Ask and ye shall receive: behavioural specificity in the accuracy of subjective memory complaints

The Cognitive Function at Work Questionnaire (CFWQ): A new scale for measuring cognitive complaints in occupational population

Cognitive functioning is a relevant work and health related topic, however, validated methods to assess subjective cognitive complaints (SCC) at work are lacking. We introduce the Cognitive Function at Work Questionnaire (CFWQ) for measuring SCC in occupational settings. 1-year follow-up data of 418 employees from a Finnish public media service company was analyzed. Participants completed web-based CFWQ, cognitive tests and a broad set of questionnaires for evaluating depression, anxiety, insomnia, daytime sleepiness, burnout, stress, mental job burden, work ability, cognitive errors, and perceived health. The factor analysis yielded a model with the CFWQ subdomains: Memory, Language, Executive Function, Speed of Processing, Cognitive Control and Name Memory. The internal consistency (Cronbach's alpha = .87) and the test-retest constancy (ICC = .84) reflected good reliability. Correlation between the CFWQ and cognitive errors at work ranged from .25 to .64 indicating adequate concurrent validity. Employees with depression, insomnia and burnout symptoms had higher (p < .001) CFWQ scores than participants without these symptoms. Depression and burnout symptom severity as well as accumulation of mood, sleep, and psychosocial stressors were associated with higher CFWQ scores (p < .001 in all). The CFWQ appears psychometrically sound measure for the assessment of SCC in occupational population.

tDCS-Induced Memory Reconsolidation Effects: Analysis of Prominent Predicting Factors

Background

Memory impairment is among one of the greatest cognitive complaints in midlife and in old age. Considering the importance of good memory functioning in everyday life, it is crucial to study interventions that can reduce the natural decline in this cognitive function. Transcranial Magnetic Stimulation (TMS) studies have demonstrated that the lateral prefrontal cortex (PFC) plays a causal role in enhancing episodic memory recall through reconsolidation. Using a similar paradigm with transcranial direct current stimulation (tDCS) over the left lateral PFC, facilitation effects were observed in delayed memory retrieval in older adults with subjective memory complaints (SMCs) and amnestic Mild Cognitive Impairment (aMCI). However, it remains unclear which potential factors (i.e., tDCS group, cognitive reserve, education level, diagnosis and encoding performance) directly and/or indirectly modulate the tDCS-induced memory reconsolidation effects.

Methods

We reanalyzed data acquired in our previous tDCS studies with 22 SMC and 18 aMCI participants from the perspective of predicting delayed memory retrieval performance. These studies included a learning session on Day 1, a reactivation by a contextual reminder followed by 15 min of tDCS session on Day 2 (24 h after Day 1), and two retrieval sessions (free recall and recognition) tested on Days 3 and 30 (48 h and 30 Days after Day 1).

Results

Univariate models showed that tDCS group (sham vs. active) significantly predicted memory recognition (but not free recall), evidenced by higher scores in the active tDCS group than in sham group, confirming our previous results. Encoding performance and diagnosis (SMC vs. aMCI) significantly predicted memory retrieval, suggesting higher performances in individuals with SMC than in those with aMCI. Regarding cognitive reserve, higher leisure time activity subscores significantly predicted better memory recognition. Finally, multiple models did not show any tDCS group × predictor interaction effects, indicating that the effects of the predictors on retrieval occurred irrespective of tDCS group.

Conclusion

Our results shed light on predicting factors of episodic memory retrieval in this reconsolidation paradigm in individuals with SMC and aMCI. The findings suggest that multifactorial interventions program may be most promising to slow cognitive decline and delay the onset of dementia.

"Do I Have a Memory Problem? I Can't Recall": An Evaluation of Measurement Invariance in Subjective Reporting of Memory Symptoms among Persons with and without Objective HIV-Associated Memory Impairment

OBJECTIVE

Memory symptoms and objective impairment are common in HIV disease and are associated with disability. A paradoxical issue is that objective episodic memory failures can interfere with accurate recall of memory symptoms. The present study assessed whether responses on a self-report scale of memory symptoms demonstrate measurement invariance in persons with and without objective HIV-associated memory impairment.

METHOD

In total, 505 persons with HIV completed the Prospective and Retrospective Memory Questionnaire (PRMQ). Objective memory impairment (n = 141) was determined using a 1-SD cutoff on clinical tests of episodic memory. PRMQ measurement invariance was assessed by confirmatory factor analyses examining a one-factor model with increasing cross-group equality constraints imposed on factor loadings and item thresholds (i.e., configural, weak, and strong invariance).

RESULTS

Configural model fit indicated that identical items measured a one-factor model for both groups. Comparison to the weak model indicated that factor loadings were equivalent across groups. However, there was evidence of partial strong invariance, with two PRMQ item thresholds differing across memory impairment groups. Post hoc analyses using a 1.5-SD memory impairment cutoff (n = 77) revealed both partial weak and partial strong invariance, such that PRMQ item loadings differed across memory groups for three items.

CONCLUSIONS

The PRMQ demonstrated a robust factor structure among persons with and without objective HIV-associated memory impairment. However, on select PRMQ items, individuals with memory impairment reported observed scores that were relatively higher than their latent score, while items were more strongly associated with the memory factor in a group with greater memory impairment.

Gendered racism and subjective cognitive complaints among older black women: The role of depression and coping

Objective: Psychosocial stress is a risk factor for cognitive impairment and a potential pathway through which disparities in cognitive functioning emerge and disproportionately disadvantage older Black adults. Gendered racism is a psychosocial stressor that has negative implications for Black women's mental and physical health. This study tested the association between lifetime experiences of gendered racism and subjective cognitive complaints, taking into account the extent to which depressive symptoms and coping styles may explain this association. Method: Data from 75 older Black women (M_age = 62.43, SD = 6.23 years) were collected using an online survey assessing lifetime experiences of gendered racism, depressive symptoms, coping styles (i.e. spirituality, social support, problem-oriented/engagement, and disengagement), and subjective cognitive complaints (i.e. memory, attention, executive functioning, language, and overall cognition). The association between gendered racism and subjective cognitive complaints was examined with simple linear regression. Two mediation models examined depressive symptoms and coping styles as independent mediators of this association. Results: More gendered racism across the lifetime was associated with more subjective cognitive complaints separately through depressive symptoms and disengagement coping, but no other coping styles. Conclusion: Gendered racism is linked to increased subjective cognitive complaints via depressive symptoms and disengagement coping. The study highlights the importance of taking into account lived experiences (gendered racism) that are inextricably linked to social positioning (race and gender) within neuropsychology. Results evidence the negative impact of psychosocial stress, specifically gendered racism, on older Black women's subjective cognitive functioning, and illuminate avenues for clinical intervention and social justice advocacy.

Fostering Self-Management of Everyday Memory in Older Adults: A New Intervention Approach

Traditional memory strategy training interventions improve older adults' performance on tests of episodic memory, but have limited transfer to episodic memory tasks, let alone to everyday memory. We argue that an alternative approach is needed to assist older adults to compensate for age-related cognitive declines and to maintain functional capacity in their own natural ecologies. We outline a set of principles regarding how interventions can successfully train older adults to increase successful goal pursuit to reduce risks of everyday memory failures. We argue that training individuals to use metacognitive self-regulatory strategies to proactively manage formulation and pursuit of daily goals can compensate for age-related cognitive changes and increase the likelihood of goal attainment. We then describe an intervention approach that instantiates these principles in a multi-modal intervention that is unique in its three-phase approach: (1) individualized assessment of an individual's current approaches to self-regulation; (2) training memory strategies, self-management skills, and new habits of mind in a group training context; and (3) a behavioral shaping period in which individuals receive coaching and feedback on their efforts to use trained procedures to improve everyday cognition. A recently completed study conducted an initial test of the intervention, with highly encouraging results. We advocate further efforts to replicate, extend, and fine-tune this type of intervention. The ultimate goal is to be able to deliver the intervention in a way that increases its potential reach, including to subpopulations of older adults at risk for everyday cognitive impairments.

Social commitment toward prospective memory tasks in cognitively impaired non-demented individuals

Prospective memory, which is the ability to remember to perform an intended action in the future, has been found to be diminished in cognitively impaired non-demented individuals (CIND). This study investigated whether providing CIND with a social motive would improve their prospective memory performance. Accordingly, CIND and controls were asked to perform a prospective memory task which includes one of the following three conditions: a reward (i.e., a candy bar), no feedback, or a social motive (i.e., that performing the prospective memory task would be a favor for the experimenter). The participants also rated their commitment to achieve the three prospective conditions. Results showed lower prospective memory in CIND than in controls. Unlike controls, CIND did not benefit from the social motive; however, both populations demonstrated commitment toward this condition relative to the "reward" or "control" conditions. Although social motivation did not ameliorate prospective memory, CIND seem to demonstrate commitment to perform prospective memory tasks that involve social benefits for others.

Brain Computer Interfaces for Improving the Quality of Life of Older Adults and Elderly Patients

All people experience aging, and the related physical and health changes, including changes in memory and brain function. These changes may become debilitating leading to an increase in dependence as people get older. Many external aids and tools have been developed to allow older adults and elderly patients to continue to live normal and comfortable lives. This mini-review describes some of the recent studies on cognitive decline and motor control impairment with the goal of advancing non-invasive brain computer interface (BCI) technologies to improve health and wellness of older adults and elderly patients. First, we describe the state of the art in cognitive prosthetics for psychiatric diseases. Then, we describe the state of the art of possible assistive BCI applications for controlling an exoskeleton, a wheelchair and smart home for elderly people with motor control impairments. The basic age-related brain and body changes, the effects of age on cognitive and motor abilities, and several BCI paradigms with typical tasks and outcomes are thoroughly described. We also discuss likely future trends and technologies to assist healthy older adults and elderly patients using innovative BCI applications with minimal technical oversight.

Does the Key Task Measure Prospective Memory? Cautionary Findings from Parallel Studies in HIV Disease and Older Adults

OBJECTIVE

Despite its brevity and face validity, little is known about the construct validity of the naturalistic "Key Task" of prospective memory (PM), in which an examinee is instructed to remind the examiner at a designated time to retrieve keys (or another belonging) placed out of sight.

METHOD

Study 1 included 162 HIV+ and 52 HIV- comparison participants who completed the Key Task alongside well-validated measures of PM and a comprehensive neuropsychological battery that included everyday functioning measures. Study 2 used broadly parallel methods in 168 older community-dwelling Australians.

RESULTS

Overall, the Key Task was not reliably associated with neurocognitive functioning (including clinical and experimental measures of PM), PM symptoms, or everyday functioning in either sample.

CONCLUSIONS

The Key Task did not demonstrate compelling evidence of construct validity among persons living with HIV disease or older adults, which raises doubts regarding its clinical usefulness as a measure of PM.

Time frame, problem specificity, and framing: the implicit structures of questions about memory in older adults

Objective: Self-reported memory complaints in older adults are common and may be an early indicator of future cognitive decline or dementia. However, there is wide variety in self-reported memory items that lack consensus on what they intend to measure. This study explored the perspectives of older adults on items currently used to assess self-reported memory.Method: A convenience sample of community dwelling older adults (n = 51) completed a free card sorting task of 16 commonly used items assessing self-reports of memory problems. Multidimensional scaling (MDS) was used to extract dimensions that describe the similarities among the self-reported items. Visual maps were created to interpret the content of each dimension and validity of the dimensions was checked using the labels provided by the participants.Results: Three underlying dimensions describing the items were identified: time frame, problem specificity, and framing. These dimensions were supported by participant provided labels.Conclusion: The three identified dimensions suggest that the commonly used self-reported memory items assess substantively different aspects of the same broad concept. To avoid inconsistencies in assessing self-reported memory problems in older adults, we recommend researchers specify the aspects of memory problems that they are interested in and link their items to those aspects. In addition, they should develop items that are a good match to their research question rather than simply selecting items that are commonly used or appear to have high face validity.

Examination of discrepancies between subjective and objective memory with latent factors of the geriatric depression scale

OBJECTIVE

The purpose of the present study was to examine whether multiple constructs of depressive symptoms explained discrepancies between subjective (SM) and objective memory (OM) in older adulthood.

METHOD

A sub-sample (Range: 65-98 years, N = 606) of the 2000 Wave Panel 3 of the Long Beach Longitudinal Study was used to explore underlying latent factors within the Geriatric Depression Scale (GDS).

RESULTS

Four GDS factors were identified (Dysphoria, Vigor/Withdrawal, Cognitive Concerns, and Agitation); the factor solution was tested in a confirmatory factor analysis. Mechanisms of the GDS factors on SM and OM were tested by using structural equation modeling. Dysphoria negatively predicted OM, but not SM, suggesting that people who scored high in Dysphoria might not sense their memory failures although they obviously performed poorly in OM. Cognitive concerns negatively predicted SM, but not OM, suggesting that cognitive concerns were not influential for OM, but negatively affected one's evaluation of SM.

CONCLUSION

The study results have clinical implications since such relationships can be concealed while assessing depressive symptoms as a single GDS factor. Thus, the patterns of the GDS factors, SM, and OM derived from this study can be very useful for clinicians who conduct assessments on depressive symptoms and memory failures.

Behaviors and Strategies Supporting Everyday Memory in Older Adults

BACKGROUND

Little is known about the means by which older adults achieve memory-demanding goals in everyday life or alternatively about why they fail to do so.

OBJECTIVES

We conducted qualitative interviews to evaluate what older people do to support everyday memory functioning. A principal focus was on understanding the ways in which individuals use internal memory strategies and external memory aids.

METHODS

We interviewed 25 community-dwelling older adults (mean age 70 years) in a semi-structured interview. The transcribed results were coded by extracting segments of the interviews and classifying the responses into emergent categories. All coded interview segments were reviewed by category. Memos were created and relevant themes identified.

RESULTS

The older adults reported everyday memory failures (such as forgetting names), often without nominating explicit methods for avoiding these problems. They also reported using a number of external memory aids such as calendars and lists. Our interviews indicated this use was typically a part of complex routines and habits of living that often seemed vulnerable to errors. For instance, people would report filling medication organizers or completing to-do lists without mentioning plans for how to effectively use these aids later. Furthermore, they often reported reliance on spontaneous encoding and retrieval - for example, stating that they would routinely remember to perform important actions in the future.

CONCLUSIONS

Older adults' reported everyday memory failures were linked to suboptimal use of external memory aids and to a reliance on incidental learning and remembering. There is potential value for interventions that improve procedures for managing everyday life goals that rely on memory.

The effects of licit and illicit recreational drugs on prospective memory: a meta-analytic review

RATIONALE

There are no recent reports summarising the magnitude of prospective memory (PM) impairments in recreational drug users.

OBJECTIVE

We performed a meta-analysis of studies (with a parallel group design) examining PM performance in users of common recreational drugs (including alcohol and tobacco) who were not intoxicated during testing. Studies were also evaluated for the presence of methodological bias.

METHODS

Twenty-seven studies were included in the meta-analysis following literature searches of MEDLINE, EMBASE and PsycINFO. Effect sizes (standardised mean difference; SMD) were calculated separately for the effects of alcohol, cannabis, ecstasy, methamphetamine and tobacco use. The influences of drug use and study characteristics on effect sizes were explored using meta-regressions. Sources of study bias were also assessed.

RESULTS

Heavy drinkers and regular drug users tended to perform worse than controls on event and time-based PM tasks. Effect sizes (standardised mean differences; SMDs) for event-based PM impairment across the different drug-using groups/heavy drinkers ranged between - 1.10 and - 0.49, with no 95% CI crossing 0.00. SMDs for time-based PM ranged between - 0.98 and - 0.70. Except for the CIs associated with the ES for smokers' time-based PM performance, no CIs crossed 0.00.

CONCLUSIONS

Although all drug-using groups showed moderate-large impairments in event and time-based PM, effect sizes had low precision and moderate-high levels of heterogeneity. In addition, several methodological and reporting issues were identified in the majority of studies. As such, considerable uncertainty remains regarding the role of confounds and the magnitude of PM impairments in non-intoxicated recreational drug users.

Effects of Question Framing on Self-Reported Memory Concerns across the Lifespan

Background/Study Context: Evidence regarding whether there is an age-related increase in subjective memory concerns is mixed. The goal of this study was to investigate whether calling to mind specific instances of memory failures affects the likelihood that individuals report being concerned about their memory.

METHODS

Young, middle-aged, and older individuals responded to statements that probed general memory concerns (e.g., I am concerned about my memory) before or after probing the frequency of memory difficulties in specific everyday situations (e.g., I forget appointments).

RESULTS

We found no relationship between age and memory concern, and older compared to younger adults reported having fewer everyday memory failures. Furthermore, individuals of all ages were more likely to report being concerned about their memory if asked before relative to after rating the frequency of specific everyday memory failures.

CONCLUSION

Increasing age is associated with fewer reported difficulties with specific everyday memory situations, but people of all ages display anchoring effects on memory concern based on realistic occurrences of remembering. Our findings have implications for the measurement of self-reported memory as they show that the order of questions can influence responding.

Broad cognitive complaints but subtle objective working memory impairment in fibromyalgia patients

BACKGROUND

Cognitive dysfunction in fibromyalgia (FM) encompasses objective cognitive difficulties, as measured in neuropsychological tests, and self-reported cognitive complaints. Although it has been suggested that FM patients display problems in working memory, the data are inconsistent, and the overall working memory status of the patients is unclear. It is also not clear whether the working memory problems are related to cognitive complaints or how the dyscognition is affected by the characteristic clinical symptoms of FM.

METHODS

To clarify these aspects, we explored the neuropsychological performance for different components of working memory and the subjective self-perception of cognitive status in a sample of 38 women with FM. They were compared with a matched group of 32 healthy women.

RESULTS

Our findings suggested that the FM patients do not differ from healthy controls in their overall working memory functioning. Only a poor performance was found in a single task of visuospatial working memory, mediated by the presence of depressive symptoms, fatigue and pain. The FM patients also displayed a higher level of perception of cognitive difficulties than healthy controls, and this difference was mediated by depression and fatigue. Furthermore, cognitive complaints in FM patients were only associated with a lower verbal WM capacity.

DISCUSSION

FM patients have a subtle specific impairment in their working memory functioning, as well as elevated concern about their cognitive status. These findings suggest a disconnection between neuropsychological performance and subjective complaints. In FM patients, clinical variables such as pain, fatigue, and depression play an important role in dyscognition, as assessed by both objective and subjective measures, and should be taken into account in future research.

Prospective memory, retrospective memory, and individual differences in cognitive abilities, personality, and psychopathology

Although individual differences in processing speed, working memory, intelligence, and other cognitive functions were found to explain individual differences in retrospective memory (RetM), much less is known about their relationship with prospective memory (ProM). Moreover, the studies that investigated the relationship between ProM and cognitive functions arrived to contradictory conclusions. The relationship between ProM, personality, and psychopathology is similarly unsettled. Meta-analytic reviews of the relationships of ProM with aging and personality suggest that the contradictory findings may be due to widespread methodological problems plaguing ProM research including the prevalent use of inefficient, unreliable binary measures; widespread ceiling effects; failure to distinguish between various ProM subdomains (e.g., episodic ProM versus vigilance/monitoring); various confounds; and, importantly, small sample sizes, resulting in insufficient statistical power. Accordingly, in a large scale study with nearly 1,200 participants, we investigated the relationship between episodic event-cued ProM, episodic RetM, and fundamental cognitive functions including intelligence, personality, and psychopathology, using reliable continuous measures of episodic event-cued ProM. Our findings show that (a) continuous measures of episodic event-cued ProM were much more reliable than binary measures, (b) episodic event-cued ProM was associated with measures of processing speed, working memory, crystallized and fluid intelligence, as well as RetM, and that such associations were similar for ProM and RetM, (c) personality factors did not improve prediction of neither ProM nor RetM beyond the variance predicted by cognitive ability, (d) symptoms of psychopathology did not improve the prediction of ProM although they slightly improved the prediction of RetM, and (e) participants' sex was not associated with ProM but showed small correlations with RetM. In addition to advancing our theoretical understanding of ProM, our findings highlight the need to avoid common pitfalls plaguing ProM research.

Self-Management of Adherence to Prescribed Stimulants in College Students With ADD/ADHD

OBJECTIVE

We examined how college students manage ADHD medication and how beliefs regarding the medication and attitudes of friends and families influence adherence on weekdays and weekends during an academic semester.

METHOD

Undergraduate students ( n = 53) responded to an online survey to report their adherence, their beliefs about the effects of the medication, and their perception of important others' views of adherence.

RESULTS

Students chose to take more medication on weekdays than weekends. On weekdays, beliefs that the medications enhance academic performance and social skills influenced adherence, and on weekends, beliefs regarding negative side effects were important. The perception that medication leads to a loss of authentic self reduced adherence at both times. Generally, students believed that important others wanted them to take medication.

CONCLUSION

Students were actively weighing the costs and benefits of taking their ADHD medication and consciously adjusting adherence levels from day to day.

Decomposing the relationship between cognitive functioning and self-referent memory beliefs in older adulthood: what's memory got to do with it?

With advancing age, episodic memory performance shows marked declines along with concurrent reports of lower subjective memory beliefs. Given that normative age-related declines in episodic memory co-occur with declines in other cognitive domains, we examined the relationship between memory beliefs and multiple domains of cognitive functioning. Confirmatory bi-factor structural equation models were used to parse the shared and independent variance among factors representing episodic memory, psychomotor speed, and executive reasoning in one large cohort study (Senior Odyssey, N = 462), and replicated using another large cohort of healthy older adults (ACTIVE, N = 2802). Accounting for a general fluid cognitive functioning factor (comprised of the shared variance among measures of episodic memory, speed, and reasoning) attenuated the relationship between objective memory performance and subjective memory beliefs in both samples. Moreover, the general cognitive functioning factor was the strongest predictor of memory beliefs in both samples. These findings are consistent with the notion that dispositional memory beliefs may reflect perceptions of cognition more broadly. This may be one reason why memory beliefs have broad predictive validity for interventions that target fluid cognitive ability.

Relate it! Objective and subjective evaluation of mediator-based strategies for improving source memory in younger and older adults

The present study examined younger and older adults' ability to improve their source memory for different types of sources through imaginal and verbal (sentence) mediators. Younger (18-29 years) and older (60-75 years) adults' strategy use and source memory for either text-type (bold vs italic) or person (woman vs man) sources was assessed; strategy use was either spontaneous or the generation of imaginal mediators was instructed before encoding. Younger and older adults did not differ in spontaneous use of mediator-based strategies; however, older adults generated more images but fewer verbal mediators than younger adults. Participants were able to increase mediator generation when instructed to, resulting in substantial increases in both item and source memory for the instructed conditions in both age groups. Use of verbal mediators was more likely for the more concrete person sources for which source memory was generally better. Importantly, these objective benefits of mediator-based strategies translated into subjective benefits for both younger and older adults: Increased use of either mediator type was correlated with lower experienced task difficulty; the instructions to use imaginal mediators resulted in a significant decrease in difficulty ratings on the group level. Participants were generally able to monitor mediator benefits to both item and source memory and accurately judged mediator strategies (especially imagery) as more effective than repetition; older adults, however, rated all strategies as less effective than younger adults. Implications of these findings, especially for neuropsychological studies on source monitoring, are discussed.

Speed of Visual Search in Old Age: 1950 to 2016

OBJECTIVES

To review work on the effects of old age on speed of visual search and of discriminations between signals and choices of responses between 1950 and 2016.

METHODS

Literature review and Brain Google.

RESULTS

Mild existential despondency.

DISCUSSION

Models for age changes in discrimination between signals and choices of responses have been based on comparisons of speed. The concept of speed has been used in four distinct ways: as a directly measured task performance index, as a hypothetical functional system performance characteristic, as a factor in psychometric models computing mutual variance in calendar age and as a neurophysiological performance characteristic. Since 1950, these measures have, in turn, determined models for speed of perceptual discriminations. Since the 1990s, advances in neuroimaging have not only transformed the data available, but also the nature of the questions that we ask.

Measuring cognitive complaints in breast cancer survivors: psychometric properties of the patient's assessment of own functioning inventory

PURPOSE

Cognitive complaints are a concern for breast cancer survivors. Among various published measures for cognitive complaints, the Patient's Assessment of Own Functioning Inventory (PAOFI) is one of the few assessing a spectrum of cognitive abilities, including those most commonly reported by breast cancer survivors. This study aimed to examine the psychometric properties of the PAOFI in breast cancer survivors.

METHODS

An exploratory factor analysis was conducted with a sample of breast cancer survivors (n = 189) who had completed all primary cancer treatments. Construct validity was examined by correlating factor scores with valid measures of cognitive complaints, fatigue, and quality of life. Reliability was measured by internal consistency of the items in each factor within this sample, a separate sample of breast cancer survivors with high persistent cognitive complaints (n = 72), and healthy controls (n = 63). Factor scores were compared across the three samples.

RESULTS

A five-factor structure similar to the PAOFI standardization study was found, with factors related to executive functioning (accounting for most of the variance), two aspects of memory functioning, language, and motor/sensory-perceptual abilities. Factor scores highly correlated with measures of cognitive complaints, fatigue, and quality of life. Executive functioning and memory-related factors achieved adequate reliability across samples. Scores were significantly different across the three samples as expected.

CONCLUSIONS

The PAOFI is a reliable and valid tool for measuring cognitive complaints in breast cancer survivors.

Methods and Instruments to Evaluate Cognitive Function in Chronic Pain Patients: A Systematic Review

OBJECTIVE

We aimed to systematically review the methods and instruments used to evaluate cognitive function in chronic pain (CP) patients.

METHODS

A sensitive search strategy was designed using five databases. Based on the objectives and methodology, we selected cross-sectional studies on adults with chronic non-cancer pain in which cognitive function was assessed using validated instruments. The characteristics of the subjects, control groups, and other variables that might affect cognitive function, and the instruments used, were extracted from each article.

RESULTS

In the 42 articles identified, 53 instruments were used to assess cognitive function. Chronic pain criteria were defined in 83.3% of the articles and more than half (57.1%) included single diagnosis samples, with fibromyalgia being the most frequent studied (75%). Patients with prior cognitive impairment were excluded in 61.9% of the studies, and a control group was included in 64.3% of the studies. In most cases potential confounding variables were evaluated. More than 14% of the studies used self-report measures, and 73.8% used neuropsychological instruments, particularly for assessing attention (30%) and memory (27.5%). None of the instruments were specifically validated for pain patients and only five studies analyzed the psychometric properties of the instruments.

CONCLUSIONS

Various instruments and methods were used to assess cognitive function in CP patients, particularly fibromyalgia patients, but also other cohorts with well-defined CP. The instruments used had been validated, but not for pain populations, thus they require specific adaptation and validation to be used in CP patients. Certain recommendations are made in order to improve the evaluation of cognitive function in these patients.

Perceived Cognitive Impairment among African American elders: health and functional impairments in daily life

OBJECTIVES

The Center for Disease Control began to assess Perceived Cognitive Impairment in 2009, yet there has been no in-depth study of how perceived decline in thinking or memory skills may be associated to the health and lifestyle of an independent community-dwelling older person. Among urban-dwelling older African Americans who are at elevated risk for cognitive impairment and dementia, we know even less regarding the interaction of these risk factors.

METHOD

Five hundred and one African American elders (n=501) between the ages of 55 and 95 with an average age of 70.73 years (SD=8.6 years) participated in telephone interviews.

RESULTS

Approximately one-third of the elders reported that their memory, thinking skills, or ability to reason was worse than a year ago (n=150; 29.9%) and 25% of this group (n=38) reported that this Perceived Cognitive Impairment impacted their daily activities and/or warranted a consultation with their doctor. Bivariate analyses indicated that Perceived Cognitive Impairment was associated with increased health problems, mobility limitations, depressed mood, and lower social functioning.

CONCLUSION

Elders who reported that cognitive problems impacted their daily functioning reported the greatest health and mental health problems. Perceived Cognitive Impairment is an important health variable with implications for an older adult's overall health, mobility, and mental health.

The sensitivity and specificity of subjective memory complaints and the subjective memory rating scale, deterioration cognitive observee, mini-mental state examination, six-item screener and clock drawing test in dementia screening

BACKGROUND

The effectiveness of dementia screening depends on the availability of suitable screening tools with good sensitivity and specificity to confidently distinguish normal age-related cognitive decline from dementia. The aim of this study was to evaluate the discriminant validity of 7 screening measures for dementia.

METHODS

A sample of 140 participants aged ≥60 years living in a residential facility for the aged were assessed clinically and assigned caseness for dementia using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised diagnostic criteria. Sensitivity and specificity of a selection of the following screening measures were tested using receiver operating characteristic (ROC) analysis for individual and combined tests: the Mini-Mental State Examination (MMSE), Six-Item Screener (SIS), Subjective Memory Complaint, Subjective Memory Complaint Clinical (SMCC), Subjective Memory Rating Scale (SMRS), Deterioration Cognitive Observee (DECO) and the Clock Drawing Test (CDT).

RESULTS

Using ROC analyses, the SMCC, MMSE and CDT were found to be 'moderately accurate' in screening for dementia with an area under the curve (AUC) >0.70. The AUCs for the SIS (0.526), SMRS (0.661) and DECO (0.687) classified these measures as being 'less accurate'. At recommended cutoff scores, the SMCC had a sensitivity of 90.9% and specificity of 45.7%; the MMSE had a sensitivity of 63.6% and a specificity of 76.0%, and the CDT had a sensitivity of 44.4% and a specificity of 88.9%. Combining the SMCC and MMSE did not improve their predictive power except for a modest increase when using the sequential rule.

CONCLUSION

The SMCC is composed of valid screening questions that have high sensitivity, are simple to administer and ideal for administration at the community or primary health care level as a first level of 'rule-out' screening. The MMSE can be included at a second stage of screening at the general hospital level and the CDT in specialist clinical settings. Sequential use of the SMCC and MMSE will improve the specificity of the former and the sensitivity of the latter.

Do People Have Insight Into Their Abilities? A Metasynthesis

Having insight into one’s abilities is essential, yet it remains unclear whether people generally perceive their skills accurately or inaccurately. In the present analysis, we examined the overall correspondence between self-evaluations of ability (e.g., academic ability, intelligence, language competence, medical skills, sports ability, and vocational skills) and objective performance measures (e.g., standardized test scores, grades, and supervisor evaluations) across 22 meta-analyses, in addition to considering factors that moderate this relationship. Although individual meta-analytic effects ranged from .09 to .63, the mean correlation between ability self-evaluations and performance outcomes across meta-analyses was moderate ( M = .29, SD = .11). Further, the relation was stronger when self-evaluations were specific to a given domain rather than broad and when performance tasks were objective, familiar, or low in complexity. Taken together, these findings indicate that people have only moderate insight into their abilities but also underscore the contextual factors that enable accurate self-perception of ability.

Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire (SASCI-Q)--a research tool discriminating between subjectively cognitively impaired patients and healthy controls

BACKGROUND

Subjective cognitive impairment (SCI) is a potential early marker for actual cognitive decline. The cognitive manifestation of the SCI stage is, however, largely unknown. Self-report instruments developed especially for use in the SCI population are lacking, and many SCI studies have not excluded mild cognitive impairment and dementia. We developed and tested a patient-based questionnaire on everyday cognitive function aiming to discriminate between patients with subjective, but not objective, cognitive impairment and healthy controls.

METHODS

Individuals experiencing cognitive impairment were interviewed to generate a pool of items. After condensing to 97 items, we tested the questionnaire in 93 SCI patients seeking care at a memory clinic (age M = 64.5 years, Mini-Mental State Examination (MMSE) M = 29.0) and 50 healthy controls (age M = 69.6 years, MMSE M = 29.3). Further item reduction was conducted to maximize that remaining items would discriminate between SCI patients and controls, using a conservative α level and requiring medium to high effect sizes. Internal consistency reliability and convergent validity was subsequently examined.

RESULTS

Forty-five items discriminated between the groups, resulting in the Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire (SASCI-Q). Internal consistency was high and correlations to a single question on memory functioning were of medium to large sizes. Most remaining items were related to the memory domain.

CONCLUSION

The SASCI-Q discriminates between SCI patients and healthy controls and demonstrates satisfying psychometric properties. The instrument provides a research method for examining SCI and forms a foundation for future examining which SCI symptoms predict objective cognitive decline. The cognitive manifestation of the SCI stage is mostly related to experiences of memory deficits.

Plasticity of prospective memory through a familiarization intervention in old adults

Younger adults consistently outperform older adults in laboratory prospective memory tasks. This study examines the effectiveness of an intervention that familiarizes older adults with the sequence of ongoing events to compensate their reduced prospective memory performance. We compared performance and electrophysiological measures of an intervention group (N = 20, 69-83 years) receiving a familiarization intervention to an individually matched control group (N = 20). As ongoing activity a 2-back working memory task was administered. Neural correlates were studied using event related potentials (ERPs) and source localization (standardized low-resolution brain electromagnetic tomography). Behavioural data showed faster reaction times in correct prospective trials and fewer prospective false alarms in the familiarization intervention group. ERP analyses displayed differential patterns for the two groups and source localization measures distinctively presented group differences in prospective memory trials with the control group recruiting more resources for a successful prospective memory performance. Together our data support the hypothesis that the familiarity with the sequence of ongoing events increases prospective memory performance and that this might be based on a higher efficiency of attentional monitoring resources and evaluation processes in the intervention group.

The role of prospective memory in medication adherence: a review of an emerging literature

Although neurocognitive impairment is an established risk factor for medication nonadherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one's ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence.

HIV-associated prospective memory impairment in the laboratory predicts failures on a semi-naturalistic measure of health care compliance

HIV-associated neurocognitive impairment, particularly in the domain of prospective memory (ProM), increases the risk of poor everyday functioning outcomes, including medication non-adherence. However, whether ProM plays a role in health care compliance outside of the realm of medication adherence remains to be determined. This study evaluated the hypothesis that ProM is an independent predictor of failure to comply with non-medication-related instructions akin to those commonly given by health care providers. Participants were 139 HIV-infected adults who underwent medical, psychiatric, and neuropsychological assessments, including a laboratory-based measure of ProM. To assess real-world compliance, participants were instructed to call the examiner 24 hours after the evaluation and report how many hours they had slept. Individuals who failed to correctly comply with these instructions (n = 104) demonstrated significantly lower performance on both time- and event-based ProM at baseline than the compliant group (n = 35), an effect that was primarily driven by errors of omission. ProM remained a significant predictor of noncompliance after controlling for potential confounders, including demographics (e.g., education), traditional cognitive measures of retrospective memory and executive functions, and psychiatric factors (e.g., depression). Results support the hypothesis that ProM plays a unique role in compliance with health care instructions for HIV disease management and may inform interventions designed to improve treatment outcomes.

Are older adults more social than younger adults? Social importance increases older adults' prospective memory performance

The purpose of this study was to explore the influence of social importance on prospective remembering in younger and older adults as a possible factor contributing to the age-prospective memory paradox. Using a between-subjects design, 40 younger and 40 older adults worked on a time-based prospective memory task in which social importance was varied. Overall, younger adults outperformed older adults in the prospective memory task. Importantly, in contrast to younger adults, older adults' prospective memory performance was significantly better in the social importance condition than in the standard condition. This interaction was not reflected in participants' time-monitoring behaviour. Findings are discussed in the context of recent prospective memory theories.

Timing is everything: antiretroviral nonadherence is associated with impairment in time-based prospective memory

Nonadherence to combination antiretroviral (ARV) therapies (cART) is highly prevalent and significantly increases the risk of adverse human immunodeficiency virus (HIV) disease outcomes. The current study evaluated the hypothesis that prospective memory-a dissociable aspect of episodic memory describing the ability to execute a future intention-plays an important role in successful cART adherence. Seventy-nine individuals with HIV infection who were prescribed at least one ARV medication underwent a comprehensive neuropsychological and neuromedical evaluation prior to completing a 1-month observation of their cART adherence as measured by electronic medication monitoring. Nonadherent individuals (n = 31) demonstrated significantly poorer prospective memory functioning as compared to adherent persons (n = 48), particularly on an index of time-based ProM (i.e., elevated loss of time errors). Deficits in time-based prospective memory were independently predictive of cART nonadherence, even after considering the possible influence of established predictors of adherence, such as general cognitive impairment (e.g., retrospective learning and memory) and psychiatric comorbidity (e.g., depression). These findings extend a nascent literature showing that impairment in time-based prospective memory significantly increases the risk of medication nonadherence and therefore may guide the development of novel strategies for intervention. (JINS, 2009, 15, 42-52.).

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?

In this monograph, we ask whether various kinds of intellectual, physical, and social activities produce cognitive enrichment effects-that is, whether they improve cognitive performance at different points of the adult life span, with a particular emphasis on old age. We begin with a theoretical framework that emphasizes the potential of behavior to influence levels of cognitive functioning. According to this framework, the undeniable presence of age-related decline in cognition does not invalidate the view that behavior can enhance cognitive functioning. Instead, the course of normal aging shapes a zone of possible functioning, which reflects person-specific endowments and age-related constraints. Individuals influence whether they function in the higher or lower ranges of this zone by engaging in or refraining from beneficial intellectual, physical, and social activities. From this point of view, the potential for positive change, or plasticity, is maintained in adult cognition. It is an argument that is supported by newer research in neuroscience showing neural plasticity in various aspects of central nervous system functioning, neurochemistry, and architecture. This view of human potential contrasts with static conceptions of cognition in old age, according to which decline in abilities is fixed and individuals cannot slow its course. Furthermore, any understanding of cognition as it occurs in everyday life must make a distinction between basic cognitive mechanisms and skills (such as working-memory capacity) and the functional use of cognition to achieve goals in specific situations. In practice, knowledge and expertise are critical for effective functioning, and the available evidence suggests that older adults effectively employ specific knowledge and expertise and can gain new knowledge when it is required. We conclude that, on balance, the available evidence favors the hypothesis that maintaining an intellectually engaged and physically active lifestyle promotes successful cognitive aging. First, cognitive-training studies have demonstrated that older adults can improve cognitive functioning when provided with intensive training in strategies that promote thinking and remembering. The early training literature suggested little transfer of function from specifically trained skills to new cognitive tasks; learning was highly specific to the cognitive processes targeted by training. Recently, however, a new generation of studies suggests that providing structured experience in situations demanding executive coordination of skills-such as complex video games, task-switching paradigms, and divided attention tasks-train strategic control over cognition that does show transfer to different task environments. These studies suggest that there is considerable reserve potential in older adults' cognition that can be enhanced through training. Second, a considerable number of studies indicate that maintaining a lifestyle that is intellectually stimulating predicts better maintenance of cognitive skills and is associated with a reduced risk of developing Alzheimer's disease in late life. Our review focuses on longitudinal evidence of a connection between an active lifestyle and enhanced cognition, because such evidence admits fewer rival explanations of observed effects (or lack of effects) than does cross-sectional evidence. The longitudinal evidence consistently shows that engaging in intellectually stimulating activities is associated with better cognitive functioning at later points in time. Other studies show that meaningful social engagement is also predictive of better maintenance of cognitive functioning in old age. These longitudinal findings are also open to important rival explanations, but overall, the available evidence suggests that activities can postpone decline, attenuate decline, or provide prosthetic benefit in the face of normative cognitive decline, while at the same time indicating that late-life cognitive changes can result in curtailment of activities. Given the complexity of the dynamic reciprocal relationships between stimulating activities and cognitive function in old age, additional research will be needed to address the extent to which observed effects validate a causal influence of an intellectually engaged lifestyle on cognition. Nevertheless, the hypothesis that an active lifestyle that requires cognitive effort has long-term benefits for older adults' cognition is at least consistent with the available data. Furthermore, new intervention research that involves multimodal interventions focusing on goal-directed action requiring cognition (such as reading to children) and social interaction will help to address whether an active lifestyle enhances cognitive function. Third, there is a parallel literature suggesting that physical activity, and aerobic exercise in particular, enhances older adults' cognitive function. Unlike the literature on an active lifestyle, there is already an impressive array of work with humans and animal populations showing that exercise interventions have substantial benefits for cognitive function, particularly for aspects of fluid intelligence and executive function. Recent neuroscience research on this topic indicates that exercise has substantial effects on brain morphology and function, representing a plausible brain substrate for the observed effects of aerobic exercise and other activities on cognition. Our review identifies a number of areas where additional research is needed to address critical questions. For example, there is considerable epidemiological evidence that stress and chronic psychological distress are negatively associated with changes in cognition. In contrast, less is known about how positive attributes, such as self-efficacy, a sense of control, and a sense of meaning in life, might contribute to preservation of cognitive function in old age. It is well known that certain personality characteristics such as conscientiousness predict adherence to an exercise regimen, but we do not know whether these attributes are also relevant to predicting maintenance of cognitive function or effective compensation for cognitive decline when it occurs. Likewise, more information is needed on the factors that encourage maintenance of an active lifestyle in old age in the face of elevated risk for physiological decline, mechanical wear and tear on the body, and incidence of diseases with disabling consequences, and whether efforts to maintain an active lifestyle are associated with successful aging, both in terms of cognitive function and psychological and emotional well-being. We also discuss briefly some interesting issues for society and public policy regarding cognitive-enrichment effects. For example, should efforts to enhance cognitive function be included as part of a general prevention model for enhancing health and vitality in old age? We also comment on the recent trend of business marketing interventions claimed to build brain power and prevent age-related cognitive decline, and the desirability of direct research evidence to back claims of effectiveness for specific products.

The nature of subjective cognitive complaints of older adults

The current study investigated the nature of subjective cognitive complaints of older adults in relation to a broad array of individual cognitive functions known to decline with age. A 60-item questionnaire was developed to examine: (1) whether older adults experience problems with these cognitive functions (problems with cognition); (2) the extent to which these problems have changed over time (changes in cognition); and (3) whether these cognitive decrements interfere with their daily functioning (difficulties with cognition). The cognitive functions examined were attention, processing speed, working memory, executive function, and memory. One hundred eight-two community-dwelling adults (aged 65-92 years) completed the questionnaire. While participants reported problems with, and changes in, each cognitive function, working memory was recorded as most problematic and demonstrated the most change. Yet, although older adults experience problems with cognition and report changes in cognitive functioning over time, these did not necessarily produce difficulties in daily life. This points to the existence of support mechanisms that may assist older adults in cognitively demanding situations.

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.

Effects of age and ability on self-reported memory functioning and knowledge of memory aging

The authors examined the effects of age and ability (as measured by education and verbal ability) on self-reported memory functioning in adulthood. In Study 1, the age and ability groups responded similarly to the Cognitive Failures Questionnaire (D. E. Broadbent, P. F. Cooper, P. Fitzgerald, & K. R. Parkes, 1982), but differences emerged when the authors examined specific items tapping prospective and retrospective memory. In Study 2, the authors found age and ability differences in self-reported memory functioning, as measured by the Memory Functioning Questionnaire (M. J. Gilewski, E. M. Zelinski, & K. W. Schaie, 1990) and in knowledge of memory aging, as measured by the Knowledge of Memory Aging Questionnaire (K. E. Cherry, R. L. West, C. M. Reese, M. P. Santa Maria, & M. Yassuda, 2000). In both studies, differences in self-reported functioning were not related to objective memory performance. In the second study, knowledge was positively related to performance. Implications for conceptions of metamemory and memory aging are considered.

Prospective memory complaints can be predicted by prospective memory performance in older adults

BACKGROUND/AIMS

The aim of this study was to explore if prospective memory complaints reflect actual prospective memory performance in older adults.

METHODS

Three hundred and sixty-four older adults aged 65-80 years were investigated with regard to prospective memory complaints, prospective memory test performance, self-reported depressive symptoms, and self-reported memory capacity.

RESULTS

Separate analyses revealed that about half of the participants showed a significant relation between subjective and objective prospective memory.

CONCLUSION

Older adults appear to be heterogeneous with regard to the association between objective and subjective prospective memory. For older adults with relatively few depressive symptoms and memory concerns, prospective memory complaints may serve as a valid criterion in the assessment of prospective memory ability.

Retrieval experience in prospective memory: Strategic monitoring and spontaneous retrieval

According to the multi-process model of prospective memory (McDaniel & Einstein, 2000), performance in a prospective memory task may be due to spontaneous retrieval processes or due to strategic monitoring. Spontaneous retrieval is typically accompanied by a pop up experience and strategic monitoring by a search experience. In this study we report two experiments with young adults in which we systematically investigated whether retrieval experience differed across experimental conditions. In Experiment 1 some prospective memory targets were preceded by associated primes. We expected that presenting primes would enhance performance by an automatic activation of the intention and hence lead to an increase in pop up experiences. In Experiment 2 half of the participants received instructions containing information about the specific context in which the prospective memory task would occur, whereas the other half of the participants received no such information. We expected that specific context instructions would enhance performance by legitimate anticipation of the prospective memory task and hence would lead to an increase in search experiences. The results confirmed these expectations. They indicate that the assessment of retrieval experience can provide valuable insights into the processes underlying prospective memory performance. They also suggest that retrieval experience can vary systematically across experimental situations as predicted by the multi-process model.

Memory beliefs and function in fibromyalgia patients

OBJECTIVE

The aim of this study was to investigate memory beliefs and their relationship to actual memory function in fibromyalgia (FM) patients.

METHODS

Twenty-three FM patients, 23 age- and education-matched controls, and 22 older controls completed the Metamemory in Adulthood (MIA) questionnaire, which assessed beliefs about seven aspects of memory function. Group differences on the seven scales were assessed, and scores on the capacity scale were correlated with objective memory performance.

RESULTS

FM patients reported lower memory capacity and more memory deterioration than did either control group. Patients reported lower control or self-efficacy over memory, higher achievement motivation, higher strategy use, and higher anxiety about memory than age-matched controls did. Among the patients, perceived capacity, achievement motivation, and self-efficacy were significantly correlated with objective memory performance on a recall task.

CONCLUSION

FM patients' complaints about memory function have some accuracy.

Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach

The question of whether and how subjective cognitive complaints are related to actual cognitive performance represents a central issue in applied cognitive aging research. Until recently, however, many studies have failed to find a strong association between subjective cognitive complaints and actual cognitive performance. In our study, we examine two alternative explanations: a) for methodological reasons, strong associations exist only when latent changes rather than differences are examined, and b) strong associations exist only between changes in depression and complaints, not between changes in cognitive performance and complaints. With 427 participants (M = 63 years) and two measurements, we examine both the relation between functioning, complaints, and depressive affect at each measurement point, and the relation between changes in functioning, changes in complaints, and changes in depressive affect between the measurement points with latent difference variables. The results indicate that there are substantial relations between changes in functioning, changes in depression, and changes in complaints.

Lateralization of Deficit in Self-Awareness of Memory in Patients with Intractable Epilepsy

PURPOSE

Memory disorders are prominent among patients with intractable epilepsy. It has, however, been frequently observed that subjective memory complaints of these patients did not match their performance on objective memory tests. This discrepancy may reflect emotional, cognitive, or self-awareness deficits among these individuals. The aim of the current study was to explore the interference of cerebral dysfunction on accuracy of self-appraisal for memory.

METHODS

The degree of concordance between self-perception of memory function, as measured by a visual analogue scale, and actual performance on memory tests was computed in 35 patients who were candidates for epilepsy surgery and demographically matched normal control subjects. The difference between the self-estimated memory ability and performance on memory tests and its relation to the laterality of an epileptogenic lesion, cognitive factors, and affective status was then examined.

RESULTS

The results show that the discrepancy between the self-estimated memory ability and performance on memory tests in patients with right hemisphere epileptogenic lesions was significantly larger in magnitude compared with that in patients with left hemisphere lesions and demographically matched control subjects (p = 0.001). Furthermore, whereas patients with left hemisphere lesions and normal controls had about an equal number of positive and negative discrepancy scores, all patients with right hemisphere lesions had positive discrepancy scores, suggesting a tendency for overestimation of memory abilities.

CONCLUSIONS

These results suggest that right hemisphere lesions may introduce a systematic bias in self-awareness for memory. This bias may color patients' perceptions of self and others, affecting their perceptions of the quality of life, and necessitating an adjustment of the treatment goals and procedures.