The mediating role of ego strength in the effect of attachment styles on executive functions of people with mild cognitive impairment

One of the most critical and fundamental issues about human mental health in the middle years of life and the elderly is Mild Cognitive Impairments (MCI), known as the precursor stages of Alzheimer’s disease. Hence, conducting scientific studies on people with MCI is vital due to the intermediate role of these problems and their pathological position as a prognosis for more severe cognitive impairments. The lack of research exploring key factors affecting the well-being of individuals with MCI, combined with the absence of conceptual and structural models in this domain, underscores the importance of this study. Given the rising life expectancy and the growing aging population, it critical to focus on enhancing the mental and cognitive-emotional abilities of middle-aged and elderly individuals. By identifying the influential elements across various aspects of MCI, clinicians can develop tailored rehabilitation programs and interventions that address the specific needs and bolster the weaknesses of those affected by cognitive deficits. Therefore, this research investigates the mediating role of ego strength in how attachment styles impact executive functions in individuals with MCI.

The present study was a cross-sectional correlational study. The statistical population includes all people over 40 years of age in Tehran, Iran, with mild pathological symptoms of cognitive impairments who were referred to the Alzheimer’s Association of Tehran in the second six months of 2022. In this study, 364 people were selected using the available sampling method. The criteria for entering the research include being 40 years old or older (being in the age group of the middle-aged and elderly), the presence of mild pathological diagnostic criteria (noted in the file of people referring to the Alzheimer’s Association of Iran by an expert), obtaining a score lower than 27 in the short mental status assessment scale, agreeing to participate in the study, responding to the scales and tools used, mastering the Persian language, and having a sixth-grade education or higher. The exclusion criteria of the research were being under 40 years old (given that 40 is considered the end of youth and the beginning of middle age), incomplete completion of research tools, the presence of severe physical or psychiatric disorders, suffering from Alzheimer’s disease or advanced dementia, and severe sensory-motor and physical disabilities. In this research, ethical considerations were taken into consideration, including the principle of secrecy and confidentiality, the consent of each person to participate in the research, and the possibility of withdrawing cooperation in case of unwillingness. The research tools were the Brief Mental Status Assessment Scale (MMSE), Attachment Styles Questionnaire (RASS), Adult Executive Function Scale (ADEXI), Ego Strength Questionnaire (PIES), and Cognitive Flexibility Scale (CFI). Pearson correlation, structural equation modeling, and SPSS version 24, and AMOS version 24 software were used for data analysis.

The study results revealed the fit of the desired model. Furthermore, the direct effect of the variable of secure attachment to the variable of executive functions was insignificant (T=0.243, β=0.012). The direct effect of the variable of avoidant attachment on the variable of executive functions was insignificant (T=1.236, β=0.064). The direct effect of the anxious attachment variable on the executive functions variable was insignificant (T=-0.643, β=-0.036). The direct effect of the ego strength variable on the executive functions variable was insignificant (T=9.736, β=0.793). The direct effect of the secure attachment variable on the ego strength variable is significant (T=3.681, β=0.187). The direct effect of the avoidant attachment variable on the ego strength variable is significant (T=3.213, β=0.165). Additionally, the direct path effect of the anxious attachment variable to ego strength was significant (T=-6.592, β=-0.363). In addition, the obtained results indicate the indirect effect of the variable of secure attachment to the variable of executive functions through ego strength (β=0.138, P=0.002), the indirect effect of the variable of avoidant attachment to the variable of executive functions through ego strength means (β=0.204, P=0.002), and the indirect effect of the anxious attachment variable on the executive functions variable through ego strength were significant (β=-0.196, P=0.001). In addition, ego strength had a mediating role in the relationship between attachment styles and executive function symptoms.

According to the results of this study, seemingly, in addition to the existence of genetic and hereditary preparations in people suffering from cognitive impairments, attachment styles, specifically with the role that ego strength plays in this, can play parts in the beginning or progression of executive dysfunctions. The results of this study can be a point of hope for further studies in this field and help in formulating interventions to increase the ego capability of people with mild cognitive impairments whose executive functions are somehow impaired.