Subjective memory complaints and personality traits in normal elderly subjects

Subjective memory complaints in general practice predicts future dementia: a 4-year follow-up study

OBJECTIVE

Many older patients in general practice have subjective memory complaints (SMC); however, not all share this information with their general practitioner (GP). The association between SMC and future cognitive decline or dementia is not clear, especially in a general practice population. The aim of this study was to determine the risk for receiving a subsequent hospital-based dementia diagnosis on the basis of patients' reports of SMC in a primary care setting.

METHODS

Prospective cohort survey with 4-year register-based follow-up in general practice. All 17 practices with a total of 24 GPs working in the inner district of Copenhagen municipality, Denmark. A total of 40 865 patients were listed, and 2934 were 65 years or older. Cox proportional hazard models were used to examine the influence of risk factors for hospital-based dementia diagnosis.

RESULTS

A total of 758 non-nursing home residents aged 65 years and older consulted their GP in October and November 2002, and, when asked, 177 (24%) reported memory problems, and 50 (6.6%) received a hospital-based dementia diagnosis within the 4-years follow-up. SMC had an adjusted Hazard Ratio (HR) of 2.27 for subsequent dementia diagnosis. Other statistical significant covariates were Mini Mental State Examination < 24 (HR 3.97), age (HR 2.73 for 75-84 years and HR 3.75 for 85+ years) and receiving home care (HR 3.24)

CONCLUSIONS

This study indicates that the presence of SMC in an older general practice population is a significant independent predictor for subsequent hospital-based dementia diagnosis. Thus, the GP could consider inquiring for memory complaints to identify vulnerable older patients.

Queixa subjetiva de comprometimento da memória em idosos saudáveis: influência de sintomas depressivos, percepção de estresse e autoestima

O presente estudo analisou a relação entre percepção de estresse, sintomas depressivos e autoestima em idosos com e sem queixa subjetiva de comprometimento de memória. Foram incluídos 204 idosos (104 sem e 100 com queixa de memória) avaliados a partir do instrumento Memory Assessment Complain Questionnaire (MAC-Q). O protocolo de estudo incluiu a Escala de Estresse Percebido (EEP), a Escala de Depressão Geriátrica (GDS) e a Escala de Autoestima de Rosenberg (EAE). Os idosos com queixa de comprometimento apresentaram escores significativamente maiores na EEP e GDS e menores na EAE (p < 0.001). Foi observada correlação negativa entre o escore do MAC-Q e EPP (p < 0.001) e EAE (p = 0.01). A análise de regressão multivariada identificou somente o estresse como fator preditor da queixa subjetiva de memória. Esses dados sugerem que a percepção de estresse e os sintomas depressivos estão associados com a queixa de memória em idosos.

The Cognitive Change in Women study (CCW): informant ratings of cognitive change but not self-ratings are associated with neuropsychological performance over 3 years

The value of self-reported memory complaints for identifying or predicting future cognitive decline or dementia is controversial, but observations from a third party, or "informant," may prove more useful. The relationship between Informant and Self-ratings of cognitive status and neuropsychological test scores was examined in a cohort of 384 nondemented, community-dwelling women, aged 60 years and older, participating in a single-site Women's Health Initiative ancillary study. Each participant and her respective informant separately completed the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Participants also underwent neuropsychological testing and responded to questionnaires on depression and functioning in complex activities of daily living. All neuropsychological test scores were significantly correlated (P values <0.05 to <0.01) with IQCODE ratings whereas Self-ratings overestimated cognitive functioning in some domains. Furthermore, the Self and Informant ratings were both positively correlated with depression and negatively correlated with participants' activity level. Therefore, informant judgments of functional abilities are robust predictors of cognitive status in high functioning nondemented women. These results suggest that informants may be sensitive to changes that are not clinically significant but that may represent an incipient trend for decline.

Differential distribution of subjective and objective cognitive impairment in the population: a nation-wide twin-study

We report the prevalence of subjective cognitive impairment (SCI) and cognitive impairment no dementia (CIND), their socio-demographic profile, and the contribution of genetic background and shared familial environment to SCI and CIND. Subjects were 11,926 dementia-free twin individuals aged ≥65 from the Swedish Twin Registry. SCI was defined as subjective complaint of cognitive change without objective cognitive impairment and CIND was defined according to current criteria. Overall prevalence rates of SCI and CIND were 39% (95% CI 38-39%) and 25% (95% CI 24-25%). In multivariate GEE models, both SCI and CIND were older compared with people without any cognitive impairment. CIND were also less educated, more likely to be unmarried and to have lower socioeconomic status (SES). SCI individuals differed from persons with CIND as they were older, more educated, more likely to be married, and to have higher SES. Co-twin control analysis, which corrects for common genetic and shared environmental background, confirmed the association of low education with CIND. Probandwise concordance for SCI and CIND was 63% and 52% in monozygotic twins, 63% and 50% in dizygotic same-sex twins, and 42% and 29% in dizygotic unlike-sex twins. Tetrachoric correlations showed no significant differences between monozygotic and dizygotic same-sex twins. We conclude that subjective and objective cognitive impairment are both highly prevalent among nondemented elderly yet have distinct sociodemographic profiles. Shared environmental influences rather than genetic background play a role in the occurrence of SCI and CIND.

Performance validity and symptom validity in neuropsychological assessment

Failure to evaluate the validity of an examinee's neuropsychological test performance can alter prediction of external criteria in research investigations, and in the individual case, result in inaccurate conclusions about the degree of impairment resulting from neurological disease or injury. The terms performance validity referring to validity of test performance (PVT), and symptom validity referring to validity of symptom report (SVT), are suggested to replace less descriptive terms such as effort or response bias. Research is reviewed demonstrating strong diagnostic discrimination for PVTs and SVTs, with a particular emphasis on minimizing false positive errors, facilitated by identifying performance patterns or levels of performance that are atypical for bona fide neurologic disorder. It is further shown that false positive errors decrease, with a corresponding increase in the positive probability of malingering, when multiple independent indicators are required for diagnosis. The rigor of PVT and SVT research design is related to a high degree of reproducibility of results, and large effect sizes of d = 1.0 or greater, exceeding effect sizes reported for several psychological and medical diagnostic procedures.

Relationship between personality disorder dimensions and verbal memory functioning in a community population

Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions.

Predictors of self-reported prospective and retrospective memory in a population-based sample of older adults

In this article, the authors examined predictors of self-reported everyday memory failures using the Prospective and Retrospective Questionnaire (PRMQ; Smith, Della Sala, Logie, & Maylor, 2000) in a population-based sample of older adults (age range = 60-90 years; N = 250). The results showed that a higher frequency of reported failures was associated with lower scores on the personality dimension of self-directedness as assessed by the Temperament and Character Inventory (TCI; Cloninger, Dragan, Svrakic, & Przybeck, 1993) and more depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977). However, PRMQ scores showed no relationships with objective memory ability, as reflected by a series of retrospective memory measures and a measure of prospective memory. Neither were the PRMQ scales associated with general cognitive functioning as assessed by the Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1977). Taken together, the results indicate that within the older population, self-reported memory as assessed by the PRMQ may reflect mood-state and personality factors rather than individual differences in memory and cognitive ability.

Subjective memory in older African Americans

The current analysis examined (a) if measures of psychological well-being predict subjective memory, and (b) if subjective memory is consistent with actual memory. Five hundred seventy-nine older African Americans from the Baltimore Study of Black Aging completed measures assessing subjective memory, depressive symptomatology, perceived stress, locus of control, and verbal and working memory. Higher levels of perceived stress and greater externalized locus of control predicted poorer subjective memory, but subjective memory did not predict objective verbal or working memory. Results suggest that subjective memory is influenced by aspects of psychological well-being but is unrelated to objective memory in older African Americans.

Subjective memory complaints, vascular risk factors and psychological distress in the middle-aged: a cross-sectional study

BACKGROUND

Subjective memory complaints (SMC) are common but their significance is still unclear. It has been suggested they are a precursor of mild cognitive impairment (MCI) or dementia and an early indicator of cognitive decline. Vascular risk factors have an important role in the development of dementia and possibly MCI. We therefore aimed to test the hypothesis that vascular risk factors were associated with SMC, independent of psychological distress, in a middle-aged community-dwelling population.

METHODS

A cross-sectional analysis of baseline data from the 45 and Up Study was performed. This is a cohort study of people living in New South Wales (Australia), and we explored the sample of 45, 532 participants aged between 45 and 64 years. SMC were defined as 'fair' or 'poor' on a self-reported five-point Likert scale of memory function. Vascular risk factors of obesity, diabetes, hypertension, hypercholesterolemia and smoking were identified by self-report. Psychological distress was measured by the Kessler Psychological Distress Scale. We tested the model generated from a randomly selected exploratory sample (n = 22, 766) with a confirmatory sample of equal size.

RESULTS

5, 479/45, 532 (12%) of respondents reported SMC. Using multivariate logistic regression, only two vascular risk factors: smoking (OR 1.18; 95% CI = 1.03 - 1.35) and hypercholesterolaemia (OR 1.19; 95% CI = 1.04 - 1.36) showed a small independent association with SMC. In contrast psychological distress was strongly associated with SMC. Those with the highest levels of psychological distress were 7.00 (95% CI = 5.41 - 9.07) times more likely to have SMC than the non-distressed. The confirmatory sample also demonstrated the strong association of SMC with psychological distress rather than vascular risk factors.

CONCLUSIONS

In a large sample of middle-aged people without any history of major affective illness or stroke, psychological distress was strongly, and vascular risk factors only weakly, associated with SMC, although we cannot discount psychological distress acting as a mediator in any association between vascular risk factors and SMC. Given this, clinicians should be vigilant regarding the presence of an affective illness when assessing middle-aged patients presenting with memory problems.

Multimorbidity and its relation to subjective memory complaints in a large general population of older adults

BACKGROUND

Multimorbidity has been suggested to be associated with a variety of negative health-related outcomes. The present study was designed to evaluate the association between multimorbidity and subjective memory complaints.

METHODS

This cross-sectional study was based on data obtained from a postal survey designed by the Public Health Service (Gemeentelijke Gezondheids Dienst, GGD) involving 15,188 persons aged 55 years and over living independently in Limburg, the Netherlands. Multivariate logistic regression analyses, adjusted for potentially important covariates, were performed to evaluate the association between self-reported multimorbidity and three outcomes related to subjective memory complaints.

RESULTS

Multimorbidity was indeed related to subjective memory complaints. The association between multimorbidity and subjective memory complaints was positively influenced by age. Moreover, multimorbidity was related to the degree of worrying about memory complaints in people who perceived themselves as forgetful. Multimorbidity was also associated with reporting a larger increase in these subjective memory complaints during the past year. In this latter case, multimorbidity had more prognostic capability in men than in women. Psychological distress was related to all three subjective memory-related outcome measures.

CONCLUSIONS

In our sample, which was representative of the Dutch population, multimorbidity was associated with subjective memory complaints. The relationship between multimorbidity and subjective memory complaints differed between men and women and between age groups.

Subjective cognitive complaints and longitudinal changes in memory and brain function

OBJECTIVE

Subjective cognitive complaints are often used in the diagnosis of memory and other cognitive impairment. This study examined whether cognitive complaints are associated with longitudinal changes in cognition and cross-sectional differences in regional brain function during memory performance in 98 participants with a mean age of 75.

METHOD

The Cognitive Failures Questionnaire (CFQ) assessed cognitive complaints and mixed effects regression models were used to determine whether mean CFQ scores predicted rates of change in cognitive function over a period of 11.5 years.

RESULTS

Higher CFQ scores, reflecting increased subjective complaints, were associated with steeper rates of decline in immediate and delayed recall on the California Verbal Learning Test. Voxel-based regression analysis was used to determine the cross-sectional relationship between CFQ scores and regional cerebral blood flow measured by PET during a resting condition and during verbal and figural memory tasks. Higher levels of cognitive complaints were associated with increased activity in insular, lingual and cerebellar areas during memory tasks.

CONCLUSIONS

These findings offer some support for the validity of subjective cognitive complaints as markers of age related changes in memory and brain activity.

Everyday memory: self-perception and structural brain correlates in a healthy elderly population

Mapping the cerebral structural correlates of age-related cognitive decline is a growing area of research. The aim of the present study was to investigate the relationship between healthy elderly's perceived memory functioning in daily life, neuropsychological test performance on a standardized test on verbal memory, and cortical thickness and subcortical volumes in brain regions implicated in memory networks, including the medial temporal lobe (MTL). Eighty-three healthy and cognitively well-functioning volunteers aged 60-85 years underwent MRI scans, Everyday Memory Questionnaire (EMQ), and neuropsychological assessment. Both self-perceived memory in daily life related to attention and executive functions and an objective measure of verbal recall (CVLT) were, independently, associated with thickness of the left MTL. The two cognitive variables were uncorrelated, and including both measures in the model nearly doubled the amount of explained variance on MTL thickness. This suggests that measures of perceived everyday memory might substantially inform and supplement studies investigating the relationships between neuropsychological test performance and brain morphology. The results are consistent with a bigger-is-better relationship in the MTL and suggest that EMQ and neuropsychological test performance have detectable and comparable structural correlates in a region critically involved in memory functions in the well-functioning elderly.

Subjective cognitive complaints at menopause associated with declines in performance of verbal memory and attentional processes

BACKGROUND

Subjective cognitive complaints are commonly reported during the menopause transition. Whether they are indicative of actual cognitive impairment is unknown.

OBJECTIVES

To assess subjective attention and memory complaints in a general population sample across the stages of menopause; to assess relationships between subjective complaints and objective measures of cognitive performance; to examine potential menopause-related, hormonal, psychosocial and cognitive predictors of subjective complaints.

METHODS

Multivariate and univariate analyses of cross-sectional data from 120 pre-, peri- and postmenopausal women.

RESULTS

Attention problems were more evident in the perimenopausal and hormone therapy groups. Subjective cognitive problems were associated with declines in verbal memory, and with declining performance on reaction time measures of attention, with small-to-medium effect sizes. Predictors of subjective complaints included menopause-related symptoms, psychosocial variables, psychological symptoms and objective cognitive performance.

CONCLUSION

A link has been demonstrated between the subjective and objective aspects of cognitive function in association with the menopausal transition. It is suggested that greater recognition be given to cognitive symptoms as forming part of the constellation of menopause-related symptoms.

Bone density and brain atrophy in early Alzheimer's disease

Studies suggest a link between bone loss and Alzheimer's disease. To examine bone mineral density (BMD) in early Alzheimer's disease (AD) and its relationship to brain structure and cognition, we evaluated 71 patients with early stage AD (Clinical Dementia Rating (CDR) 0.5 and 1) and 69 non-demented elderly control participants (CDR 0). Measures included whole body BMD by dual energy x-ray absorptiometry (DXA) and normalized whole brain volumes computed from structural MRI scans. Cognition was assessed with a standard neuropsychological test battery. Mean BMD was lower in the early AD group (1.11 +/- 0.13) compared to the non-demented control group (1.16 +/- 0.12, p = 0.02), independent of age, gender, habitual physical activity, smoking, depression, estrogen replacement, and apolipoprotein E4 carrier status. In the early AD group, BMD was related to whole brain volume (b = 0.18, p = 0.03). BMD was also associated with cognitive performance, primarily in tests of memory (logical memory [b = 0.15, p = 0.04], delayed logical memory [b = 0.16, p = 0.02], and the selective reminding task - free recall [b = 0.18, p = 0.009]). BMD is reduced in the earliest clinical stages of AD and associated with brain atrophy and memory decline, suggesting that central mechanisms may contribute to bone loss in early AD.

Prevalence and predictors of “subjective cognitive complaints” in the Sydney Memory and Ageing Study

OBJECTIVES

To document the prevalence of self- and informant report of cognitive problems, usually referred to as "subjective cognitive complaints" (SCCs), in a community-dwelling sample of older adults and to examine the relationship between SCCs and objective impairment, mood, and personality measures.

PARTICIPANTS

Eight hundred twenty-seven nondemented community-dwelling adults aged 70-90 years.

MEASUREMENTS

Participants were asked 24 SCC questions, including the Memory Complaint Questionnaire (MAC-Q), and completed neuropsychological testing in the domains of memory, language, executive function, visuospatial skills, and psychomotor speed. The Geriatric Depression Scale, Goldberg Anxiety Scale, and Neuroticism, Openness, and Conscientiousness from the NEO-Five Factor Inventory were used as measures of participants' psychological status. Informants completed 19 SCC questions, including a modified short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS

Overall, 95.5% of participants or their informants endorsed at least one SCC. Although participants were more likely to endorse a memory complaint, informants seemed more accurate in endorsing a complaint when cognitive impairment was objectively present. SCC correlated with participants' scores on measures of depression, anxiety, neuroticism, and inversely with measures of openness and conscientiousness. Age, education, and sex had little impact on these effects. Regression analysis showed that psychological factors explained the number of complaints more than cognitive performance.

CONCLUSIONS

The usefulness of SCCs as a criterion for mild cognitive impairment is questioned because of their high prevalence and their relationship to psychological factors. This may be helpful for clinicians to bear in mind when presented with patients with cognitive complaints.

Impact of APOE on the healthy aging brain: a voxel-based MRI and DTI study

Neuroimaging studies of apolipoprotein E (ApoE4) have implicated its association with brain atrophy in Alzheimer's disease. To date, few studies have used automated morphological analysis techniques to assess ApoE4-related brain structure change in both gray and white matter in nondemented older adults. Nondemented (CDR = 0, n = 53) subjects over 60 had MRI, diffusion tensor imaging, and neurocognitive assessments. We assessed differences in cognition and brain structure associated with ApoE4 genetic variation using voxel-based morphometry techniques, and tract-based spatial statistics of fractional anisotropy change. In nondemented older adults with the E4 allele, cognitive performance was reduced, and atrophy was present in the hippocampus and amygdala compared to ApoE4 negative participants. We also report that E4 carriers have decreased fractional anisotropy in the left parahippocampal gyrus white matter. In conclusion, the presence of an ApoE4 allele in nondemented older adults is associated with decreases in cognition and gray and white matter changes in the medial temporal cortex. Overall we provide further evidence of the effects of genetic variance related to imaging and cognitive measures of risk for Alzheimer's disease.

Neural correlates of impaired functional independence in early Alzheimer's disease

Cognitive and physical decline are important predictors of functional independence in Alzheimer's disease (AD). However, little is known about AD-related neural change leading to decreased independence. We hypothesized that regional gray matter atrophy, including the medial frontal cortex, would be related to cognition, physical function, and functional independence. Individuals without dementia (n=56) and subjects with early-stage AD (n=58) underwent MRI and a comprehensive cognitive and physical function evaluation. The relationship of cognitive and physical function measures and independence performing complex daily activities was explored using correlation and mediation analysis. These results suggest that cognition had both a strong direct effect and mediated the influence of physical function on independence for those with AD. We followed this with a voxel-based morphometric global conjunction analysis of imaging data within each group to identify neural substrates common to our function measures. Imaging evidence supported our mediation analysis results. Imaging evidence revealed that in AD, regional gray matter atrophy measures in medial frontal and temporo-parietal areas were related to decreased cognition, physical function, and independence. Loss of independence in early AD is closely related to impaired cognition associated with performing complex behaviors. People with early AD may have decreased gray matter volume in the medial frontal and temporal-parietal cortices that is associated with loss of independence in activities of daily living. These results are the first to identify regionally specific brain volume changes that may be related to functional dependence seen in early AD.

Association between subjective memory complaints and health care utilisation: a three-year follow up

Background

Subjective memory complaints (SMC) are common among elderly patients and little is know about the association between SMC and health care utilisation. Thus, the aim of this study was to investigate health care utilisation during a three-year follow-up among elderly patients consulting their general practitioner and reporting subjective memory complaints (SMC).

Methods

This study was conducted as a prospective cohort survey in general practice with three-year follow-up. Selected health care utilisation or costs relative to SMC adjusted for potential confounders were analyzed in a two-part model where the incidence of use of a selected health care service were analyzed separately from the quantity of use for those that use the service. The former analyzed in a Poisson regression approach, the latter in a generalized linear regression model.

Results

A total 758 non-nursing home residents aged 65 years and older consulted their GP in October and November 2002 and participated in the present study. The adjusted probability of nursing home placement was significantly increased in subjects with SMC relative to subjects without SMC (RR = 2.3). More generally, SMC was associated with an increase in the cost of selected health care utilisation of 60% over three years (p = 0.003).

Conclusion

The data of this study indicated that in an elderly primary care population the presence of SMC increased the cost of health care utilisation by 60% over three years. Thus, inquiry into SMC may contribute to a risk profile assessment of elderly patients and may identify patients with an increased use of health care services.

Subjective cognitive impairment: increased prefrontal cortex activation compared to controls during an encoding task

OBJECTIVE

Subjective cognitive impairment (SCI) has been proposed as a clinical stage which may precede mild cognitive impairment in the clinical continuum of AD, and is characterised by the presence of subjective memory complaints in the absence of objective cognitive deficits. Specific memory-related brain activation differences have been reported in mild cognitive impairment and in cognitively normal individuals at known genetic risk of AD; our objective was to determine whether similar differences are present in people with SCI.

METHODS

We compared brain activation in a memory clinic sample of 10 SCI subjects and 10 controls during a verbal episodic memory encoding task using functional magnetic resonance imaging (fMRI).

RESULTS

There were no differences between groups on measures of encoding success (recognition accuracy) nor was there evidence of altered semantic processing. Both groups activated left prefrontal cortex (PFC) and cerebellum during encoding. The SCI group also demonstrated activation in left medial temporal, occipitoparietal and medial frontal cortex. Group comparisons revealed increased activation in SCI in left PFC, where activation strength correlated with memory task performance.

CONCLUSIONS

The activation differences reported in this study may reflect the employment of compensatory strategies in the face of early AD pathology, although a number of alternative explanations need to be considered. Further studies with larger samples may help to determine whether the observed activation changes are likely to be associated with early neuropathological processes or with other unrelated factors.

[The 5-word test in 85 patients with generalized anxiety disorder]

OBJECTIVES

Patients with generalized anxiety disorder (GAD) expressed frequent memory complaints leading to consultations in memory clinics. The 5-word test (5WT) is a serial verbal memory test with semantic cuing. It is proposed to rapidly evaluate memory of people with memory complaints. It has previously shown its sensitivity and its specificity in identifying patients with Alzheimer's disease (AD). The objective was to evaluate memory performances of patients with GAD.

METHODS

Characteristics of the 5WT were investigated in a sample of 85 patients with GAD compared with 183 normal controls aged from 40 to 70 years.

RESULTS

For each score of the 5WT, GAD patients significantly differed from controls. Forgetting rate was twice more important in GAD patients than in controls. However, for any score of the 5WT, Receiver Operating Characteristic (ROC) curves found no significant cut-off scores combining reliable sensitivity, specificity and correct classification of the subjects.

DISCUSSION

In spite of ancient and severe mnestic complaints, GAD patients have significant difficulties with the 5WT as compared to controls without being of the magnitude of those observed in AD patients.

CONCLUSION

The 5WT is an easy and rapid test allowing a reliable evaluation of memory in GAD patients. Results could usually confort patients. The presence of true memory deficits with the 5WT could not be ascribed to anxiety but to other pathological conditions. Consequently, further memory testing should be done.

The relationship between memory complaints and age in normal aging

Normal aging can be characterized by a gradual decline in some cognitive functions, such as memory. Memory complaints are common among older adults, and may indicate depression, anxiety, or cognitive decline.

Association between subjective memory complaints and nursing home placement: a four-year follow-up

OBJECTIVE

In order to evaluate whether elderly persons with subjective memory complaints may be regarded as a group of potentially vulnerable patients who need close follow-up, we investigated the risk of nursing home placement during a 4-year follow-up period.

METHODS

Prospective cohort survey with 4-year follow-up in general practice. Cox proportional hazard models were used to examine the influence of risk factors on nursing home placement.

RESULTS

A total 758 non-nursing home residents aged 65 years and older consulted the General Practitioners in October and November 2002 of whom 50 nursing home placements were observed. Subjective memory complaints were associated with an adjusted Hazard Ratio (HR) of 2.59 for nursing home placement. Other statistical significant covariates were MMSE < 24 (HR = 3.95), Age (HR = 3.92 for 75-84 years and HR = 19.90 for 85 + years) and extreme anxiety/depression (HR = 4.74). The effect of subjective memory complaints is seen to moderate when subjects are older.

CONCLUSION

The data of this study indicated that in an elderly primary care population the presence of subjective memory complaints was a significant independent predictor for nursing home placement together with other known risk factors.

How are memory complaints in functional memory disorder related to measures of affect, metamemory and cognition?

OBJECTIVE

Memory complaints are a common finding in outpatients, especially in psychosomatic and neurological practice. In a substantial group of patients persistent memory complaints are found in the absence of abnormal neuropsychology. Different labels such as "functional memory complaint" have been suggested for this phenomenon. We characterise a group of patients with such memory complaints, which we termed functional memory disorder (FMD). The aim of the present study is to describe patients with FMD.

METHODS

Thirty-nine patients with FMD were compared to 38 control subjects. Data were collected on the German version of the Rey Auditory Verbal Learning test and the Zahlenverbindungstest (cognitive speed), subscales of the Metamemory in Adulthood questionnaire (MIA), the Perceived Stress Questionnaire (PSQ), the Global Severity Index (GSI) of the Symptom Checklist, the Beck Depression Inventory (BDI), and other psychological questionnaire measures.

RESULTS

We found significant group differences on all psychological questionnaire measures, with more pathological scores in the patient group. GSI and PSQ were the best predictors of memory self-efficacy. MIA-Memory Self-Efficacy (MSE), MIA-Achievement, and BDI were the best predictors of group membership (FMD vs. control group). When MSE was excluded, MIA-Achievement and BDI or GSI were the only predictors of group membership. Neuropsychological measures predicted neither MSE nor group membership.

CONCLUSIONS

Pathological scores on measures of metamemory, stress, and depression are typical of FMD. Low MSE and a high memory-related achievement motivation seem to be key features of FMD. Other important features are increased perceived stress, general psychosomatic complaint, and elevated depression scores. Neuropsychological test performance is not associated with FMD symptoms.

Do memory complaints represent impaired memory performance in patients with major depressive disorder?

Memory complaints are found to be associated with depression. However, the question is, "How much these subjective complaints indicate objective memory impairments?" The aim of this study is to determine whether subjective memory complaints represent objective memory impairments and to establish the demographic and clinical characteristics of patients with major depressive disorder (MDD) and subjective memory complaints. Sixty-four patients with MDD were assessed for objective memory performance through subtests of the Wechsler Memory Scale-III. Memory complaints also were assessed in these patients with a structured interview. Thirty healthy controls were also included in the study to compare memory performance among groups. The Hamilton Rating Scale for Depression was used to measure the severity and characteristics of depression. Patients with MDD who had longer duration and earlier onset of depression reported more memory complaints. MDD patients with memory complaints had more hypochondriac concerns but not more depression severity compared with those without memory complaints. There was no relationship between subjective memory complaints and objective memory performance in MDD patients. Patients with MDD with and without memory complaints had lower scores on the Wechsler Memory Scale-III than the control group. Subjective memory complaints are not a valid indictor of objective memory impairments, and the diagnostic value of self-reported memory is being questioned in patients with MDD. The cognitive status of MDD patients should be assessed routinely, regardless of the patient awareness of his or her cognitive deficits.

Cardiorespiratory fitness in early-stage Alzheimer disease

There is an increasing interest in exercise and fitness in Alzheimer disease (AD) given evidence suggesting a role in the maintenance of cognitive health. There is, however, little data on the objective measure of cardiorespiratory fitness in individuals with AD. Thus, we assessed cardiorespiratory fitness in early AD and its relationship with physical activity levels, health markers, and cognitive performance in nondemented (Clinical Dementia Rating 0, n=31) and early-stage AD (Clinical Dementia Rating 0.5 and 1, n=31) participants. Cardiorespiratory fitness was assessed with maximal exercise testing to determine peak oxygen consumption (VOpeak2). Additionally, dual emission x-ray absorptiometry scanning for body composition and glucose tolerance tests were conducted. Despite reductions in physical performance and habitual physical activity levels in early AD, cardiorespiratory fitness (VOpeak2) was comparable in the 2 groups (19.8 in early AD vs. 21.2 mL/kg/min in nondemented, P=0.26). AD participants performed well on treadmill tests with similar levels of perceived exertion, maximal heart rate, and respiratory exchange ratio compared with nondemented individuals. After controlling for age and sex, VOpeak2 was associated with a beneficial glucoregulatory profile and inversely associated with percent body fat, body mass index, and triglycerides. A relationship between cognitive performance measures and VOpeak2 was not apparent. These results suggest that individuals in the early stages of AD have the capacity for maximal exercise testing and have comparable levels of cardiorespiratory fitness as nondemented individuals. Reduced physical activity associated with early AD underscores the need for further defining the role of exercise as a potential therapeutic intervention in the early stages of AD.

Memory complaints in healthy young and elderly adults: reliability of memory reporting

The relationship between memory complaints and objective memory performance remains poorly understood, particularly in young and middle aged people. We studied the relationship between reports of memory complaints and objective memory performance, and the possibility of differentiating good and poor reporters across the lifespan based on concordance between reported abilities and objectively assessed performance. This cross-sectional study enrolled 292 healthy individuals, aged 18 to 87 years, able to perform common activities of daily living and without neurological or psychiatric conditions or systemic diseases likely to interfere with cognition. No correlation between memory complaints, as assessed by the Subjective Memory Complaints scale (SMC) score and the objective memory performance, evaluated by the long-delay free recall (LDFR) score of the California Verbal Learning Test (CVLT), was found, even when grouping the participants by decade. The SMC score was influenced by the presence of depressive symptoms. Participants who were more educated, female and younger tended to have a higher CVLT-LDFR score. Younger subjects were more likely to have good memory performance and report few memory complaints than older subjects. In conclusion, there are differences in the reliability of memory reporting across the lifespan, younger subjects being more likely to correctly report good memory than older subjects.

The moderating role of negative affect on objective verbal memory performance and subjective memory complaints in healthy older adults

Subjective memory complaints (SMCs) are part of the diagnostic criteria for Mild Cognitive Impairment (MCI), yet little is known about their etiology. In some previous studies, no direct relation has been found between SMCs and objective memory performance, yet significant correlations have been identified between SMCs and psychological factors such as depression and anxiety. In the current study, we examined whether negative affect moderated the relation between objective memory functioning and SMCs in a sample of healthy, non-demented participants aged 65 and older. As predicted, several negative affect measures moderated the relationship between objective cognitive functioning and SMCs. In the absence of objective memory impairment as indexed by the Rey Auditory Verbal Learning Test (RAVLT) and the Dementia Rating Scale-2nd Edition (DRS-2), higher levels of negative affect were associated with increased levels of SMCs. Moreover, a lower order negative affect factor, anxiety sensitivity, significantly moderated the relation between objective memory functioning and SMCs, after controlling for higher order measures of general negative affectivity. Findings suggest that negative affect, particularly anxiety sensitivity, distorts the subjective appraisal of one's own memory, such that people high on negative affect factors report more episodes of forgetting, even in the absence of objective cognitive impairments.

Memory complaints to the general practitioner: data from the GuidAge study

Memory complaints are relatively common in elderly people, although they are not always reported to the general practitioner (GP). These subjective complaints do not necessarily correlate with objective measures of memory impairment or cognitive performance, but they may be an early indication of impairment at a state that is undetectable by standard testing instruments. Memory complaints may also predict future cognitive decline. The GuidAge study is a secondary prevention trial for Alzheimer's disease involving non-demented individuals aged 70 years or older having spontaneously complained of memory problems to their GP. More than half of participants had a Clinical Dementia Rating score of 0.5 at baseline. The percentage of participants reporting problems on the McNair and Kahn scale varied from 6.2% to 78.6% per item. Certain specific memory complaints may be more related than others to the beginning of the neurodegenerative process, and could predict future cognitive decline. The importance of memory complaints should not be underestimated in clinical practice.

Patterns of subjective memory impairment in the elderly: association with memory performance

BACKGROUND

The association of subjective memory impairment (SMI) with cognitive performance in healthy elderly subjects is poor because of confounds such as depression. However, SMI is also a predictor for future dementia. Thus, there is a need to identify subtypes of SMI that are particularly related to inferior memory performance and may represent at-risk stages for cognitive decline.

METHOD

A total of 2389 unimpaired subjects were recruited from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe), as part of the German Competence Network on Dementia. Clusters of SMI according to patterns of response to SMI questions were identified. Gender, age, depressive symptoms, apolipoprotein E (apoE) genotype, delayed recall and verbal fluency were included in a Classification and Regression Tree (CART) analysis to identify discriminators between the clusters.

RESULTS

We identified three clusters. Cluster 1 contained subjects without memory complaints. Cluster 2 contained subjects with general memory complaints, but mainly without memory complaints on individual tasks of daily living. Cluster 3 contained subjects with general memory complaints and complaints on individual tasks of daily living. Depressive symptoms, as the first-level discriminator, distinguished between clusters 1 and 2 versus cluster 3. In subjects with only a few depressive symptoms, delayed recall discriminated between cluster 1 versus clusters 2 and 3.

CONCLUSIONS

In SMI subjects with only a minor number of depressive symptoms, memory complaints are associated with delayed recall. As delayed recall is a sensitive predictor for future cognitive decline, SMI may be the first manifestation of future dementia in elderly subjects without depression.

Cognitive complaints after mild traumatic brain injury: things are not always what they seem

OBJECTIVE

To compare nonreferred, emergency department (ED)-admitted mild traumatic brain injury (MTBI) patients with and without self-reported cognitive complaints on (1) demographic variables and injury characteristics; (2) neuropsychological test performance; (3) 12-day self-monitoring of perceived cognitive problems; and (4) emotional distress, physical functioning, and personality.

METHODS

(Neuro)psychological assessment was carried out 6 months post-injury in 79 patients out of a cohort of 618 consecutive MTBI patients aged 18-60, who attended the ED of our level I trauma centre. Cognitive complaints were assessed with the Rivermead Postconcussional Symptoms Questionnaire (RPSQ). In addition, patients monitored concentration problems and forgetfulness during 12 consecutive days.

RESULTS

Self-reported cognitive complaints were reported by 39% of the patients. These complaints were strongly related to lower educational levels, emotional distress, personality, and poorer physical functioning (especially fatigue) but not to injury characteristics. Severity of self-reported cognitive complaints was neither associated with the patients' daily observations of cognitive problems nor with outcome on a range of neuropsychological tests.

CONCLUSION

Self-reported cognitive complaints were more strongly related to premorbid traits and physical and emotional state factors than to actual cognitive impairments. In line with previous work, this suggests that treatment of emotional distress and fatigue may also reduce cognitive complaints. Cognitive outcome assessment of symptomatic MTBI patients should not be restricted to checklist ratings only, but also include a (neuro)psychological screening. In addition, daily monitoring of complaints is a useful method to gather information about the frequency and pattern of cognitive problems in daily life.

Subjective memory complaints and clinical characteristics in elderly Koreans: A questionnaire survey

OBJECTIVES

The overall objectives of the Ajou-Bundang Study for the Elderly (AB study) were to describe the current geriatric diseases and health behaviors, and to improve the visiting health service in South Korea. The particular objectives of the current study were to describe the AB study and to investigate the associations between subjective memory complaints (SMCs) and objective cognitive function, to assess the clinical characteristics of SMCs, and to measure possible differences between elderly people with and without cognitive dysfunction.

METHODS

A cross-sectional study of a sample of people from the AB study was constructed to study the association between SMCs and demographic variables. SMCs, cognitive function, and demographic characteristics were ascertained. A total of 9,477 subjects aged 65 years or over were recruited from the residents of Bundang, Korea.

RESULTS

SMCs were reported by 57.3% of the study participants. SMCs were correlated with advanced age and with being female. Further analyses of cognitive functions revealed that associated factor profiles differed between the participants with and without cognitive dysfunction.

CONCLUSIONS

These results show that age is associated with SMCs, irrespective of the level of cognitive function. Longitudinal SMC studies should be undertaken to investigate potentially associated clinical parameters.

Subjective memory complaints: presence, severity and future outcome in normal older subjects

BACKGROUND/AIMS

Subjective memory complaint (SMC) in normal individuals may predict future cognitive decline. The goal of this study was to examine whether the probability of decline increases with growing intensity of complaint.

METHODS

Normal subjects over the age of 50 years were included in a longitudinal retrospective study (mean follow-up time = 8 years). All subjects (n = 230) underwent cognitive and medical examination at baseline. The presence of SMC was determined based on Global Deterioration Scale staging. A subgroup of 83 participants also received baseline assessment for the intensity of SMC. Logistic regression was used to predict outcome from baseline variables. Three outcome groups were established at the final visit: nondeclining, declining and diagnostically unstable (i.e. the diagnosis changed over time: from normal to mild cognitive impairment, then back to normal).

RESULTS

The presence of SMC was a predictor of future decline but also increased the likelihood of the unstable diagnosis. Increasing intensity of SMC did not further raise the risk for decline. High intensity of complaints and more pronounced affective symptoms predicted the unstable clinical diagnosis.

CONCLUSIONS

The presence of SMC contributes to the risk of future decline, however, the increasing intensity of the perceived impairment does not further enhance the risk.

Perceived Threat of Alzheimer Disease (AD)

The fear of developing Alzheimer disease (AD) is highly salient, particularly for biologic family members. The current study evaluated social/cognitive explanations for perceived AD threat beyond genetic relatedness, including personal experience with AD, belief in negative aging stereotypes, and performance on delayed memory tasks. Participants were 97 healthy older adults aged 50 to 85, self-referred for a free community memory screen. Results showed that, as expected, personal AD experience was related to perceived AD threat. Furthermore, consistent with expectations, AD experience moderated the relationship between perceived AD threat and other explanatory variables, including age, belief in negative aging stereotypes, and cognitive performance. In those with AD experience, whether genetic or not, younger age was associated with more perceived AD threat, but an inverse relationship was seen in those without AD experience. Those with genetic AD experience seem particularly vulnerable to the effects of negative age stereotype beliefs on perceived AD threat, and show an inverse relationship between their actual cognitive performance and their perception of personal AD threat. Results highlight the importance of considering personal experience with AD when assessing a person's self-reported concerns about AD or his/her own memory changes.

Autobiographical Recall Training in Elderly Adults with Subjective Memory Complaint: A Pilot Study

Subjective memory complaint is a self-reported memory impairment which affects elderly people. This problem does not interfere with daily living activities but could decrease quality of life. This study's purpose was to verify whether a specific, newly developed, autobiographical recall training could modify self-perception of memory of subjects with subjective memory complaint. Seven elderly subjects (4 women and 3 men; mean age 65.5 yr., SD = 11) with such complaint, evidenced through a specific questionnaire, attended the training course and were prospectively assessed on standard neuropsychological tests, depressive symptomatology, and self-perception of memory. Self-perception of memory, as assessed by scores on a formalized questionnaire, improved significantly after the training, while depressive symptoms did not change. Neuropsychological performances were normal before and after the training, but a statistically significant improvement was observed only on the phonological fluency test. Thus the present pilot study suggested that the training may be effective in improving self-perception of memory and metamnestic capacity in elderly people with subjective memory complaints but not in changing subjects' depressive symptoms. This requires replication of this work with a much larger sample so statistical power is adequate.

Subjective memory complaints and cognitive impairment in older people

Subjective memory complaints (SMCs) are common in older people and are often thought to indicate cognitive impairment. We reviewed research on the relationship between SMCs and (a) current cognitive function, (b) risk of future cognitive decline, and (c) depression and personality. SMCs were found to be inconsistently related to current cognitive impairment but were more strongly related to risk of future cognitive decline. However, SMCs were consistently related to depression and some personality traits, e.g. neuroticism. In conclusion, the determinants of SMCs are complex. The utility of SMCs in the diagnosis of pre-dementia states (e.g. mild cognitive impairment) is uncertain and requires further evaluation.

Metamemory monitoring in mild cognitive impairment: Evidence of a less accurate episodic feeling-of-knowing

This study aimed at exploring metamemory and specifically the accuracy of memory monitoring in mild cognitive impairment (MCI) using an episodic memory feeling-of-knowing (FOK) procedure. To this end, 20 people with MCI and 20 matched control participants were compared on the episodic FOK task. Results showed that the MCI group made less accurate FOK predictions than the control group by overestimating their memory performance on a recognition task. The MCI overestimation behavior was found to be critically related to the severity of their cognitive decline. In the light of recent neuroanatomical models showing the involvement of a temporal-frontal network underlying accurate FOK predictions, the role of memory and executive processes was evaluated. Thus, participants were also administered memory and executive neuropsychological tests. Correlation analysis revealed a between-group differential pattern indicating that FOK accuracy was primarily related to memory abilities in people with MCI, whereas it was specifically related to executive functioning in control participants. The lesser ability of people with MCI to assess their memory status accurately on an episodic FOK task is discussed in relation to both their subjective memory complaints and to their actual memory deficits which might be mediated by the brain vulnerability of their hippocampus and medial temporal system. It is suggested that their memory weakness may lead people with MCI to use other less reliable forms of memory monitoring.

Response inhibition and everyday memory complaints in older adult women

OBJECTIVE

To explore the association of executive functions to the everyday memory complaints of healthy older adults.

METHODS

Ninety-nine community-dwelling women aged 60 and above were administered a battery that included neuropsychological tests of executive functions and memory, along with self-report measures of everyday memory complaints, depression, and anxiety.

RESULTS

Multivariate regression analyses revealed that a measure of response inhibition (Stroop Color-Word) accounted for unique variance in predicting memory complaints above and beyond measures of episodic memory, depression, and anxiety. Depression, however, accounted for the largest variance in memory complaints.

CONCLUSIONS

Higher frequency of everyday memory complaints among older adults was associated with decreased response inhibition independent of episodic memory and affective state. Further research is needed to understand the interrelationships among these and other predictors of everyday memory complaints.

Subjective memory and mood of Hong Kong Chinese adults with epilepsy

Clinicians are often confronted with the self-report of memory difficulties by patients. This study explored the possible correlates of subjective memory in 67 adult Chinese patients with epilepsy in Hong Kong. These correlates include epilepsy-related factors, mood state, and actual performance on neuropsychological tests. Results suggested that there exists no significant systematic relationship between subjective and illness-related factors such as seizure frequency, age at onset, and medication. Instead, stepwise regression analysis revealed that mood (anxiety) explained about 17% of the variance of subjective memory difficulties, whereas performance on a memory test accounted for only 8% of the variance. Findings are discussed in the light of the need to attend to the anxiety of patients with epilepsy in the process of rehabilitation.

Does Social Activity Influence the Accuracy of Subjective Memory Deficit? Findings from a British Community Survey

OBJECTIVES

To investigate the association between subjective memory deficit (SMD) and cognitive impairment in a community population and modification of this association by level of social activity.

DESIGN

Cross-sectional survey.

SETTING

A defined geographic catchment area in north London, England.

PARTICIPANTS

Six hundred fifty-four residents aged 65 and older.

MEASUREMENTS

SMD and cognitive impairment were derived from the relevant sections of the short Comprehensive Assessment and Referral Evaluation instrument, and social activity was derived from the Social Support Deficit Scale. Potential confounding factors taken into account included depression and level of functioning.

RESULTS

Twenty-nine percent of the sample reported SMD, which was associated with objective impairment (odds ratio (OR)=3.4, 95% confidence interval (CI)=2.1-5.8). This association was stronger in participants with higher social activity (OR=6.1, 95% CI=2.9-13.0) than in those who were more isolated (OR=1.8, 95% CI=0.8-3.8). The interaction with social activity remained significant after adjustment for potential confounding factors (P=.03).

CONCLUSION

A person's social environment influences the accuracy of SMD. This may reflect the level of cognitive demands encountered in daily life or the extent to which others notice cognitive impairment.

A clinical perspective of mild cognitive impairment: what radiologists should know

Mild cognitive impairment (MCI), a major risk factor for dementia, has an amnestic subtype that has a high probability of progressing to Alzheimer's disease. The rate of progression may be predicted by the severity of memory impairment at baseline, the severity of hippocampal atrophy, and, possibly, the presence of an epsilon4 allele of the apolipoprotein E gene. MCI can be diagnosed using purely clinical or a combination of clinical and neuropsychologic criteria. Treatment trials show no disease-modifying effect. The radiologists' role is to determine whether or not the hallmarks of degenerative and vascular disease of the brain are present, aiding in the diagnosis of the cause of MCI.