Iranian Journal of Psychiatry 2018. 13(3):207-214.

Psychosocial Predictors of Cognitive Impairment in the Elderly: A Cross-Sectional Study
Mahbobeh Faramarzi, Maryam Zarin Kamar, Farzan Kheirkhah, Ahmad Karkhaneh, Ali Bijani, Seyed Reza Hosseini


Objective: Cognitive impairment is a major public health problem among elderly population. The aim of this study was to assess some psychosocial predictors of cognitive impairment (age, education, living alone, smoking, depression and social support) in the Iranian elderly population.

Method: A total of 1612 elderly (over 60 years) were enrolled in this cross-sectional study. Cognitive function was assessed using Mini Mental State Examination (MMSE). In addition, data from psychological tests and demographic characteristics were analyzed.

Results: Older age, low education level, living alone, smoking, depressive symptoms, and lower social support were associated with an increased risk of cognitive impairment. Ages 70 to 74 (OR = 3.47; 95% CI, 2.13-5.65), 75 to79 (OR = 3.05; 95% CI, 2.11-4.41) and 80 to 85 (OR = 5.81; 95% CI, 2.99-11.22) and depression symptoms (OR = 1.64; 95% CI, 1.27-2.13) were significant positive predictors, whereas social support with scores ranging from 26 to 30 (OR =0. 32; 95% CI, 0.16-0.62) and 31 to 33 (OR =0.29; 95% CI, 0.14-0.61) and more than 5 years of education (OR = 0.19; 95% CI, 0.14-0.27) were the negative predictors of cognitive impairment.

Conclusion: The findings suggest older age and depression as positive predictive factors and higher education level and social support as negative predictive factors of cognitive impairment in the elderly population.


Cognitive Impairment, Depressive Symptoms, Older People, Predictors, Social Support

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Benjamin J. Sadock, Virginia A. Sadock, Pedro Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th eds. London: Lippincott Williams & Wilkins; 2015.

G. Levy G, Tang M-X, Louis ED, Côté LJ, Alfaro B, Mejia H, SternY, Marder K. The association of incident dementia with mortality in PD. Neurology 2002; 59: 1708-1713.

Dementia: a public health priority. World Health Organization and Alzheimer’s disease International 2012.

Keage HA, Ince PG, Matthews FE, Wharton SB, McKeith IG, Brayne C. Impact of less common and disregarded neurodegenerative pathologies on dementia burden in a population-based cohort. J Alzheimers Dis 2012; 28: 485–493.

Beerens HC , Zwakhalen S M.G, Verbeek H, Ruwaard D, Hamers J P.H. Factors associate d with quality of life of people with dementia in long-term care facilities: A systematic review. Int J NursStud 2013; 50 (9): 1259–1270.

Wei C-J, Cheng Y, Zhang Y, Sun F, Zhang W-S, Zhang MY. Risk factors for dementia in highly educated elderly people in Tianjin,China. Clin Neurol Neurosurg 2014; 122: 4–8.

Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002; 288: 1475–1483.

Kheirkhah F, Poorkarim K, Hosseini S R, Bijani A, Parsian H, Hamidia A et al. The Association Between Zinc and Cognitive Impairment in Elderly People of Iran. Shiraz E-Med J 201718: e13093.

Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2008; 23: 170–177.

Schweitzer I, Tuckwell V, O’Brien J, Ames D. Is late onset depression a prodrometo dementia? Int JGeriatr Psychiatry 2012; 17, 997–1005.

Gao Y, HuangC, Zhao K, Ma L, Qiu X, Zhang L, et al. Depression as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Int JGeriatr Psychiatry 2013; 28: 441–449.

Da Silva J, Gonc¸ alves-Pereira M, Xavier M, Mukaetova-Ladinska EB. Affective disorders and risk of developing dementia: systematic review. Br J Psychiatry 2013; 202: 177-186.

Li G, Wang LY, Shofer JB, Thompson ML, Peskind ER, McCormick W, et al. Temporal relationship between depression and dementia: findings from a large community-based 15-year follow-up study. Arch Gen Psychiatry 2011; 68: 970-977.

Brommelhoff JA, Gatz M, Johansson B, McArdle JJ, Fratiglioni L, Pedersen NL. Depression as a risk factor or prodromal feature for dementia? Findings in a population-based sample of Swedish twins. Psychol Aging 2009; 24: 373–384.

Benmarhnia T, Zunzunegui MV. The role of social support on macroeconomic determinants on elderly people health: a hypothesis about a counterexample in Spain. J Epidemiol Community Health 2014; 68: 391-92.

Helgeson VS. Social support and quality of life. Qual Life Res 2003; 12: 25-31.

Jennifer Yeh S-C J, Liu Y-Y. Influence of social support on cognitive function in the elderly. BMC Health Services Research 2003, 3:1-9.

Hosseini SR, Cumming RG, Kheirkhah F, Nooreddini H, Baiani MA, Mikaniki E, et al. Cohort profile: The Amirkola Health and Aging Project (AHAP). Int J Epidemiol 2014; 43: 1393-1400.

Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–98.

Pezzotti P, Scalmana S, Mastromattei A, Di Lallo D. The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: A prospective observational study. BMC Family Practice 2008; 9: 1-11.

Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922-935.

Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M: Mini Mental State Examination: a normative study in Italian elderly population. Eur J Neurol 1996; 3: 198-202.

Goodger B, Byles J, Higganbotham N. Assessment of short scale to measure social support among older people. Aust N Z J Public Health 1999; 23: 260-265.

Bayrami M, AndalibKourayem M, Pouresmali A, Mohammadibakhsh L. The comparison of social support and religiosity in post-traumatic stress disorder patients, their wives and control group. Journal of Kermanshah University of Medical Sciences 2013; 17: 68-75.

Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. ClinGerontol 1986; 37: 819-820.

Gori C, Appollonio I, Riva G P, Spiga D, Ferrari A , Trabucchi M, et al. Using a single question to screen for depression in the nursing home. Arch GerontolGeriatrSuppl 1998; 6: 235–240.

Cheng S, Chan A CM. A brief version of the Geriatric Depression Scale for the Chinese. Psychol Assess 2004; 16: 182–186.

Malakouti SK, Fatollahi P, Mirabzadeh A, Salavati M, Zandi T. Reliability, Validity and factor structure of the GDS-15 in Iranian elderly. Int J Geriatr psychiatr 2006; 21: 588-593.

Hamid TA, Krishnaswamy S, Abdullah SS, Momtaz YA. Socio-demographic risk factors and correlates of dementia in older Malaysians. Dement GeriatrCognDisord 2010; 30: 533-539.

Faramarzi M, Cheraghi M, Zamani M, et al. Gender specific predictors of depressive symptoms among community elderly. J Res Health Sci 2017; 17: E1-6

Barry LC, Kasl SV, Lichtman J, Harlan M, Krumholz HM. Social support and change in health-related quality of life 6 months after coronary artery bypass grafting. J Psychosom Res 2006; 60: 185-193.

Melchiorre MG, Chiatti C, Lamura G, Torres-Gonzales F, Stankunas M, Lindert J, et al. Health and Abuse among Older People in Seven European Countries. PLOS One 2013; 8: 1-10.

Alipour F, Sajadi H, Forozan A, Nabavi H, Khedmati E. [The role of social support in the anxiety and depression of elderly (Persian)]. Iranian Journal of Aging 2009; 4: 53-61.

Zhu K, van Hilten JJ, Marinus J. Predictors of dementia in Parkinson 's disease; findings from a 5-year prospective stud y using the SCOPA-COG. Parkinsonism and Related Disorders2014; 20: 980-985.

Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA, Au R. Depressive symptoms and risk of dementia: the Framingham Heart Study. Neurology 2010; 75: 35–41.

Meeks TW, Vahia IV, Lavretsky H, Kulkarni G, Jeste DV. A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129:126–142.

Brommelhoff JA, Gatz M, Johansson B, McArdle JJ, Fratiglioni L, Pedersen NL. Depression as a risk factor or prodromal feature for dementia? Findings in a population-based sample of Swedish twins. Psychol Aging 2009; 24: 373–84.

Landes AM, Sperry SD, Strauss ME. Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer’s disease. J Neuropsych Clin Neurosci 2005; 17: 342–349.

Barnes DE, Alexopoulos GS, Lopez OL, Williamson JD, Yaffe K. Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry 2006; 63: 273–279.

Kohler S, Thomas AJ, Lloyd A, Barber R, Almeida OP, O’Brian JT. White matter hyperintensities, cortisol levels, brain atrophy and continuing cognitive deficits in late-life depression. Br J Psychiatry 2010; 196:143–9.

Heun R, Hein S. Risk factors of major depression in the elderly. Euro Psychiatry 2005; 20(3):199–204.

Yip AG, Brayne C, Matthews FE. Risk factors for incident dementia in England and Wales: the medical research council cognitive function and ageing study. A population-based nested case-control study. Age Ageing 2006; 35: 154–160.

Prokop CK, Bradley LA, Burish TG, Anderson KO, Fox JE. The diathesis-stress model. In Health psychology: Clinical methods and research. New York: MacMillan Publishing Company; 1991.

Hogan BE, Linden W, Najarian B. Social support interventions. Do they work? Clin Psychol Rev 2002; 22: 381-440.

Richardson LG. Psychosocial issues in patients with congestive heart failure. Prog Cardiovasc Nurs 2003; 18: 19-27.

Faramarzi M, HosseiniSH, Cumming RJ, Kheirkhah F, Parsaie F, Bijani A. A negative association between social support and depression in the elderly population of Amircola City. British Journal of Medicine & Medical Research. In press.


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