Cognition in Patients with Dementia: Ambulation vs Affective Disorders

Background: It is known that physical disabilities, and affective disorders affect the progression of dementia, cognitive decline, and therefore influence medication regimen and therapeutic interventions. According to Bennett et al the relationship between depression and dementia is complex and still not well understood [1]. Per Magdalena et al a decline in cognition is associated with a decline in mobility [2]. The aim of this research is to characterize depression / anxiety and mobility as they influence cognitive decline in dementia, in the assisted living environment. Therefore, leading to identifying patient risk and development of potential treatment interventions and appropriate therapies.

Objectives: To analyze the relationships between dementia, depression/anxiety and ambulation to determine their relative roles in cognitive performance and suggest treatment strategies.

Methods: This IRB approved study recruited residents from 3 memory care facilities with established diagnosis of mild, moderate, or severe dementia. Diagnosis was confirmed by patient exam, chart review and Mini2 Mental State Exam (MMSE) score. There were 81, power of attorney, consented participants. This sample size (N=81) included 47 females and 34 males, with an age range from 58 to 98 years. After analyzing 34 clinical data points (i.e. medications, number of falls, smoking history and others) ANOVA and Kruskal-Wallis analysis found a relationship between lack of ambulation, affective disorder and cognitive performance, leading to a comparison between these data to determine which has a greater impact on cognitive performance.

Results: Wheelchair-bound patients with dementia averaged a lower MMSE score (9.78) than ambulatory participants (14.4) with a statistical significance of p=0.03. Wheelchair-bound participants with depression or anxiety averaged the lowest MMSE score (8.77) than ambulatory participants with the same affective disorders (14.9) with a statistical significance of p=0.01.

Conclusion: Dementia patients, who are ambulatory regardless of affective comorbidity score higher on MMSE while those that were wheelchair-bound, appear to have worse cognitive status. Wheelchair-bound patients, who are concomitantly suffering from depression or anxiety, may be specifically at higher risk for detrimental cognitive effects in their dementia progress. Presenting the opportunity for a more tailored therapeutic ambulatory intervention.

Keywords: Dementia, Depression, Anxiety, Affective Disorder, Wheelchair, Ambulatory.