Acute Affective Reactivity and Quality of Life in Older Adults with Amnestic Mild Cognitive Impairment: A Functional MRI Study

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Article Highlights

Objectives

Poor quality of life (QoL) is a major concern among older adults with amnestic mild cognitive impairment (MCI). Maladaptive affective regulation and its relevant frontal dysfunction that are often observed in older adults with MCI may provide an insight into the understanding of their QoL.

Methods

In this case-controlled study, participants (MCI patients, N = 18; healthy comparisons [HC], N = 21) completed cognitive tasks, and underwent resting-state functional magnetic resonance imaging (rs-fMRI) immediately before and after the tasks. The amplitude of low-frequency fluctuations (ALFF) of rs-fMRI signals was calculated to examine the brain's spontaneous activity. The change in valence from the Self-Assessment Manikin indexed affective reactivity. QoL was assessed using Quality of Life-AD measure. Multiple mediator model was used to examine the mediating effect of frontal regions' ALFF reactivity between the affective reactivity and QoL.

Results

The MCI group had significantly worse QoL and more negative affective reactivity than HC group. Less negative affective reactivity was significantly associated with better QoL in MCI not HC. ALFF in the anterior cingulate cortex, medial prefrontal cortex (MPFC), and superior frontal gyrus (SFG) increased significantly less after cognitive tasks in MCI than HC. For the entire sample, greater increases of ALFF in MPFC and SFG were significantly associated with better QoL, and SFG alone significantly mediated the association between affective reactivity and QoL.

Conclusions

Enhancing SFG activation, especially among those with MCI, may provide a therapeutic target for addressing the negative impact of maladaptive affective regulation on QoL.

Section snippets

Participants

Thirty-nine participants (HC = 21, MCI = 18) completed the study. Participants with amnestic MCI were recruited from the university-affiliated memory clinics using the clinical diagnosis of “mild cognitive impairment due to Alzheimer disease”.22 All MCI group participants had deficits in memory based on a comprehensive neuropsychological battery, intact basic activities of daily living, intact or mild deficits in instrumental activities of daily living, and an absence of dementia using

Sample Characteristics

The two groups were similar in their age, sex, and education. The MCI group had significantly lower scores for the MoCA and RAVLT than the HC group.

Group Comparison for QoL and Valence

The MCI group also had significantly lower scores on QoL measure (see Table 1). There was a significant decline in valence score after the cognitive tasks in the MCI group (F(1, 37) = 10.37, p = 0.005), but not the HC group (F(1, 37) = 2.50, p = 0.13) (see Figure 1A).

Group Comparison for ALFF Reactivity

Applying repeated-measures ANOVA in whole brain voxel-wise ALFF analysis, we

Discussion

The present study investigated the neural correlates of the association between acute affective reactivity to the cognitive tasks and perceived QoL in older adults at high risk for AD. Compared with HC, MCI participants had significantly more negative affective response to cognitive challenges and showed a significant lower perceived QoL. Furthermore, in MCI patients, less negative affective reactivity to the cognitive tasks was associated with better QoL, but this association was not found in

Conclusions

Compared with cognitively healthy older adults, individuals with amnestic MCI tended to have poorer QoL, which was more sensitive to the negative affect arising from cognitive challenges. The PFC's reactivity to cognitive challenges, especially in the SFG, may reveal the neural correlates for the relationship between affective reactivity and QoL.

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    © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.