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Background: Most cognitive screening tests used in primary care to identify adults with cognitive impairment, including Alzheimer's disease and related dementias, have been limited in their diagnostic accuracy, especially in mild cases. Resultant false positives or false negatives (e.g., delayed diagnoses) have respective harms. While expressed concern of an individual's real‐world self‐care abilities from a caregiver can improve confidence in a screening result, as many as half of patients with cognitive complaints may lack this informant. We explored whether the addition of an objective, brief, health literacy assessment could improve the accuracy of a longstanding, common cognitive screening tool. Method: Data came from a longitudinal aging study of older adults from Chicago, IL. Cognitive function was assessed using Z‐scores generated from a comprehensive neurocognitive battery of 13 measured across 5 domains. Participants were determined to have an impairment if they scored ←1 on ≥2 tests within at least one domain. The Mini Mental Status Exam (MMSE) and the Newest Vital Sign (NVS), a common 3‐minute, 6‐item measure of health literacy, were administered. Receiver operating characteristic (ROC) curves assessed the specificity and sensitivity of adjusted MMSE models (cut‐off score ≤26) with and without the NVS to detect cognitive impairment. Areas under the curve (AUCs) were compared using the DeLong test. Result: Participants (N = 389) were on average 71 years old (SD 5.2); most participants were female (72%) and non‐Hispanic White (56%). Most (86%) had 2+ chronic conditions (M 3.4 (SD 1.8)), and 28% had at least a mild cognitive impairment based on our comprehensive neurocognitive battery. ROC analyses indicated that cognitive impairment detection by the MMSE alone (AUC = 0.79, 95% CI [0.73‐0.84]) was significantly improved (Z = ‐3.68, 95% CI [0.03,0.11], p‐value = <0.001) with inclusion of the NVS (AUC = 0.86, 95% CI [0.82‐0.90]). Conclusion: Our findings demonstrate the potential benefit of integrating a brief assessment of real‐world self‐care task performance and health literacy, such as the NVS, with routine cognitive screening tests to improve accurate identification of cognitive impairment in primary care. Improving the accuracy of common screening tools may help facilitate earlier detection, diagnosis, and subsequent care. [ABSTRACT FROM AUTHOR] more...

Background: Chronic depression impacts the ability to successfully manage one's health, yet mechanisms underlying this relationship are not fully understood. Cognitive dysfunction, or impairment, may result from persistent depression. We aimed to determine whether chronic depressive symptoms, leading to poor cognition, impacted self‐management capacity among older adults with chronic conditions. Method: Data from 369 older adults from Chicago, IL and participating in a longitudinal cohort study on aging was used for this analysis. The Patient‐Reported Outcomes Measurement Information System (PROMIS) Depression 8‐item survey was administered across 4 time points over 10 years; raw scores were transformed into T‐scores. Group‐based trajectory modeling was used to identify latent depressive symptom trajectory groups. The Comprehensive Health Activities Scale (CHAS) was used to measure chronic disease self‐management skills, including comprehension and recall of print, spoken, and multimedia information. A factor score representing fluid cognitive function was derived from 11 measures across 4 cognitive domains (processing speed, working memory, inductive reasoning, long‐term memory). Demographic‐adjusted multinomial linear regressions were used to assess associations between depressive symptom trajectory groups and self‐management skills, first without and then including fluid cognitive function. Result: Mean participant age was 71 years (SD 5.3); most participants were female (71%) and non‐Hispanic white (54%). 86% had 2+ chronic medical conditions (mean 3.3 (SD 1.8)). Three distinct depressive symptom trajectories emerged: participants displayed either consistently minimal (42%), normative (46%), or persistently elevated (12%) symptoms. In multivariable analyses, participants in the persistently elevated group had poorer self‐management performance (β = ‐6.4; 95% CI: ‐11.1, ‐1.7; p = 0.007). Adjusting for cognitive function attenuated this association to a level of non‐significance, while a strong association emerged between cognition and self‐management skills (β = 16.1; 95% CI: 14.4, 17.8; p<0.001). Conclusion: Persistent depression may reduce self‐care capacity, likely due to poorer cognitive function. Improved understanding of how depression may alter cognitive function or lead to its progressive decline, and ultimately impact self‐care capacity, may inform future health system interventions to support the management of comorbid conditions. [ABSTRACT FROM AUTHOR] more...