59 Effects of Cognitive Impairment, Geriatric Depression, and Anxiety on the Texas Functional Living Scale (TFLS) in a Memory Disorder Clinic

Abstract

Objective:

The Texas Functional Living Scale (TFLS) is a measure of adaptive functioning commonly utilized across the geriatric population. Current research suggests that those with Alzheimer’s disease and other dementias perform poorly on the TFLS, compared to those with mild cognitive impairment (MCI) and normal cognition (Cullum et al., 2001). Additional research is needed to examine the influence anxiety and depressive symptoms have on activities of daily living (ADLS) in individuals being evaluated for memory disorders. This study will examine the effects of anxiety and depression on adaptive functioning across all patients, and within samples of those with dementia and MCI. It is hypothesized that higher reported anxiety and depressive symptoms will predict lower scores of ADLS.

Participants and Methods:

Patients at a memory disorder clinic (N = 756; 58.2% female) were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). A brief neuropsychological evaluation (BNE) was then conducted in which the TFLS, Geriatric Depression Scale (GDS), and Geriatric Anxiety Inventory (GAI) were administered, among other measures.

Results:

A stepwise hierarchical regression was conducted on the entire sample to examine the effects of anxiety and depressive symptoms on TFLS performance, controlling for cognitive impairment using the MoCA. Lower MoCA scores explained a significant amount of variance in TFLS performance (R² = 0.456, F(1, 754) = 632.78, p < .001). MoCA scores (b = 1.27, p < .001), the GAI (b = 0.14, p = .019), and the GDS (b = 0.10, p = 0.039) were significant predictors of poor TFLS performance across the entire sample. Although the MoCA, GDS, and GAI were each significant predictors of the TFLS, the increased variance explained by the GDS and GAI individually was incremental (AR² = 0.003, F(1, 752) = 3.90, p = .049). Stepwise hierarchical regressions were also conducted on subsamples diagnosed with MCI (N = 171) and dementia (N = 394). For those with MCI, MoCA scores explained a significant amount of variance in TFLS performance (R² = 0.044, F(1, 169) = 7.80, p = .006). Neither the GAI nor GDS explained significant additional variance. Only MoCA scores (b = .30, p =.006) predicted TFLS performance. For those with dementia, MoCA scores explained significant variance in TFLS scores (R² = 0.338, F(1, 392) = 200.47, p < .001). The GAI explained additional significant variance when added (AR² = 0.009, F(1, 391) = 5.26, p = .022). The GDS did not explain any additional variance. Both the MoCA (b = 1.29, p < .001) and the GAI (b = -0.15, p = .002) significantly predicted TFLS performance.

Conclusions:

While results suggest that anxiety and depressive symptoms alone do not explain a significant degree of variance within scores of adaptive functioning across the entire sample, elevated ratings of anxiety and depressive symptoms were significant predictors of lower scores of ADLS, suggesting some support for our hypothesis. Additionally, anxiety symptoms significantly explained increased variance in TFLS scores for those diagnosed with dementia, suggesting a potential relationship between anxiety levels and poor adaptive functioning for dementia patients.