Specific Autobiographical Recall Mediates Impact of Cognition and Depression on Independence Function and Well-Being in Older Adults

Holland, Carol A.; Boukouvalas, Alexis; Clarkesmith, Danielle; Cooke, Richard · 2021 · Crossref

DOI: 10.3389/fpsyg.2021.652600

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Summary

This longitudinal study investigates whether autobiographical memory specificity (AMS) mediates the relationship between cognitive function, depression, and functional independence in older adults. Motivated by evidence that active supported living environments improve well-being and that AMS is linked to both cognitive health and depression, the researchers aimed to determine if AMS serves as a functional intermediary that explains how underlying cognition and mood affect daily independence and perceived health. The study specifically examined whether moving to such an environment enhances AMS and whether this improvement subsequently reduces functional limitations. The study involved 162 older adults moving into "extra care" supported living schemes and 39 controls who remained in their original homes. Assessments were conducted at baseline, 3, 12, and 18 months. Measures included the Addenbrooke’s Cognitive Examination (ACE-R) for general cognition, verbal fluency for executive function, the Hospital Anxiety and Depression Scale (HADS) for depression, and the Autobiographical Memory Test (AMT) for AMS. Functional outcomes were assessed using Instrumental Activities of Daily Living (IADL) scores, the Functional Limitations Profile (FLP), and self-rated perceived health. A subset of participants also kept activity diaries. Latent growth curve models and bootstrapped mediation analyses were used to test hypotheses regarding longitudinal changes and mediating effects. Results confirmed that AMS improved significantly over time for residents but declined for controls, supporting the positive impact of the active environment. AMS mediated the impact of executive function on perceived health throughout the study and mediated the impact of general cognition on social functional limitations at 12 and 18 months. Furthermore, AMS consistently mediated the relationship between depression and outcomes including IADL, perceived health, and total functional limitations across all time points. A multiple mediation model revealed that higher AMS reduced the negative mediating effect of depression on functional limitations, indicating that better memory specificity buffers the impact of depressive symptoms on independence. Additionally, the mediating effects of AMS on various outcomes diminished over time, suggesting its role is particularly critical during periods of social transition. The findings demonstrate that AMS is a dynamic cognitive function that links basic cognition and mood to functional independence and well-being in older adults. The improvement in AMS associated with moving to a socially active environment suggests that such settings support cognitive health. The study highlights the potential for autobiographical memory interventions to mitigate the functional impacts of depression and cognitive decline, particularly during life transitions. These results validate the importance of socially accessible environments in maintaining independence and quality of life in aging populations.

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• cognitive impairment