title: Influence of depression, anxiety and stress on cognitive performance in community-dwelling older adults living in rural Ecuador: results of the Atahualpa Project.
abstract: OBJECTIVE
  To assess the relationship between cognitive status and self-reported symptoms of depression, anxiety and stress of older adults living in an underserved rural South American population.
  
  
  METHODS
  Community-dwelling Atahualpa residents aged ≥60 years were identified during a door-to-door census, and evaluated with the Depression Anxiety Stress Scale-21 (DASS-21) and the Montreal Cognitive Assessment (MoCA). We explored whether positivity in each of the DASS-21 axes was related to total and domain-specific MoCA performance after adjustment for age, sex and education.
  
  
  RESULTS
  A total of 280 persons (59% women; mean age, mean age 70 ± 8 years) were included. Based on established cut-offs for the DASS-21, 12% persons had depression, 15% had anxiety and 5% had stress. Mean total MoCA scores were significantly lower for depressed than for not depressed individuals (15.9 ± 5.5 vs 18.9 ± 4.4, P < 0.0001). Depressed participants had significantly lower total and domain-specific MoCA scores for abstraction, short-term memory and orientation. Anxiety was related to significantly lower total MoCA scores (17 ± 4.7 vs 18.8 ± 4.5, P = 0.02), but not to differences in domain-specific MoCA scores. Stress was not associated with significant differences in MoCA scores.
  
  
  CONCLUSIONS
  The present study suggests that depression and anxiety are associated with poorer cognitive performance in elderly residents living in rural areas of developing countries.
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Del Brutto
authors.forename: Gladys E
authors.initials: GE
authors.lastname: Maestre
authors.forename: Hannah
authors.initials: H
authors.lastname: Gardener
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
mesh_terms: D000368:Aged; D001007:Anxiety / Q000208:ethnology / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000208:ethnology / Q000523:psychology*; D003906:Developing Countries; D004484:Ecuador; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012423:Rural Health / Q000208:ethnology*; D057566:Self Report; D013315:Stress, Psychological / Q000208:ethnology / Q000523:psychology*; D063189:Symptom Assessment
keywords: Atahualpa; Ecuador; Montreal Cognitive Assessment; anxiety; cognitive decline; depression; developing countries; population-based study