Anxiety symptoms and theory of mind in older and younger adults: curvilinearity moderated by age group.

OBJECTIVES: Theory of mind (ToM), the ability to reason about mental states, declines in later life. While anxiety symptoms may predict ToM abilities, the nature of associations requires more elucidation. Further, it is unknown whether age group moderates associational patterns. We examined associations between anxiety symptoms (linear and curvilinear) and cognitive ToM (C-ToM) and affective ToM (A-ToM); and moderation by age group (older vs. younger adults). METHODS: In a sample of healthy younger (n = 90, Mage = 20.17 years) and older adults (n = 87, Mage = 71.52), we used hierarchical regressions with polynomial and interaction terms to assess the association between anxiety symptoms and ToM in younger and older adults. RESULTS: Anxiety symptoms were associated with C-ToM but not A-ToM. Age group interacted linearly with anxiety (ß = -1.64, p = .02), and with anxiety's quadratic polynomial (ß = .84, p = .04). The inverted-U shaped association in younger adults (highest C-ToM at moderate anxiety) contrasted with older adults' linear decline in C-ToM with increasing anxiety. CONCLUSION: We highlight the importance of anxiety symptoms for predicting ToM, and clarify that associations vary by age. Elucidating associations may be critical to developing interventions that improve social wellbeing.

Component Processes of Decision Making in a Community Sample of Precariously Housed Persons: Associations With Learning and Memory, and Health-Risk Behaviors.

The Iowa Gambling Task (IGT) is a widely used measure of decision making, but its value in signifying behaviors associated with adverse, "real-world" consequences has not been consistently demonstrated in persons who are precariously housed or homeless. Studies evaluating the ecological validity of the IGT have primarily relied on traditional IGT scores. However, computational modeling derives underlying component processes of the IGT, which capture specific facets of decision making that may be more closely related to engagement in behaviors associated with negative consequences. This study employed the Prospect Valence Learning (PVL) model to decompose IGT performance into component processes in 294 precariously housed community residents with substance use disorders. Results revealed a predominant focus on gains and a lack of sensitivity to losses in these vulnerable community residents. Hypothesized associations were not detected between component processes and self-reported health-risk behaviors. These findings provide insight into the processes underlying decision making in a vulnerable substance-using population and highlight the challenge of linking specific decision making processes to "real-world" behaviors.

Negative affect and self-agency's association with immunosuppressant adherence in organ transplant: A meta-analysis.

Objective: In organ transplant, prevalence estimates of negative affect (e.g., depressive symptoms) are higher than in the general population and self-agency is required for successful regimen self-management. Nonetheless, the roles of these psychological factors for immunosuppressant adherence in this population remain unclear. Method: Meta-analytic techniques were used to determine the associations between negative affect and self-agency with adherence and to identify moderators of these associational effect sizes (ES). Results: Across 50 studies and 46,106 adult organ recipients, there is a small negative association between negative affect and adherence (mean weighted ES: r = -.14, p < .001; 95% confidence interval, CI [-.175, -.096]) and a small positive association between self-agency and adherence (ES: r = .17, p < .001; 95% CI [.094, .251]). Studies conducted outside of Europe and North America, assessing illness-specific negative affect and utilizing questionnaire adherence measures, and studies of better quality were associated with a larger ES, explaining 54% of the heterogeneity in the negative affect and adherence association. For the association between self-agency and adherence, a higher percentage of females and medication-specific self-agency were associated with a larger ES, explaining 34% of the heterogeneity. Conclusions: By elucidating overlooked trends in the existing literature for the associations between negative affect and self-agency with adherence, the current meta-analyses clarify previously contradicting findings in organ transplant. The findings also shed light on factors contributing to the existing variability and highlight the importance of careful consideration of methodology in studies of adherence postorgan transplant. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of Once- Versus Twice-Daily Tacrolimus Dosing on Medication Adherence in Stable Renal Transplant Recipients: A Canadian Single-Center Randomized Controlled Trial.

BACKGROUND: Prevalence of immunosuppressant nonadherence in renal transplant recipients is high despite negative clinical outcomes associated with nonadherence. Simplification of dosing has been demonstrated to improve adherence in renal transplant recipients as measured through electronic monitoring and self-report. OBJECTIVE: The purpose of this study was to replicate and extend previous findings by measuring adherence with multiple methods in a Canadian sample. DESIGN: The study design was a randomized controlled medication dosing trial in adult renal transplant patients. The trial length was 4 months. SETTING: This study was conducted within the Solid Organ Transplant (SOT) Clinic at Vancouver General Hospital (VGH; Vancouver, Canada). PATIENTS: A total of 46 adult renal recipients (at least 1 year post-transplant) were recruited through the SOT clinic. With 8 withdrawals, 38 individuals completed all phases of the study. MEASUREMENTS: Medication adherence was measured for a period of 4 months using multiple methods, including electronic monitoring (MEMS [Medication Event Monitoring System]), pharmacy refill data (medication possession ratio [MPR]), and by self-report using the Adherence subscale of the Transplant Effects Questionnaire (TEQ). METHODS: Participants were randomized to twice-daily (n = 19) or once-daily tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic study visits. Comparisons between the treatment groups were performed using the Mann-Whitney U and chi-square tests, for continuous and categorical variables, respectively. RESULTS: As outlined in Table 3, the once-daily dosing group showed significantly better MEMS Dose Adherence (P = .001), whereas MEMS Timing Adherence showed a tendency toward better adherence for this group, but was not significant (P = .052). MEMS Days Adherent (P = .418), MPR% (P = .123), and self-reported adherence (P = .284) did not differ between the once- and twice-daily dosing groups when measured as continuous variables. The MPR% was significantly better for the once-daily dosing group when measured dichotomously but not continuously (P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred this to the twice-daily regimen. LIMITATIONS: Limitations included small sample size and short follow-up period, precluding the examination of clinical outcome differences. CONCLUSIONS: Results for dose adherence replicate the finding that dose simplification increases adherence to immunosuppressants as measured through electronic monitoring. Such an advantage for the once-daily dosing group was not seen across the 2 other electronic monitoring measurement variables (days and timing adherence). This study extends previous research by examining adherence in once versus twice-daily dosing via prescription refill data in a Canadian sample. Given the gravity of potential health outcomes associated with nonadherence, although results indicate inconsistencies in significance testing across measurement methods, the medium to large effect sizes seen in the data favoring better adherence with once-daily dosing provide an indication of the potential clinical significance of these findings. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (NCT01334333) on April 11, 2011.

CONTEXTE: Bien que la non-observance du traitement immunosuppresseur soit associée à de mauvais résultats cliniques, sa prévalence demeure élevée chez les receveurs d'une greffe rénale. Il a été démontré qu'une posologie simplifiée améliorait l'observance thérapeutique mesurée par suivi électronique et auto-évaluation dans cette population. OBJECTIF: Cette étude visait à reproduire et à élargir les résultats d'études précédentes en mesurant par différentes méthodes l'observance thérapeutique dans un échantillon de patients canadiens. TYPE D'ÉTUDE: Un essai contrôlé à répartition aléatoire d'une durée de quatre mois examinant la posologie médicamenteuse d'adultes greffés rénaux. CADRE: L'étude s'est tenue au sein de la Solid Organ Transplant Clinic (clinique SOT) du Vancouver General Hospital (VGH; Vancouver, Canada). SUJETS: Quarante-six greffés rénaux adultes ont été recrutés (au moins un an post-transplantation) par l'entremise de la clinique SOT. En raison de huit retraits, l'étude porte sur trente-huit individus ayant complété toutes les phases de l'étude. MESURES: L'observance thérapeutique a été mesurée sur une période de quatre mois, selon différentes méthodes, notamment le suivi électronique (MEMS), le renouvellement des ordonnances (rapport de possession de médicaments­RPM) et l'auto-évaluation avec la sous-échelle d'observance du Transplant Effects Questionnaire (TEQ). MÉTHODOLOGIE: Les participants ont été répartis aléatoirement pour recevoir du tacrolimus deux fois par jour (n = 19) ou une fois par jour (n = 19) et ont été suivis pendant quatre mois au moyen de visites mensuelles à la clinique. Les comparaisons entre les groupes de traitement ont été effectuées par tests U de Mann-Whitney (variables continues) et tests de chi-deux (variables nominales). RÉSULTATS: Comme indiqué dans le tableau 3, lorsque l'observance est mesurée par MEMS, le groupe ayant reçu une dose quotidienne unique a montré une observance nettement supérieure au niveau de la dose (P = 0.001), de même qu'une tendance vers une meilleure observance du traitement au niveau du moment, quoique cette dernière ne soit pas significative (P = 0.052). Le nombre de jours d'observance mesuré par MEMS (P = 0.418), le pourcentage RPM (P = 0.123) et l'observance auto-déclarée (P = 0.284) n'ont pas différé entre les groupes lorsque mesurés comme variables continues. Le pourcentage RPM était significativement plus élevé pour le groupe traité une fois par jour, lorsque mesuré de façon dichotomique, mais non continue (P = 0.044). La majorité des patients traités par une dose unique quotidienne (63.2%) ont préféré ce schéma posologique à une prise deux fois par jour. LIMITES: La petite taille de l'échantillon et la courte période de suivi empêchent l'examen des différences observées dans les résultats cliniques. CONCLUSION: Les résultats sur l'observance de la dose reproduisent la conclusion selon laquelle un dosage simplifié augmenterait l'observance du traitement immunosuppresseur, lorsque mesurée par MEMS. Un tel avantage pour le groupe recevant une dose quotidienne unique n'a pas été observé pour les deux autres variables de mesure par MEMS (observance en jours et du moment de la prise du médicament). La présente étude élargit les recherches antérieures en examinant l'observance de la posologie (une ou deux fois par jour) avec les données de renouvellement des ordonnances dans un échantillon canadien. Compte tenu de la gravité des effets potentiels de la non-observance thérapeutique sur la santé, et bien que les résultats indiquent des incohérences entre les méthodes de mesure dans la vérification des hypothèses, l'ampleur moyenne à grande de l'effet observé dans les données favorisant une meilleure observance à une dose unique quotidienne souligne l'importance clinique potentielle de ces résultats.

Diffusion tensor imaging of neurocognitive profiles in a community cohort living in marginal housing.

OBJECTIVE: We investigated white matter differences associated with distinct neurocognitive profiles derived from a large cohort of marginally housed persons with comorbid physical and mental illnesses. Our prior work identified three profile cluster groups: a high functioning group (Cluster 1), a low functioning group with relative strength in decision-making (Cluster 3), and an intermediary group with a relative decision-making weakness (Cluster 2). This study extends previous findings of cortical gray matter differences between these groups with evidence for putative neurodevelopmental abnormalities in the low cognitive functioning group (i.e., Cluster 3). We hypothesized that altered white matter diffusion would be associated with the lowest functioning neurocognitive profile and would be associated with previously observed gray matter differences. METHOD: Participants from a socially impoverished neighborhood in Vancouver, Canada underwent neurocognitive evaluation and neuroimaging. We performed Tract-Based Spatial Statistics using diffusion tensor imaging data from 184 participants to examine whole-brain differences in white matter microstructure between cluster analytically derived neurocognitive profiles, as well as unitary neurocognitive measures. Correlations between frontal gray and white matter were also examined. RESULTS: Cluster 3 showed increased diffusion in predominately bilateral frontal and interhemisphere tracts (vs. Clusters 1 and 2), with relatively greater diffusion in the left hemisphere (vs. Cluster 1). Differences in radial diffusivity were more prominent compared with axial diffusivity. A weak association between regional frontal fractional anisotropy and previously defined abnormalities in gyrification was observed. CONCLUSIONS: In a socially marginalized sample, we established several patterns in the covariation of white matter diffusion and neurocognitive functioning. These patterns elucidate the neurobiological substrates and vulnerabilities that are apt to underlie functional impairments inherent to this complex and heterogeneous population.

The role of illness burden in theory of mind performance among older adults.

Background/Study Context: Theory of Mind (ToM) reflects the ability to reason about mental states in order to understand and predict behavior. Research has identified links between increased pulse pressure, a measure of vascular health, and reduced cognitive ToM in older adults. However, the relationships between other vascular and nonvascular conditions and reduced ToM are unknown. We examined (1) illnesses as predictors of cognitive and affective ToM and (2) neurocognitive mediators of illness burden and ToM. METHODS: We used hierarchical regression and mediation to investigate the effects of vascular illness burden (hypertension, Type 2 diabetes, high cholesterol, and high pulse pressure) and nonvascular illness burden (osteoporosis, osteoarthritis, rheumatoid arthritis, and thyroid dysfunction) on cognitive and affective ToM in N = 86 community-dwelling older adults (59 females; 27 males, M age = 71.74 years). RESULTS: Vascular illness burden emerged as a significant predictor of older adults' cognitive ToM (R2 = .43, p < .001), and this relationship was mediated by executive functioning. Nonvascular illness burden did not predict cognitive nor affective ToM in this sample. CONCLUSION: Our findings highlight the specific importance of considering vascular health as a risk factor for declines in ToM in later life. Further elucidation of the associations between health, neurocognition, and ToM will be valuable in developing effective interventions for older adults given the high prevalence of vascular illness in later life.

Medication adherence in renal transplant recipients: A latent variable model of psychosocial and neurocognitive predictors.

OBJECTIVE: Estimates indicate that 20-70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. METHODS: Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. RESULTS: Everyday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. CONCLUSIONS: We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients.

"Do it-yourself": Home blood pressure as a predictor of traditional and everyday cognition in older adults.

BACKGROUND: Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored. METHODS: We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed "everyday cognition" measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks. RESULTS: Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures. CONCLUSION: Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.

Age Differences in Cognitive and Affective Theory of Mind: Concurrent Contributions of Neurocognitive Performance, Sex, and Pulse Pressure.

OBJECTIVES: Theory of mind (ToM) allows us to detect and make inferences about cognitive and affective mental states. Mixed findings exist regarding (a) age differences in cognitive and affective ToM and (b) what mechanisms may underlie changes in the two components. We addressed these questions by examining the unique and joint contributions of neurocognitive performance, pulse pressure (PP), and biological sex to age differences in cognitive and affective ToM. METHOD: We tested 86 young and 85 older adults on standardized measures of neurocognitive performance and ToM. Predictors were derived from demographics (sex), in-office PP, and measures of executive functions, semantic memory, and episodic memory. We used path analysis to identify concurrent predictors of cognitive and affective ToM between groups and invariance analyses to assess age differences in the relative strength of identified predictors. RESULTS: We demonstrated robust age differences in cognitive and affective ToM. Certain neurocognitive predictors of ToM were more salient among older individuals; most predictors were shared across age groups and equivalent in magnitude. DISCUSSION: To our knowledge, this study represents the most comprehensive investigation to date of predictors of ToM in aging. Findings highlight the need for continued investigation of ToM within a multidimensional framework.