Highlights
- •What is the primary question addressed by this study?
-
What are the combined effects of changes in neuroticism and changes in stress on cognitive decline among older depressed adults?
- •What is the main finding of this study?
-
The interaction effect of 3-year change in Total Neuroticism score and 3-year change in Total Stressors on change in delayed story memory (Logical Memory-2, LM-II) was statistically significant. Specifically, we found that 1) when total stressors increased by 2 or more over 3 years, LMII change was inversely associated with neuroticism change, and 2) when neuroticism improved less, LMII change score was inversely associated with total stressor change.
- •What is the meaning of the finding?
-
In the course of treatment of late-life depression, it is clinically important to monitor changes in neuroticism and psychosocial stress, as these factors may impact long-term memory performance.
Abstract
Objective
The relationships among depression, personality factors, stress, and cognitive decline
in the elderly are complex. Depressed elders score higher in neuroticism than nondepressed
older individuals. Independently, the presence of neuroticism and the number of stressful
life events are each associated with worsening cognitive decline in depressed older
adults. Yet little is known about combined effects of changes in neuroticism and changes
in stress on cognitive decline among older depressed adults.
Design
Longitudinal observational study.
Setting
Academic Health Center.
Participants
The authors examined 62 participants in the Neurobiology of Late-life depression (NBOLD)
study to test the hypothesis that, compared with older depressed subjects who experience
improved neuroticism and lower psychosocial stressors over time, those with worsening
neuroticism and greater psychosocial stressors will demonstrate more cognitive decline.
Measurements
The authors measured neuroticism using the NEO-Personality Inventory-Revised at baseline
and 1 year. Study psychiatrists measured depression using the Montgomery-Ǻsberg Depression
Rating Scale. At annual assessments, subjects reported the number of psychosocial
stressors in the prior year and completed a neuropsychological evaluation. Participants
completed a detailed neuropsychological battery at baseline and annually over 3 years.
The battery included a test of delayed story memory (Logical Memory-2 or LMII). The
outcome 3-year change in cognitive scores was regressed against 3-year change scores
of neuroticism and number of psychosocial stressors, plus their interaction, while
adjusting for sex, age, race, education, baseline cognitive score, and 3-year change
in MADRS score as covariates.
Results
In multivariable linear regression analysis with the above covariates, the interaction
effect of 3-year change in Total Neuroticism score and 3-year change in Total Stressors
on change in LMII performance was statistically significant (B = −0.080[95%CL: −0.145
to −0.015], T = −2.48, df = 52, p = 0.017). Further exploration of this finding showed
that 1) when total stressors increased by 2 or more over 3 years, LMII change was
inversely associated with neuroticism change; and 2) when neuroticism improved less,
LMII change score was inversely associated with total stressor change. There were
no other significant interactions between stress and neuroticism on cognition.
Conclusion
Our findings document the importance of tracking change in neuroticism and monitoring
psychosocial stress over the long-term course of treatment in geriatric depression.
Both factors exert important combined effects on memory over time. Future studies
in larger samples are needed to confirm our results and to extend them to examine
both cognitive change and development of dementia.
Keywords
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Article info
Publication history
Published online: October 21, 2022
Accepted:
October 18,
2022
Received in revised form:
October 14,
2022
Received:
September 12,
2022
Identification
Copyright
© 2022 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reimagining Research on Personality, Stress and Cognition in Depressed Older Adults: Reflections on Steffens et al.The American Journal of Geriatric PsychiatryVol. 31Issue 3
- PreviewSteffens et al.1 add to the growing literature on the contributions of stressors and personality to cognitive impairment in older adults. For more than a decade, prospective studies have examined self-reported personality2and stress3 as predictors of cognitive decline, mild cognitive impairment, and dementia. For more than 3 decades, retrospective studies have repeatedly documented informant-reported personality change in cognitive decline. The article by Steffens et al. might be one of the first, if not the first, to explore the implications of both change in trait Neuroticism (the tendency to experience negative emotions) and change in self-reported stressors for cognitive outcomes.
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