Patients having co-occurring borderline personality disorder and alcohol use disorders represent a common, but particularly severe and refractory subgroup. An individual, time-limited treatment, dynamic deconstructive psychotherapy (DDP), has been shown to be effective for this subgroup, but long-term outcomes are not known. Participants were recruited from a sample of 30 patients enrolled in a 12-month randomized controlled trial of DDP versus optimized community care (OCC). Outcomes were assessed after an additional 18 months of naturalistic follow-up. DDP participants received an equivalent amount of individual treatment and less group therapy than those receiving OCC, but demonstrated large, sustained treatment effects over a broad range of outcomes and achieved significantly greater improvement in core BPD symptoms, depression, parasuicide, and recreational drug use over the 30-month study. These results suggest that DDP is a cost-effective treatment that can lead to broad and sustained improvement for the dually diagnosed subgroup.
Studies using ecological momentary assessment (EMA) of activity participation rely on items tapping domains informed by factor analyses based on single time points. Analyses from a single time point focus on differences between participants and provide little insight into how activities cluster together within a person across moments or days. The present study compared the factor structure in activity participation between- and within-persons using an expanded set of momentary activity items in middle and older adulthood. Using tablets, 81 adults aged 41 to 94 years reported activities completed in the past 3-4 hours five times per day for 14 days. The most common activities during the day involved social interactions, reading, and computer work. Watching TV or videos was the most common evening activity. Multilevel factor analysis simultaneously computed both intra-individual factors (within-person) and inter-individual factors (between-person). Four within-person and 4 between-person factors provided the best model fit, with three common factors: cognitive (read, computer); social (events, mentoring, providing care); and passive (TV, games) factors. There were notable differences in the fourth factor. Although three common activity factors were found between individuals and within persons from day to day, the divergence between the fourth intra- and inter-individual factors provides insight into how activity engagement operates at different timescales and likely reflect daily demands versus long-term goals. EMA provides a window into engagement throughout and across days, but researchers who commonly use retrospective reports of between-person activity engagement may find distinctly different results from factor analyses.
Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns.
Cognitive behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is associated with improvements in patients' and partners' mental health and relationship satisfaction. Some pretreatment relationship characteristics have predicted CBCT for PTSD outcomes for patients, but findings were limited to a single community sample consisting primarily of female patients with male partners. A better understanding of whether pretreatment relationship characteristics predict outcomes in other patient populations and whether there are partners who may be particularly responsive to couple therapy for PTSD could optimize treatment matching. This study investigated whether pretreatment partner accommodation and relationship satisfaction predicted patient and partner treatment outcomes from an uncontrolled trial of an abbreviated, intensive, multicouple group version of CBCT for PTSD conducted with 24 active-duty military or veteran couples (96% male patients/female partners). In general, changes in patients' PTSD and comorbid symptoms and relationship satisfaction did not vary by pretreatment partner accommodation or patients' own pretreatment relationship satisfaction. In contrast, pretreatment relationship characteristics predicted partner outcomes. Partners who engaged in higher levels of accommodation pretreatment and partners who reported lower levels of pretreatment relationship satisfaction experienced greater declines in psychological distress following treatment. Also, partners who began the study relationally distressed exhibited significant increases in relationship satisfaction following treatment, whereas those who were not relationally distressed did not. Findings suggest that improvements generally do not vary by pretreatment relationship characteristics for patients, whereas partners who begin treatment with elevated relationship risk factors may be especially likely to experience improvement across outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Background Perceived stress decreases memory performance and escalates the risk of developing cognitive impairment. Despite these concerning cognitive outcomes, longitudinal assessment of the relationship between perceived stress and memory complaints within a racially diverse sample remains scant.Method 391 cognitively intact older adults (M = 77.31, SD = 4.75) from the Einstein Aging Study were measured annually for up to nine years. Memory complaint items included self-reported frequency of forgetfulness, one-year memory decline, and 10-year memory decline. Multilevel models examined between-person and within-person associations between perceived stress and memory complaints while controlling for demographic differences and neuroticism.Results Strong between-person associations emerged such that older adults with generally higher perceived stress were more likely to report memory complaints, and vice versa. No significant concurrent within-person associations emerged. One lagged association emerged showing that within-person increases in perceived stress translated to a higher likelihood of reporting 10-year memory decline at the next annual screening.Conclusion Older adults with higher perceived stress are at risk for memory complaints over time. Further research into the relationship between perceived stress and memory complaints is necessary to augment our understanding of how risk factors of cognitive decline present throughout the aging process.
Abstract Background SCC may play an important role in identification of pre‐clinical dementia, especially among individuals who experienced disparities. A small number of studies examined the differential prediction of objective cognitive decline between blacks and whites using SCC, yielding mixed results. It is important to identify any differential patterns of SCC endorsement among racially diverse groups to enhance the ability to capture current and future cognitive status. Method Using data from the EAS, a longitudinal community residing cohort aged 70+, an SCC composite was derived using 22 self‐reported items. Cognitive status was diagnosed by consensus conference (dementia, MCI, cognitively normal). Objective cognition was measured using 3 factor scores (memory, executive function, global/verbal) derived from a principal component analysis of our neuropsychological battery. Multiple linear regression models were used to evaluate racial differences in SCC at baseline for those who were cognitively normal, as well as to determine whether there was a differential association between SCC and objective cognition among racial groups. Cox models were applied to determine if there was racial heterogeneity for the effect of SCC on incident MCI, adjusting for demographics, estimated premorbid intelligence, medical co‐morbidities, and depressive symptoms. Result 1720 participants of non‐Hispanic white or black race were cognitively normal at baseline and included in these analyses. There was no significant difference between blacks and whites on the SCC composite; however, there was a significant interaction between race and SCC on 2 of 3 objective cognition factors. Having more SCC at baseline was associated with worse objective cognitive performance in the memory and global/verbal domains in white and black participants, but the association was significantly weaker among blacks. While SCC was associated with greater risk of incident MCI (<0.0001), there was no significant interaction between race and SCC on incident MCI. Conclusion Despite having weaker, though still significant, associations with memory and global/verbal tasks in blacks compared to whites, SCC consistently predicted incident MCI across the two races. Future work should expand upon these results through replication in other diverse samples, inclusion of informant report data, and investigation of differential change in SCC over time and in relation to clinical conversion.
Cognitive, visual, and physical performance are associated with driving safety among older adults. However, there are few comprehensive models that empirically evaluate how such factors jointly impact driving safety. The present study evaluated Anstey’s original Multifactorial Model of Driving Safety (2005) as well as a modified updated version of this model that incorporates recent research. We used structural equation modeling (SEM) to analyze the impact of cognition, vision and physical function on older adult’s driving safety using the baseline data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Participants (n = 2391) were between 65 and 91 years old, and 73.3% of were female. While the original model did not achieve adequate fit (CFI = 0.850, TLI = 0.777, RMSEA = 0.074), the modified model did (CFI = 0.958, TLI = 0.932, RMSEA = 0.041). There was a negative relationship between physical function and driving avoidance (β = 0.28, p < 0.001), and there was a positive relationship between cognition and physical function (β = 0.60, p < 0.001). Visual acuity was not associated with driving safety. Additionally, in our final modified model, driving avoidance partially mediated the relationship between physical function and crash, which indicated that only the effect of physical function on crash operated through driving avoidance. This study highlights the importance of cognition and physical function in older adults’ safe driving. Future research should examine possible dynamic changes between these predictors and driving in a longitudinal model.
Interview assessments of intimate partner violence (IPV) may provide more accurate behavior frequency estimates than self-report questionnaires. However, concerns have been raised about whether participants underreport IPV during interviews due to an emotional response to the interviewer.
Abstract Understanding individual factors (e.g., personality) associated with self-reported memory problems is important to refine identification of individuals at a higher risk of developing Alzheimer’s disease (AD). Using multilevel modeling, we examined the association of family history of AD and personality traits with self-reported memory problems in older adults (n = 421; 72.21% White; 62.95% female; Mage = 76.69). Results showed that individuals with a family history of AD reported more frequent memory problems and greater one-year memory decline. Similar findings were reported for individuals with higher extraversion scores. Further, older adults with higher neuroticism scores reported greater one- and ten-year memory decline. Neuroticism was positively related to frequency of memory problems, but only among participants with a family history of AD. Findings suggest that higher neuroticism and lower extraversion may increase older adults’ reports of memory problems. Family history of AD may further exacerbate this tendency.
