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Cognition, coping, and outcome in Parkinson's disease

Published online by Cambridge University Press:  22 May 2012

Catherine S. Hurt ,
Sabine Landau ,
David J. Burn ,
John V. Hindle ,
Mike Samuel ,
Ken Wilson  and
Richard G. Brown
Catherine S. Hurt*
Affiliation:
School of Health Sciences, City University London, London, UK
Sabine Landau
Affiliation:
Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
David J. Burn
Affiliation:
Clinical Ageing Research Unit, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
John V. Hindle
Affiliation:
Department of Care of the Elderly, Betsi Cadwaladr University Health Board, Llandudno Hospital, Llandudno; and School of Medical Sciences, University of Bangor, Bangor, UK
Mike Samuel
Affiliation:
Department of Neurology, King's College Hospital NHS Foundation Trust, King's Health Partners, London; and Department of Neurology, East Kent Hospitals NHS Trust, Ashford, KentUK
Ken Wilson
Affiliation:
Emi Academic Unit, St Catherine's Hospital, University of Liverpool, Wirral, UK
Richard G. Brown
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
*
Correspondence should be addressed to: Dr. Catherine S. Hurt, Health Services Research, Room 224, College Building, City University London, Northampton Square, London EC1V 0HB, UK. Phone: +44-20-7040-0883; Fax: +44-20-7040-0875. Email: Catherine.hurt.1@city.ac.uk.
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Abstract

Background: Cognitive impairment and depression are common and disabling non-motor symptoms of Parkinson's disease (PD). Previous studies have shown associations between them but the nature of the relationship remains unclear. In chronic illness, problem- or task-oriented coping strategies are associated with better outcome but often require higher level cognitive functioning. The present study investigated, in a sample of patients with PD, the relationships between cognitive function, choice of coping strategies, and a broad index of outcome including depression, anxiety, and health-related quality of life (QoL). It was hypothesized that the coping strategy used could mediate the association between cognition and outcome.

Methods: 347 participants completed the Coping Inventory for Stressful Situations, the Hospital Anxiety and Depression Scale, the Parkinson's Disease Questionnaire-8, the Unified Parkinson's Disease Rating Scale, and the Addenbrooke's Cognitive Examination–Revised. Structural Equation Modeling was used to test the hypothesized model of cognition, coping, and outcome based on a direct association between cognition and outcome and an indirect association mediated by coping.

Results: Overall, poorer cognition predicted less use of task-oriented coping, which predicted worse outcome (a latent variable comprised of higher depression and anxiety and lower QoL). The analyses suggested a small indirect effect of cognition on outcome mediated by coping.

Conclusions: The findings suggest that patients who fail to employ task-oriented coping strategies may be at greater risk of depression, anxiety, and poor health-related QoL. Even mild to moderate cognitive impairment may contribute to reduced use of task-oriented coping. Suitably adapted cognitive–behavioral approaches may be useful to enable the use of adaptive coping strategies in such patients.

Keywords

copingcognitive impairmentParkinson's diseasedepressionanxiety
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 10 , October 2012 , pp. 1656 - 1663
Copyright
Copyright © International Psychogeriatric Association 2012

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