A medication screening tool for cognitive aging researchers.

A Web-based medication screening toll that provides researchers with information about side effects associated with medications commonly used by older participants is described. this tool can be used for research purposes to better separate the effects of normal, healthy aging processes from the deleterious effects often associated with medication usage. Researchers can use this tool, called SMART (Screening Medications: Aging Research Taxonomy), to (a) obtain information pertaining to the cognitive, sensory, and motor side effects associated with specific medications, and (b) screen medications in their research for side effect severity. The Web address for the tool is www.psychology.gatech.edu/SMART. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting medication adherence and employment status following kidney transplant: The relative utility of traditional and everyday cognitive approaches.

Objective: The authors investigated the utility of both traditional and everyday cognitive measures in predicting medication adherence and employment status among kidney transplant recipients. In addition, the role of noncognitive predictors was examined. Method: Cognitive measures of processing speed, memory, everyday problem solving, executive functioning, and questionnaires assessing mood, medication adherence, and employment status were individually administered to 108 kidney transplant recipients. Because the eligibility criteria differed for the two analyses, there were 103 participants in the medication adherence analyses and 94 participants in the employment analyses. Stepwise hierarchical regression and sequential binomial logistic regression analyses were conducted for continuous and dichotomous outcome measures, respectively. Results: Findings indicate that both poorer performance on the everyday problem-solving test and a higher number of depressive symptoms were predictive of poorer self-reported medication adherence (R2 = .19, p R2 = .29, ps     

Changes in functional health, changes in medication beliefs, and medication adherence.

Objective: Medication adherence often lies below recommendations although it is crucial for effective therapies, particularly in older adults with multiple illnesses. Medication beliefs are important factors for individual adherence, but little is known about their origin. We examine whether changes in functional health predict changes in medication beliefs, and whether such changes in beliefs predict subsequent medication adherence. Design: At three points in time over a 6-month period, 309 older adults (65–85 years) with multiple illnesses were assessed. Latent true change modeling was used to explore changes in functional health and medication beliefs. Adherence was regressed on changes in beliefs. Main Outcome Measures: Medication beliefs were measured by the Beliefs About Medicines Questionnaire; medication adherence by the Reported Adherence to Medication Scale. Results: Functional health and medication beliefs changed over time. Increasing physical limitations predicted increases in specific necessity and specific concern beliefs, but not in general beliefs. Changes in specific necessity beliefs predicted intentional adherence lapses, changes in general overuse beliefs predicted unintentional adherence lapses. Conclusions: Medication beliefs partly depend on health-related changes, and changes in beliefs affect individual adherence, suggesting to target such beliefs in interventions and to support older adults in interpreting health changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emergent coordination of cognitive function.

1/f scaling has been observed throughout human physiology and behavior, but its origins and meaning remain a matter of debate. Some argue that it is a byproduct of ongoing processes in the brain or body and therefore of limited relevance to psychological theory. Others argue that 1/f scaling reflects a fundamental aspect of all physiological and cognitive functions, namely, that they emerge in the balance of independent versus interdependent component activities. In 4 experiments, series of key-press responses were used to test between these 2 alternative explanations. The critical design feature was to take 2 measures of each key-press response: reaction time and key-contact duration. These measures resulted in 2 parallel series of intrinsic fluctuations for each series of key-press responses. Intrinsic fluctuations exhibited 1/f scaling in both reaction times and key-contact durations, yet the 2 measures were uncorrelated with each other and separately perturbable. These and other findings indicate that 1/f scaling is too pervasive to be idiosyncratic and of limited relevance. It is instead argued that 1/f scaling reflects the coordinative, metastable basis of cognitive function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of homework in cognitive behavior therapy of depression.

Homework is particularly important in the cognitive-behavioral treatment of depression because the pervasive nature of the characteristic cognitive, affective, and motivational disturbances undercut the impact of didactic and supportive verbal interventions. Despite the importance of homework, a relatively small number of studies have quantified the causal relationship between homework completion and symptomatic outcome. Most of these studies have limited power to detect small-to-moderate effect sizes and rely on retrospective or incomplete measurements of homework that do not distinguish between the quantity and quality of the assigned tasks. Nevertheless, there is relatively consistent evidence from correlational studies to conclude that homework adherence is associated with significantly better outcomes. These findings point to new questions for research (i.e., does ongoing use of homework decrease the likelihood of relapse following termination of time-limited therapy?) and have implications for clinical practice. Examples of homework assignments are provided and strategies to improve homework adherence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress-related cognitive interference predicts cognitive function in old age.

Both subjective distress and cognitive interference have been proposed as mechanisms underlying the negative effects of stress on cognition. Studies of aging have shown that distress is associated with lower cognitive performance, but none have examined the effects of cognitive interference. One hundred eleven older adults (Mage=80) completed measures of working memory, processing speed, and episodic memory as well as self-report measures of subjective distress and cognitive interference. Cognitive interference was strongly associated with poorer performance on all 3 cognitive constructs, whereas distress was only modestly associated with lower working memory. The results suggest that cognitive process related to stress is an important predictor of cognitive function in advanced age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of Structural Ecosystems Therapy for HIV medication adherence with African American women.

A systemic family therapy intervention, Structural Ecosystems Therapy (SET; Mitrani, Szapocznik, & Robinson-Batista, 2000; Szapocznik et al., 2004), has been shown to promote adaptation to living with HIV by reducing psychological distress and family hassles. This investigation examines the effect of SET on HIV medication adherence relative to a person-centered condition and a community control condition. Medication adherence was assessed on 156 trial participants. Results of a 2-part model showed that SET was significantly more likely to move women to high levels of adherence (defined as at least 95% adherence) than a person-centered therapy. Family hassles were also significantly reduced by SET, though the effect of SET on medication adherence did not appear related to this change in family hassles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression.

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of aging and frontal function on the neural correlates of regulative and evaluative aspects of cognitive control.

The influence of aging and frontal function on the neural correlates of regulative and evaluative control was examined by means of event-related brain potentials (ERPs). The behavioral data indicated that interference was greater for older than for younger adults and that this difference was mediated by frontal function. The ERP data revealed effects of aging on the neural correlates of both regulative and evaluative control. Prestimulus neural activity was correlated with response time and frontal function, and these relationships were moderated by the response-to-stimulus interval (RSI); the poststimulus data also revealed age-related differences in the neural correlates of evaluative control that interacted with RSI. These data support predictions derived from the context processing deficit theory of aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of age on long-term cognitive function after traumatic brain injury.

Objective: To examine the association of age and time postinjury with cognitive outcome 5–22 years following traumatic brain injury (TBI), in relation to matched uninjured controls. Methods: One hundred twelve participants with mild to very severe TBI, aged 16–81 years at the time of injury, were cognitively assessed on measures of processing speed and attention, verbal and visual memory, executive function, and working memory. Results were compared with those of 112 healthy controls individually matched for current age, gender, education, and estimated IQ. Results: Older injured individuals performed worse than did younger injured individuals across all cognitive domains, after controlling for the performance of controls. In relation to matched controls, long-time survivors performed disproportionately worse than did more recently injured individuals, irrespective of age. Conclusions: After maximum spontaneous recovery from TBI, poorer cognitive functioning appears to be associated with both older age at the time of injury and increased time postinjury. These findings have implications for prognosis, early treatment recommendations, and long-term issues of differential diagnosis and management planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of mobile telephones as adjuncts to cognitive behavioral psychotherapy.

Despite the rapid proliferation of technological adjuncts in cognitive behavior therapy (CBT), much of this development appears to have occurred on an ad hoc basis and in many cases has resulted in applications that are beyond the resources of most practicing clinicians. The authors delineate the specific areas in which CBT can be augmented through use of technology and outline the characteristics of an ideal therapy augmentor. Mobile telephones are identified as a low-cost and accessible device whose use has been largely untapped to date. The existing literature on use of the mobile phone is reviewed, and potential areas for its application in CBT are examined. The authors conclude with clinical guidelines for its use and the recommendation that use of mobile phones in CBT is a promising avenue for both clinical practice and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selectivity of executive function deficits in mild cognitive impairment.

Impairment in executive cognition (EC) is now recognized as relatively common among older persons with mild cognitive impairment (MCI) and may be predictive of the development of dementia. However, both MCI and executive functioning are broad and heterogeneous constructs. The present study sought to determine whether impairments in specific domains of EC are associated with specific subtypes of MCI. MCI patients (n = 124) were divided into 4 subgroups (amnestic vs. nonamnestic, and single- vs. multiple-domain) on the basis of their performance of widely used neuropsychological screening tests. These patients and 68 normal older persons were administered 18 clinical and experimental tests of executive function. Principal components analysis suggested 2 highly reliable EC components, planning/problem solving and working memory, and a less reliable 3rd component, judgment. Planning/problem solving and working memory, but not judgment, were impaired among the MCI patients. This was true even among those with “pure amnestic” MCI, the least impaired group overall. Multiple-domain MCI patients had more severe impairments in planning/problem solving and working memory than single-domain patients, leading to the supposition that they, not pure amnestic MCIs, are at highest risk of imminent dementia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual function and cognitive aging: Differential role of contrast sensitivity in verbal versus spatial tasks.

Cognitive and sensory function are correlated in older adults. Sensory function may provide an index of neurological integrity (common-cause hypothesis). Declining sensory input may also directly impair cognition (direct-cause hypothesis). Accordingly, sensory function should more strongly predict cognitive performance and should account for more age-related variability in tasks with higher sensory demands. In a cross-sectional adult life span sample, visual contrast sensitivity was a better predictor and accounted for more of the age-related variability in high sensory-demand tasks, compared with low sensory-demand tasks, consistent with the direct-cause hypothesis. The results suggest a direct role for sensory function in cognitive aging when task conditions place heavy demands on sensory processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-associated predictors of medication adherence in HIV-positive adults: Health beliefs, self-efficacy, and neurocognitive status.

Objective: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. Design: Prospective, cross-sectional observational design. Main Outcome Measures: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). Results: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. Conclusion: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of sensory factors in cognitive aging research.

Performance on complex, cognitive tasks often is sensitive to low-level sensory and perceptual factors. These relations are particularly important for cognitive aging researchers because aging is associated with a variety of changes in sensory and perceptual function. In this article, the author first selectively outlines some relations between task performance and sensory function. Next, the author summarizes age-related changes in visual function and the implications of these changes for task performance, using the digit-symbol subtest of the Wechsler Adult Intelligence Test as an example. Then the author offers some reasons why age-related sensory decline may not be important to all cognitive tasks. Finally, several recommendations are offered for cognitive gerontologists who want to minimize the risk that the age differences they observe are sensory in nature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stability of cognitive controls.

Test-retest reliabilities of measures of cognitive controls reported in a previous publication (Gardner et al., 1959) were seen to be, in general, statistically high. The assumption is made, therefore, that cognitive controls are relatively stable features of cognitive organizations. From Psyc Abstracts 36:02:2HE85G. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Olfactory acuity and cognitive function converge in older adulthood: Support for the common cause hypothesis.

Visual and auditory thresholds and cognitive variables have shown converging losses in old age, which might exist because standard cognitive tests rely on these modalities for assessment. The present study examined convergence between olfactory acuity and cognitive function to investigate the common cause hypothesis in another sensory modality. Multiple-groups structural equation modeling techniques (EQS) were used to test the fit of a model representing the common cause hypothesis for olfactory acuity (threshold, detection) and cognitive function (verbal memory, letter and category fluency, reasoning, processing speed, and vocabulary level) data from 98 nondemented older adults (aged 55 to 97) and 103 younger adults (aged 18 to 45). The model fit better the data from the older adults, consistent with the hypothesis that measures of sensory and cognitive functioning converge in older adulthood due to a common factor; however, direct chronological age effects were found that suggest that there are unique influences of age beyond those shared between cognitive and sensory variables. The results suggest that olfactory functioning may be a valid indicator of the integrity of the aging brain in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.

Objective: To evaluate cognitive-behavioral therapy to enhance medication adherence and reduce depression (CBT-AD) in individuals with HIV. Design: A two arm, randomized, controlled, cross-over trial comparing CBT-AD to enhanced treatment as usual only (ETAU). ETAU, which both groups received, included a single-session intervention for adherence and a letter to the patient's provider documenting her or his continued depression. The intervention group also received 10 to 12 sessions of CBT-AD. Main Outcome Measures: Adherence to antiretroviral therapy as assessed by Medication Event Monitoring Systems (MEMs) and depression as assessed by blinded structured evaluation. Results: At the acute outcome assessment (3-months), those who received CBT-AD evidenced significantly greater improvements in medication adherence and depression relative to the comparison group. Those who were originally assigned to the comparison group who chose to cross over to CBT-AD showed similar improvements in both depression and adherence outcomes. Treatment gains for those in the intervention group were generally maintained at 6- and 12-month follow-up assessments. By the end of the follow-up period, those originally assigned CBT-AD demonstrated improvements in plasma HIV RNA concentrations, though these differences did not emerge before the cross-over, and hence there were not between-groups differences. Conclusions: CBT-AD is a potentially efficacious approach for individuals with HIV struggling with depression and adherence. Replication and extension in larger efficacy trials are needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Injection anxiety remains a long-term barrier to medication adherence in multiple sclerosis.

Objective: To evaluate the contribution of injection anxiety to disease modifying therapy (DMT) adherence among individuals with multiple sclerosis (MS). Injection anxiety has been associated with medication discontinuation early in the course of treatment, but little is known about the relationship between injection anxiety and sustained DMT adherence over time. Method: Eighty-nine outpatients receiving care at a Veterans Administration MS clinic completed a telephone survey at baseline and monthly telephone follow-up for 6 months. Results: Participants were established DMT users (M = 3.43 years, SD = 3.29), with relatively high adherence overall (over 80% achieved 80% adherence or greater). Using logistic regression and controlling for demographics, MS disability, type of DMT, and time on DMT, the authors found that baseline injection anxiety predicted lower levels of adherence at 4 months and 6 months, with a similar trend at 2 months. Conclusion: Sustained adherence to DMT remains a challenge for a subset of individuals with MS well beyond the initial period of acclimation. Injection anxiety is an important and promising target of psychological intervention during all periods of medication use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)