Sherry A. Beaudreau

Late-Life Anxiety and Cognitive Impairment: A Review

Emerging research implicates a consistent reciprocal relationship between late-life anxiety and cognition. Understanding this relationship may clarify pathophysiological substrates of cognitive impairment and why co-occurring anxiety and cognitive impairment relates to poorer treatment prognosis for both conditions. This article critically reviews evidence of more prevalent anxiety in cognitively impaired older adults, elevated anxiety related to poorer cognitive performance, and more severe anxiety symptoms predicting future cognitive decline. It considers pathophysiologic mediators and moderators, and the influence of comorbid depression or medical illness in anxiety. Identified directions for future research includes use of in-depth anxiety assessment comparing normal and mild cognitively impaired older adults and use of challenging neuropsychological tests to determine if specific cognitive domains suffer in anxious older adults.

Reliability and Validity of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in Older Men

BACKGROUND The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are commonly used to quantify sleep and excessive daytime sleepiness in older adults. These measures, however, have not been comprehensively evaluated for their psychometrics in older men. We determined the internal consistency reliability and construct validity of the PSQI and ESS in a sample of older men. METHODS Participants were 3,059 men (mean age = 76.4 years) in the Osteoporotic Fractures in Men Study (MrOS) who completed the two questionnaires, wrist actigraphy, and a range of additional psychosocial and health measures. RESULTS Internal consistency was adequate for the PSQI (Cronbachs α =.69) and the ESS (α = .70) total scores. PSQI daytime dysfunction and sleep medications components were weakly associated with the total score, but their removal did not notably improve internal consistency. PSQI and ESS totals were associated with each other and with theoretically related variables (ie, actigraphic variables, depressive symptoms, mobility/instrumental activities of daily living, health-related quality of life) in expected directions. The PSQI differentiated participants reporting no sleep disorder from those reporting particular disorders more reliably than the ESS. CONCLUSIONS In general, we found evidence of the internal consistency reliability and construct validity of the PSQI and ESS in older men. Despite low correlation with the PSQI global score, the PSQI daytime dysfunction and sleep medications components do not appreciably reduce the PSQI total scores reliability or validity in older men.

Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women

OBJECTIVES Despite routine use with older adults, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) have not been adequately validated in older samples, particularly those from diverse racial backgrounds. The objective of this study was to determine the reliability and validity of and to provide normative data for these questionnaires in community-dwelling older women. METHODS Participants were 306 black and 2662 white women aged ≥70 from the Study of Osteoporotic Fractures. Participants completed the PSQI and ESS; provided self-reported assessments of mood, cognition and functioning; and underwent wrist actigraphy for sleep-wake estimation. RESULTS Good internal consistency in both black and white women was demonstrated for the PSQI and ESS. Two PSQI subscales, however, were found to have inadequate reliability (Medications and Daytime Dysfunction). Both the PSQI and ESS were associated with theoretically similar measures in the expected directions. The PSQI also differentiated participants with no reported sleep disorder from those reporting at least one sleep disturbance, such as insomnia, sleep apnea and restless legs. The ESS only differentiated women reporting no sleep disorder from those reporting insomnia. CONCLUSION In general, findings suggest that the PSQI and ESS are internally consistent, valid measures of self-reported sleep problems in older women. Additional research is required to evaluate the impact of removing the Medications and Daytime Dysfunction PSQI subscales on this measures internal consistency in older women.

The association of anxiety and depressive symptoms with cognitive performance in community-dwelling older adults.

The authors examined the association of anxiety, depressive symptoms, and their co-occurrence on cognitive processes in 102 community-dwelling older adults. Participants completed anxiety and depression questionnaires as well as measures of episodic and semantic memory, word fluency, processing speed/shifting attention, and inhibition. Participants with only increased anxiety had poorer processing speed/shifting attention and inhibition, but depressive symptoms alone were not associated with any cognitive deficits. Although coexisting anxiety and depressive symptoms were associated with deficits in 3 cognitive domains, reductions in inhibition were solely attributed to anxiety. Findings suggest an excess cognitive load on inhibitory ability in normal older adults reporting mild anxiety.

The Relationship Between Objectively Measured Sleep Disturbance and Dementia Family Caregiver Distress and Burden

The aim of this study was to determine whether distress and burden were associated with objective measures of sleep disturbance in dementia caregivers. Using wrist actigraphy, sleep was measured in 60 female, Caucasian dementia family caregivers (mean age, 64.8 years). Caregivers completed questionnaires about demographics, health, depression, duration of caregiving and care recipient nighttime behavior. Care recipients completed a mental status exam. We investigated whether these measures were associated with actigraphic sleep parameters. Greater depressive symptoms among caregivers were associated with poorer sleep efficiency. Older caregiver age and poorer self-rated health were associated with longer time in bed. Sleep disturbance, which is common among dementia caregivers, might be an important index of caregiver distress (ie, depression) but might not be associated with burden (based on the care recipients general cognitive impairment or nighttime awakenings.)

Application of a cognitive neuroscience perspective of cognitive control to late-life anxiety

Recent evidence supports a negative association between anxiety and cognitive control. Given age-related reductions in some cognitive abilities and the relation of late life anxiety to cognitive impairment, this negative association may be particularly relevant to older adults. This critical review conceptualizes anxiety and cognitive control from cognitive neuroscience and cognitive aging theoretical perspectives and evaluates the methodological approaches and measures used to assess cognitive control. Consistent with behavioral investigations of young adults, the studies reviewed implicate specific and potentially negative effects of anxiety on cognitive control processes in older adults. Hypotheses regarding the role of both aging and anxiety on cognitive control, the bi-directionality between anxiety and cognitive control, and the potential for specific symptoms of anxiety (particularly worry) to mediate this association, are specified and discussed.

Gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being.

Objectives: Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimers disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD. Method: Baseline measures were collected from 162 AD patients and their partners enrolled in a multi-site study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors. Results: While over 70% of all patients initiated physically intimate activities (i.e., kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p < 0.01). Satisfaction with intimacy was significantly associated with fewer stress and depressive symptoms in female caregivers (r = −0.29, p < 0.01). Caregiver gender, satisfaction with intimacy, and caring for a patient with mild AD were significant predictors of caregiver depressive symptoms (ps < 0.05). Conclusion: The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patients level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.

Measuring anxiety in late life: A psychometric examination of the Geriatric Anxiety Inventory and Geriatric Anxiety Scale

We examined the psychometric properties, internal scale reliability and validity, of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS). We also determined the extent to which memory ability influenced the psychometric properties of these measures. Older adult participants (N=110; M age=75 years) completed self-report, clinician-rated and diagnostic psychiatric measures and a neuropsychiatric battery. GAI and GAS scores had good internal consistency, adequate reliability, and strong convergent validity. GAI scores had better discriminant validity than GAS scores relative to a health rating. Both measures had strong associations with depression scores. Psychometric properties were decreased in participants with average delayed memory recall compared with those with superior recall. Both measures had good psychometric support, particularly in those with strong memory abilities. Psychometric performance characteristics indicate that the GAI and GAS may be good alternatives to anxiety measures not designed specifically for older adults.

Depression and anxiety symptoms in male veterans and non-veterans: the Health and Retirement Study

We examined whether veteran status was associated with elevated depression and anxiety symptoms in men aged 50 and older after adjusting for sociodemographic factors.

Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study.

The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms.