Background: Aphasia, one of the core symptoms of cortical dementia, is routinely evaluated using graded naming tests like the Boston Naming Test (BNT). However, the application of this 60-item test is time-consuming and shortened versions have been devised for screening. The hypothesis of this research is that a specifically designed shortened version of the BNT could replace the original 60-item BNT as part of a mini-battery for screening for dementia. The objective of this study was to design a short version of the BNT for a rural population in Galicia (Spain).

Methods: A clinic group of 102 patients including 43 with dementia was recruited along with 78 healthy volunteers. The clinic and control groups were scored on the Spanish version of the Mini-mental State Examination (MMSE) and BNT. In addition, the clinic group was tested with standard neuropsychological instruments and underwent brain investigations and routine neurological examination. BNT items with specificity and sensitivity above 0.5 were selected to compose a short battery of 11 pictures named BNTOu11. ANOVA and mean comparisons were made for MMSE and BNT versions. Receiver operating characteristics (ROC) curves and internal consistency were calculated.

Results: Areas under ROC curves (AUC) did not show statistically significant differences; therefore BNTOu11's AUC (0.814) was similar to the 60-item BNT versions (0.785 and 0.779), to the short versions from Argentina (0.772) and Andalusia (0.799) and to the Spanish MMSE (0.866). BNTOu11 had higher internal consistency than the other short versions.

Conclusions: BNTOu11 is a useful and time-saving method as part of a battery for screening for dementia in a psychogeriatric outpatient unit.

Background: The Cambridge Cognitive Examination (CAMCOG) is a useful test in screening for Alzheimer's disease (AD). However, the interpretation of CAMCOG cut-off scores is problematic and reference values are needed for different educational strata. Given the importance of earlier diagnoses of mild dementia, new cut-off values are required which take into account patients with low levels of education. This study aims to evaluate whether the CAMCOG can be used as an accurate screening test among AD patients and normal controls with different educational levels.

Methods: Cross-sectional assessment was undertaken of 113 AD and 208 elderly controls with heterogeneous educational levels (group 1: 1–4 years; group 2: 5–8 years; and group 3: ≥ 9 years) from a geriatric clinic. submitted to a thorough diagnostic evaluation for AD including the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). Controls had no cognitive or mood complaints. Sensitivity (SE) and specificity (SP) for the CAMCOG in each educational group was assessed with receiver-operator-characteristic (ROC) curves.

Results: CAMCOG mean values were lower when education was reduced in both diagnostic groups (controls – group 1: 87; group 2: 91; group 3: 96; AD – group 1: 63; group 2: 62; group 3: 77). Cut-off scores for the three education groups were 79, 80 and 90, respectively. SE and SP varied among the groups (group 1: 88.1% and 83.5%; group 2: 84.6% and 96%; group 3: 70.8% and 90%).

Conclusion: The CAMCOG can be used as a cognitive test for patients with low educational level with good accuracy. Patients with higher education showed lower scores than previously reported.

Background: In light of inconsistencies in cut points for identifying non-major depression, this study examined the classification efficiency of the Geriatric Depression Scale (GDS and GDS-15) total scores and individual items, and four additional depressive symptoms for identification of subthreshold, minor, or criterion depression among 166 vulnerable residents of congregate housing.

Methods: Depression (combined categories of major depressive episode, minor, or subthreshold depression) was determined by the Mini-International Neuropsychiatric Interview (MINI) diagnostic interview depression module administered by telephone to 166 older residents of congregate housing facilities who also completed the 30-item GDS and four other yes/no potential indicators of geriatric depression. Classification agreement and ROC curve analysis for the full and 15-item GDS scale scores were calculated. Individual item hit rates for MINI criterion were calculated for GDS items and four new items.

Results: GDS and GDS-15 at standard cut points had 70–75% agreement with MINI. Best sensitivity and specificity were obtained at lower than standard cut points. Some GDS Withdrawal, Apathy, lack of Vigor (WAV) and cognitive items obtained very low hit rates. New items “I just don't feel like myself” and “I feel I am a burden to others” better discriminated MINI depression than most GDS items and had good item-to-total correlations with the GDS.

Conclusions: Diagnostic criteria and GDS screen had partial agreement. Some GDS items did not adequately represent depression among functionally impaired or oldest old older adults. Feeling one is a burden and the sense of feeling “different” from usual may be useful indicators of depression among vulnerable older adults.

Background: Behavioral and psychological symptoms, such as verbal or physical aggression, aberrant motor behaviors, psychotic symptoms, anxiety, depressive symptoms and apathy are common among people with dementia. The aim of the present study was to compare the one-week prevalence of behavioral and psychological symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 2000 and 2007.

Methods: A comparison was made between two cross-sectional samples, collected in 2000 and 2007, comprising 4054 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to assess cognitive impairment and behavioral and psychological symptoms. The use of psychotropic drugs was recorded.

Results: Between 2000 and 2007, 15 out of 39 behavioral or psychological symptoms had become less common and no symptoms had become more common, after controlling for demographic changes. Four out of six behaviors within the cluster of aggressive behaviors had declined in prevalence. Patients prescribed anti-dementia drugs increased from 5.1% to 18.0% and antidepressant drug use increased from 43.2% to 49.1%, while anxiolytic, hypnotic, sedative and antipsychotic drug use remained largely unchanged.

Conclusion: The prevalence of many behavioral symptoms had declined from 2000 to 2007, and among these changes, the decline in aggressive behaviors probably has the greatest clinical impact.

Background: Extrapyramidal signs (EPSs), which are important characteristics of Parkinson's disease (PD), occur frequently in Alzheimer's disease (AD). Although AD and PD share common clinical features such as EPSs, these diseases vary with respect to vascular risk factors. The presence of vascular risk factors increases the risk of AD; however, these factors have been known to be inversely associated with PD. We aimed to assess the effect of vascular risk factors and white matter lesions (WMLs) on EPSs in AD.

Methods: We recruited 1,187 AD patients and 333 controls with neither cognitive impairment nor EPSs. All participants underwent detailed clinical evaluations which included assessments of vascular risk factors, cognitive function, and EPSs, as well as WMLs on brain MRIs. EPS subtypes were classified into tremor-dominant, postural instability gait difficulty, or indeterminate; WMLs subtypes were classified into periventricular WML (pvWML) or deep WML (dWML).

Results: EPSs were present in 17.9% of subjects with AD and were significantly associated with vascular risk factors such as age, male gender, diabetes mellitus, and WMLs. Additionally, a multivariate logistic regression analysis showed that EPSs in AD were associated with pvWML (odds ratio (OR), 1.61–2.52), not with dWML. With respect to EPS subtypes, the majority (78.4%) of EPSs in AD were postural instability gait difficulty, which was also associated with WMLs (OR 1.84–2.41), pvWML (OR 2.09–3.14), and dWML (OR 1.83–3.42).

Conclusions: EPSs in AD are associated with selected vascular risk factors as well as WMLs.

Background: The field of geriatric medicine has identified a need for an evaluative tool that can rapidly quantify global cognitive ability and accurately monitor change over time in patients with a wide range of impairments. We hypothesized that the development of an adaptive test approach to cognitive measurement would help to meet that need. This study aimed to provide evidence for the interpretability of scores obtained from a novel, adaptive approach to cognitive assessment, called the Geriatric Rapid Adaptive Cognitive Estimate (GRACE) method.

Methods: An adaptive method for cognitive assessment was developed using data from 185 patients referred for geriatric cognitive assessment, and pilot tested in an additional 137 patients. Correlations between test scores and between rank orders of patients were computed to examine the reliability and validity of cognitive ability scores obtained by (1) administering test questions out of their usual order, (2) administering only a subset of questions, and (3) administering questions adaptively using simplified selection rules based on the most difficult question passed.

Results: Cognitive ability scores obtained with the GRACE method correlated highly with the Montreal Cognitive Assessment (MoCA) scores (r = 0.93) and ranked patients similarly in order of ability (r > 0.87). A simplified adaptive testing algorithm for pencil-and-paper assessment demonstrated moderately high correlations with scores obtained from administering the full set of MMSE and MoCA items as well as the MoCA items alone.

Conclusions: Scores from the GRACE method can be obtained easily in 5–10 minutes, reducing test burden. The resulting numeric score quantifies cognitive ability, allowing clinicians to compare patients and monitor change in global cognition over time. The adaptive nature of this method allows for evaluation of persons across a broader range of cognitive ability levels than currently available tests.

Background: Previous studies have reported that nurse detection of delirium has low sensitivity compared to a research diagnosis. As yet, no study has examined the use of nurse-observed delirium symptoms combined with research-observed delirium symptoms to diagnose delirium. Our specific aims were: (1) to describe the effect of using nurse-observed symptoms on the prevalence of delirium symptoms and diagnoses in long-term care (LTC) facilities, and (2) to compare the predictive validity of delirium diagnoses based on the use of research-observed symptoms alone with those based on research-observed and nurse-observed symptoms.

Methods: Residents aged 65 years and over of seven LTC facilities were recruited into a prospective study. Using the Confusion Assessment Method (CAM), research assistants (RAs) interviewed residents and nurses to assess delirium symptoms. Delirium symptoms were also abstracted independently from nursing notes. Outcomes measured at five month follow-up were: death, the Hierarchic Dementia Scale (HDS), the Barthel ADL scale, and a composite outcome measure (death, or a 10-point decline in either the HDS or the ADL score).

Results: The prevalence of delirium among 235 LTC residents increased from 14.0% (using research-observed symptoms only) to 24.7% (using research- and nurse-observed symptoms). The relative risks (and 95% confidence intervals) for prediction of the composite outcome, after adjustment for covariates, were: 1.43 (0.88, 1.96) for delirium using research-observed symptoms only; 1.77 (1.13, 2.28) for delirium using research- and nurse-observed symptoms, in comparison with no delirium.

Conclusions: The inclusion of delirium symptoms observed by nurses not only increases the detection of delirium in LTC facilities but improves the prediction of outcomes.

Background: Cognitive assessment of older persons, particularly those with impairment, is hampered by measurement error and the ethical issues of testing people with dementia. A potential source of valuable information about end-of-life cognitive status can be gained from those who knew the respondent well – mostly relatives or friends. This study tested the association between last cognitive assessment before death and a retrospective informant assessment of cognition.

Methods: Data were analyzed from 248 participants from the Medical Research Council Cognitive Function and Ageing Study who were aged 71 to 102 years at death. Late-life cognition was assessed 0 to 8 years before death using the Mini-mental State Examination (MMSE) and the informant measure was taken 0 to 7 years after death using a Retrospective Informant Interview (RInI).

Results: Zero-inflated Poisson regression showed a strong association between MMSE scores and RInI scores – those scoring 29–30 on the MMSE had a RInI score four times lower than those who scored <18 (p < 0.001). The time between MMSE and death was also a significant predictor with each additional year increasing RInI scores by 12.4% (p < 0.001). The time between death and RInI was only a significant predictor when including measures that were taken four years or more after death.

Conclusions: Cognitive scores from retrospective informant interviews are strongly associated with late-life MMSE scores taken close to death. This suggests that the RInI can be used as a proxy measure of cognition in the period leading up to death.

Background: The principal goal of this study was to compare the diagnostic accuracy of three brief instruments in memory clinic attendees. Two of the instruments were based on face-to-face clinical assessment (Standardized Mini-mental State Examination and Rowland Universal Dementia Assessment Scale), whereas the third group used proxy information from an informant (Informant Questionnaire on Cognitive Decline in the Elderly). Dementia diagnosis as provided by a specialist physician (geriatrician, psychiatrist or neurologist) was used as the reference standard.

Methods: This was a cross-sectional study. Data were collected from 204 consecutive memory clinic attendees (M = 76.90, 56% female) and their family caregivers. Comparative utility was assessed through receiver operating characteristic (ROC) analyses.

Results: One hundred and fifty-two patients (75%) were diagnosed as having dementia. Diagnostic accuracy, as indicated by the area under the ROC curve (AUC), was similar for the three instruments as follows: SMMSE (AUC = 0.82, 95% CI = 0.76, 0.87, p < 0.0001) and RUDAS (AUC = 0.83, 95% CI = 0.77, 0.88, p < 0.0001), and slightly lower for IQCODE (AUC = 0.77, 95% CI = 0.71, 0.83, p < 0.0001). There was no significant difference between the areas under the curve (χ2 = 2.57, df = 2, p = 0.28).

Conclusions: Diagnostic accuracy was similar for the three instruments, which all proved to be moderately useful tools for initial screening for cognitive impairment in the memory clinic environment. Being a proxy measure, the IQCODE had specific practical use in this context, where the patient might not be able to provide information. The RUDAS exhibited high specificity and proved to be less dependent upon cultural factors than the SMMSE, making it particularly valuable in a multicultural setting.

Background: The aim of the study was to explore the value of a daily observation scale in the assessment of patients' memory function by nurses on a geriatric ward.

Methods: An observational study of 50 geriatric inpatients was carried out. The relationship between the memory items of the Nurses' Behavioral Rating Scale for Geriatric Inpatients (GIP) and four types of neuropsychological memory tests was examined: visual paired-associate learning (Visual Association Test, VAT), word-list learning (Eight Word Test, 8WT from the Amsterdam Dementia Screening, ADS), and the subtests Route Recall and Story Recall from the Rivermead Behavioural Memory Test (RBMT). Correlations with the overall measures assessing level of dementia such as the Mini-mental State Examination (MMSE), Clinical Dementia Rating scale (CDR) and the 15-item Geriatric Depression Scale (GDS-15) were examined as well.

Results: The Pearson's correlation coefficients between GIP and the four memory tests were between 0.45 and 0.71 (p < 0.01). The GIP correlations with the MMSE and CDR were 0.63 and 0.46, respectively (p < 0.01). No significant correlation was found with the GDS-15. Statistically significant differences in GIP memory scores between patients with dementia and non-demented patients were found (p < 0.01).

Conclusions: Results indicate that an observation scale of memory function may have value for providing information about the underlying memory impairment. The results of nurses' observations may be used in triage contributing to the diagnostic process by selecting patients requiring further neuropsychological assessment.

Background: Depression is under-diagnosed and under-treated in older adults. The purposes of this study were to (a) evaluate the psychometric properties of the Collateral Source Geriatric Depression Scale (CS-GDS), (b) compare collateral source scores on the CS-GDS with patient scores on the GDS, and (c) examine factors associated with any discrepancies between the CS-GDS and the GDS.

Methods: This secondary analysis used data from 132 older adults and their collateral sources attending a geriatric assessment program over a 15-month period. Scores on the 30-, 15-, and 5-item CS-GDS were compared to clinician diagnoses of depression using DSM-IV-TR criteria and patient GDS scores.

Results: The three forms of the CS-GDS had acceptable internal consistency, sensitivity and specificity with recommended cut-off scores of 18, 9 and 3, respectively. Collateral sources reported more depressive symptoms than patients did themselves. Simple regression analysis showed that caregiver burden significantly influenced the discrepancy between CS-GDS scores and GDS scores (β = 0.147; p = 0.004). Functional limitations and collateral relations to the patient were not associated with these discrepancies.

Conclusion: All three collateral versions had acceptable psychometric properties, which supports the use of the CS-GDS to assess depression in older adults. The CS-GDS provides an important alternative for depression screening with older adults who cannot complete screening tools themselves; however, alternative cut-off scores must be used for high sensitivity and specificity.

Background: This study explored the relationship between “worthlessness” and all cause non-suicide mortality in Chinese elderly men.

Methods: Data from interviews of 1999 men aged 65 years and over were collected. Clinically significant depressive symptoms were measured using the validated Chinese version of Geriatric Depression Scale. “Worthlessness” was defined by one of the 15 questions from the Geriatric Depression Scale with a yes/no response. All-cause mortality over six years was collected using data from the National Death Registry with adjudication by 4-monthly telephone interviews. Two men were excluded after suicide death.

Results: Age-adjusted mortality rates at five years were 44.3 and 23.9 per 1,000 person years for those who felt “worthless” and those did not, respectively. The adjusted relative risk for all-cause mortality associated with feeling worthless was 1.34 (95% CI: 1.02–1.76) after adjusting for potential confounders that included age, marital status, education, smoking, alcohol consumption, number of chronic diseases, self-rated health, body mass index, cognitive status, physical activity, occupation and maximum lifetime income. There was no statistically significant association between other depressive symptoms or overall depression and mortality.

Conclusion: Worthlessness may be independently associated with all-cause mortality in Chinese elderly men.

Background: This population-based study examined the relative and combined relationships of chronic medical illness (CMI) and depressive symptoms with health care utilization among older adults in South Korea.

Methods: A nationally representative sample of 3224 older adults participating in the Korean Longitudinal Study of Ageing (KLoSA) were categorized into four groups based on clinical characteristics: CMI only; depressive symptoms only; CMI and depressive symptoms; and neither CMI nor depressive symptoms. We estimated the use of various health care services by the groups while adjusting for clinical and sociodemographic characteristics.

Results: Depressive symptoms, as measured by the short-form Center for Epidemiological Studies-Depression scale (CES-D10), were prevalent, often occurring together with CMI in community-dwelling older adults in South Korea. Having depressive symptoms was positively associated with the use of inpatient services, outpatient physician services, and public health centers. The odds of using health care services were larger among older people with both depressive symptoms and CMI than depressive symptoms only.

Conclusions: Self-reported depressive symptoms and self-reported CMI are prevalent among older adults in South Korea, often occurring together and possibly increasing health care utilization. These findings imply a need for chronic disease management targeting older people with complex mental and medical conditions and evaluation of its effects on health outcomes and service use.

Background: This paper reports the development and validation of the Chinese Significant Wish Fulfillment Scale (CSWFS), a new multidimensional scale for assessing the perceived importance and level of fulfillment of wishes of older adults.

Methods: Three studies were involved. Study 1 developed a 26-item pool on wish fulfillment through in-depth interviews with 22 older adults. Study 2 reduced the pool to 23 items through validation with a new sample of 315 older adults and examined the internal reliability. Study 3 involved a confirmatory factor analysis (CFA) and examined the test-retest reliability and the convergent validity of the scale with the construct of regret.

Results: A five-factor structure model of 23 items was identified through exploratory factor analysis, which accounted for 51.67% of variance. As informed by the CFA in Study 3, a five-factor 22-item model was the best fit. Internal reliability and test-retest reliability was found to be good. Convergent validity was examined through correlation with the construct of future regret. The correlation, though statistically significant, was small.

Conclusion: CSWFS demonstrates good psychometric properties, but the construct might be slightly different from that of future regrets. Probably, CSWFS addresses a construct that is under-explored but is of importance to older adults and especially to the Chinese community.

Background: Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.

Methods: The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.

Results: The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91–6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions – 67.8% in the AD and 62.9% in the non-AD group – were generated in primary care situations.

Conclusion: One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.

Background: Sleep disturbance is a common consequence of providing care to a loved one with Alzheimer's disease (AD). We explored the usefulness of the Pleasant Events and Activity Restriction (PEAR) model for predicting multiple domains of sleep disturbance.

Methods: Our sample consisted of 125 spousal AD caregivers. Participants completed the Pittsburg Sleep Quality Index (PSQI) and were questioned regarding the frequency with which they engaged in pleasant events and the extent to which they felt restricted in engaging in social and recreational activities in the past month. Participants were classified into one of three groups: HPLR = High Pleasant Events + Low Activity Restriction (= reference group; N = 38); HPHR/LPLR = either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 52); and LPHR: Low Pleasant Events + High Activity Restriction (N = 35). These three groups were compared on the seven subscales of the PSQI.

Results: Significant differences were found between the HPLR and LPHR groups on measures of subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, and daytime dysfunction. Additionally, significant differences were found between the HPLR and HPHR/LPLR groups on subjective sleep quality, sleep latency, and habitual sleep efficiency, and between the HPHR/LPLR and LPHR groups on sleep disturbance and daytime dysfunction.

Conclusions: This study provides broad support for the PEAR model and suggests that interventions focusing on behavioral activation may potentially provide benefits to non-affective domains including sleep.

Background: The aim of this study was to verify the reliability and validity of the Italian version of the Assessment for Adults with Developmental Disabilities (AADS-I), the only available measure specifically designed to assess the frequency, management difficulties and impact on the quality of life (QoL) of positive and negative non-cognitive symptoms in persons with intellectual disabilities (ID) and dementia.

Methods: AADS-I was administered to professional carers of 63 aging ID individuals. We computed the internal consistency separately of the frequency, management difficulty and effect on the QoL subscales of Behavioral Excesses and Behavioral Deficits and their inter-rater and test-retest reliabilities.

Results: Homogeneity of AADS-I was found to range from good to excellent: Cronbach's α coefficients were 0.77, 0.83 and 0.82, respectively for frequency, management difficulty and effect on the QoL of Behavioral Excesses, and 0.82, 0.76 and 0.79 of Behavioral Deficits. Intraclass correlation coefficients (ICC) between two independent carers were 0.67, 0.79 and 0.73 and 0.67, 0.67 and 0.67 for frequency, management difficulty and effect on the QoL of Behavioral Excesses and Deficits, respectively. Corresponding ICC for test-retest reliability were 0.80, 0.75, 0.78 and 0.70, 0.81, 0.81. Age, gender and typology of ID did not correlate with the AADS-I subscale scores, whereas the severity of ID related only with the frequency subscale of Behavioral Deficits. This subscale also correlated with the Dementia Questionnaire for Persons with Intellectual Disabilities. Behavioral deficits are more frequent in subjects with dementia.

Conclusions: These results confirm the reliability and validity of the Italian version of AADS.

Background: Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies.

Methods: A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer.

Results: The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors.

Conclusions: Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.

Background: The purpose of this study was to examine the mediating impact of executive functioning on the link between other neuropsychological domain scores and informant-based rating of functional status.

Methods: Data on 181 participants were analyzed from an ongoing epidemiological study of rural health, Project FRONTIER (mean age = 64.6 ± 13.8 years, 69% women, 42% Mexican American). Executive functioning was assessed by the EXIT25 and other neuropsychological domains were assessed via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Informant-based rating of functional status was assessed via the Clinical Dementia Rating Scale sum of boxes scores (CDR SB).

Results: RBANS Index scores were each significantly (p < 0.05) related to CDR SB scores and EXIT25 scores. EXIT25 score was a significant partial mediator of the link between four RBANS indices (Immediate Memory, Attention, Visuospatial/Construction, Delayed Memory) and CDR SB scores, and a complete mediator of the fifth index (Language).

Conclusion: Executive functioning is a mediator of the link between other neuropsychological domains and daily functioning. Neuropsychological assessments that do not measure executive functioning will provide only a partial clinical picture with adults and elders.

Background: Prefrontal cortical lobe function is related to social behavior in humans. We investigated whether performance on tests of prefrontal cortical function was associated with social vulnerability. Associations with non-frontal cognitive function were investigated for comparison.

Methods: 1216 participants aged 70+ of the Canadian Study of Health and Aging-2 screening examination, who also underwent detailed neuropsychological testing, comprised the study sample. Performance on WAIS-R abstraction, WAIS-R comprehension, Trails B, FAS and category verbal fluency, Block construction, Token Test and Wechsler Memory Scale Information Subset was tested in relation to the participant's level of social vulnerability using regression models adjusted for age, education, sex, frailty, MMSE score, diagnosis of depression, and use of psychoactive medications. Social vulnerability was measured by an index comprising many social problems or “deficits”.

Results: The most socially vulnerable group had worse performance on FAS verbal fluency, generating 4.1 fewer words (95% CI: 1.8–6.4, p<0.001) than those in the least socially vulnerable group; those with intermediate social vulnerability generated 2.6 fewer words (95% CI: 0.4–4.8, p = 0.02). Social vulnerability was also associated, though less strongly, with category verbal fluency. The most socially vulnerable people had impaired performance on the Trails B, taking 37 seconds longer (95% CI: 11–63, p = 0.005). These results were independent of age, education, sex, frailty, MMSE score, depression, and psychoactive medications. Social vulnerability was not associated with performance on WAIS-R abstraction, WAIS-R comprehension, Block Design, Token Test or Wechsler Memory Scale tests

Conclusions: High social vulnerability was associated with impaired performance on verbal fluency and set shifting but not with common sense judgment, abstraction, long-term memory, constructional ability, or language comprehension. The association between social functioning and the cognitive functions subserved by prefrontal cortex warrants further study.