title: The influence of medical burden severity and cognition on functional competence in older community-dwelling individuals with schizophrenia.
abstract: OBJECTIVE
  Cognition predicts functional competence among individuals with schizophrenia across the lifespan. However, as these individuals age, increasing levels of medical burden may also contribute to functional deficits both directly and indirectly through cognition. Thus, we assessed the relationship among, cognition, medical burden, and functional competence in older individuals with schizophrenia.
  
  
  METHODS
  We analyzed data obtained from 60 community-dwelling participants with schizophrenia and 30 control participants aged 50 or above. Cognition was assessed using the MATRICS Consensus Cognitive Battery (MCCB), functional competence was assessed using the USCD Performance-Based Skills Assessment (UPSA), and medical burden was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Group differences were assessed using independent samples t-tests or chi-square tests. Mediation analyses using bootstrapping techniques were used to assess whether cognition mediated the effects of medical burden on functional competence.
  
  
  RESULTS
  Participants with schizophrenia had higher levels of medical burden, cognitive deficits, and functional impairments. In participants with schizophrenia, cognition, but not medical burden, predicted functional competence after adjusting for age, education, gender, clinical symptoms, and anticholinergic burden of medications. In control participants, cognition and medical burden both predicted functional competence after adjusting for age, education, and gender. Further, cognition was found to fully mediate the association between medical burden and functional competence in control participants.
  
  
  CONCLUSIONS
  Cognition is a robust predictor of functional competence among older individuals with schizophrenia, regardless of medical burden. Cognitive deficits associated with schizophrenia may mask any further cognitive impairment associated with medical burden and its impact on function.
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tsoutsoulas
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Sawsan M
authors.initials: SM
authors.lastname: Kalache
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Ghazala
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Aristotle N
authors.initials: AN
authors.lastname: Voineskos
authors.affiliation: Department of Psychiatry, University of Pittsburgh, PA, USA.
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Butters
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Menon
authors.affiliation: Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada. Electronic address: Tarek.Rajji@camh.ca.
authors.forename: Tarek K
authors.initials: TK
authors.lastname: Rajji
mesh_terms: D000368:Aged; D003071:Cognition; D060825:Cognitive Dysfunction / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index
keywords: Cognition; Elderly; Functional competence; Medical burden; Schizophrenia