Auditory Processing but Not Peripheral Hearing Differs Between Older Adults With and Without Mild Cognitive Impairment.

PURPOSE: Impairments of hearing and auditory processing (AP) have been indicated as risk factors for dementia, but it remains unclear if persons with clinically diagnosed mild cognitive impairment (MCI) show such impairments. The objective of these analyses was to compare AP between those with and without a clinical diagnosis of MCI using a battery of AP measures. METHOD: Data from 274 older adults from the Keys to Staying Sharp randomized clinical trial (NCT03528486) were analyzed. A battery of AP measures in which three domains (temporal processing, binaural processing, and degraded speech understanding) were addressed by six tests was administered. Analyses were registered at https://osf.io/nga4v. RESULTS: Those with and without a clinical diagnosis of MCI differed significantly in age, p = .002; pure-tone hearing in the left ear, p = .007; sex, p = .015; and race, p < .001. These covariates were included in multivariate analysis of covariance, which indicated significant differences between persons with and without MCI on measures of binaural processing (ps ≤ .006), but not on measures of temporal processing or degraded speech (ps ≥ .093). Pure-tone hearing averages did not significantly differ among those with or without MCI after adjusting for age, sex, and race (ps ≥ .292). CONCLUSIONS: AP in the binaural domain is impaired in MCI, but peripheral hearing did not significantly differ between those with and without MCI. Poor performance on AP measures of binaural processing may reflect problems dividing attention and may be indicative of dementia risk. Results have clinical implications for early detection of and intervention for cognitive impairment.

Indicators of Crash Risk in Older Adults: A Longitudinal Analysis From the ACTIVE Study.

Objective: This study aims to examine indicators of crash risk longitudinally in older adults (n = 486). Method: This study applied secondary data analyses of the 10 years of follow-up for the ACTIVE study combined with state-recorded crash records from five of the six participating sites. Cox proportional hazards models were first used to examine the effect of each variable of interest at baseline after controlling for miles driven and then to assess the three cognitive composites as predictors of time to at-fault crash in covariate-adjusted models. Results: Older age, male sex, and site location were each predictive of higher crash risk. Additionally, worse scores on the speed of processing cognitive composite were associated with higher crash risk. Discussion: Results support previous findings that both age and male sex are associated with higher crash risk. Our significant finding of site location could be attributed to the population density of our testing sites and transportation availability.

The Preventing Alzheimer's with Cognitive Training (PACT) randomized clinical trial.

BACKGROUND: To address the rising prevalence of Alzheimer's disease and related dementias, effective interventions that can be widely disseminated are warranted. The Preventing Alzheimer's with Cognitive Training study (PACT) investigates a commercially available computerized cognitive training program targeting improved Useful Field of View Training (UFOVT) performance. The primary goal is to test the effectiveness of UFOVT to reduce incidence of clinically defined mild cognitive impairment (MCI) or dementia with a secondary objective to examine if effects are moderated by plasma ß-amyloid level or apolipoprotein E e4 (APOE e4) allele status. METHODS/DESIGN: This multisite study utilizes a randomized, controlled experimental design with blinded assessors and investigators. Individuals who are 65 years of age and older are recruited from the community. Eligible participants who demonstrate intact cognitive status (Montreal Cognitive Assessment score > 25) are randomized and asked to complete 45 sessions of either a commercially available computerized-cognitive training program (UFOVT) or computerized games across 2.5 years. After three years, participants are screened for cognitive decline. For those demonstrating decline or who are part of a random subsample, a comprehensive neuropsychological assessment is completed. Those who perform below a pre-specified level are asked to complete a clinical evaluation, including an MRI, to ascertain clinical diagnosis of normal cognition, MCI, or dementia. Participants are asked to provide blood samples for analyses of Alzheimer's disease related biomarkers. DISCUSSION: The PACT study addresses the rapidly increasing prevalence of dementia. Computerized cognitive training may provide a non-pharmaceutical option for reducing incidence of MCI or dementia to improve public health. REGISTRATION: The PACT study is registered at http://Clinicaltrials.govNCT03848312.

Applying the Health Belief Model to Quantify and Investigate Expectations for Computerized Cognitive Training.

Despite the demonstrated benefits of computerized cognitive training for older adults, little is known about the determinants of training behavior. We developed and tested scales to quantify expectations about such training, examine whether expectations predicted training adherence, and explore if training expectations changed from pre- to post-training. Participants (N=219) were healthy older adults aged 55-96 years (M=75.36, SD=9.39), enrolled in four studies investigating Dakim, Insight, or Posit Science Brain Fitness computerized cognitive training programs. Instruments were adapted from existing health behavior scales: Self Efficacy for Cognitive Training, Outcome Expectations for Cognitive Training, Perceived Susceptibility to Cognitive Decline, Dementia or Alzheimer's Disease, and Perceived Severity of Cognitive Decline, Dementia or Alzheimer's Disease. Participants completed scales at baseline (N=219) and post-training (n=173). Eight composites were derived from factor analyses. Adherence rates were high (M=81%), but none of the composites predicted training adherence. There was an overall significant effect of time, Wilks' λ=.843, F(8, 114)=2.65, p=.010, partial η 2 =.157, a significant overall effect of training group, Wilks' λ=.770, F(16, 228)=1.99, p=.015, partial η 2 =.123, and an overall significant group x time interaction, Wilks' λ=.728, F(16, 226)=2.44, p=.002, partial η 2 =.147. Significant effects of time were found for expected psychological outcomes and self-efficacy. Post-training, participants more strongly agreed that training was enjoyable and increased their sense of accomplishment. Changes in self-efficacy for cognitive training varied by program, improvingfor Dakim- and declining for the more challenging Brain Fitness- and InSight participants. These newly devised scales may be useful for examining cognitive training behaviors. However, more work is needed to understand factors that influence older adults' enrollment in and adherence to cognitive training.

Dynamic Useful Field of View Training to Enhance Older Adults' Cognitive and Motor Function: A Pilot Study.

Useful Field of View (UFOV) computerized cognitive training improves older adults' gait speed and balance and reduces dementia risk. We investigated a new form of UFOV training requiring physical movement, Training Under Cognitive Kinematics (TUCK). We hypothesized TUCK would be acceptable, feasible, and potentially efficacious to improve UFOV Test- and motor performance. Sixty-nine older adults were randomized to TUCK, computerized UFOV training, or an active control group. Cognitive- and motor function were assessed before and immediately after the intervention period. Participants rated TUCK as enjoyable, engaging and satisfying, indicating acceptability. Eighty-five percent of participants completed TUCK, demonstrating feasibility. Overall, effect sizes for TUCK did not indicate greater efficacy than computerized UFOV training relative to controls. UFOV training showed effect sizes indicating improved balance as measured by Turn 360 (d=0.37) and Optogait (d=0.51-0.69) from pre- to post- training relative to controls. Incorporating movement into UFOV cognitive training did not enhance cognitive or motor functional gains. Future investigations are needed to elucidate the underlying mechanisms of UFOV cognitive training to enhance motor function. Research should continue to investigate the association of cognitive and motor function and interventions to improve these outcomes among older adults. The trial and planned analyses were pre-registered: https://osf.io/7utgw.

Are auditory processing and cognitive performance assessments overlapping or distinct? Parsing the auditory behaviour of older adults.

OBJECTIVE: Auditory processing predicts cognitive decline, including dementia, in older adults. Auditory processing involves the understanding, interpretation, and communication of auditory information. Cognition is linked to auditory processing; however, it is disputed whether auditory processing is a separate construct distinct from cognition. The purpose of this study was to determine if auditory processing is distinct from cognition in older adults. DESIGN: Participants completed 14 cognitive and auditory processing assessments. Assessments were subjected to exploratory factor analysis with principal components extraction and varimax rotation with Kaiser normalisation. Study sample: 213 community-dwelling older adults (M = 71.39 years, 57% female, 93% Caucasian, M = 16 years education) with and without mild cognitive impairment (MCI) participated. RESULTS: Four factors were identified, explaining 66.3% of the total variance: (1) executive functions, visual processing speed, and dichotic auditory processing, (2) auditory processing of degraded speech, (3) memory, and (4) auditory temporal processing of nonspeech. CONCLUSIONS: Two domains of auditory processing (processing degraded speech and temporal processing) account for unique variance to which cognitive measures are not sensitive, while measures of auditory dichotic processing appear to be tapping similar abilities as measures of cognition. Older adults who perform poorly on dichotic measures should be screened for cognitive impairment.

A systematic review and meta-analysis of older driver interventions.

The purpose of this systematic review and meta-analysis was to summarize and quantify the effects of different driving interventions among older adults on outcomes of crashes, on-road driving performance, self-reported outcomes of errors and crashes, and driving simulator performance. Randomized controlled trials examining the effects of a driving intervention among older adults ≥ 50 years of age were included. Thirty-one studies were identified using a systematic literature review, and 26 were included in meta-analyses. The following types of driving interventions were identified: physical retraining/exercise (e.g., flexibility and coordination training); visual-perceptual training (e.g., improving figure-ground discrimination); cognitive training (e.g., Useful Field of View cognitive training); education (e.g., classroom driver refresher course); context-specific training (i.e., on-road training in car, driving simulator training); combined intervention approaches (e.g., education and context-specific training combined). Effect sizes were calculated for each driving intervention type relative to control groups using random-effects. Physical retraining/exercise, visual-perceptual training, and combined intervention approaches demonstrated medium to large effects on on-road driving performance, ds = 0.564-1.061, ps < .050. Cognitive training approaches reduced at-fault crashes by almost 30 %, OR = 0.729, 95 % CI [0.553, 0.962], p = .026. Education and context-specific approaches were not efficacious to improve driving safety outcomes, ps> .050. In summary, skill-specific interventions (physical retraining/exercise, visual-perceptual training, cognitive training) and combined intervention approaches improved on-road driving performance and reduced at-fault crashes. Optimizing interventions that target age-related functional declines and combined intervention approaches is recommended.

Cortical auditory evoked potentials in mild cognitive impairment: Evidence from a temporal-spatial principal component analysis.

Mild cognitive impairment (MCI) is considered an intermediate transitional stage for the development of dementia, especially Alzheimer's disease. The identification of neurophysiological biomarkers for MCI will allow improvement in detecting and tracking the progression of cognitive impairment. The primary objective of this study was to compare cortical auditory evoked potentials between older adults with and without probable MCI to identify potential neurophysiological indicators of cognitive impairment. We applied a temporal-spatial principal component analysis to the evoked potentials achieved during the processing of pure tones and speech sounds, to facilitate the separation of the components of the P1-N1-P2 complex. The probable MCI group showed a significant amplitude increase in a factor modeling N1b for speech sounds (Cohen's d = .84) and a decrease in a factor around the P2 time interval, especially for pure tones (Cohen's d = 1.17). Moreover, both factors showed a fair discrimination value between groups (area under the curve [AUC] = .698 for N1b in speech condition; AUC = .746 for P2 in tone condition), with high sensitivity to detect MCI cases (86% and 91%, respectively). The results for N1b suggest that MCI participants may suffer from a deficit to inhibit irrelevant speech information, and the decrease of P2 amplitude could be a signal of cholinergic hypoactivation. Therefore, both components could be proposed as early biomarkers of cognitive impairment.

Keys to staying sharp: A randomized clinical trial of piano training among older adults with and without mild cognitive impairment.

BACKGROUND: The prevalence of dementia, the most expensive medical condition (Kirschstein, 2000 and Hurd et al., 2013 [1,2]), and its precursor, mild cognitive impairment (MCI) are increasing [3]. Finding effective intervention strategies to prevent or delay dementia is imperative to public health. Prior research provides compelling evidence that central auditory processing (CAP) deficits are a risk factor for dementia [4-6]. Grounded in the information degradation theory [7, 8], we hypothesize that improving brain function at early perceptual levels (i.e., CAP) may be optimal to attenuate cognitive and functional decline and potentially curb dementia prevalence. Piano training is one avenue to enhance cognition [9-13] by facilitating CAP at initial perceptual stages [14-18]. OBJECTIVES: The Keys To Staying Sharp study is a two arm, randomized clinical trial examining the efficacy of piano training relative to music listening instruction to improve CAP, cognition, and everyday function among older adults. In addition, the moderating effects of MCI status on piano training efficacy will be examined and potential mediators of intervention effects will be explored. HYPOTHESES: We hypothesize that piano training will improve CAP and cognitive performance, leading to functional improvements. We expect that enhanced CAP will mediate cognitive gains. We further hypothesize that cognitive gains will mediate functional improvements. METHOD: We plan to enroll 360 adults aged 60 years and older who will be randomized to piano training or an active control condition of music listening instruction and complete pre- and immediate post- assessments of CAP, cognition, and everyday function.

Can Cognitive Speed of Processing Training Improve Everyday Functioning Among Older Adults With Psychometrically Defined Mild Cognitive Impairment?

OBJECTIVE: The aim of these secondary analyses was to examine cognitive speed of processing training (SPT) gains in cognitive and everyday functioning among older adults with psychometrically defined mild cognitive impairment (MCI). METHOD: A subgroup of participants from the Staying Keen in Later Life (SKILL) study with psychometrically defined MCI ( N = 49) were randomized to either the SPT intervention or an active control group of cognitive stimulation. Outcome measures included the Useful Field of View (UFOV), Road Sign Test, and Timed Instrumental Activities of Daily Living (IADL) Test. A 2 × 2 repeated-measures MANOVA revealed an overall effect of training, indicated by a significant group (SPT vs. control) by time (baseline vs. posttest) interaction. RESULTS: Effect sizes were large for improved UFOV, small for the Road Sign test, and medium for Timed IADL. DISCUSSION: Results indicate that further investigation of cognitive intervention strategies to improve everyday functioning in patients with MCI is warranted.

Examination of the Psychometric Properties of the Geriatric Fear of Falling Measure Among Community-Dwelling Older Adults in the United States.

This current study investigated the construct validity and reliability of the Geriatric Fear of Falling Measure (GFFM) among community-dwelling older adults in the United States. Eighty-eight participants were assessed on the GFFM together with demographics, falls, and fear of falling and falls-efficacy measures at baseline and an 8-week follow-up visit. Cronbach's alpha, regression analyses, and correlation analyses were used to examine the psychometric properties of the GFFM. The results showed that the GFFM demonstrated good construct validity and reliability among community-dwelling older adults in the United States. Our findings provide evidence for the validity and reliability of the GFFM. Further study with a larger and diverse sample is needed to determine whether the GFFM has potential as a quick screening tool of fear of falling in clinical settings.

Comparison of Subjective and Objective Measures of Hearing, Auditory Processing, and Cognition Among Older Adults With and Without Mild Cognitive Impairment.

Purpose: The aims of the study were to compare the Cognitive Self-Report Questionnaire (CSRQ; Spina, Ruff, & Mahncke, 2006) Hearing and Cognitive subscale ratings among older adults with and without probable mild cognitive impairment (MCI) and to examine whether self-report, as measured by the CSRQ, is associated with objective measures of hearing, auditory processing, and cognition. Method: Data analyses included 97 older adults of ages 61-91 years. Participants completed the CSRQ self-report measure as well as a battery of objective measures, including pure-tone audiometry, degraded speech understanding, temporal processing, and memory. Results: Older adults with probable MCI rated their cognitive abilities more poorly than those without MCI (p = .002), but ratings of hearing and auditory abilities did not differ between the two groups (p = .912). Age and CSRQ Hearing subscale ratings explained a significant proportion of variance in objective measures of hearing and degraded speech understanding (R2 = .39, p < .001). Age, sex, mental status, and CSRQ Cognition subscale ratings explained a significant proportion of variance in objective memory performance (R2 = .55, p < .001). Conclusions: Taken together, these results suggest that the CSRQ is an appropriate self-report measure of hearing, cognition, and some aspects of auditory processing for older adults with and without probable MCI.

Systematic review and meta-analyses of useful field of view cognitive training.

Systematic review and meta-analyses were conducted of Useful Field of View (UFOV) training, which was evaluated by Institute of Medicine criteria. Forty-four studies of UFOV training from 17 randomized trials conducted among adults were identified in systematic review. Results addressing the Institute of Medicine criteria indicated that: (a) UFOV training enhanced neural outcomes, speed of processing, and attention. (b) UFOV training effects were equivalent when compared to active- or no-contact control conditions. (c) UFOV training showed far transfer to everyday function. (d) Improvements on the trained skills endured across ten years. (e) Half of the clinical trials identified were conducted by researchers without financial interests in UFOV training. Results indicated that UFOV training effects were larger for adaptive- than non-adaptive training techniques, and in community-based as compared to clinical samples. UFOV training did not transfer to other neuropsychological outcomes, but positively enhanced well-being, health, and quality of life longitudinally. Criticisms of cognitive training are addressed. UFOV training should be implemented among older adults to improve real-world functional outcomes and well-being.

Speed of processing training results in lower risk of dementia.

INTRODUCTION: Cognitive training improves cognitive performance and delays functional impairment, but its effects on dementia are not known. We examined whether three different types of cognitive training lowered the risk of dementia across 10 years of follow-up relative to control and if greater number of training sessions attended was associated with lower dementia risk. METHODS: The Advanced Cognitive Training in Vital Elderly (NCT00298558) study was a randomized controlled trial (N = 2802) among initially healthy older adults, which examined the efficacy of three cognitive training programs (memory, reasoning, or speed of processing) relative to a no-contact control condition. Up to 10 training sessions were delivered over 6 weeks with up to four sessions of booster training delivered at 11 months and a second set of up to four booster sessions at 35 months. Outcome assessments were taken immediately after intervention and at intervals over 10 years. Dementia was defined using a combination of interview- and performance-based methods. RESULTS: A total of 260 cases of dementia were identified during the follow-up. Speed training resulted in reduced risk of dementia (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.50-0.998, P = .049) compared to control, but memory and reasoning training did not (HR 0.79, 95% CI 0.57-1.11, P = .177 and HR 0.79, 95% CI 0.56-1.10, P = .163, respectively). Each additional speed training session was associated with a 10% lower hazard for dementia (unadjusted HR, 0.90; 95% CI, 0.85-0.95, P < .001). DISCUSSION: Initially, healthy older adults randomized to speed of processing cognitive training had a 29% reduction in their risk of dementia after 10 years of follow-up compared to the untreated control group.

Cognitive Training Enhances Auditory Attention Efficiency in Older Adults.

Auditory cognitive training (ACT) improves attention in older adults; however, the underlying neurophysiological mechanisms are still unknown. The present study examined the effects of ACT on the P3b event-related potential reflecting attention allocation (amplitude) and speed of processing (latency) during stimulus categorization and the P1-N1-P2 complex reflecting perceptual processing (amplitude and latency). Participants completed an auditory oddball task before and after 10 weeks of ACT (n = 9) or a no contact control period (n = 15). Parietal P3b amplitudes to oddball stimuli decreased at post-test in the trained group as compared to those in the control group, and frontal P3b amplitudes show a similar trend, potentially reflecting more efficient attentional allocation after ACT. No advantages for the ACT group were evident for auditory perceptual processing or speed of processing in this small sample. Our results provide preliminary evidence that ACT may enhance the efficiency of attention allocation, which may account for the positive impact of ACT on the everyday functioning of older adults.

Auditory Processing of Older Adults With Probable Mild Cognitive Impairment.

Purpose: Studies suggest that deficits in auditory processing predict cognitive decline and dementia, but those studies included limited measures of auditory processing. The purpose of this study was to compare older adults with and without probable mild cognitive impairment (MCI) across two domains of auditory processing (auditory performance in competing acoustic signals and temporal aspects of audition). Method: The Montreal Cognitive Assessment (Nasreddine et al., 2005) was used to classify participants as with or without probable MCI. In this cross-sectional study, participants (n = 79) completed 4 measures of auditory processing: Synthetic Sentence Identification with Ipsilateral Competing Message (Gates, Beiser, Rees, D'Agostino, & Wolf, 2002), Dichotic Sentence Identification (Fifer, Jerger, Berlin, Tobey, & Campbell, 1983), Adaptive Tests of Temporal Resolution (ATTR; Lister & Roberts, 2006; across-channel and within-channel subtests), and time-compressed speech (Wilson, 1993; Wilson, Preece, Salamon, Sperry, & Bornstein, 1994). Audiometry was also conducted. Results: Those with probable MCI had significantly poorer performance than those without MCI on Synthetic Sentence Identification with Ipsilateral Competing Message, Dichotic Sentence Identification, and the ATTR within-channel subtest. No group differences were found for time-compressed speech, ATTR across-channel, or audiometric measures. Conclusions: Older adults with cognitive impairment not only have difficulty with competing acoustic signals but may also show poor temporal processing. The profile of auditory processing deficits among older adults with cognitive impairment may include multiple domains.

The Impact of Three Cognitive Training Programs on Driving Cessation Across 10 Years: A Randomized Controlled Trial.

Purpose of the Study: Driving is important for older adults' health and well-being, yet little research has examined interventions to maintain driving mobility. As fluid cognitive abilities are strongly linked to driving, targeted cognitive training interventions may impact driving mobility longitudinally. This study assessed the effects of three different cognitive training programs (reasoning, speed of processing, and memory) on driving cessation in older adults across 10 years (n = 2,390). Design and Methods: Cox regression analyses evaluated the impact of each program relative to a no-contact control group with intent-to-treat (ITT) analyses. The effects of randomization to additional booster sessions were also examined. Subsample analyses repeated these models in participants who were at-risk for driving mobility declines. Results: There were no training (n = 2,390) or booster training (n = 1,540) effects on driving cessation with ITT analyses. Individuals at-risk for future mobility declines were 49% (Hazard Ratio (HR) = 0.51, 95% confidence interval [CI]: 0.28, 0.94; n = 336) less likely to cease driving after speed of processing training and 55% (HR = 0.45, 95% CI: 0.24, 0.86; n = 324) less likely to quit driving subsequent to reasoning training. Additional booster sessions for speed of processing training resulted in a 70% reduction of driving cessation (HR = 0.30, 95% CI: 0.11, 0.82; n = 252) in the subsample analyses. There were no significant effects of memory training. Implications: Some cognitive interventions transfer to maintained driving among those at-risk for mobility declines due to cognitive impairment. Future research should identify moderators and mediators of training and transfer effects.

Examination of Heart Failure as a Predictor of Driving Cessation.

Cognitive dysfunction is a predictor of driving cessation in older adults and a common sequela of heart failure (HF). Although HF has been associated with an increased risk of driving cessation, the independent relationship between HF and driving cessation after cognitive function is considered remains to be established. The objective of these analyses is to examine HF as an independent predictor of driving cessation across three years among a cohort of older drivers in the United States. Analyses included 850 older adults who completed sensory, cognitive, and physical measures at baseline and mobility and health measures at a three-year follow-up. Cox regression was used to examine the effects of HF, stroke, vision, cognition, and physical function as predictors of incident driving cessation over three years. Participants with HF were over three times more likely to cease driving, HR = 3.19, 95% CI [1.27, 8.02], p = .014. However, HF was no longer a significant predictor of driving cessation when cognitive performance was considered, HR = 1.70, 95% CI [0.67, 4.30], p = .262. These findings suggest that the risk of driving cessation may be a consequence of the cognitive dysfunction associated with HF, rather than from HF itself. Cognitive training should be investigated among persons with HF to potentially prolong driving mobility.

Association of Hearing Impairment and Subsequent Driving Mobility in Older Adults.

Purpose of the Study: Hearing impairment (HI) is associated with driving safety (e.g., increased crashes and poor on-road driving performance). However, little is known about HI and driving mobility. This study examined the longitudinal association of audiometric hearing with older adults' driving mobility over 3 years. Design and Methods: Secondary data analyses were conducted of 500 individuals (63-90 years of age) from the Staying Keen in Later Life (SKILL) study. Hearing (pure tone average of 0.5, 1, and 2kHz) was assessed in the better hearing ear and categorized into normal hearing ≤25 dB hearing level (HL); mild HI 26-40 dB HL; or moderate and greater HI ≥41 dB HL. The Useful Field of View Test (UFOV) was used to estimate the risk for adverse driving events. Multivariate analysis of covariance compared driving mobility between HI levels across time, adjusting for age, sex, race, hypertension, and stroke. Adjusting for these same covariates, Cox regression analyses examined incidence of driving cessation by HI across 3 years. Results: Individuals with moderate or greater HI performed poorly on the UFOV, indicating increased risk for adverse driving events (p < .001). No significant differences were found among older adults with varying levels of HI for driving mobility (p values > .05), including driving cessation rates (p = .38), across time. Implications: Although prior research indicates older adults with HI may be at higher risk for crashes, they may not modify driving over time. Further exploration of this issue is required to optimize efforts to improve driving safety and mobility among older adults.

Depressive Symptoms, Cognition, and Everyday Function Among Community-Residing Older Adults.

OBJECTIVE: The aim of this study was to understand the relationships among depressive symptoms, cognition, and functional performance in a community-based sample of older adults. METHOD: Older adults ( N = 885) from the Staying Keen in Later Life study completed tests of executive function, speed of processing, and memory. The Center for Epidemiologic Depression Scale assessed depressive symptoms. The Timed Instrumental Activities of Daily Living Test assessed participants' everyday functional performance. RESULTS: Depressive symptoms had significant associations with measures of executive function, speed of processing, memory, and everyday functional performance. Cognitive performance completely mediated the association between depressive symptoms and everyday function. DISCUSSION: Among community-dwelling older adults, depressive symptoms were associated with impaired cognition across multiple domains, which detrimentally affected everyday function. Health care providers should be aware of these associations to monitor and manage changes in depressive symptoms and cognitive performance and thereby potentially mitigate functional decline.