title: Association of attentional shift and reversal learning to functional deficits in geriatric depression.
abstract: OBJECTIVE
  The objective of this study is to examine the association between self-reported functional disability in depressed older adults and two types of executive function processes, attentional set shifting and reversal learning.
  
  
  METHODS
  Participants (N = 89) were aged 60 or over and enrolled in a naturalistic treatment study of major depressive disorder. Participants provided information on self-reported function in instrumental activities of daily living (IADL) and completed the Intra-Extra Dimensional Set Shift test (IED) from the Cambridge Neuropsychological Testing Automated Battery, which assesses intra-dimensional attentional shifts, extra-dimensional attentional shifts, and reversal learning. Participants were categorized by the presence or absence of IADL difficulties and compared on IED performance using bivariable and multivariable tests.
  
  
  RESULTS
  Participants who reported IADL difficulties had more errors in extra-dimensional attentional shifting and reversal learning, but intra-dimensional shift errors were not associated with IADLs. Only extra-dimensional shift errors were significant in multivariable models that controlled for age, sex, and depression severity.
  
  
  CONCLUSIONS
  Attentional shifting across categories (i.e., extra-dimensional) was most strongly associated with increased IADL difficulties among depressed older adults, which make interventions to improve flexible problem solving a potential target for reducing instrumental disability in this population.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. guy.potter@duke.edu
authors.forename: Guy G
authors.initials: GG
authors.lastname: Potter
authors.forename: Douglas R
authors.initials: DR
authors.lastname: McQuoid
authors.forename: Martha E
authors.initials: ME
authors.lastname: Payne
authors.forename: Warren D
authors.initials: WD
authors.lastname: Taylor
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001288:Attention / Q000502:physiology*; D003865:Major Depressive Disorder / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012193:Reversal Learning / Q000502:physiology*