A brief metacognition questionnaire for the elderly: comparison with cognitive performance and informant ratings the Cache County Study

Escala de Avaliação da Metacognição em Idosos: Evidências de Validade e Consistência Interna

RESUMO O objetivo deste estudo foi investigar as evidências de validade e precisão de um instrumento que avalia a metacognição em idosos, denominado Escala Metacognitiva Sênior (EMETA-S). Participaram da amostra 194 idosos de ambos os sexos, que responderam a própria EMETA-S, composta por 74 itens. A análise fatorial exploratória com rotação Varimax revelou a presença de dois fatores, responsáveis por 27,18% da variância da escala. Após a exclusão de itens, a EMETA-S ficou composta por 27 itens, com consistência interna de 0,85. Não foram encontradas diferenças significativas entre a média do desempenho em relação às variáveis: sexo, escolaridade e idade dos participantes. A análise das evidências de validade e precisão indicou adequação dos itens ao conceito proposto e boa consistência interna da escala.

Detection of cognitive impairment using self-rated AD8 and informant-reported AD8

BACKGROUND/PURPOSE

Screening of dementia can help to initiate proper management of the disorder. The use of the Ascertain Dementia 8-item Questionnaire (AD8) in screening has been promoted in Taiwan recently. The purpose of this study was to compare the psychometric properties and appropriateness of informant-reported and self-rated AD8 in cognitive impairment screening in Taiwan.

METHODS

The AD8 were administered to 153 participants and their informants recruited from two neurology out-patient clinics. The discriminative abilities for early cognitive impairment [Clinical Dementia Rating scale (CDR) 0.5 and 1] of informant-based and self-rating AD8 were determined and compared with their areas under the receiver operating curve. κ coefficients representing the agreement between self-rated and informant-reported AD8 scores were also calculated.

RESULTS

Participants and their informants were aged 76.9 years and 56.0 years on average, respectively. Only informant-reported AD8 was significantly associated with CDR level (Spearman ρ=0.469, p<0.001) and Cognitive Abilities Screening Instrument score (Spearman ρ=-0.458, p<0.001). The item-by-item agreements between self-rated and informant-reported AD8 were poor (κ coefficients: -0.030 to 0.206). The area under the receiver-operator characteristic curve was 0.59 for self-rated AD8 scores, and 0.77 for informant-reported AD8 scores, indicating that the discriminating ability of AD8 scores between CDR 0 and CDR 0.5 or greater is better when reported by informant than when rated by self.

CONCLUSION

Informant-rated AD8 gave more accurate screening results than self-reported AD8 in an out-patient clinic setting.

Talk the talk and walk the walk. Evaluation of autonomy in aging and Alzheimer disease by simulating instrumental activities of daily living: the S-IADL

Objective

The autonomy of individuals is linked to the achievement of instrumental activities of daily living that require complex behavior. In the elderly, the assessment of autonomy is usually based on questionnaires that have strong subjective constraints. Considering this fact, we tested elderly healthy adults and Alzheimer disease patients using a new measure, the S-IADL (Simulation of Instrumental Activities for Daily Living), to assess the ability to perform effectively activities of daily living.

Method

The S-IADL shares many items with the well-known IADL questionnaire proposed by Lawton & Brody (1969). However, as opposed to the IADL, the assessment of autonomy is not based on the completion of a questionnaire but requires the realization or simulation of various activities of daily living. Eighty-three participants (69 healthy elderly, and 14 Alzheimer Disease patients) completed the IADL and performed the S-IADL assessment.

Results

Results revealed that, like the IADL, the S-IADL is able to identify AD patients who are likely to encounter difficulties in performing everyday activities, and no major differences were found between the IADL and the S-IADL.

Conclusions

We outlined some advantages for prefering, in certain situation, this new tool based on simulation of activities in functional evaluation. Finally, we discuss the main limits of the S-IADL that should be investigated prior to its utilization by clinicians.

Mnemonic anosognosia in Alzheimer's disease is caused by a failure to transfer online evaluations of performance: Evidence from memory training programs

INTRODUCTION

There is a debate about the ability of patients with Alzheimer's disease to build an up-to-date representation of their memory function, which has been termed mnemonic anosognosia. This form of anosognosia is typified by accurate online evaluations of performance, but dysfunctional or outmoded representations of function more generally.

METHOD

We tested whether people with Alzheimer's disease could adapt or change their representations of memory performance across three different six-week memory training programs using global judgements of learning.

RESULTS

We showed that whereas online assessments of performance were accurate, patients continued to make inaccurate overestimations of their memory performance. This was despite the fact that the magnitude of predictions shifted according to the memory training. That is, on some level patients showed an ability to change and retain a representation of performance over time, but it was a dysfunctional one. For the first time in the literature we were able to use an analysis using correlations to support this claim, based on a large heterogeneous sample of 51 patients with Alzheimer's disease.

CONCLUSION

The results point not to a failure to retain online metamemory information, but rather that this information is never used or incorporated into longer term representations, supporting but refining the mnemonic anosognosia hypothesis.

How valid are subjective ratings of prospective memory in mild cognitive impairment and early dementia?

BACKGROUND

Prospective memory refers to memory for future intentions and is a critical predictor of functional capacity in late adulthood. For many other cognitive abilities, self- and informant-rated methods of assessment are routinely used to guide clinical decision-making. However, little is known about the validity (and consequently the clinical utility) of subjective reports of prospective memory difficulties.

OBJECTIVE

The aim of this study was to compare clinical [mild cognitive impairment (MCI), dementia] and nonclinical older adults (healthy controls) on self- and informant-rated versions of prospective and retrospective memory function, as well as objective measures of prospective memory. Critical here was not only the assessment of between-group differences, but also whether these different methods of assessing memory function would show appropriate convergent and discriminant validity.

METHODS

A total of 138 participants aged between 64 and 92 years, diagnosed with dementia (n=37), MCI (n=48) or no impairment (n=53), were asked to complete self- and informant-rated versions of the Prospective and Retrospective Memory Questionnaire (PRMQ). Participants also completed behavioural measures of global cognitive function [the Mini-Mental State Examination (MMSE)], as well as a behavioural measure of prospective memory (Virtual Week).

RESULTS

Self-reported impairments were equivalent across the three groups, and informant reports of impairment, while higher for those with dementia, did not distinguish MCI from controls. For the combined sample and for all three groups separately, both self- and informant reports of prospective memory showed poor convergent validity, at best correlating only weakly with Virtual Week. Self-reported prospective memory was correlated with informant report only in the dementia group, not in the control or MCI groups. Convergent and discriminant validity were poor, with self- and informant-rated prospective memory more strongly related to self- and informant-rated retrospective memory than to scores on Virtual Week.

CONCLUSION

These data indicate that self-report and informant report may neither accurately measure prospective memory of older people, nor be sensitive to objective prospective memory difficulties in people with MCI and dementia. These data have potentially important implications for clinical practice.

Correlates and moderators of change in subjective memory and memory performance: findings from the health and retirement study

Aging researchers have long been interested in understanding individuals' subjective perceptions of their own memory functioning. Previous research has shown that subjective memory ratings are partly based on memory performance but also reflect the influence of other factors, such as depressive symptoms. The aim of the present study was to examine (1) longitudinal associations between trajectories of subjective memory and memory performance, (2) variables that predict levels of and changes in subjective memory and memory performance, and (3) variables that moderate associations between these constructs. We applied a latent growth curve model to four occasions of data from 15,824 participants of the Health and Retirement Study (HRS; mean age at baseline=64.27 years, SD=9.90; 58% women). Results revealed that latent changes in subjective memory were correlated with latent changes in memory performance (φ=0.49), indicating that participants who reported steeper declines of subjective memory indeed showed steeper declines of memory performance over time. Three major patterns of associations emerged with respect to predictors of subjective memory and subjective memory change. First, the level of memory performance showed stronger associations with age, gender, and education, whereas subjective memory was more strongly associated with subjective age and personality traits. For example, women performed better than men on the episodic memory test, but there were no gender differences in subjective memory. Also, older age was associated with steeper declines of memory performance but with less decline of subjective memory. Second, personality traits that predicted subjective memory intercepts did not predict subjective memory slopes. Third, the strength of associations between levels and slopes of subjective memory and memory performance varied as a function of gender, education, depressive symptoms, and personality traits. Conscientiousness moderated the relationship of the level of subjective memory to the level of memory performance, consistent with the hypothesis that persons high in conscientiousness more accurately monitor memory successes and failures. The results reinforce the importance of depressive symptoms as a predictor of subjective memory but also indicate that a broader perspective on the reasons why memory complaints have modest correlations with memory itself is needed.

A systematic review of the assessment tools used to measure metamemory in patients with brain injury

[Purpose] The purpose of this study was to provide various assessment tools for metamemory of a patient with brain injury to develop accurate metamemory measurement methods which can be effectively applied in rehabilitation training programs in clinics. [Subjects and Methods] For this study, we carried out a systematic document search of the literature for articles published between January, 2001, and December, 2013, in order to review studies of measurement tools used to assess the metamemory of patients with brain injury. [Results] The initial search of the databases yielded 57 articles, 48 of which did not meet the inclusion criteria. Thus 9 studies were included in our review. The quality level of all the studies was IIA2b and PEDro scale scores were found to range from 4 to 6. [Conclusion] More studies need to be made, using various measurement tools for metamemory of more diverse patient groups. We believe studies should be made of the assessment of metamemory and interventions for it in accordance with the diagnoses and the cognitive levels of the patients with brain injury.

Self-evaluation of memory systems: development of the questionnaire

OBJECTIVES

The term metamemory refers to the knowledge one has about the development and use of memory in general, and one's own memory processes in particular. The current theoretical perspective on memory processes is best described by the memory systems framework which represents a useful tool in specifying different 'kinds' of memory. We present here the Self-evaluation of Memory Systems Questionnaire (SMSQ), which assesses the multidimensional construct of metamemory based on the memory systems framework.

METHOD

SMSQ has been developed on a large and heterogeneous sample (N = 3088) via both, web-based and paper-and-pencil form. With the aim of increasing its general utility, we used items referring to situations or materials which are highly likely for everyone to have encountered during their everyday life.

RESULTS

Analyses revealed good content validity, factorial validity, internal consistency reliability, and construct validity in terms of expected theoretical group differences. SMSQ is represented by six distinct factors: subjective evaluation, episodic memory, semantic memory, memory for numbers, visuospatial memory, and reminder and aids. Age differences found on SMSQ between young and old adults confirm the well-established empirical findings on the memory and aging.

CONCLUSION

SMSQ is a brief, easily administrable, multidimensional metamemory questionnaire, marked with the sound background from the findings on memory systems and cognitive aging.