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Unique and Interactive Effects of Depression, Age, Socioeconomic Advantage, and Gender on Cognitive Performance of Normal Healthy Older People
Rabbitt, Patrick1,4; Donlan, Christopher1; Watson, Peter2; McInnes, Lynn3; Bent, Nuala1 Volume 10(3), September 1995, p 307313 [Articles] 1995 by the American Psychological Association
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ISSN: 0882-7974 Registro: 00002004-199509000-00001 Texto completo (PDF) 1137 K

Autor(es): Nmero: Tipo de publicacin: Editor:

Age and Cognitive Performance Research Centre, University of Manchester, Manchester, England
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Medical Research Council Applied Psychology Unit, Cambridge, England

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Department of Psychology, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, Instituciones: England.

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Correspondence concerning this article should be addressed to Patrick Rabbitt, University of Manchester Age and Cognitive Performance Research Centre, Manchester M13 9PL, England. Received Date: September 3, 1993; Revised Date: July 11, 1994; Accepted Date: October 14, 1994

Abstract
A sample of 4,243 residents of Manchester, England and Newcastle-upon-Tyne, England, aged 50 to 93 years, completed the Beck Depression Scale (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) and a battery of 6 different cognitive tests. Beck scores were low, indicating gradations of dysphoria rather than clinical depression. Beck scores did not vary with age but were significantly higher for women than for men and for disadvantaged than for advantaged socioeconomic groups. Measures of fluid, but not of crystallized, ability declined as age increased. Socioeconomic disadvantage was associated with poorer performance on all cognitive tests. Men scored higher on a test of spatial reasoning, and women scored higher on a test of word definition and on 2 tests of verbal memory and learning. However, after variance associated with all these demographic and individual-difference variables was considered, and within a range indicative of dysphoria rather than clinical depression, higher Beck scores were associated with significantly poorer performance on both crystallized and fluid measures of cognitive ability. This association was less marked in women than in men, but age, socioeconomic advantage, and estimated lifetime intellectual ability did not act as protective or risk factors for vulnerability of cognitive processes to dysphoria.

The current literature makes it difficult to assess whether moderate levels of depression contribute to cognitive

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changes in old age. Large epidemiological studies have identified incidence of depression in terms of diagnostic thresholds for clinical referral (e.g., Blazer & Williams, 1980; Copeland et al., 1987; Griffiths et al., 1987). Applied clinical studies have either not assessed cognitive performance or have only used tests designed to detect marked cognitive loss (e.g., the Mini-Mental State Examination, Folstein, Folstein, & McHugh, 1975; the Portable Mental Status Questionnaire, Pfeiffer, 1975; the Mental Test Score, Hodkinson, 1972; or Inventories of Activities of Daily Living, Wiener, Hanley, & Clark, 1990). It is not yet clear whether moderate levels of depression contribute to slight cognitive changes in old age. Levels of depression have typically been assessed by questionnaires that differentiate more accurately between levels of subclinical dysphoria (i.e., unhappiness), common in the population at large, than between the relative intensities of rare, clinically significant depressions (Bech et al., 1975; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Blazer and Williams (1980) emphasized that clinical depression represents only the extreme of a continuum of unhappiness in older samples: Much of what is called depression in the elderly may actually represent decreased life satisfaction and periodic episodes of grief secondary to the physical, social and economic circumstances encountered by ageing individuals in the community (p. 443). Because laboratory studies have shown that even light and transient negative moods may reduce cognitive performance (Ellis, Thomas, & Rodriguez, 1984; Hertel & Hardin, 1990), we must consider whether even decreased life satisfaction may reduce cognitive efficiency. This is an important issue for interpretation of data on cognitive changes in normal old age because the extent of variation in cognitive ability among individuals increases in older populations (Rabbitt, 1993), and we need to discover how much this is due to intrinsic biological aging of the central nervous system (CNS) and how much is due to increased risk factors for unhappiness. Negative correlations between expressed depression and scores on cognitive tests cannot indicate functional causality because the risk factors for unhappiness may also, quite independently, affect cognitive competence. Ben-Arie, Swartz, and Dickman (1987) found that socioeconomic disadvantage is not only a risk factor for depression, but also for illnesses that are known to affect maintenance of cognitive competence in old age (Holland & Rabbitt, 1991). Blazer, Burchett, Service, and George (1991) elegantly showed that when large populations are screened, measures of ability and of depression will not be independent, because both may reflect the impact of increasing age on both general health and cognitive status. Perlmutter and Nyquist (1990) illustrated further complexities in the relationships among depression, cognitive ability, and aging. They found that for volunteers aged 60 to 90, but not for younger adults, poorer mental health ratings, especially reports of depressive symptoms, were also associated with significantly lower scores on measures of crystallized ability. This hints that increased age, of itself, may increase vulnerability to the cognitive impacts of depression. This admirable small study also shows that analyses of the effects of depression on cognitive performance must take into account the possibility that age and depression may have characteristically different impacts on different cognitive skills. These complexities set stringent methodological criteria for further studies: It is necessary to assess the effects of mild as well as of clinically significant levels of depression. Because the effects of depression may be subtle, and different from those of old age, it is necessary to use many different sensitive tests to detect slight as well as gross impairments and to assess a wide range of mental abilities. In particular, performance on tests of crystallized abilities, such as vocabulary skills (which are known to be relatively unaffected by normal aging) may be vulnerable to depression (Perlmutter & Nyquist, 1990). Age-robust vocabulary tests must be included to allow researchers to determine whether age increases or reduces the vulnerability of cognitive processes to depression. It is essential to screen very large and diverse populations to detect the effects of demographic and socioeconomic variables that may modify or determine relationships between mental ability, age, and depression. We must consider the possibility that factors such as age, gender, socioeconomic status, and general intellectual competence not only affect the level of depression experienced but also act as protective or risk factors that alter its impact on cognitive performance. These criteria guided a survey of relationships among age, gender, socioeconomic status, self-reports on the Beck Depression Inventory (Beck et al., 1961) and cognitive performance in 4,243 independently living residents of Greater Manchester, England and Newcastle-upon-Tyne, England, aged 50 to 93 years.

Method

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Participants
Data were gathered during a longitudinal study of cognitive performance in normal healthy older participants funded by the United Kingdom (UK) Medical Research Council and Economic and Social Research Council at the Universities of Newcastle-upon-Tyne and Manchester. Volunteers ages 50 to 93 years responded to media advertisements or personal contacts. We screened 2,050 individuals in Newcastle-upon-Tyne between 1982 and 1985 and 2,193 individuals in Manchester between 1985 and 1988. Socioeconomic group (SEG) categorizations followed the UK Registrar General's Occupational Categories (Office of Population Census and Surveys, 1980). General descriptions of groups are as follows: (a) professional occupations, (b) intermediate occupations, (c) nonmanual skilled occupations, (d) manual skilled occupations, (e) partly skilled occupations, and (f) unskilled occupations. Married women were classified in terms of salaried occupations or, if they had never worked for salary, in terms of their husband's occupations. Individuals were classified in terms of their most skilled occupation. Table 1 shows distributions of gender, age and SEG. The sample included more women (71%) than men (29%). Almost half of the participants (48%) were in their 60's. Volunteers were predominantly white-collar and skilled industrial workers, but other groups were quite substantially represented.

Table 1 Distribution of Socioeconomic Group, Gender, and Agea A specific estimate of years of education was obtained for a randomly selected 10% subset of this sample (n = 360) from a questionnaire that all participants completed with this study. Years of full-time secondary education were evaluated by asking participants to state the type of institution associated with further full-time education and any qualifications gained. Years in further education were added to years in full-time secondary education to obtain total time in full-time education. The modal value was 9 years (i.e., the UK minimum statutory school attendance from ages 5 to 14 during the relevant historical period), with a range from 8 to 25 years. Fifty-six percent had 10 or more years of education, and many of these had received further education. As expected, years of education correlated very strongly (r = .890) with SEG. Thus, for practical purposes, SEG can be taken as an equivalent index to years of education in all analyses described below. The correlation between years of full-time education and current age was not significant ( r = -.078, p > .1). Volunteers also rated their health status at time of testing on a scale from 1 (very bad) to 5 (very good) and also separately rated how their health had changed over the over the previous 5 years. Distributions of responses given by a 43% subset of the entire sample are given in Table 2.

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Table 2 Frequencies of (%) Self-Ratings of Current and Pretest Health Status Seventy percent of the subset reported that they were currently in good or in very good health, and 75% reported stable or improved health during the preceding 5-year period. Volunteers' current and retrospective health ratings showed significant but small negative correlations with their ages (r = -.049, p < .05 and r = -.051, p < .05, respectively).

Measures of Cognitive Performance and of Depression

The cognitive test battery included the AH4 IQ test (Heim, 1970) and the Mill Hill Vocabulary Test, Parts A and B (Raven, 1965). The AH4 is a test of general reasoning ability given in two parts, with each part consisting of 65 questions. The first, AH4 (1), tests verbal reasoning and logical and arithmetical ability. The second, AH4 (2), tests spatial reasoning ability. The number of questions correctly answered on each part within 10 min provided indexes of fluid ability that correlated in this sample highly (rs = .760 to .920) with scores on other, well-standardized and widely used tests of fluid intelligence such as the Raven's Progressive matrices and the Wechsler Adult Intelligence Scale (Wechsler, 1955). Volunteers also completed the Mill Hill Vocabulary Test, Part A (MHA), which requires multiple choice synonym selection, and Part B (MHB), which requires word definition. Both were untimed. The analyzed data are unadjusted raw scores obtained as recommended in the test manuals, that is, total numbers of items correctly answered without count of errors. Volunteers also completed two memory tasks. The first was cumulative learning (CL) in which the same list of 15 nouns was balanced for frequency (Thorndike Lorge A and AA), imageability (words over 6.0 for imageability in the sample described by Paivio, Yuille, & Madigan, 1986), and length (two, three, and four syllables), and was presented visually at a rate of one item every 2 s in a different random order on four successive occasions. After each presentation volunteers immediately wrote down as many items as they could recall in any order. The analyzed scores are total words correctly reported over all four presentations. A second memory task was immediate free recall (FR) of a list of 30 nouns, selected as described above and presented once at a rate of one item every 2 s. The analyzed scores are the total numbers of words correctly recalled in any order. As is usual in FR experiments, false positives and intrusions were too rare to be informative. It would, of course, have been possible to derive and analyze a variety of other indexes from these tasks, such as first trial recall (memory span) and rate of subsequent learning in the CL task or primacy and recency effects from the FR task. However, the total number correct was used because this proved sensitive to the individual-difference variables studied here and provided indexes exactly comparable to those used in previous studies. Depression was assessed with the Beck Depression Inventory. Many comparative studies, such as that by Bech et al. (1975), have shown that the Beck has high validity, both in relation to clinical assessments and to other well-validated instruments and has the further advantage of efficiency in assessing subclinical levels of depression and dysphoria (cf. Beck et al., 1961). An important practical point is that the test is easily administered to large groups. Test batteries were administered to groups of 10 to 25 volunteers during two separate 1.5-hr sessions held in

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university lecture rooms in Newcastle-upon-Tyne, England and Manchester, England. Volunteers were paid a flat rate of 3 per test session to cover their travel expenses. The average interval between sessions was never longer than 3 months. Test characteristics. Means, standard deviations, and testretest reliabilities were evaluated for all measures. Reliability was high for the AH4 and Mill Hill tests and at acceptable levels for other measures. These results are shown along the diagonal in Table 3, which gives correlations between all cognitive and demographic measures.

Table 3 Correlations, Reliabilities, Means, and Standard Deviations for Measures Intercorrelations between measures. Intertest score correlations were positive and highly significant (p < .001). The MHA, MHB, and AH4, Parts 1 and 2, correlated highly with each other (r > .490) and moderately well with the memory tests (.340 < r < .500). AH4 (1) and AH4 (2) scores correlated negatively and significantly with age (r = -.330 and r = -.420, respectively), as did memory test scores (CL: r = -.300; FR: r = -.280), but MH scores did not (MHA: r = .004; MHB: r = .030). Beck scores showed small but significant negative correlations with all cognitive measures (r > -.080). Gender correlated modestly in various directions with all cognitive measures (-.070 < r < .130), and SEG showed significant strong negative correlations (r > -.250) with all cognitive measures. Beck scores and demographics. The KolmogorovSmirnov test, (Kolmogorov, 1933) showed that the distribution of Beck scores was negatively skewed (z = 3.95, p < .001). Most volunteers had very low Beck scores, with very few cases beyond the thresholds for clinical depression. The mean of 7.6 (SD = 6.1) contrasts to values of 18, 25, and 30 that Beck et al. (1961) estimated as thresholds for mild, moderate, and severe clinical depression, respectively. Associations between Beck scores and demographic variables were broadly consistent with findings from earlier studies. Chronic illness, functional disability, and severe cognitive impairment were minimized in this sample of healthy, independently living, and highly motivated volunteers. Thus, the absence of any increase in Beck scores with age is consistent with Blazer et al.'s (1991) finding that the association of age with increased incidence of depression is mediated by factors such as chronic illness, functional disability, and severe cognitive impairment. However, a new finding is that Beck scores were significantly associated with gender and with SEG. Note that these relationships

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cannot be explained by mediating associations of gender and SEG with medical problems because no such relationships appeared in the subset of the sample whose self-ratings of health were examined (see McInnes & Rabbitt, 1994). Beck scores and cognitive performance. Because MHA scores were independent of age in this sample, they could be used both as a dependent variable (so that the unique effect of Beck scores on MHA scores could be evaluated) and, where appropriate, as a factor in the statistical model used to evaluate the unique effect of Beck scores on other cognitive measures. Only complete cases were analyzed. In the following regression analyses, Beck scores were divided into three groups with ranges of 06, 713, and 14+ representing low, middle, and high scoring groups, respectively. Because of low numbers in SEGs 1 and 5, SEG 1 was pooled with 2, and 5 was pooled with 4.

Results
The analysis was performed using GLIM (Baker, 1985). The analysis consisted of a series of hierarchical regressions that were conducted on the two AH4 scores, the two MH scores, and the CL and FR tasks. First, variation in test score that was due to age, gender, SEG, and, where appropriate, MHA, was removed. Beck scores were then entered to identify their unique relationship with test score. Any significant interaction terms were then added using the forward stepwise method and beginning with second order terms. Results are presented in Table 4.

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Table 4 Hierarchical Regressions of Cognitive Scores When interactions involved a group variable, regression coefficients given in the tables represent the cognitive effect of an explanatory variable involved in the interaction within each group. The R2 given in Table 4 is given by

Equation (Uncited) where TSS represents total variation in a test score, RSS represents the variation in test score not explained by the regressors, and DF represents the appropriate degrees of freedom.

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Model Checking
Residuals, which are obtained from fitting models that result from using hierarchical regressions, should be normally distributed. This assumption was checked by computing correlations proposed by Filliben (1975). In all cases, the Filliben correlation was at least .99 (to two decimal places), indicating a close fit to the normal distribution. Direction of variable influence was obtained by examining the signs of associated regression coefficients, and strength of association was evaluated by F ratios. The familywise error rate (Howell, 1987) was used in assessing significance of group multiple comparisons when there was a significant overall group effect. To minimize the number of chance findings the number of multiple comparisons was limited to those involving lowest valued groups (i.e., the Beck group containing scores <= 6, or SEGs 1 and 2), and model terms were regarded as statistically significant only if their p value was less than .01.

AH4 (1) and AH4 (2) Scores

Both AH4 (1) and (2) scores decreased with age. This decline was more marked on AH4 (1) in high MHA scorers. AH4 scores were lower in SEGs that were Grade 3 nonmanual workers (3N) than in SEGs 1 and 2 and increased with MHA, (although AH4 [1] scores increased at different rates with MHA across the SEGs). Men had lower AH4 (1) scores than women in the high Beck group and had higher AH4 (2) scores overall. For both AH4 (1) and (2), the middle and high Beck groups had significantly lower scores than the low Beck group.

MHA and MHB Scores

MHA and MHB scores did not differ with age; they were lower in SEGs 3N and below than in the pooled SEGs 1 and 2. Women had lower MHA scores but higher MHB scores; MHB had a strong positive association with MHA, though this association varied with SEG. The difference in MHB score between the two pooled SEGs was greatest in the high Beck group. Beck scores had a weak but significant negative association with MHA score and a strong negative association with MHB score, with the low Beck group differing from both of the other groups.

CL and FR Scores
Both FR and CL scores decreased with age. The age decline in FR was more pronounced in higher MHA scorers. Both FR and CL scores were higher in women and lower in SEGs that were Grade 3 skilled manual workers (3M) and below (whereas, for FR, additionally being lower in SEG 3N compared with the pooled SEGs 1 and 2). Both correlated positively with MHA and negatively with Beck scores. The high Beck group had significantly lower scores than the low Beck group.

General Discussion
In a demographically representative UK sample there were strong relationships between illness, age, and gender and, probably, significant interactions among Beck scores, age, and gender. Furthermore, because incidence of poor health, disability, and negative life events was greater in disadvantaged SEGs, we might also expect complex interaction among Beck scores, age, gender, and SEG. Such information might be very useful to epidemiologists and health economists but would prevent us from asking the questions answered here. Because this self-selected sample shows no statistical relation between age and SEG or between age and health status, we are able to replicate and extend findings from earlier studies: There appears to be no residual relationship between Beck scores and age when risk factors are eliminated by sample self-selection rather than by post hoc partialing of variance. Data from this elite sample also allow us to show that when health factors are controlled by sample selection rather than by post hoc statistical analysis, variation within a very low range of Beck scores (indicative of dysphoria rather than depression) significantly affects cognitive performance. There is every reason to suppose that these relationships are general, with the caution necessary for all extrapolationsthat comparable control of variance must be exercised, whether by statistical analysis or by cohort selection.

Demographic Variables and Beck Scores

Beck scores did not increase with age. This confirms that depression is not necessarily related to age but rather to socioeconomic status and to medical risk factors related to age (Blazer et al., 1991). The finding that Beck scores increase with socioeconomic disadvantage is familiar (Blazer & Williams, 1980; Blazer et al., 1991). A new finding is that this relationship persists within an elite population with a very low range of Beck scores in which self-selection has eliminated some major risk factors associated with socioeconomic disadvantage such

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as poor health. We might expect an interaction among Beck score, age, and SEG to appear in a demographically normal sample in which increased age would probably also imply increased risk of socioeconomic deprivation. Self-selection probably explains its absence in this sample. The finding that women had higher Beck scores than men is familiar (Griffiths et al., 1987). A new finding is that although both gender and SEG affected Beck scores their impacts did not interact. Apparently the risk factors for depression associated with being a woman may be independent of, and so possibly qualitatively different from, those associated with socioeconomic disadvantage.

Beck Scores and Cognitive Performance

People with higher Beck scores performed less well on all cognitive tests. Most affected were scores on the AH4 (1) and (2) then scores on CL and MHB, and then FR and MHA scores. Previous studies have shown effects of depression on cognitive function but not within a range of Beck scores well below conventional threshold values for diagnoses of clinical depression. As expected, both greater age and higher Beck scores were associated with lower levels of cognitive performance on all cognitive tasks. A new finding is that their effects did not interact. There is no evidence that greater age, of itself, increases vulnerability to the effects of depression on cognitive performance. Another new finding is that age and Beck scores had qualitatively different patterns of effects across cognitive tasks. Both increased age and Beck scores and reduced AH4, CL, and FR scores. However, though age between 50 and 93 years did not affect MHA or MHB scores, Beck scores did. With earlier findings that depression lowers performance on tests of crystallized ability (Perlmutter & Nyquist, 1990), although age, on its own does not (Horn, 1982, 1986; Horn & Cattell, 1966), this result suggests that, in contrast to age, depression not only reduces the speed of problem solving and efficiency of verbal learning but also fluent access to a vocabulary that has been built up over a lifetime. The question of causality arises: Laboratory demonstrations have shown that negative mood states can reduce cognitive efficiency (Ellis et al., 1984; Hertel & Hardin, 1990). However, in this study, we must ask whether Beck scores correlated negatively with scores on cognitive tests because unhappiness reduced cognitive efficiency or because participants were made unhappy if they noticed that their cognitive efficiency had declined. Concurrent with the Beck scores, volunteers in this sample also rated the frequency with which they experienced everyday cognitive lapses and memory failures (on the Broadbent Cognitive Failures Questionnaire [CFQ], Broadbent, Cooper, Fitzgerald, & Parkes, 1982; and the Sunderland and Harris Memory Failures Questionnaire [MFQ], Sunderland, Watts, & Baddeley, 1983). Within the entire sample MFQ scores did not correlate with Beck scores, thus giving no evidence that individuals with high Beck scores noticed more memory problems. CFQ scores correlated positively with Beck scores (r = .38). Previous studies have also found that the CFQ loads for depression (e.g., Broadbent et al., 1982; Rabbitt & Abson, 1990). Nevertheless, across this entire sample there was no relationship between MFQ or CFQ scores and scores on any cognitive test (for the entire sample r ; see also a detailed analysis from a random subset of 442 members of the present sample by Rabbitt & Abson, 1990). The association between CFQ and Beck scores suggests that people who are unhappy have relatively poor views of their own competence or, indeed, vice versa. However, the absence of any association between volunteers' perceptions of their everyday cognitive efficiency and their scores on these cognitive tests suggests no relationship between their levels of satisfaction with their own abilities and their cognitive test scores. Thus, although we know that dysphoria can reduce cognitive competence, and it is reasonable to suppose that perceptions of loss of cognitive competence may increase dysphoria, on balance the trends found in this analysis seem to reflect the former relationship. However, these data do not settle the matter, and the way forward seems to be through a detailed joint analysis of cognitive self-assessment, depression, and objective ability.

Possible Variables Modifying the Effects of Depression on Cognition

It was possible that age, general intellectual ability, gender, or socioeconomic advantage might have modified the impact of unhappiness on cognitive performance. As expected, people in advantaged SEGs performed better on all cognitive tasks and also had lower Beck scores. However, the sizes and qualitative profiles of the effects of Beck scores on cognitive test scores were the same for all social groups. It seems that, in this sample, level of socioeconomic advantage was neither a protective nor a risk factor for the impact of unhappiness on cognitive efficiency.

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Because MHA scores were unaffected by ages between 50 and 93 years they could be included in the GLIM model both as an index of lifetime general ability, which might be affected by all other factors, and also as an age-independent predictor variable. The strength of the negative relationship between Beck scores on the one hand and AH4 (1) and (2), MHB, CL, and FR scores on the other remained the same across the range of MHA scores. Thus, there was no evidence that lifetime level of general intellectual ability modified the impact of depression on cognition. Gender played a much more complicated role. As in most previous studies, women performed as well as men on an IQ test assessing verbal and logical reasoning and arithmetical ability [the AH4 (1)] but less well at comparison and manipulation of shapes and spatial reasoning [the AH4 (2)]. Most studies have found that women perform better than men on vocabulary tests. In our study, this was true for the more difficult vocabulary test, MHB, but not for the easier MHA. A sufficient explanation for this discrepancy is that the women in the present sample belonged to generations that were educationally disadvantaged and had poorer job opportunities than their male peers. The new finding is that women performed significantly better than men at cumulative learning of lists of 15 nouns and at free recall of lists of 30 nouns. This difference remained robust even after individual differences in age, SEG, and MHA scores were considered. The entry of gender into higher order interactions is complex. An interesting finding is that the effects of increasing Beck scores on AH4 (1) were significantly less marked for women than for men. This raises the possibility that women may be more resistant than men to the cognitive impact of low levels of depression. It may also mean that women are more willing than men to express their unhappiness, so that levels of complaints expressed on the Beck by the two sexes reflect different levels of actual depression.

References
Baker, R. J. (1985). GLIM 3. 77 reference manual. Oxford, England: Numerical Algorithms Group. [Context Link] Bech, P., Gram, L. F., Dein, E., Jacobsen, O., Vitiger, J., & Bolwig, T. G. (1975). Quantitative rating of depressive states. Acta Psychiatrica Scandinavica, 51, 161170. [Context Link] Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571. Texto Completo Otros recursos Texto Completo Enlaces Bibliograficos [Context Link] Ben-Arie, O., Swartz, L., & Dickman, B. J. (1987). Depression in the elderly living in the community: Its presentation and features. British Journal of Psychiatry, 150, 169174. Otros recursos Texto Completo Enlaces Bibliograficos [Context Link] Blazer, D., Burchett, B., Service, C., & George, L. K. (1991). The association of age and depression among the elderly: An epidemiological exploration. Journal of Gerontology, 46, M210M215. [Context Link] Blazer, D., & Williams, C. (1980). Epidemiology of dysphoria and depression in an elderly population. American Journal of Psychiatry, 137, 439444. Texto Completo Otros recursos Texto Completo Enlaces Bibliograficos [Context Link] Broadbent, D. E., Cooper, P. J., Fitzgerald, P. F., & Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology, 21, 116. Texto Completo Enlaces Bibliograficos [Context Link] Copeland, J. R. M., Dewey, M. E., Wood, N., Searle, R., Davidson, I. A., & McWilliam, C. (1987). Range of mental illness among the elderly in the community. Prevalence in Liverpool using the GMS-AGECAT. British Journal of Psychiatry, 150, 815823. Otros recursos Texto Completo Enlaces Bibliograficos [Context Link] Ellis, H. C., Thomas, R. L., & Rodriguez, L. A. (1984). Emotional mood/states & memory: Elaborative encoding, semantic processing, & cognitive effort. Journal of Experimental Psychology: Learning, Memory, and Cognition, 1,

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