Receiving a Mild Cognitive Impairment diagnosis and adjusting to this condition is challenging, given the uncertain clinical trajectory surrounding progression to dementia. We aimed to explore the influence of illness perceptions and cognitive fusion on coping and emotional responses in a sample of people diagnosed with Mild Cognitive Impairment.
Research design and method: A cross-sectional study of 34 participants with Mild Cognitive Impairment (47% female and 53% male; mean age 76.4 years) evaluated the relationships between cognitive impairment, illness perceptions and cognitive fusion on levels of distress and quality of life. Participants completed standardised measures for cognitive assessment, illness perceptions, cognitive fusion, depression, anxiety and quality of life. Relationships between variables were analysed using correlation, regression and conditional process analyses.
Results
At the group level, illness perceptions were found to be a stronger predictor of depression and quality of life in the current sample than objective cognitive impairment. Illness perceptions did not directly predict anxiety, rather cognitive fusion significantly mediated this relationship. Cognitive fusion also significantly mediated the relationship between illness perceptions and depression. Illness perceptions had a significant, direct effect on quality of life; however, there was no significant indirect effect via cognitive fusion. Greater fusion with threatening illness perceptions was significantly related to increased anxiety and depression.
Discussion and implications: Data suggest multiple potential treatment targets in helping people diagnosed with Mild Cognitive Impairment to successfully adapt and adjust. Targeting appraisals (illness perceptions) using Cognitive Therapy is one potential treatment target. In addition, psychological treatments such as Acceptance and Commitment Therapy, which target cognitive fusion, could also warrant further investigation in this population, due to the significant indirect paths from illness perceptions to distress and quality of life, via cognitive fusion.
BakaA.FiggouL.TrigaV. (2012). Neither agree, nor disagree': A critical analysis of the middle answer category in Voting Advice Applications. International Journal of Electronic Governance, 5(3–4), 244–263.
2.
BanninghL. W. J. W.PrinsJ. B.Vernooij-DassenM. J.WijnenH. H.RikkertM. G. O.KesselsR. P. (2011). Group therapy for patients with mild and their significant others: Results of a waiting-list controlled trial. Gerontology, 57(5), 444–454.
3.
BaronR. M.KennyD. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality & Social Psychology, 51, 1173–1182.
4.
BeardR. L.NearyT. M. (2013). Making sense of nonsense: Experiences of mild. Sociology of Health & Illness, 35(1), 130–146.
5.
BiringerE.MykletunA.DahlA. A.SmithA. D.EngedalK.NygaardH. A.LundA. (2005). The association between depression, anxiety, and cognitive function in the elderly general population—The Hordaland Health Study. International Journal of Geriatric Psychiatry, 20(10), 989–997.
6.
BlampiedN. M. (1999). A legacy neglected: Restating the case for single-case research in cognitive-behaviour therapy. Behaviour Change, 16(2), 89–104.
ByrneG. J.PachanaN. A. (2011). Development and validation of a short form of the Geriatric Anxiety Inventory – The GAI-SF. International Psychogeriatrics, 23(1), 125–131.
9.
CornerL.BondJ. (2006). The impact of the label of mild on the individual’s sense of self. Philosophy, Psychiatry & Psychology, 13(1), 3–12.
10.
DeanK.WilcockG. (2012). Living with mild: The patient’s and carer’s experience. International Psychogeriatrics, 24(6), 871–881.
11.
DennisonL.Moss-MorrisR.ChalderT. (2009). A review of psychological correlates of adjustment in patients with multiple sclerosis. Clinical Psychology Review, 29(2), 141–153.
12.
EvansD.NormanP. (2009). Illness representations, coping and psychological adjustment to Parkinson's disease. Psychology and Health, 24(10), 1181–1196.
13.
EversA. W.KraaimaatF. W.van LankveldW.JongenP. J.JacobsJ. W.BijlsmaJ. W. (2001). Beyond unfavorable thinking: The illness cognition questionnaire for chronic diseases. Journal of Consulting and Clinical Psychology, 69(6), 1026.
14.
FangM. L.CoattaK.BadgerM.WuS.EastonM.NygårdL., … SixsmithA. (2017). Informing understandings of mild for older adults: Implications from a scoping review. Journal of Applied Gerontology, 36(7), 808–839.
15.
FaulF.ErdfelderE.BuchnerA.LangA. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behaviour Research Methods, 41, 1149–1160.
16.
FerenbachC.GillandersD.HarperA. (2011). The process of psychological adjustment to multiple sclerosis: Comparing the roles of appraisals, acceptance and cognitive fusion (Doctoral thesis). University of Edinburgh, UK.
17.
FoxwellR.MorleyC.FrizelleD. (2013). Illness perceptions, mood and quality of life: A systematic review of coronary heart disease patients. Journal of Psychosomatic Research, 75(3), 211–222.
18.
Freitas, S., Simoes, M.R., Alves, L., and Santana, I. (2013). Montreal Cognitive Assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease & Associated Disorders, 27(1), 37--43.
19.
FritzM. S.MacKinnonD. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233–239.
20.
Gauntlett-GilbertJ. (2011). Team working and the social contexts of healthcare. In McCrackenL. (Ed.), Mindfulness & acceptance in behavioral medicine: current theory and practice (pp. 455–487). Oakland, CA: New Harbinger.
21.
GillandersD. T.BolderstonH.BondF. W.DempsterM.FlaxmanP. E.CampbellL.MasleyS. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45(1), 83–101.
22.
GillandersD. T.FerreiraN. B.BoseS.EsrichT. (2013). The relationship between acceptance, catastrophizing and illness representations in chronic pain. European Journal of Pain, 17(6), 893–902. DOI:10.1002/j.1532-2149.2012.00248.x
23.
GillandersD. T.SinclairA. K.MacLeanM.JardineK. (2015). Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogeneous sample of adults, after cancer. Journal of Contextual Behavioral Science, 4(4), 300–311.
24.
GillandersS.GillandersD. (2014). An acceptance and commitment therapy intervention for a woman with secondary progressive multiple sclerosis and a history of childhood trauma. Neurodisability & Psychotherapy, 2, 19–40. Retrieved from http://karnacbooks.metapress.com/index/D830964244715133.pdf
25.
GomersallT.AstellA.NygårdL.SixsmithA.MihailidisA.HwangA. (2015). Living with ambiguity: A metasynthesis of qualitative research on mild. The Gerontologist, 55(5), 892–912.
26.
GrahamC. D.GillandersD.StuartS.GouickJ. (2015). An Acceptance and Commitment Therapy (ACT)-based intervention for an adult experiencing post-stroke anxiety and medically unexplained symptoms. Clinical Case Studies, 14(2), 83–97. DOI:10.1177/1534650114539386
27.
GrahamC. D.GouickJ.KrahéC.GillandersD. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review, 46, 46–58. :10.1016/j.cpr.2016.04.009
28.
GroarkeA.CurtisR.CoughlanR.GselA. (2004). The role of perceived and actual disease status in adjustment to rheumatoid arthritis. Rheumatology, 43(9), 1142–1149.
29.
HayesA. F. (2013). Introduction to mediation, moderation and conditional process analysis: A regression-based approach. New York, NY: The Guilford Press.
30.
HayesS. C.StrosahlK.WilsonK. G. (1999). Acceptance and commitment therapy. New York, NY: Guilford Press.
31.
HayesS. C.StrosahlK. D.WilsonK. G. (2012). Acceptance and commitment therapy (2nd ed.). New York, NY: Guilford Press.
32.
HoylM.AlessiC. A.HarkerJ. O.JosephsonK. R.PietruszkaF. M.KoelfgenM., … RubensteinL. Z. (1999). Development and testing of a five‐item version of the Geriatric Depression Scale. Journal of the American Geriatrics Society, 47(7), 873–878.
33.
HudsonJ. L.BundyC.CoventryP. A.DickensC. (2014). Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care: A systematic review with meta-analysis. Journal of Psychosomatic Research, 76(4), 265–274.
34.
IBM Corp. (2016). IBM SPSS statistics for Windows, version 24.0. Armonk, NY: Author.
35.
JohncoC.KnightA.TadicD.WuthrichV. M. (2015). Psychometric properties of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) in a clinical and non-clinical sample of older adults. International Psychogeriatrics, 27(7), 1089–1097.
36.
KapteinA. A.HelderD. I.ScharlooM.Van KempenG. M.WeinmanJ.Van HouwelingenH. J.RoosR. A. (2006). Illness perceptions and coping explain well-being in patients with Huntington's disease. Psychology and Health, 21(4), 431–446.
37.
KarakayaT.FußerF.SchroderJ.PantelJ. (2013). Pharmacological treatment of mild as a prodromal syndrome of Alzheimer’s disease. Current Neuropharmacology, 11(1), 102–108.
38.
KoepsellT. D.MonsellS. E. (2012). Reversion from mild to normal or near-normal cognition Risk factors and prognosis. Neurology, 79(15), 1591–1598.
39.
LeventhalH.MeyerD.NerenzD. (1980). The common-sense representation of illness danger. In RachmanS. (Ed.), Contributions to medical psychology (Vol. 2, pp. 7–30). New York, NY: Pergamon Press.
40.
LeventhalH.NerenzD. R.SteeleD. J. (1984). Illness representation and coping with health threats. In BaumA.TaylorS. E.SingerJ. E. (Eds.), Handbook of psychology and health (pp. 219–252). Hillsdale, NJ: Lawrence Erlbaum Associates.
41.
LiX. X.LiZ. (2018). The impact of anxiety on the progression of mild to dementia in Chinese and English data bases: A systematic review and meta‐analysis. International Journal of Geriatric Psychiatry, 33(1), 131–140.
42.
LinF.GleasonC. E.HeidrichS. M. (2012). Illness representations in older adults with mild. Research in Gerontological Nursing, 5(3), 195–206.
43.
LinF.HeidrichS. M. (2012). Role of older adult's illness schemata in coping with mild. Journal of Psychosomatic Research, 72(5), 357–363.
44.
LogsdonR. G.GibbonsL. E.McCurryS. M.TeriL. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64(3), 510–519.
45.
MacKinnonD. P.LockwoodC. M.HoffmanJ. M.WestS. G.SheetsV. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83.
46.
McCrackenL. M.VowlesK. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process and progress. American Psychologist, 69(2), 178–187.
47.
MitchellA. J.Shiri-FeshkiM. (2009). Rate of progression of mild to dementia – Meta-analysis of 41 robust inception cohort studies. Acta Psychiatrica Scandinavica, 119, 252–265.
48.
Moss-MorrisR.WeinmanJ.PetrieK.HorneR.CameronL.BuickD. (2002). The revised Illness Perception Questionnaire (IPQ-R). Psychology and Health, 17(1), 1–16.
49.
MouraoR. J.MansurG.Malloy-DinizL. F.Castro CostaE.DinizB. S. (2016). Depressive symptoms increase the risk of progression to dementia in subjects with mild: Systematic review and meta‐analysis. International Journal of Geriatric Psychiatry, 31(8), 905–911.
50.
NadlerJ. T.WestonR.VoylesE. C. (2015). Stuck in the middle: The use and interpretation of mid-points in items on questionnaires. The Journal of General Psychology, 142(2), 71–89.
51.
NasreddineZ. S.PhillipsN. A.BédirianV.CharbonneauS.WhiteheadV.CollinI., … ChertkowH. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild. Journal of the American Geriatrics Society, 53(4), 695–699.
52.
NordinL.RorsmanI. (2012). Cognitive behavioural therapy in multiple sclerosis: A randomized controlled pilot study of acceptance and commitment therapy. Journal of Rehabilitation Medicine, 44(1), 87–90. DOI:10.2340/16501977-0898
53.
ParkerR.Hagan-BurkeS.VannestK. (2007). Percentage of All Non-Overlapping Data (PAND): An alternative to PND. The Journal of Special Education, 40(4), 194–204.
54.
PetersenR. C.CaraccioloB.BrayneC.GauthierS.JelicV.FratiglioniL. (2014). Mild : A concept in evolution. Journal of Internal Medicine, 275(3), 214–228.
55.
RotterJ. B. (1966). Generalised expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied, 80, 1–28. DOI:10.1037/h0092976.
56.
SachdevP. S.LipnickiD. M.CrawfordJ.ReppermundS.KochanN. A.TrollorJ. N.LuxO. (2013). Factors predicting reversion from mild to normal cognitive functioning: A population-based study. PLoS One, 8(3), e59649.
57.
Scott, W., Daly, A., Yu, L., & McCraken L.,M (2017) Treatment of chronic pain for adults 65 and over: Analyses of outcomes and changes in psychological flexibility following interdisciplinary acceptance and commitment therapy (ACT). Pain Medicine, 18(2), 252--264.
58.
SevereijinsR.VlaeyenJ. W.van den HoutM. A.WeberW. E. (2001). Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. The Clinical Journal of Pain, 17(2), 165–172.
59.
SheppardS. C.ForsythJ. P.HicklingE. J.BianchiJ. (2010). A novel application of acceptance and commitment therapy for psychosocial problems associated with multiple sclerosis. International Journal of MS Care, 12(4), 200–206. DOI:10.7224/1537-2073-12.4.200
60.
SobelM. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. In LeinhartS. (Ed.), Sociological methodology (pp. 290–312). San Francisco, CA: Jossey-Bass.
61.
SpainL. A.TubridyN.KilpatrickT. J.AdamsS. J.HolmesA. C. N. (2007). Illness perception and health‐related quality of life in multiple sclerosis. Acta Neurologica Scandinavica, 116(5), 293–299.
62.
SpitzG.SchönbergerM.PonsfordJ. (2013). The relations among cognitive impairment, coping style, and emotional adjustment following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 28(2), 116–125.
63.
StevensonA.GillandersD.FerreiraN.GilroyD. (2014). Psychosocial adjustment to mild: Assessing the involvement of illness perceptions, cognitive impairment and psychological flexibility (Unpublished Doctoral thesis). University of Edinburgh, UK.
64.
StillmanA. N.RoweK. C.ArndtS.MoserD. J. (2012). Anxious symptoms and cognitive function in non‐demented older adults: An inverse relationship. International Journal of Geriatric Psychiatry, 27(8), 792–798.
65.
TatsumiH.YamamotoM.NakaakiS.HadanoK.NarumotoJ. (2011). Utility of the Quality of Life–Alzheimer's Disease Scale for mild. Psychiatry and Clinical Neurosciences, 65(5), 533–533.
66.
ValvanoA.FloydR. M.Penwell-WainesL.SteplemanL.LewisK.HouseA. (2016). The relationship between cognitive fusion, stigma, and well-being in people with multiple sclerosis. Journal of Contextual Behavioral Science, 5(4), 266–270.
67.
World Health Organization. (1992). The ICD-10 classification of mental behaviours and disorders: Clinical descriptions and diagnostic guidelines (10th ed.). Geneva, Switzerland: World Health Organisation.
