Addressing Psychosocial Factors in Cognitive Impairment Screening from a Holistic Perspective: The DeCo-Booklet Methodology Design and Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Bibliographic Review
2.2. Data Collection Booklet Design
2.2.1. Socio-Demographic Factors
2.2.2. Cognitive Impairment
2.2.3. Meaning in Life
2.2.4. Psychosocial Factors
2.2.5. Health Problems
2.2.6. Lifestyle
2.3. Healthy Aging
2.4. Population
2.5. Statistical Analysis
2.6. Ethical Approval
Variable | Tools or Scale | No. of Items | Study |
---|---|---|---|
Meaning in Life | |||
Whole construct | Meaning in Life Questionnaire (MLQ) | 10 | McGee et al., 2017 [41] Aftab et al., 2019 [42] |
Sense of coherence | Orientation to Life Questionnaire(OLQ) | 13 | Bartrés-Faz et al., 2018 [26] Macià et al., 2021 [43] Sutin et al., 2020 [23] |
Purpose in life | Purpose in life subscale of Ryff’s Well-Being Scale (PiL) | 6 | Bartrés-Faz et al., 2018 [26] Macià et al., 2021 [43] |
7 | Sutin et al., 2018 [44] Lewis et al., 2021 [45] Kim et al., 2019 [22] | ||
6 and 7 | Sutin et al., 2021 [21] | ||
PiL scale from Ryff and Keyes’ Psychological Wellbeing Scale | 10 | Wingo et al., 2020 [46] Boyle et al., 2021 [47] | |
Engagement with life | Engaged Living Scale(ELS) | 16 | Bartrés-Faz et al., 2018 [26] Macià et al., 2021 [43] |
Psychosocial Factors | |||
Resilience | Brief Resilience Coping Scale (BRCS) | 4 | Meléndez et al., 2018 [48] |
Connor–Davidson Resilience Scale (CD-RISC) | 25 | Eyre et al., 2017 [49] | |
Stress | Perceived Stress Scale(PSS) | 4 | Turner et al., 2017 [50] Feeney et al., 2018 [51] |
10 | Elkana et al., 2020 [52] | ||
14 | Katz et al., 2016 [53] Jiang et al., 2017 [54] | ||
Loneliness | UCLA Loneliness Scale | 3 | Lara et al., 2019 [55] Jang et al., 2021 [56] |
11 | Lee et al., 2021 [57] | ||
20 | Kwon et al., 2017 [58] Gené-Badia et al., 2020 [59] | ||
De Jong Gierveld Loneliness Scale | 6 | Burholt et al., 2017 [60] Fung et al., 2019 [61] Evans et al., 2019 [62] | |
Social isolation | Lubben Social Network Scale(LSNS) | 6 | Burholt et al., 2017 [60] Evans et al., 2019 [62] Li et al., 2019 [63] Gené-Badia et al., 2020 [59] Jang et al., 2021 [56] Foong et al., 2021 [64] |
12 | Siette et al., 2020 [65] | ||
Shankar Index | 5 | Lara et al., 2019 [55] |
3. Results
3.1. Selection of the Tools to Assess Meaning in Life and Psychosocial Factors
3.2. Data Collection Booklet and Pilot Study
3.2.1. Sociodemographic Factors
3.2.2. Cognitive Impairment
3.2.3. Meaning in Life
3.2.4. Psychosocial Variables
3.2.5. Health Problems
3.2.6. Lifestyle
3.2.7. Healthy Aging
3.3. Data Analysis
3.3.1. Correlations between Variables
3.3.2. Correlations between Variables and Cognitive Impairment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
---|---|
Validated scales | Non-validated or ad hoc tools |
Scales translated into Spanish or tested in the Spanish population | Non-community dwelling population Population aged under 50 years |
Suitable for a face-to-face interview | Cognitive impairment or Alzheimer’s disease at the baseline |
Administration time and/or length ensures a suitable interview length (maximum of 10 min) | Literature related to COVID-19 disease |
Structure of the Data Collection Booklet | Pilot Study Results | |||
---|---|---|---|---|
Ref. | No. of Items | Variable, Validated Test/Criteria, and Categories | N (%) or Mean ± SD | Time (min) |
1. Sociodemographic Factors | ||||
4 | Sex | 1 | ||
Women | 131 (61.2) | |||
Men | 81 (37.9) | |||
Age | 72.8 ± 11.2 | |||
[50, 65) | 57 (27.1) | |||
[65, 80) | 85 (40.5) | |||
[80, 95] | 68 (32.4) | |||
Marital status | ||||
Married | 139 (65.6) | |||
Widow | 57 (26.6) | |||
Separated/divorced | 6 (2.8) | |||
Single | 10 (4.7) | |||
Family history of dementia | ||||
Yes | 34 (16.0) | |||
No | 179 (84.0) | |||
2. Cognitive Impairment | ||||
1 | Subjective memory complaint | 79 (37.1) | <1 | |
[30] | 8 | Memory Impairment Screen (MIS) [0, 8] | 6.8 ± 2.0 | 2 |
CI risk [0, 4] | 21 (9.9) | |||
No CI risk (4, 8] | 191 (90.1) | |||
[32] | 10 | Short Portable Mental State Questionnaire (SPMSQ) [0–10] | 1.1 ± 1.3 | 3 |
CI risk [3–4, 10] | 28 (13.2) | |||
No CI risk [0, 3–4) | 185 (87.0) | |||
[31] | 1 | Semantic Verbal Fluency (SVF) [0, +∞) | 17.5 ± 7.1 | 1 |
CI risk [0, 10] | 16 (7.5) | |||
No CI risk [10, +∞) | 196 (92.5) | |||
3. Meaning in Life | ||||
[66] | 13 | Sense of coherence | 8 | |
Orientation to Life Questionnaire (OLQ-13) [13, 91] | 69.1 ± 11.9 | |||
[67] | 6 | Purpose in life | 4 | |
PiL subscale of Ryff’s Well-Being Scale (PiL) [6, 36] | 29.6 ± 5.6 | |||
[68] | 16 | Engagement with life | 8 | |
Engaged Living Scale (ELS) [16, 80] | 70.1 ± 10.8 | |||
4. Psychosocial Factors | ||||
[69] | 4 | Resilience | 2 | |
Brief Resilient Coping Scale (BRCS) [4, 20] | 16.7 ± 3.0 | |||
Low [4, 13) | 24 (11.3) | |||
Intermediate [13, 17] | 104 (48.8) | |||
High (17, 20] | 85 (39.9) | |||
[70] | 5 | Depression | 1 | |
Geriatric Depression Scale (GDS-5) [0, 5] | 0.8 ± 1.3 | |||
Risk of depression [2, 5] | 46 (21.6) | |||
No risk of depression [0, 2) | 167 (78.4) | |||
[71] | 4 | Psychological distress | 2 | |
Patient Health Questionnaire-4 (PHQ-4) [0–12] | 2.6 ± 2.6 | |||
None [0, 2] | 126 (59.2) | |||
Mild [3, 5] | 57 (26.8) | |||
Moderate [6, 8] | 22 (10.3) | |||
Severe [9, 12] | 8 (3.8) | |||
[72] | 4 | Stress | 2 | |
Perceived Stress Scale (PSS-4) [0, 16] | 3.8 ± 3.1 | |||
Perceived stress (5.4, 16] | 59 (27.7) | |||
No perceived stress [0, 5.4) | 154 (72.3) | |||
[73] | 3 | Loneliness | 1 | |
UCLA-3 [3, 9] | 3.9 ± 1.5 | |||
Loneliness [6, 9] | 27 (12.7) | |||
No loneliness [3, 6) | 186 (87.3) | |||
[74] | 6 | Social isolation | 5 | |
Lubben Social Network Scale (LSNS-6) [0, 30] | 18.8 ± 5.0 | |||
Social isolation [0, 12] | 24 (11.3) | |||
No social isolation (12, 30] | 189 (88.7) | |||
5. Health Problems | ||||
[75] | 1 | Hypertension | 5 | |
Yes [systolic BP > 140 mmHg–diastolic BP > 90 mmHg] | 126 (60.0) | |||
No [systolic BP ≤ 140 mmHg–diastolic BP ≤ 90 mmHg] | 84 (40.0) | |||
[76] | 1 | Hypercholesterolemia | ||
Yes [CT > 200 mg/dL–CLDL > 100 mg/dL–CHDL ≤ 35–40 mg/dL] | 94 (44.8) | |||
No [CT ≤ 200 mg/dL–CLDL ≤ 100 mg/dL–CHDL > 35–40 mg/dL] | 116 (55.2) | |||
[77] | 1 | Diabetes | ||
Yes [blood glucose > 126 mg/dL–HbA1c > 6.5%] | 50 (23.5) | |||
No [blood glucose ≤ 126 mg/dL–HbA1c < 6.5%] | 163 (76.5) | |||
1 | Smoking habit | <1 | ||
Non-smoker | 117 (54.9) | |||
Former smoker | 53 (24.9) | |||
Passive smoker | 12 (5.6) | |||
Smoker | 31 (14.6) | |||
[39] | 7 | Risk of cardiovascular disease | 1 | |
ERICE Scale [1, 84] | 28.5 ± 17.4 | |||
Low [1, 5) | 1 (0.5) | |||
Mild [5, 9] | 37 (17.4) | |||
Moderate [10, 14] | 18 (8.5) | |||
Moderate–high [15, 19] | 17 (8.0) | |||
High [20, 29] | 42 (19.7) | |||
Very high [30, 84] | 92 (42.2) | |||
[40] | 11 | Dependency | 1 | |
Independent for P-ADL and I-ADL [0, 11] | 0.8 ± 2.0 | |||
Dependent [1, 11] | 48 (22.5) | |||
1 | Hearing loss | <1 | ||
Yes [self-perceived] | 95 (44.6) | |||
No | 118 (55.4) | |||
1 | Chronic pain | <1 | ||
Visual analogue scale (VAS) [0–10] | 3.4 ± 2.8 | |||
No pain [0] | 54 (25.4) | |||
Mild [1, 3] | 57 (26.8) | |||
Moderate [4, 6] | 65 (30.5) | |||
Severe [7, 8] | 23 (10.8) | |||
Excruciating [9, 10] | 9 (4.2) | |||
6. Lifestyle | ||||
[78] | 2 | Anthropometry | <1 | |
WHO stepwise method | ||||
BMI (kg/m2) | 27.2 ± 4.1 | |||
Normal weight [18.5, 25) | 61 (28.6) | |||
Overweight [25, 30) | 96 (46.6) | |||
Obese [30, +∞) | 49 (23.8) | |||
1 | Retired | <1 | ||
Yes | 145 (68.7) | |||
No | 66 (31.3) | |||
[79] | 8 | Cognitive reserve | 2 | |
Cognitive Reserve Questionnaire (CRC) [0, 25] | 10.3 ± 5.1 | |||
Low [0, 6] | 55 (25.9) | |||
Intermediate–low [7, 9] | 46 (21.7) | |||
Intermediate–high [10, 14] | 65 (30.7) | |||
High [15, 25] | 46 (21.7) | |||
Nutrition | ||||
[80] | 14 | Mediterranean Diet Adherence Score (MeDAS) [0, 14] | 9.2 ± 2.1 | 3 |
Low [0, 6] | 20 (9.4) | |||
Intermediate [7, 9] | 99 (46.7) | |||
High [10, 14] | 93 (43.9) | |||
[81] | 6 | Mini Nutritional Assessment (MNA) [0–14] | 12.2 ± 1.9 | 2 |
Risk of malnutrition [0, 12) | 74 (34.7) | |||
Normal nutrition [12, 14] | 139 (65.0) | |||
[82] | 7 | Physical activity | 5 | |
International Physical Activity Questionnaire (IPAQ) | ||||
Low | 50 (23.5) | |||
Moderate | 95 (44.6) | |||
High | 68 (31.9) | |||
Sleep | ||||
[83] | 4 | Jenkins Sleep Scale (JSS) [0, 20] | 7.38 ± 5.0 | 2 |
Sleep disorder [12, 20] | 41 (19.3) | |||
No sleep disorder [0, 12) | 172 (80.8) | |||
[84] | 8 | STOP-Bang Questionnaire [0, 8] | 3.1 ± 1.4 | 2 |
Low [0, 2] | 81 (38.0) | |||
Intermediate [3–4] | 97 (45.5) | |||
High [5, 8] | 35 (16.4) | |||
Total | 159 | No. of variables = 31; No. of tests = 23 | 69 |
Variable | Totals n (%) 213 (100) | Risk CI n (%) 52 (24.4) | No Risk CI n (%) 161 (75.6) | p-Value |
---|---|---|---|---|
1. Sociodemographic Factors | ||||
Age | ||||
( ± s) | 72.8 ± 11.2 | 78.9 ± 7.7 | 71.0 ± 11.5 | <0.001 a *** |
[50, 65) | 57 (27.1) | 1 (2.0) | 56 (35.0) | <0.001 b *** |
[65, 80) | 85 (40.5) | 25 (51.0) | 60 (37.0) | |
[80, 95] | 68 (32.4) | 23 (47.0) | 45 (28.0) | |
Marital status | ||||
Married | 139 (65.6) | 26 (51.0) | 113 (70.2) | 0.013 b * |
Widow | 57 (26.9) | 22 (43.1) | 35 (21.7) | |
Separated/Divorced | 6 (2.8) | 0 (0.0) | 6 (3.7) | |
Single | 10 (4.7) | 3 (5.9) | 7 (4.3) | |
2. Cognitive Impairment | ||||
Subjective memory complaint | ||||
Yes | 79 (37.1) | 25 (48.1) 27 (51.9) | 54 (33.5) 107 (66.5) | 0.070 c |
No | 134 (62.9) | |||
Memory Impairment Screen (MIS) [0, 8] | ||||
( ± s) | 6.8 ± 1.9 | 4.9 ± 2.7 | 7.4 ± 1.1 | <0.001 d *** |
CI risk [0, 4] | 21 (9.9) | 21 (40.4) | 0 (0.0) | <0.001 b *** |
No CI risk (4, 8] | 191 (90.1) | 31 (59.6) | 160 (100.0) | |
Short Portable Mental State Questionnaire (SPMSQ) [0, 10] | ||||
( ± s) | 1.1 ± 1.3 | 2.4 ± 1.6 | 0.7 ± 0.9 | <0.001 d *** |
CI risk [3–4, 10) No CI risk [0, 3–4) | 28 (13.1) | 28 (53.8) | 0 (0.0) | <0.001 b *** |
185 (86.9) | 24 (46.2) | 161 (100.0) | ||
Semantic Verbal Fluency (SVF) [0, +∞) ( ± s) | 17.4 ± 7.1 | 13.5 ± 5.1 | 18.7 ± 7.2 | <0.001 d *** |
CI risk [0, 10] No CI risk [10, +∞) | 16 (7.5) | 16 (30.8) | 0 (0.0) | <0.001 b *** |
196 (92.5) | 36 (69.2) | 160 (100.0) | ||
3. Meaning in Life | ||||
Purpose in life (PiL) [6, 36] ( ± s) | 29.6 ± 5.6 | 28.2 ± 5.9 | 30.0 ± 5.4 | 0.020 d * |
Engagement with life (EwL) [16, 80] ( ± s) | 70.1 ± 10.8 | 72.3 ± 13.1 | 69.5 ± 9.9 | 0.016 d * |
4. Psychosocial Factors | ||||
Brief Resilient Coping Scale (BRCS) [4, 20] ( ± s) | 16.3 ± 3.0 | 15.5 ± 3.1 | 16.5 ± 3.0 | 0.018 d * |
Low [4, 13) Intermediate [13, 17] High (17, 20] | 24 (11.3) | 10 (19.2) | 14 (8.7) | 0.075 c † |
104 (48.8) | 26 (50.0) | 78 (48.4) | ||
85 (39.9) | 16 (30.8) | 69 (42.9) | ||
5. Health Problems | ||||
Hypertension | ||||
Yes [systolic BP > 140 mmHg or diastolic BP > 90 mmHg] No [systolic BP ≤ 140 mmHg and diastolic BP ≤ 90 mmHg] | 126 (60.0) | 38 (76.0) | 88 (55.0) | 0.008 c ** |
84 (40.0) | 12 (24.0) | 72 (45.0) | ||
Hypercholesterolemia | ||||
Yes [Total > 200 mg/dL or LDL >100 mg/dL or HDL ≤ 35–40 mg/dL] No [Total ≤ 200 mg/dL or LDL ≤ 100 mg/dL or HDL > 35–40 mg/dL] | 94 (44.8) | 29 (55.8) | 65 (41.1) | 0.078 c † |
116 (55.2) | 23 (44.2) | 93 (58.9) | ||
Diabetes | ||||
Yes [Blood glucose > 126 mg/dL or HbA1c > 6.5%] No [Blood glucose ≤ 126 mg/dL and HbA1c ≤ 6.5%] | 50 (23.5) | 18 (34.6) | 32 (19.9) | 0.038 c * |
163 (76.5) | 34 (65.4) | 129 (80.1) | ||
ERICE Scale [1, 84] ( ± s) | 28.4 ± 17.4 | 36.9 ± 15.9 | 26.0 ± 17.1 | <0.001 d *** |
Low [1, 5) | 1 (0.5) | 0 (0.0) | 1 (0.6) | 0.002 b ** |
Mild [5, 9] | 37 (17.9) | 3 (6.4) | 34 (21.2) | |
Moderate [10, 14] | 18 (8.7) | 1 (2.1) | 17 (10.6) | |
Moderate–high [15, 19] | 17 (8.2) | 2 (4.3) | 15 (9.4) | |
High [20, 29] | 42 (20.3) | 8 (17.0) | 34 (21.2) | |
Very high [30, 80] | 92 (44.4) | 33 (70.2) | 59 (36.9) | |
Dependent chronic pain [0, 10] ( ± s) | 3.4 ± 2.8 | 4.2 ± 2.7 | 3.2 ± 2.8 | 0.013 d * |
No pain [0] | 54 (26.0) | 5 (10.0) | 49 (31.0) | 0.018 b * |
Mild [1, 3] | 57 (27.4) | 17 (34.0) | 40 (25.3) | |
Moderate [4, 6] | 65 (31.2) | 19 (38.0) | 46 (29.1) | |
Severe [7, 8] | 23 (11.1) | 5 (10.0) | 18 (11.4) | |
Unbearable [9, 10] | 9 (4.3) | 4 (8.0) | 5 (3.2) | |
6. Lifestyle | ||||
BMI ( ± s) | 27.2 ± 4.1 | 28.3 ± 3.8 | 26.8 ± 4.1 | 0.017 a * |
Normal weight [18.5, 25) | 61 (29.6) | 8 (16.3) | 53 (33.9) | 0.046 c * |
Overweight [25, 30) | 96 (46.6) | 26 (51.3) | 70 (44.6) | |
Obese [30, +∞) | 49 (23.8) | 15 (30.6) | 34 (21.7) | |
Retired | ||||
Yes No | 145 (68.7) | 48 (94.1) | 97 (60.6) | <0.001 b *** |
66 (31.3) | 3 (5.9) | 63 (39.4) | ||
Cognitive Reserve Questionnaire (CRC) [0, 25] ( ± s) | 10.3 ± 5.1 | 8.2 ± 5.1 | 11.0 ± 5.0 | <0.001 d *** |
Low [0, 6] | 55 (25.9) | 22 (43.1) | 33 (20.5) | 0.010 b * |
Intermediate–low [7, 9] | 46 (21.7) | 11 (21.6) | 35 (21.7) | |
Intermediate–high [10, 14] | 65 (30.7) | 12 (23.5) | 53 (32.9) | |
High [15, 25] | 46 (21.7) | 6 (11.8) | 40 (24.8) | |
STOP–Bang Questionnaire [0, 8] ( ± s) | 3.1 ± 1.4 | 3.5 ± 1.3 | 3.0 ± 1.5 | 0.005 d ** |
Low [0, 2] | 81 (38.0) | 13 (25.0) | 68 (42.2) | 0.075 b † |
Intermediate [3, 4] | 97 (45.5) | 28 (53.8) | 69 (42.9) | |
High [5, 8] | 35 (16.4) | 11 (21.2) | 24 (14.9) |
Variable | βi | SD | Wald | d.f. | p-Value | Exp(βi) | 95% CI | |
---|---|---|---|---|---|---|---|---|
UL | LL | |||||||
Model A | ||||||||
Intercept | −2.51 | 1.34 | −1.87 | 1 | <0.1 † | 0.08 | 0.00 | 0.86 |
Age (50, 65) (65, 80) (80, 95) | - 3.17 3.23 | - 1.04 1.04 | - 3.05 3.09 | - 1 | - <0.01 ** <0.01 ** | - 23.81 25.20 | - 4.77 4.94 | - 433.32 461.20 |
Purpose in life | −0.05 | 0.03 | −1.66 | 1 | <0.1 † | 0.95 | 0.89 | 1.01 |
Model B | ||||||||
Intercept | −6.10 | 1.60 | −3.80 | 1 | <0.001 *** | 0.00 | 0.00 | 0.04 |
Age (50, 65) (65, 80) (80, 95) | - 3.08 3.35 | - 1.04 1.04 | - 2.97 3.20 | - 1 | - <0.01 ** <0.01 ** | - 21.71 28.52 | - 4.35 5.59 | - 394.88 522.08 |
Engagement with life | 0.03 | 0.02 | 1.69 | 1 | <0.1 † | 1.03 | 1.00 | 1.07 |
Model C | ||||||||
Intercept | −2.24 | 1.32 | −1.69 | 1 | <0.1 † | 0.11 | 0.00 | 1.09 |
Age (50, 65) (65, 80) (80, 95) | - 3.20 3.37 | - 1.04 1.04 | - 3.08 3.22 | - 1 | - <0.01 ** <0.01 ** | - 24.59 28.97 | - 4.91 5.72 | - 447.94 529.72 |
Resilience | −0.11 | 0.07 | −2.01 | 1 | <0.05 * | 0.89 | 0.80 | 1.00 |
Model D | ||||||||
Intercept | −4.57 | 1.05 | −4.33 | 1 | <0.001 *** | 0.01 | 0.00 | 0.95 |
Age (50, 65) (65, 80) (80, 95) | - 3.16 3.27 | - 1.04 1.05 | - 3.03 3.13 | - 1 | - <0.01 ** <0.01 ** | - 23.61 26.33 | - 4.68 5.16 | - 431.38 482.29 |
Dependent chronic pain | 0.15 | 0.07 | 2.22 | 1 | <0.05 * | 1.16 | 1.02 | 1.32 |
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García, C.; Moreno, L.; Alacreu, M.; Muñoz, F.J.; Martínez, L.A. Addressing Psychosocial Factors in Cognitive Impairment Screening from a Holistic Perspective: The DeCo-Booklet Methodology Design and Pilot Study. Int. J. Environ. Res. Public Health 2022, 19, 12911. https://doi.org/10.3390/ijerph191912911
García C, Moreno L, Alacreu M, Muñoz FJ, Martínez LA. Addressing Psychosocial Factors in Cognitive Impairment Screening from a Holistic Perspective: The DeCo-Booklet Methodology Design and Pilot Study. International Journal of Environmental Research and Public Health. 2022; 19(19):12911. https://doi.org/10.3390/ijerph191912911
Chicago/Turabian StyleGarcía, Cristina, Lucrecia Moreno, Mónica Alacreu, Francisco J. Muñoz, and Luis A. Martínez. 2022. "Addressing Psychosocial Factors in Cognitive Impairment Screening from a Holistic Perspective: The DeCo-Booklet Methodology Design and Pilot Study" International Journal of Environmental Research and Public Health 19, no. 19: 12911. https://doi.org/10.3390/ijerph191912911