Differences in emotional health across cognitively normal adults and with mild cognitive impairment and Alzheimer’s disease: Results from the Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA) study

Abstract Background Changes in emotional health are common both as part of typical aging and for individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Thus, there is a critical need to identify differences in emotional functioning between adults with and without cognitive impairment. In the current study, we explore whether the NIH‐Toolbox Emotional Battery (NIHTB‐EB), a set of validated, reliable, and efficient measures of emotional functioning, can be used to potentially detect differences in emotional functioning across older adults with varying levels of cognitive impairment. Method Data were drawn from a longitudinal, multi‐site study ‐ the Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA). Participants were recruited from 11 existing cohorts nationwide, and included 1) cognitively normal (NC) adults (N=276), 2) individuals with MCI (N=103), and 3) individuals with AD (N=69); M age = 78 ( SD = 8.25); 53.2% were female. Baseline emotional health was assessed from 2019 to 2020 using NIHTB‐EB. Univariate and ANCOVA analyses tested differences in a variety of emotion dimensions across three groups, adjusting for important covariates, and post‐hoc Tukey pairwise comparisons were performed. Result Controlling for age, gender, marital status, and education, a significant main effect of clinical group was found on measures of sadness, fear‐affect, anger‐physical aggression, loneliness, self‐efficacy, and the negative affect composite score [all p s<0.05; see Figure 1 ]. Tukey post‐hoc pairwise comparison showed MCI and NC differed in negative affect (diff=4.18), sadness (diff=3.08), and anger‐physical aggression (diff=3.08); and AD and NC differed in negative affect (diff=3.65), anger‐physical aggression (diff=4.60), loneliness (diff=3.95), sadness (diff=4.60), and self‐efficacy (diff=‐3.18) [all ps < 0.05; Figure 1 ]. Conclusion Individuals with MCI and AD reported higher levels of negative emotions and a lower level of self‐efficacy than normal controls. Based on a comprehensive set of emotional functioning measures, these findings extended our understanding of how older adults with and without cognitive impairment differ on aspects emotional functioning essential to quality of life. Importantly, we found that the NIHTB‐EB is a useful tool to assess and differentiate emotional health outcomes among cognitively normal adults as well as those with MCI and AD diagnoses.