baseline and was significantly associated with the risk of cognitive decline (odds ratio, 1.42: confidence interval, 1.01-1.98), after controlling for potential confounding by age, gender, education, smoking, alcohol drinking, depressive symptoms, APOE-e4 status, level of leisure activities, baseline MMSE, and length of follow-up. CONCLUSION The MS was associated with increased risk of cognitive decline in Chinese older adults.

Orthostatic Hypotension, Hypotension and Cognitive Status : Early Comorbid Markers of Primary Dementia?

Objective: Few studies have explored the relationship between orthostatic hypotension (OH) and cognition. The aim of this study was to examine the association of OH with cognitive impairment and decline in a cohort of Chinese elderly, and its effect modification by blood pressure (BP) status at baseline. Method: Among 2,321 community-living older adults, free of cardiovascular disease and stroke, baseline BP measurements were used to determine the presence of OH and categorize participants as hypotensives, normotensives or hypertensives. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment (MMSE score <24). Cognitive decline (decrease in MMSE score by ≧1) was assessed from 1 to 2 years of follow-up for 1,347 participants without baseline cognitive impairment. Results: Mean age of the subjects was 65.5 years and 381 (16.6%) showed OH. OH was not associated with cognitive impairment overall. However, among hypotensives, OH increased the odds of cognitive impairment (OR = 4.1, 95% CI = 1.11–15.1), while hypertensives with OH showed reduced odds of cognitive impairment (OR = 0.48, 95% CI = 0.26–0.90). Among cognitively intact participants, OH was not associated with cognitive decline overall or in BP subgroups. Conclusion: The increased risk of cognitive impairment in hypotensives with OH suggests that hypotension with OH may be an early comorbid marker of a primary incipient dementia.

APOE-ϵ4, Depressive Symptoms, and Cognitive Decline in Chinese Older Adults: Singapore Longitudinal Aging Studies

BACKGROUND The precise relationship between depression and cognitive decline in older adults is unclear. We investigated the influence of apolipoprotein E (APOE)-epsilon4 genotype in modulating the effect of depressive symptoms on cognitive decline. METHODS Prospective cohort study of 1,487 cognitively high-functioning Chinese older adults. Depressive symptoms (Geriatric Depression Scale score >/=5) and Mini-Mental State Examination (MMSE) were assessed at baseline, and cognitive decline (at least 1-point drop in MMSE) at 1-2 years after baseline. RESULTS There was no significant difference in cognitive decline between depressed (32.9%) and nondepressed (31.5%) participants in the whole sample or among non-APOE-epsilon4 carriers. Among APOE-epsilon4 carriers, depressed participants showed more cognitive decline (40.0%) than their nondepressed counterparts (28.6%), odds ratio = 2.89, 95% confidence interval: 1.03-8.12; p = .04, after controlling for age, gender, education, vascular risk factors/events, smoking, alcohol drinking, physical functioning, subjective memory complaint, length of follow-up, and baseline MMSE scores (p for interaction = .03). CONCLUSIONS Our study suggests that the presence of the APOE-epsilon4 allele significantly enhanced the risk of cognitive decline associated with depressive symptoms. This finding should be independently replicated in future studies.

Albumin, haemoglobin, BMI and cognitive performance in older adults

OBJECTIVES to examine the relationships between serum albumin, haemoglobin and body mass index (BMI) with cognitive performance among community-living older adults. METHOD design--population-based cross-sectional study; setting--local community in Southeast Region of Singapore; subjects--Chinese older adults aged 55 and above (N = 2, 550); measurements--serum albumin, haemoglobin, BMI and Mini-Mental State Examination (MMSE). RESULTS in multivariable analyses controlling for gender, age, education and vascular risk factors, low albumin in the bottom quintile (OR 2.04; 95% CI 1.22-3.41) and low haemoglobin in the bottom quintile (OR 1.56; 95% CI 1.00-2.47) and low BMI with chronic comorbidity (OR 1.73; 95%CI 1.02-2.95) were independently associated with poor cognitive performance (MMSE < or = 23). Among cognitively intact respondents (MMSE > or = 24), albumin concentration showed a significant inverse linear relationship with MMSE scores (P for trend =0.002). CONCLUSION low albumin, low haemoglobin and low BMI (in the presence of chronic comorbidity) are independently associated with poor cognitive performance in community-living older adults.

Depressive symptoms and incident cognitive impairment in cognitively well-functioning older men and women.

OBJECTIVES: To investigate whether the effect of depressive symptoms on the risk of cognitive decline and incident cognitive impairment (CI) in cognitively well‐functioning older persons differed between men and women and whether sex differences in cerebrovascular factors might explain this.