Distress symptoms of old age and mild cognitive impairment are two distinct dimensions in older adults without major depression: effects of adverse childhood experiences and negative life events

Background: Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression. Aims: To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL). Methods: This case-control study recruited 61 participants with aMCI (diagnosed using Petersen's criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions. Results: We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA) comprising anxiety, depression, perceived stress and neuroticism scores, and mild cognitive dysfunctions (mCoDy) comprising episodic memory test scores, and the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). While ACE and NLE have a highly significant impact on the DSOA, they are not associated with the mCoDy scores. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI. Conclusions: The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research is supported by the Ratchadapisek Sompoch Fund, Faculty of Medicine, Chulalongkorn University (Grant no. GA66/037); The 90th Anniversary of Chulalongkorn University Scholarship under the Ratchadapisek Somphot Endowment Fund (Grant no. GCUGR1125661006D), Thailand. MM received funding from the Thailand Science Research and Innovation Fund, Chulalongkorn University (Grant no. HEA663000016), and a Sompoch Endowment Fund, Faculty of Medicine, Chulalongkorn University (Grant no. RA66/016). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Institutional Review Board (IRB) of the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (IRB no. 0372/65), which complies with the International Guideline for Human Research Protection as required by the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The dataset generated during and/or analysed during the current study will be available from MM upon reasonable request and once the authors have fully exploited the dataset.