Date of Award

5-2027

Document Type

Doctoral Research Project

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Brian Fisak

Second Advisor

Vida L. Tyc

Third Advisor

Kimberly N. Sloman

Fourth Advisor

Anthony LoGalbo

Abstract

Introduction: Research has consistently shown that depressive symptoms are associated with cognitive impairments, namely in memory, attention, and executive functioning (for a review, see Rock et al., 2014), particularly in individuals with mild cognitive impairment (MCI). As MCI is often a precursor to dementia, understanding and addressing modifiable factors that influence this trajectory is essential for prevention and intervention efforts. Resilience, defined as the capacity to adapt positively to adversity, has been identified as a potential protective factor against age-related cognitive decline. Prior studies (e.g., Laird et al., 2019b; Miller et al., 2023) suggest that resilience buffers against the cognitive impairments associated with depression by promoting stress regulation, enhancing coping strategies, and contributing to cognitive reserve. However, these investigations have predominantly focused on cognitively unimpaired older adults (i.e., those without a formal diagnosis of MCI or dementia) and subjective self-reports of cognitive decline. Therefore, a critical gap exists in understanding how resilience functions in clinically vulnerable populations, such as those individuals already diagnosed with MCI. Given the potential for resilience to mitigate the adverse effects of depression on cognition, more targeted research is necessary to explore the role of resilience in this high-risk group. This study aimed to address an urgent need to bridge existing research gaps through focusing on objective cognitive performance rather than subjective self-reports of cognitive functioning, and by examining resilience in a clinically meaningful population (i.e., older adults at risk of further cognitive decline).

Method: Participants underwent a comprehensive neuropsychological evaluation at the Health First Memory Disorder Clinic (HFMDC), an outpatient clinic specializing in diagnosing and treating neurocognitive conditions among older adults. These patients completed a standardized battery of cognitive and psychological tests, including the 14-item Resilience Scale (RS-14), Geriatric Depression Scale (GDS), Supraspan Serial List Learning Task (SVLT), Digit Span (DS) subtest of the Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV), and Trail Making Test Part B (TMT-B), administered by trained doctoral-level clinical psychology students, under the supervision of a board-certified clinical neuropsychologist. Patients who 1) completed the RS-14, GDS, SVLT, DS subtest of the WAIS-IV, and TMT-B as part of their comprehensive neuropsychological evaluation, 2) received a diagnostic impression of cognition within normal limits (CN), mild cognitive impairment (MCI), or Alzheimer’s disease (AD), and 3) were fluent in English were included in the current study. Diagnostic impressions were made by a multidisciplinary team that included a geriatrician or geriatric nurse practitioner, a neuropsychologist, pharmacists, and doctoral-level clinical psychology students. The multidisciplinary team reviewed patients’ history (medical and social), collateral report (if available), neuroimaging (if available), laboratory workup (if available), and neuropsychological test data to formulate diagnostic impressions. After removing individuals who did not meet the inclusion criteria, a total of 138 participants were included in the current study. Participants (N = 138; 57.2% female) ranged in age from 63 to 93 years (Mage = 78.46, SD = 6.25). Among them, 29 individuals were classified as CN, 55 as MCI, and 54 as AD. Among the MCI group (Mage = 78.22, SD = 5.71; 60.0% female), 35 had amnestic MCI (aMCI; 19 single domain, 16 multiple domains) and 20 had non-amnestic MCI (naMCI; 16 single domain, 4 multiple domains).

Results: Simple and multiple regression analyses examined whether depression (GDS) and resilience (RS-14) predicted cognitive performance across delayed verbal memory (SVLT), attention (DS), and executive functioning (TMT-B) domains in individuals with MCI. Among individuals with MCI, neither GDS nor RS-14 scores significantly predicted cognitive outcomes. When all diagnostic groups were included in the analyses, along with relevant covariates, models for delayed verbal memory and attention explained significant variance, driven primarily by gender and education, respectively. Executive functioning models revealed education as a consistent predictor across analyses, while GDS and RS-14 scores were nonsignificant predictors. Moderation analyses indicated that RS-14 scores did not moderate the relationship between depression and cognition. Finally, multinomial logistic regression showed that RS-14 scores did not predict diagnostic group membership; only gender distinguished AD from CN participants such that females were more likely to be classified as AD compared to males.

Conclusion: Results from the current study revealed that depression and resilience were not significant predictors of objective cognitive performance within MCI, nor did resilience moderate the relationship between depression and cognition. However, depression did predict delayed verbal memory performance when considering the broader diagnostic spectrum (i.e., CN, MCI, and AD). Moreover, certain sociodemographic factors (i.e., age, gender, and education) consistently emerged as significant predictors in the full sample. These findings highlight the complex interplay of psychological and sociodemographic variables in cognitive aging and underscore the importance of considering sociodemographic characteristics when studying cognitive outcomes in older adults. While resilience may not exert direct effects on cognition, it may nonetheless play an important role in emotional adaptation and quality of life in geriatric populations, warranting continued investigation in relation to clinical outcomes beyond neuropsychological test performance.

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