Cognition and its association with the factors of the EURO-D: Suffering and Motivation. Findings from SHARE Wave 6

Objective The aims of this study were (1) to analyse the relationship between cognition and clinical and sociodemographic variables, (2) to explore the relationship between cognitive tests and factors of EURO‐D depression scale (Suffering and Motivation), and (3) to determine the relevance of cognition with respect to clinical and sociodemographic variables in the scores of the EURO‐D factors. Method: About 63 755 participants in the Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 6 (2015) were included. Instruments are as follows: the SHARE study, the EURO‐D scale, and cognitive tests. Bivariate, correlation, and multiple linear regression analyses were performed. Results: In the regression analysis with cognition, the variables associated with poor cognition were higher age (β = .29), lower educational level (β = −.26), economic difficulties (β = .17), and depression (β = .10). The correlation between cognition and EURO‐D factors was weak in Suffering (r = −0.139) and moderate in Motivation (r = −0.382). In the regression analysis with the EURO‐D, loneliness, poor self‐perceived physical health, female gender, and low cognition were associated with higher depression levels. The main differences in the predictor variables of each factor were cognition (Motivation = −0.248, P < .001; Suffering = 0.002, P = .648) and the female sex (Motivation = 0.015, P < .001, Suffering = 0.175, P < .001). Conclusions: In the EURO‐D depression scale, poor cognition was associated with higher scores in the Motivation factor only, while the female gender presented higher scores in the Suffering facto

Quality of life in people aged 65+ in Europe: associated factors and models of social welfare analysis of data from the SHARE project (Wave 5)

Purpose To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+, and to examine the relationship with models of social welfare in Europe. Methods Cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Instruments: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis: bivariate and multilevel. Results In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared with Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4). Conclusions Perceived quality of life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live

Factor structure of depressive symptoms using the EURO-D scale in the over-50s in Europe. Findings from the SHARE project

Objectives: The aims of this study are: to analyze the factor structure of the EURO-D depression scale; to explore the variables associated with depressive symptoms in the total sample and in the EURO-D factors; and to compare the presence of depressive symptoms and the factor distribution in 15 European countries. Method: 62,182 participants in Wave 5 (2013) of the Survey of Health, Aging and Retirement in Europe (SHARE) were included. Instruments: The SHARE study and the EURO-D scale. Factor, bivariate and multilevel analyses were performed. Results: Higher levels of depressive symptoms were associated with a poorer self-perception of physical health (η2 = 0.22) and economic difficulties (η2 = 0.07). Factor analysis of the EURO-D identified two factors: Suffering and Motivation. Higher levels of depressive symptoms were associated with female gender and younger age (≤ 60) in the Suffering factor, and with less activity and exercise, older age (≥ 71), widowhood and lower educational level in the Motivation factor. Poorer self-perception of physical health and economic difficulties were associated with higher depressive symptomatology in both factors. Conclusions: Poorer self-perception of physical health, female gender, economic difficulties, widowhood, lower levels of activity and exercise and lower educational level were associated with higher depressive symptomatology. In the countries of southern Europe, the Motivation factor predominated

Depresión y variables asociadas en personas mayores de 50 años en España

Introducción: La depresión es un trastorno psiquiátrico incapacitante y frecuente en la edad adulta asociado a mayor mortalidad y discapacidad funcional. Objetivos: Determinar la asociación de las variables clínicas y sociodemográficas con la depresión, en una muestra de personas mayores de 50 años residentes en España, y comparar la prevalencia de depresión con los demás países del estudio SHARE (Survey of Health, Ageing and Retirement in Europe) Material y métodos: Muestra de 5.830 participantes de la muestra española de la 'Wave 5', de 2013, del estudio SHARE. Instrumentos: EURO-D (Depresión) y CASP-12 (Calidad de vida). Análisis estadístico: Bivariante y Regresión Logística binaria. Resultados: En la regresión logística binaria, las variables asociadas a la depresión (Euro-D ≥4) fueron, principalmente, la mala percepción de salud física (OR = 13,34 IC 95% 9,74-18,27), la presencia de >2 dificultades en las Actividades de la Vida Diaria (AVD) (OR = 4,46 IC 95% 3,13-6,34) y el género femenino (OR = 2,16; CI95% 1,83-2,56). La depresión fue más frecuente en los participantes que padecían Alzheimer (76,4%), trastornos emocionales (73,9%), Parkinson (57,4%), fractura de cadera (55,4%) y reumatismos (50,9%). En la comparación con países europeos, España tenía un porcentaje de personas con depresión (29,3%) superior a la media europea (27,9%). Conclusiones: Las variables más relevantes asociadas a la depresión fueron la mala percepción de salud física, la presencia de dificultades en las AVD y el género femenino

Symptoms of depression and associated factors in persons aged 50 and over in Europe and Israel: Analysis of data from the SHARE project

It is estimated that by 2020 depression will be the second most common health problem affecting older people. Depressive disorders among the elderly are often under-diagnosed and under-treated despite being one of the main causes of disability, resulting in an increased use of health services, poorer physical health and greater medical costs. The mean prevalence of depressive syndromes among elderly people has been reported to be 13.5% (Beekman et al., 1999). The objective of this study was to identify the variables associated with the presence of depressive symptoms in non-institutionalized individuals aged 50 and over

Depression and variables associated with quality of life in people over 65 in Spain and Europe. Data from SHARE 2013

Background and objectives: The perception of quality of life (QoL) in people over 65 years of age can be affected by individual clinical and sociodemographic characteristics, and also by the nature of the welfare models in place in particular countries. The objective of this study was to compare the association between clinical/sociodemographic variables and QoL in people ≥65 in samples from Spain and from Central-Northern European countries, using data from the SHARE (Survey of Health, Ageing and Retirement in Europe) study. Methods: Data from 22,189 participants in Wave 5 (2013) of the SHARE study were obtained. Instruments: CASP-12 (quality of life) and EURO-D (depression). Statistical analysis: Bivariate and multiple linear regression and correlations. Results: In the regression analysis, the variables most closely associated with a lower QoL (CASP-12) in both groups (Spain, r2 = 0.586 and Central-Northern Europe, (r2 = 0.453) were high depression (β = 0.444 vs. 0.361), poor physical health, economic difficulties, and deficits in activities of daily living (ADL); low level of education was relevant only in the Spanish sample. The mean QoL score in Spain was lower than in the other countries (34.8 ± 6.8 vs. 38.5 ± 5.8, p < 0.001; d = 0.58) and depression was more frequent (34.9% vs 27.4%, p < 0.001; V = 0.06). Conclusions: In all countries, low QoL was associated with high rates of depression and poor physical health. The Spanish sample had lower QoL than their Central-Northern European counterparts. A high rate of depression was the most relevant differential variabl

Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with alzheimer's disease: a 24-month follow-up study

Objectives: Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. Methods: A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of Life-Alzheimer's Disease (QoL-AD), and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. Results: In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. Conclusion: Neuropsychiatric symptoms and anosognosia have differential effects on patient and caregiver ratings of the quality of life of patients with Alzheimer's disease. Key words: Alzheimer's disease, quality of life, anosognosia, neuropsychiatric symptoms, caregivers, patients

Kinship and cohabitation in relation to caregiver burden in the context of Alzheimer's disease: a 24-month longitudinal study

Objectives: The aims of the study were to identify the clinical characteristics of three groups of caregivers: spouses, live-in adult-child or non-live-in adult-child, and their relation to the degree of perceived burden (Caregiver Burden Interview). Methods: The sample comprised 275 Alzheimer's disease (AD) primary caregivers, with a follow-up of 24 months. Cognitive, functional and behavioural characteristics were evaluated in persons with AD (PwD), while socio-demographic data, use of socio-medical resources, physical and mental health, and self-perceived burden were assessed in caregivers. Generalized estimating equations (GEE) were used for longitudinal data analysis. Results: Spouse caregivers were 45.0% men, sole caregivers (> 80%), used few external resources, and had worse physical health. The number of female adult-child caregivers was higher (>75%). The live-in adult-child group, compared with the non-live-in adult-child group, were less likely to be married, had a lower level of education, were more commonly the sole caregiver, and used fewer external resources. The greatest burden was observed in live-in adult-child caregivers, and the lowest in the non-live-in adult-child group, with no significant variation in the follow-up for both groups. Spouses had an intermediate level of perceived burden, which rose significantly during follow-up (p <0.001). Conclusions: Kinship and cohabitation with the PwD were associated with different scores and evolution of the burden, with an increase in the follow-up of the spouses, and with more or less burden, depending on cohabitation, in the adult-child groups. Interventions to reduce the level of burden on caregivers should consider these differences

Self-perceived quality of life among patients with Alzheimer's disease: Two longitudinal models of analysis

The objective was to analyze the factors that influence self-perceived quality of life (QoL) in patients with Alzheimer's disease (AD), contrasting two different longitudinal models. A total of 127 patients were followed up over 24 months. The instruments applied were: Quality of Life in Alzheimer's Disease scale (QoL-AD), Geriatric Depression Scale-15, Anosognosia Questionnaire-Dementia, Disability Assessment in Dementia, Neuropsychiatric Inventory, and the Mini Mental State Examination. Two models for grouping patients were tested: 1) Baseline score on the QoL-AD (QoL-Baseline), and 2) Difference in QoL-AD score between baseline and follow-up (QoL-Change). Generalized estimating equations (GEE) were used to analyze longitudinal data, and multinomial regression analyses were performed. Over the follow-up period the QoL-Baseline model showed greater variability between groups (Wald χ2 = 172.3, p 37 QoL-AD). The model based on baseline scores (QoL-Baseline) was better than the QoL-Change model in terms of identifying trajectories and predictors of QoL in AD

Sense of Coherence Mediates the Relationship Between Cognitive Reserve and Cognition in Middle-Aged Adults

In recent years, supported by new scientific evidence, the conceptualization of cognitive reserve (CR) has been progressively enriched and now encompasses not only cognitive stimulating activities or educational level, but also lifestyle activities, such as leisure physical activity and socialization. In this context, there is increasing interest in understanding the role of psychological factors in brain health and cognitive functioning. In a previous study, we have found that these factors mediated the relationship between CR and self-reported cognitive functioning. In this study, we have confirmed an association between two important constructs included in the psychological wellbeing and salutogenic models, 'purpose in life' and 'sense of coherence,' CR, as assessed using a questionnaire, and cognitive functioning, as evaluated using a comprehensive neuropsychological battery. Results from 888 middle-aged healthy participants from the Barcelona Brain Health Initiative indicate that both sense of coherence (SoC) and CR were positively associated with verbal memory, reasoning and attention, working memory, and global cognition. Moreover, the relation between CR and cognitive functioning in the different domains is partially mediated by SoC. When we controlled for brain integrity, introducing into the model neurofilament light chain measures, the mediator role of SoC was confirmed for reasoning and attention and global cognition. However, purpose in life was not associated with cognitive functioning. These results reveal the central role of the SoC construct, which mediates the association between classic CR estimates and cognitive functions, potentially representing a modifiable target for interventions that aim to promote brain health