Do Subjective Memory Complaints Lead or Follow Objective Cognitive Change? A Five-Year Population Study of Temporal Influence

Subjective memory measures: Metamemory questionnaires currently in use

Subjective memory evaluation is important for assessing memory abilities and complaints alongside objective measures. In research and clinical settings, questionnaires are used to examine perceived memory ability, memory complaints, and memory beliefs/knowledge. Although they provide a structured measure of self-reported memory, there is some debate as to whether subjective evaluation accurately reflects memory abilities. Specifically, the disconnect between subjective and objective memory measures remains a long-standing issue within the field. Thus, it is essential to evaluate the benefits and limitations of questionnaires that are currently in use. This review encompasses three categories of metamemory questionnaires: self-efficacy, complaints, and multidimensional questionnaires. Factors influencing self-evaluation of memory including knowledge and beliefs about memory, ability to evaluate memory, recent metamemory experiences, and affect are examined. The relationship between subjective and objective memory measures is explored, and considerations for future development and use of metamemory questionnaires are provided.

Development of a Revised Version of Subjective Memory Complaints Questionnaire in Taiwan: A Preliminary Study

OBJECTIVES

Research has suggested that subjective memory complaints (SMC) are predictive of cognitive decline in cases of Alzheimer's disease; however, multidimensional characteristics of SMC make it difficult to formulate causal links. The Subjective Memory Complaints Questionnaire (SMCQ) has proven effective in capturing the nature of SMC. In this study, we developed a revised version of SMCQ (SMCQ-R) with corresponding normative data for application in Taiwan.

METHODS

This study recruited 100 cognitively normal participants (> 45 years) stratified according to demographic characteristics. Assessments were performed to evaluate test-retest reliability, criterion-related validity, and construct validity of SMCQ-R. SMCQ-R scores of 20 matched patients with mild cognitive impairment (MCI) were also compared with those of normal participants to test construct validity.

RESULTS

Reliability of SMCQ-R was satisfactory (0.81-0.95). Factor analysis revealed a three-factor structure: everyday memory problems (EMP), recent severe memory problems (RSMP), and long-term memory problems (LTMP). EMP and RSMP scores were negatively associated with objective cognitive function (r = -.20 to .39). Depressive symptoms were positively associated with all factors (r = .23-.33). Age was positively associated with total (b = 0.09, p < .05) and EMP scores (b = 0.06, p < .01). MCI patients obtained higher scores (p < .05) on all subscales. SMCQ-R scores discriminated between normal and MCI individuals (area under the curve = 0.77). This study established a norm based on scores adjusted to control for effects of age.

CONCLUSIONS

SMCQ-R has sound psychometric properties and could potentially be used as a tool to assess SMC in clinical settings.

Subjective cognition and memory lapses in the daily lives of breast cancer survivors: Examining associations with objective cognitive performance, fatigue, and depressed mood

OBJECTIVE

Subjective reports of cancer-related cognitive impairment often far exceed that documented using in-person neuropsychological assessment. This study evaluated whether subjective cognition was associated with real-time objective cognitive performance in daily life versus performance on an in-person neuropsychological battery, as well as fatigue and depressed mood.

METHODS

Participants were 47 women (M age = 53.3 years) who completed adjuvant treatment for early-stage breast cancer 6-36 months previously. During an in-person assessment, participants completed a neuropsychological battery and questionnaires on subjective cognition, fatigue, and depressed mood. Over 14 days, participants responded to up to 5 prompts that assessed real-time processing speed and memory and self-reported ratings of depressed mood and fatigue. In the evenings, participants rated their subjective cognition that day and reported on memory lapses (e.g., forgetting a word).

RESULTS

During the in-person assessment, participants who rated their cognition worse reported worse depressed mood, but did not exhibit poorer objective cognitive performance. Women with worse rated daily subjective cognition reported more daily fatigue but did not demonstrate worse real-time objective cognition. Finally, women who reported memory lapses at the end of the day reported more fatigue and depressed mood, demonstrated better real-time performance on processing speed (p = 0.001), and worse in-person processing speed and visuospatial skills (p's ≤ 0.02).

CONCLUSION

Subjective cognition was consistently associated with self-reported fatigue and depressed mood. Specific memory lapses were related to in-person and daily objective cognitive performance. This suggests that incorporating reports of memory lapses may help clinicians identify those with objectively measured cancer-related cognitive impairment.

The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter?

OBJECTIVES

We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships.

METHODS

Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD.

RESULTS

SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD.

CONCLUSION

Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.

Longitudinal association between subjective and objective memory in older adults: a study with the Virginia Cognitive Aging Project sample

Using the bivariate dual change score approach, the present study investigated the directionality of the SMC-OMP association in a sample of healthy older adults (N = 2,057) from the Virginia Cognitive Aging Project. The sample was assessed throughout 10 years, five time points, and the impact of education, depressive symptoms, and low-memory functioning was tested. The Memory Functioning Questionnaire was used to assess SMC. There was a lack of longitudinal association with no significant coupling effects found between subjective and objective memory. After including depressive symptoms as a covariate, Frequency of Forgetting significantly predicted subsequent negative changes in OMP . A similar result was found for the low-memory functioning group after the inclusion of depression, with the frequency of memory complaints predicting subsequent memory decline . Our results do not support a predictive value of SMC without accounting for the influence of depressive symptoms and low-memory functioning.

Longitudinal changes in participant and informant reports of subjective cognitive complaints are associated with dementia risk

Background

Individuals with subjective cognitive complaints (SCCs) are at an increased risk of dementia. Questions remain about participant-reported versus informant-reported SCCs as indicators of future dementia and about longitudinal changes in participant-and informant-reported SCCs and risk of incident dementia.

Method

Participants were 873 older adults (M = 78.65-years; 55% female) and 849 informants from the Sydney Memory and Ageing Study. Comprehensive assessments occurred biennially, and clinical diagnoses were made by expert consensus for 10-years. SCCs were participants' and informants' responses to a single binary question concerning their/the participant's memory decline (Yes/No) over the first 6-years. Categorical latent growth curve analyses, using the logit transformation, were used to model SCC change over time. Associations of initial propensity to report SCCs at baseline, and change in propensity to report SCCs over time, with dementia risk were examined using Cox regression.

Results

70% of participants reported SCCs at baseline, with a proportional increase in the odds of reporting by 11% for each additional year in the study. In contrast, 22% of informants reported SCCs at baseline, with a proportional increase by 30% in the odds of reporting per year. Participants' initial level of (p = 0.007), but not change in SCC reporting (p = 0.179), was associated with risk of dementia controlling for all covariates. Both informants' initial level of (p < 0.001), and change in (p < 0.001), SCCs significantly predicted incident dementia. When modelled together, informants' initial level of, and change in, SCCs were still independently associated with increased dementia risk (p's < 0.001).

Conclusion

These data suggest that informants' initial impressions, and increased reporting, of SCCs appear to be uniquely prognostic of future dementia compared to participants', even based on a single SCC question.

Paradoxical relationship between subjective and objective cognition: the role of sleep

STUDY OBJECTIVES

Subjective memory complaints and objective cognitive dysfunction are common in aging populations, however research investigating the associations between them is inconclusive. Given the high prevalence of sleep complaints in middle-aged/older adults, this research tested whether objective cognition interacted with sleep parameters in its associations with subjective cognition.

METHODS

Cognitively healthy adults aged 50+ completed the Pittsburgh Sleep Quality Index, Cognitive Failures Questionnaire (CFQ) and cognitive tasks: Stroop, Sternberg, and Posner cueing. Multiple regression and simple slope analyses examined whether objective cognition interacted with sleep parameters in its associations with subjective memory.

RESULTS

Stroop performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, better Stroop performance (faster reaction time, RT-control trials) was associated with more memory complaints at worst and average, but not best sleep efficiency. Additionally, faster RT was associated with more memory complaints only for worst sleep disturbance. Similarly, Sternberg performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, higher proportion correct was associated with more memory complaints only at worst sleep efficiency and sleep disturbance. Finally, Posner performance and sleep disturbance had an interactive association with CFQ-memory. Faster exogenous orienting was associated with more memory complaints only for worst sleep disturbance.

CONCLUSIONS

Objective cognition interacts with sleep efficiency and sleep disturbances in its associations with subjective memory in mid-to-late life. Findings suggest sleep fragmentation plays a role in the discrepant relationship between objective and subjective cognition. Future studies should investigate this relationship in aging populations with sleep disorders and/or cognitive impairments.

Subjective memory in adults over 50 years of age: associations with affective and physiological markers of emotion regulation

OBJECTIVES

To examine associations among subjective memory reports, psychophysiological markers of emotion regulation, and cognitive performance in healthy adults over 50 years of age.

METHOD

A cross-sectional laboratory study was conducted with healthy, community-dwelling, non-depressed adults (M age = 60.4 years, SD = 8.4). The Metamemory in Adulthood (MIA) questionnaire provided reports of subjective memory capacity and stability (versus decline) and anxiety about memory. Poorer emotion regulation was marked by greater negative affect (NA) and lower high frequency heart rate variability (HF-HRV) responses to a challenging working memory task. Regression models were used to identify associations between subjective memory and emotion regulation markers, and structural equation modeling was used to explore whether emotion regulation mediated associations between subjective memory and objective task performance.

RESULTS

A total of 115 participants were included in the final sample. Subjective memory decline (indicated by lower scores on memory stability) was associated with lower HF-HRV response and worse working memory performance. Poorer subjective memory capacity and more anxiety about memory were both associated with greater negative affect in response to the working memory task. There was an indirect effect of subjective memory capacity on working memory performance through negative affect response.

CONCLUSIONS

The findings here suggest that worse subjective memory may signal reduced capacity for emotion regulation. Along with known cognitive risks of depression and anxiety, more subtle emotion regulation difficulties may be involved in pathways of poor cognitive aging.

Trajectories of Insomnia Symptoms Among Aging Employees and Their Associations With Memory, Learning Ability, and Concentration After Retirement - A Prospective Cohort Study (2000-2017)

Objectives

We applied a person-oriented approach and used latent class linear mixed models to identify sleep trajectories that explain memory, concentration, and learning ability problems after retirement.

Methods

Data consist of prospective surveys from four phases of the Helsinki Health Study between 2000–2017 (n = 3748, aged 55–77 years, 80% women). Multinomial regression was used to examine the associations between sleep trajectories and cognitive function, adjusting for sociodemographic, health-related behavior, and health factor covariates.

Results

Among statutory retirees, three latent group trajectories of insomnia-related symptoms were identified: stable low, decreasing, and increasing. Among those who had retired for disability reasons, we identified one additional latent group trajectory: stable high. Insomnia symptoms were associated with worse cognitive function.

Discussion

Early detection of insomnia symptoms would be a potential intervention point to improve both sleep quality and prevent cognitive decline in later life. However, intervention studies are needed.

Subjective Cognitive Complaints: Predictors and Health Outcomes in People Living with HIV

There is a paucity of research on the prevalence of subjective cognitive complaints in people living with human immunodeficiency virus, along with the predictors and outcomes related to these complaints. We assessed demographics, substance use and psychiatric predictors, and HIV-related outcomes associated with subjective cognitive complaint items from the Cognitive Difficulties Scale. The sample consisted of 889 people living with HIV in the survey-based Florida Cohort. Results of multivariable regression models indicated that age (45-54), hazardous alcohol consumption, more frequent marijuana use and psychiatric symptoms (depression, anxiety, PTSD) were significant predictors of subjective cognitive complaints. Subjective cognitive complaints were associated with lower adherence to antiretroviral therapy in bivariate analyses, but this relationship was no longer significant after controlling for depression, race, alcohol and drug use. Further research into the relationship between depressive and subjective cognitive complaints may provide additional avenues for intervention.

Subjective Cognitive Decline Is More Accurate When Metamemory Is Better

Objective

Subjective cognitive decline (SCD) has emerged as one of the first manifestations of Alzheimer's disease (AD). However, discrepancies in its relationship with tests of memory and other cognitive abilities have hindered SCD's diagnostic utility. Inter-individual heterogeneity in metamemory, or memory awareness, and the use of clinical measures of cognition lacking sensitivity to early cognitive dysfunction, may contribute to these discrepancies. We aimed to assess if the relationship between SCD and markers of early cognitive dysfunction is moderated by metamemory abilities.

Methods

The sample included 79 cognitively healthy older adults (77% female, 68% White, and 32% Black participants) with a mean age of 74.4 (SD = 6.1) and 15.9 (SD = 2.7) years of education. Metamemory was assessed using an episodic Feeling of Knowing test with four 5-item trials. Outcome measures included a resolution metric defined as a gamma correlation reflecting the accuracy of item-level predictions ("Will you know the correct answer?"). Early cognitive dysfunction was measured through the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) and the Short-Term Memory Binding Test (STMB), measures sensitive to preclinical AD. SCD was assessed with a 20-item questionnaire that asked participants to compare themselves to others their age on a 7-point Likert scale. Regression analyses examined whether a potential relation between SCD and early cognitive dysfunction was moderated by metamemory.

Results

Subjective cognitive decline was associated with susceptibility to semantic proactive interference such that greater complaints were associated with increased susceptibility to semantic proactive interference (b = -0.30, p = 0.003) only. Metamemory moderated the association between SCD and susceptibility to and recovery of semantic proactive interference such that those with more accurate metamemory showed a stronger association between increased complaints and susceptibility to semantic proactive interference (b = -0.71, p = 0.005; b = -0.62, p = 0.034). Metamemory, however, did not moderate the association of SCD with retroactive semantic interference nor short term memory binding.

Discussion

The accuracy of an individual's metamemory, specifically their ability to adjust moment to moment predictions in line with their performance, can influence the extent to which SCD maps onto objective cognition. Such self-referential assessment should be considered when interpreting SCD.

Subjective memory concerns, poor vascular health, and male sex predict exacerbated memory decline trajectories: An integrative data-driven class and prediction analysis

OBJECTIVE

Subjective memory decline (SMD) has been identified as a potential early marker of nonnormal and accelerated cognitive decline. We performed data-driven analyses that integrated trajectory classification with prediction modeling to test declining trajectory class prediction by SMD facets, pulse pressure (PP; i.e., a robust proxy for vascular health), and sex.

METHOD

The longitudinal design featured memory trajectories across a 40-year band (55-95 years) of nondemented aging (N = 580; Mage = 70.2 years; 65% female) from the Victoria Longitudinal Study. First, latent class growth analyses identified distinct classes of memory trajectories. Second, we used the three-step method (R3STEP) to predict membership in the declining memory classes using six measures: memory complaints, memory concerns, memory compensation, memory self-efficacy, PP, and sex.

RESULTS

First, we identified four classes of memory aging trajectories: (a) stable memory aging (STABLE), (b) typical memory aging (TYPICAL), (c) slowly declining memory aging (SLOW), and (d) rapidly declining memory aging (RAPID). Second, more memory concerns predicted membership in the SLOW and RAPID classes. Higher PP predicted membership in the SLOW class. Male sex predicted membership in the declining (TYPICAL, SLOW, RAPID) classes.

CONCLUSION

Among SMD facets, memory concerns represent the most severe degree of apprehension about subjectively experienced memory losses. The present integrative data-driven analysis indicated that such concerns predicted membership in declining memory trajectory classes in addition to worse vascular health (higher PP) and sex (male). In nondemented aging, concerns about increasing memory failures may be veridical indicators of memory loss, especially when coupled with vascular comorbidity and being male. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Troubled past: A critical psychometric assessment of the self-report Survey of Autobiographical Memory (SAM)

The Survey of Autobiographical Memory (SAM) was designed as an easy-to-administer measure of self-perceived autobiographical memory (AM) recollection capacity. We provide a comprehensive psychometric evaluation of the SAM in younger and older adults. First, we evaluated the reliability of the SAM as a measure of self-perceived recollective capacity. Next, we tested whether the SAM was a valid measure of episodic and autobiographical memory performance, as assessed with widely used performance-based measures. Finally, we investigated associations between the SAM, cognitive measures and self-reported assessments of psychological functioning. The SAM demonstrated reliability as a self-report measure of perceived recollective capacity. High internal consistency was observed across subscales, with the exception of SAM-semantic. Evidence for independence among the subscales was mixed: SAM-episodic and SAM-semantic items showed poor correspondence with respective subscales. Good correspondence was observed between the future and spatial items and their SAM subscales. The SAM showed limited associations with AM performance as measured by the Autobiographical Interview (AI), yet was broadly associated with self-reported AI event vividness. SAM scores were weakly associated with performance-based memory measures and were age-invariant, inconsistent with known age effects on declarative memory. Converging evidence indicated that SAM-episodic and SAM-semantic subscales are not independent and should not be interpreted as specific measures of episodic or semantic memory. The SAM was robustly associated with self-efficacy, suggesting an association with confidence in domain general self-report abilities. We urge caution in the use and interpretation of the SAM as a measure of AM, pending revision and further psychometric validation.

Cross-lagged relationships between sense of purpose in life, memory performance, and subjective memory beliefs in adulthood over a 9-year interval

OBJECTIVES

Previous studies have found a positive association between having a sense of purpose in life and memory functioning in old age. We extend these findings by examining the relationships between sense of purpose, memory performance, and subjective memory beliefs over time in a large sample of adults in mid to later adulthood.

METHOD

We used data from 3633 participants of the second and third wave of the MIDUS study. Cross-lagged panel analysis investigated the relationships between the variables at the two points, which were approximately 9 years apart, while controlling for gender, age, education, positive and negative affect, and self-rated health.

RESULTS

Sense of purpose in life, memory performance, and subjective memory beliefs were all cross-sectionally related to each other at both times. Longitudinally, sense of purpose was a positive predictor of subjective memory beliefs. Memory performance and subjective memory beliefs positively predicted each other over time. Furthermore, all three variables showed correlated changes over time. Exploratory analyses suggest that the covariates of affect and self-rated health are possible mediators or confounders in respectively the relationship between subjective memory beliefs and later sense of purpose, and sense of purpose and later objective memory performance.

CONCLUSION

Our findings underscore once more the relevance of sense of purpose in life as a predictor of positive late life functioning, as it is related to both performance-based and subjective cognitive outcomes. More work is needed to understand mechanisms underlying the purpose-memory association in order to develop and implement purpose interventions.

Increased reporting of subjective cognitive complaints over time predicts cognitive decline and incident dementia

BACKGROUND

Subjective cognitive complaints (SCCs) are a risk factor for dementia; however, little is known about their trajectories.

METHOD

Participants were 873 older adults (mage = 78.65 years; 55% females) from the Sydney Memory and Ageing Study that were followed-up biennially. SCCs were measured using the six-item Memory Complaint Questionnaire. Associations between initial level of SCC reporting, linear change in SCC reporting, and change in global cognition over 6 years was examined using latent growth curve analysis. Risk of dementia was examined over 10 years using Cox regression.

RESULTS

After controlling for demographics, mood and personality, results revealed a negative longitudinal association between the slope of SCCs and the slope of global cognition scores (b = -0.01, p = 0.005, β = -0.44), such that participants who reported increasing SCCs showed a steeper rate of decline in global cognition over 6 years. Cox regression also revealed participants who reported increasing SCCs had a nearly fourfold increased risk of developing dementia over 10 years (hazard ratio 3.70, 1.24-11.01).

CONCLUSION

This study explored whether initial levels of, and change in, SCCs over time are associated with both cognitive decline and risk of dementia. These findings are clinically relevant as GPs should note patients reporting increasing SCCs as they may be at greater risk of cognitive decline and incident dementia.

Driving Habits of Older Adults: A Population-based Study

OBJECTIVES

To describe factors associated with driving history, habits, and self-reported driving difficulties of 1982 older adults in a population-based survey.

SETTING

This was a community setting.

PARTICIPANTS

Age-stratified random population sample drawn from publicly available voter registration list.

DESIGN

Participants underwent assessments including cognitive testing and self-reported current and past driving status, instrumental activities of daily living, self-rated health, social supports, physical limitations, and depressive symptoms. We built multivariable logistic regression models to identify factors associated with never having driven, having ceased driving, and reporting difficulties while driving.

RESULTS

In the multivariable model, "never drivers" were more likely than "ever drivers" to be older, female, less educated and to leave home less frequently. Former drivers were significantly older, more likely to be women, have lower test performance in the cognitive domain of attention, have more instrumental activity of daily living difficulties, leave home less frequently and have visual field deficits in the right eye than current drivers. Current drivers with reported driving difficulties were more likely than those without difficulties to have lower test performance in attention but higher in memory, were more likely to report depressive symptoms and to have both vision and hearing loss.

CONCLUSION

Age, female sex, marital status, and education appear to be associated with driving cessation. Cognitive and functional impairments, mood symptoms and physical health also seem to influence driving cessation and reduction. Our findings may have implications for clinicians in assessing and educating their patients and families on driving safety.

The relationship of functional hippocampal activity, amyloid deposition, and longitudinal memory decline to memory complaints in cognitively healthy older adults

We evaluated whether self-reports of worse cognition in older adults with normal cognitive function reflected actual memory decline, amyloid pathology, and subtle vulnerabilities in hippocampal function. We measured subjective cognitive decline (SCD) in 156 older participants from the Dallas Lifespan Brain Study. Functional hippocampal activation during encoding, measured with fMRI, and longitudinal memory change that was measured in the four years preceding the SCD measures were used to predict the magnitude of SCD. A subsample (N=105) also underwent ¹⁸F-Florbetapir PET imaging that measured amyloid burden. Results showed that increased SCD were associated with greater prior memory decline and amyloid deposition. Importantly, decreased hippocampal activation during encoding was a significant predictor of SCD, particularly in young-old adults below 69 years old, above and beyond prior memory change and amyloid deposition. These results indicate that multiple measures of neural and cognitive dysfunction are simultaneously associated with SCD. Moreover, SCD in younger seniors appears to reflect deficient hippocampal activity that increases their reports of poorer memory, independent of amyloid. This manuscript is part of the Special Issue entitled "Cognitive Neuroscience of Healthy and Pathological Aging" edited by Drs. M. N. Rajah, S. Belleville, and R. Cabeza. This article is part of the Virtual Special Issue titled COGNITIVE NEU-ROSCIENCE OF HEALTHY AND PATHOLOGICAL AGING. The full issue can be found on ScienceDirect at https://www.sciencedirect.com/journal/neurobiology-of-aging/special-issue/105379XPWJP.

The Factor Structure of Items Assessing Subjective Memory: Between-Persons and Within-Persons across Time

INTRODUCTION

Current understanding of the psychometric properties of items intended to assess the multidimensional construct of subjective memory (SM) is limited, as longitudinal studies of aging commonly use single items or brief sets of items to assess SM. Investigating how SM items cluster within individuals over time would increase the understanding of how combining these items impacts their utility as an early indicator of cognitive change in the aging trajectory. To address this need, the current study examined the factor structure of a brief set of SM items in an existing longitudinal study focused on cognitive aging at both the within-person and between-person levels.

METHODS

Data were drawn from the Einstein Aging Study, a longitudinal cohort study of aging (N = 1,239, Mage = 77.51, SD = 5.03; 69.50% white; 24.27% black; 6.23% other). Community-dwelling older adults from an urban area of New York City were interviewed annually. At each wave, participants responded to 6 items intended to assess SM. Items assessed participants' perceived memory decline as well as current memory ability. Multilevel exploratory factor analyses examined which factor solution best fit the data at between-person and within-person levels.

RESULTS

Factor structure of the SM items varied at the two levels. At the within-person level, two factors emerged, whereas at the between-person level, a single factor best represented the SM items. Items assessing perceived declines in memory functioning tended to have similar trajectories, while items assessing current memory ability were less related to change over time.

CONCLUSION

Items appeared to assess two different dimensions of SM when examining within-person changes in SM across time; however, the item structure suggested no other items covaried systematically within persons over time. In contrast to the conceptualization of SM as a multidimensional construct, our findings suggest that when measuring SM between individuals, SM items tend to capture a single dimension underlying SM. This may be due to the long retrospection period of items assessing perceived memory ability. A single item assessing perceived memory decline in older adults without evidence of objective cognitive impairment may be sufficient to monitor memory change in clinical or research settings.

Associations between activity fragmentation and subjective memory complaints in middle-aged and older adults

INTRODUCTION

Subjective memory complaints (SMC) are often considered a clinical marker of mild cognitive impairment and dementia and could manifest as shortening of activity bouts throughout the day causing daily activity to accumulate in a more fragmented pattern. In the current study we explored the association between activity fragmentation and SMC in middle-aged and older adults.

METHODS

We used data from 3820 participants in the National Health and Nutrition Examination Survey (2003-2006) with valid accelerometer SMC data. The analyses were conducted in 2020. To calculate activity fragmentation, an active-to-sedentary transition probability was calculated as the number of physical activity bouts (i.e., consecutive minutes registering 100+ counts/min) divided by the total sum of minutes spent in physical activity. A multivariable ordinal logistic regression model was conducted to examine the association between activity fragmentation (scaled) and SMC (yes/no).

RESULTS

Higher activity fragmentation was associated with an increased likelihood of self-reported SMC in the study population (Odd Ratio [95% Confidence Interval] = 1.335 [1.067, 1.669]; Average Marginal Effect [95%CI] = 0.029 [0.006, 0.052]; p-value = 0.021). This association was independent of total physical activity volume.

CONCLUSIONS

The findings provide support that studying fragmented activity patterns can be useful in identifying those at risk for SMC, over and above total volume of physical activity. Future longitudinal studies are required to establish causality and the temporal order of the observed association. Nevertheless, activity fragmentation in middle-aged and older adults may reflect pre-clinical signs of future neurodegenerative processes indicating potential targets for modification through intervention.

Subjective Cognitive Complaints Given in Questionnaire: Relationship With Brain Structure, Cognitive Performance and Self-Reported Depressive Symptoms in a 25-Year Retrospective Cohort Study

BACKGROUND

Subjective cognitive complaints are common but it is unclear whether they indicate an underlying pathological process or reflect affective symptoms.

METHOD

800 community-dwelling older adults were drawn from the Whitehall II cohort. Subjective cognitive complaint inquiry for memory and concentration, a range of neuropsychological tests and multimodal MRI were performed in 2012-2016. Subjective complaints were again elicited after 1 year. Group differences in grey and white matter, between those with and without subjective complaints, were assessed using voxel-based morphometry and tract-based spatial statistics, respectively. Mixed effects models assessed whether cognitive decline or depressive symptoms (over a 25-year period) were associated with later subjective complaints. Analyses were controlled for potential confounders and multiple comparisons.

RESULTS

Mean age of the sample at scanning was 69.8 years (±5.1, range: 60.3-84.6). Subjective memory complaints were common (41%) and predicted further similar complaints later (mean 1.4 ± 1.4 years). There were no group differences in grey matter density or white matter integrity. Subjective complaints were not cross-sectionally or longitudinally associated with objectively assessed cognition. However, those with subjective complaints reported higher depressive symptoms ("poor concentration": odds ratio = 1.12, 95% CI 1.07-1.18; "poor memory": odds ratio = 1.18, 1.12-1.24).

CONCLUSIONS

In our sample subjective complaints were consistent over time and reflected depressive symptoms but not markers of neurodegenerative brain damage or concurrent or future objective cognitive impairment. Clinicians assessing patients presenting with memory complaints should be vigilant for affective disorders. These results question the rationale for including subjective complaints in a spectrum with Mild Cognitive Impairment diagnostic criteria.

Discordance Between Subjective and Objective Cognitive Function in Older Korean Americans

Objectives: To examine predictors of membership in discordant groups identified by subjective and objective measures of cognitive function. Methods: Participants in the Study of Older Korean Americans (N = 2046) were classified according to their subjective cognitive ratings (excellent/very good/good vs. fair/poor) and Mini-Mental State Examination scores (normal cognition vs. cognitive impairment), yielding two discordant groups: (1) positive ratings but cognitive impairment and (2) negative ratings but normal cognition. Logistic regression models examined how the discordant group membership was associated with personal resources. Results: Among those with positive cognitive ratings, the odds of belonging to the discordant group were associated with low personal resources (advanced age and lower levels of education, acculturation, and knowledge about Alzheimer's disease). However, an opposite pattern was observed among those with negative ratings. Discussion: The pattern of discordance suggests ways to promote early detection of cognitive impairment and close the gap in cognitive health care.

Examining the temporal associations between self-reported memory problems and depressive symptoms in older adults

Objectives: Older adults commonly report problems with their memory which can elicit sadness and worry about future development of cognitive impairment. Conversely, ongoing depressive symptoms can negatively impact older adults' perceptions of their memory performance. The current study examined the longitudinal associations between self-reported memory problems and depressive symptoms to explore which symptom tends to appear first.Method: Two datasets from ongoing observational, longitudinal studies of aging (Memory and Aging Project; Minority Aging Research Study) were used for secondary analyses. Older adults (n = 1,724; M_age = 77.03; SD = 7.54; 76.80% female; 32.26% Black) completed up to 18 annual assessments of self-reported memory (two items: perceived decline in memory and frequency of memory problems) and depressive symptoms. Multilevel models were used to examine intra-individual variability and time-lagged relationships between self-reported memory and depressive symptoms.Results: Concurrently, self-reported memory problems and depressive symptoms were significantly related; at times when older adults reported poorer memory, they also reported more depressive symptoms, regardless of the type of memory self-report. Prospectively, perceived memory decline predicted future depressive symptoms, but depressive symptoms did not predict future reports of memory decline. Self-reported frequency of memory problems did not predict future depressive symptoms or vice versa.Conclusion: The current study's findings suggest a temporal relationship between perceived memory decline and depressive symptoms, such that perceived memory decline can lead to future depressive symptoms. These findings can inform future studies focused on developing a standardized assessment of self-reported memory that is separable from depressive symptoms.

In multiple facets of subjective memory decline sex moderates memory predictions

INTRODUCTION

Two established subjective memory decline facets (SMD; complaints, concerns) are early indicators of memory decline and Alzheimer's disease. We report (1) a four-facet SMD inventory (memory complaints, concerns, compensation, self-efficacy) and (2) prediction of memory change and moderation by sex.

METHODS

The longitudinal design featured 40 years (53 to 97) of non-demented aging (n = 580) from the Victoria Longitudinal Study. Statistical analyses included confirmatory factor analyses and conditional latent growth modeling.

RESULTS

The four-facet SMD Inventory was psychometrically confirmed. Longitudinal analyses revealed significant variability in level and change for SMD and memory. Prediction analyses showed complaints and concerns predicted lower level and steeper memory decline; however, follow-up moderation analyses revealed selective predictions for females. Memory compensation predicted decline overall. Lower memory self-efficacy predicted steeper decline selectively for males.

DISCUSSION

Although traditional and novel SMD facets predicted memory decline, differential sex moderation was observed. SMD research benefits from conceptual complementarity and precision prediction.

Visuospatial/executive abilities and mood affect the reliability of a subjective memory complaints measure

BACKGROUND

Inconsistent results are reported so far in the literature on the relationship between subjective memory complaints (SMC) and objective memory performance. Mixed findings triggered the need to investigate whether other potential mediating variables, such as mood and non-memory domains, affect the relationship between SMC and memory performance.

AIMS

The present study aimed to contribute in clarifying the relation between subjective and objective memory considering the potential role of mood and visuospatial/executive functions.

METHODS

Six hundred and sixty Italian community-dwelling adults (52-91 years old) were enrolled. Italian version of Montreal Cognitive Assessment Test (MoCA), Geriatric Depression Scale and Subjective Memory Complaints Questionnaire (SMCQ) were administered. Four subsamples were composed according to the following criteria: (a) participants with high visuospatial/executive function (VSE) score at MoCA and high mood; (b) participants with high VSE score and low mood; (c) participants with low VSE score and high mood and; (d) participants with low VSE score and low mood.

RESULTS

Preliminarily, two confirmatory factor analysis have set the one-factor structure of SMCQ as the best fitting model. Diagnostic accuracy of the SMCQ in discriminating high and low memory score was assessed. ROC analyses confirmed that a low score in executive tasks was associated with poor reliability of the SMCQ. On the contrary, well-preserved executive functions and high mood levels ensured a good reliability of SMCQ in detecting memory problems.

DISCUSSION AND CONCLUSIONS

Although mood is a key mediator in the relationship between subjective and objective memory, preserving executive functions is essential for ensuring the accuracy of memory self-appraisal in adulthood and elderly.

Factors associated with subjective cognitive function in epilepsy and psychogenic non-epileptic seizures

OBJECTIVE

To identify factors associated with subjective cognitive complaints in people with presumed seizure disorders referred for video electroencephalogram monitoring (VEM).

METHODS

Adult patients admitted for inpatient VEM were recruited. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Screening Tool, subjective cognitive function with the Quality of Life in Epilepsy Inventory-89 subscales, and anxiety and depressive symptoms with the Hospital Anxiety and Depression Scale. Multivariate Bayesian general linear models were used to identify predictors of subjective cognitive function.

RESULTS

331 patients met inclusion criteria. Mean age was 39.3 years and 61.9 % patients were female. Diagnoses included epilepsy, psychogenic non-epileptic seizures (PNES) or both conditions. Depression, anxiety and objective cognitive function were predictors of subjective cognitive function across all domains. Depression was the strongest predictor of subjective memory and attention, whilst objective cognition was the strongest predictor of subjective language function. Mood also mediated the relationship between objective function and subjective function across all domains to varying extents; depression exerted the strongest effect of 22 % for the memory domain; conversely, language domain was least influenced by mood, with depression mediating 11 % and anxiety mediating only 9% of the subjective-objective relationship.

SIGNIFICANCE

Mood and objective cognitive function are both important contributors to subjective cognitive function for patients undergoing VEM. Clinicians should consider referring patients with cognitive complaints for both neurocognitive workup and neuropsychiatric evaluation. Future work may examine the effects of treating concomitant mood disorders on subjective cognitive function.

Age, cohort, and period effects on metamemory beliefs

Questionnaires like the Metamemory in Adulthood Questionnaire (MIA; Dixon, Hultsch, & Hertzog, 1988) have been used to examine longitudinal changes and cross-sectional age differences in multiple metamemory facets (e.g., memory self-efficacy). This study used 3 independent cross-sectional samples (N = 1,555; ages 55-85) from the Victoria Longitudinal Study collected in 1986, 1992, and 2000 to evaluate period and cohort effects on 8 MIA scales. Alternative general linear models analyzed age, cohort, and period effects, while subsequently assessing gender differences in metamemory beliefs. Period effects were detected on the MIA Internal Strategy and External Strategy scales; self-reported use of internal strategies decreased while use of external memory aids increased over the historical period. Reliable cohort (generational) differences were found for MIA Change, with the lowest levels of perceived change in individuals born between 1916 and 1925. MIA Task, measuring knowledge about memory, produced small age and cohort effects. Gender differences emerged in metamemory, especially for the Internal Strategy and External Strategy scales (women reporting higher strategy use). Gender differences were also seen for the Capacity, Locus, Anxiety, and Achievement scales, with women reporting higher perceived memory efficacy, control, memory anxiety, and greater motivation to have better memory, respectively. The historical trends in metamemory beliefs should be replicated with other measures and other populations; however, the results generally confirm conclusions from earlier cross-sectional studies regarding age sensitivity of metamemory beliefs from middle age to old age. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The factors associated with subjective cognitive decline and cognitive function among older adults

AIMS

To explore the risk factors for subjective cognitive decline and cognitive function among older adults in South Korea.

DESIGN

This study employed a descriptive cross-sectional design.

METHODS

A convenience sample of 182 patients was recruited from a senior welfare center in Seoul. The mean age of the participants was 78.4 years (SD 5.91). Among them, 64.3% were women. The data were collected by a trained research assistant using structured questionnaires from September 2016-February 2017. Demographic characteristics, comorbidities, depression, physical and cognitive activity levels, instrumental activities of daily living, subjective cognitive decline, and cognitive function were assessed. Student's t tests, chi-square tests, and hierarchical multiple regression analyses were used for statistical analyses.

RESULTS

The findings revealed that 37.4% of the participants were not cognitively intact. Depression, perceived health status, and cognitive function were significantly associated with subjective cognitive decline (F = 7.10, p < .001, adjusted R²  = 25.3). Age, educational level, perceived health status, and subjective cognitive decline were significantly related to cognitive function (F = 20.98, p < .001, adjusted R²  = 47.0). After controlling for these variables, cognitive activity was significantly and independently related to cognitive function.

CONCLUSION

The results suggest that for the maintenance of cognitive function, cognitive activity should be encouraged. In addition, older adults who complain of subjective cognitive decline and have risk factors such as depression need therapeutic interventions to prevent actual decrease of cognitive function.

IMPACT

The present findings advance prior knowledge by considering variables such as physical and cognitive activity levels to provide novel evidence that can be used to develop interventions for community-dwelling older adults. Thus, to be effective, nursing interventions must seek to improve cognitive function through intellectual stimulation.

Developing a Spatial Navigation Screening Tool Sensitive to the Preclinical Alzheimer Disease Continuum

OBJECTIVE

There remains a need for a non-invasive and cost-effective screening measure that could be administered prior to the provision of a lumbar puncture or positron emission tomography scan for the detection of preclinical Alzheimer disease (AD). Previous findings suggest that a hippocampally-based spatial navigation task may be effective for screening individuals for the preclinical AD continuum (i.e., low cerebrospinal fluid (CSF) Aβ42). Unfortunately, this task took 1.5-2 hours to administer, which would be time-prohibitive in a clinical setting. Therefore, the goal of this study was to compare psychometric properties of six spatial navigation-related tasks in order to take the next steps in developing a clinically appropriate screening measure.

METHODS

Psychometric properties (i.e., reliability, diagnostic accuracy, validity) of a modified version of the cognitive mapping task, two binding tasks, a visual perspective taking task, and self- and informant report versions of a questionnaire were examined in a sample of 91 clinically normal (CN) individuals. CSF Aβ42 and ptau181 were available for 30 individuals.

RESULTS

The learning phase of the cognitive mapping task and the self-report questionnaire were sensitive to identifying individuals in the preclinical AD continuum (93% and 87% sensitivity, 60% and 67% specificity, respectively). These two measures also demonstrated good test-retest stability (intraclass correlation coefficients = .719 and .838, respectively) and internal consistency (Cronbach's αs = .825 and .965, respectively).

CONCLUSIONS

These findings suggest that a self-report questionnaire and aspects of a cognitive mapping task may be particularly appropriate for development as screening tools for identifying individuals in the preclinical AD continuum.

Episodic memory boosting in older adults: exploring the association of encoding strategies and physical activity

Background: Contextual memory is susceptible to the effects of aging and its impairment compromises episodic memories and quality of life in older adults. Objective: Compare the effects of cognitive support on incidental contextual memory free recall and recognition with a naturalistic experimental paradigm and explore the association of encoding strategies and physical activity on memory improvement. Methods: Subjects (≥60 years, n = 52) were assigned to one of two encoding conditions for the contextual memory task: with or without an incidental associative instruction to encourage association of an item to its spatial context. Immediate free recall and recognition tests were run to assess the encoding instruction efficiency. The association of memory performance and physical activity was analyzed using the scores on the International Physical Activity Questionnaire (IPAQ) to subdivide each experimental group into Low IPAQ (below median) and High IPAQ (above median) subgroups. Results: The associative encoding instruction increased contextual memory free recall and recognition, with greater effects on free recall. The most robust associations between physical activity and contextual memory were also seen on free recall, in which higher levels of physical activity corresponded to increased baseline performance (non-associative encoding condition) and greater improvement of memory by the encoding support (associative encoding condition). Conclusion: Cognitive support at encoding can improve contextual memory free recall and recognition, suggesting they are prone to rehabilitation. Moreover, higher physical activity levels were positively associated with encoding strategies on contextual memory improvement, increasing the availability of latent process-based components of the cognitive reserve.

Handedness, Grip Strength, and Memory Function: Considerations by Biological Sex

Background and Objective: The objective of this study was to evaluate the potential independent and interactive effects of handedness and grip strength on episodic memory function, and whether biological sex moderated these relationships. Materials and Methods: 162 young adults (Mage = 20.7 years) completed a series of memory assessments including a subjective memory complaint evaluation and several objective measures of memory. Handedness (i.e., left-hand dominant, inconsistent handedness (ICH), and right-hand dominant) was evaluated using the Edinburgh Handedness Inventory. Handgrip strength was determined from a handgrip dynamometer. Results: When compared to ICH individuals, retrospective memory scores were statistically significantly worse for left-handed (p = 0.02) and right-handed (p = 0.03) individuals. Higher grip strength was statistically significantly associated with fewer retrospective memory complaints (b = 0.10, 95% CI: 0.01, 0.19, p = 0.04). Conclusions: The present study provides some suggestive evidence that ICH (inconsistent handedness) and greater grip strength are associated with fewer retrospective memory complaints. However, we did not observe any evidence of an interaction effect of handedness and grip strength on memory, and similarly, biological sex did not interact with these parameters to influence memory.

The REIm-13

Abstract. The Rational-Experiential Multimodal Inventory (REIm) is a recent tool showing promise in the measurement of self-reported thinking style – preference for rational or experiential processing – and offers three-faceted measurement of the latter. We present the first short form of the measure, the REIm-13, and test its factor structure, reliability, and validity in a large community sample. Participants were N = 920 Australian adults (502 females) who completed an online survey ( N = 510 of whom participated in a follow-up survey). In addition to the REIm, participants completed a Big Five personality measure. The internal consistency of the REIm-13 was acceptable given the limited number of items (.52–.68). Furthermore, test-retest reliability was high (ρ = .64–.74) for the theorized four-factor and two-factor solutions. Construct validity was established by examining the relationship between short-form and full REIm factors (ρ = .65–.71), and the validity of composite scoring was confirmed against factor scoring. Relationship with age (a slight negative relationship to both main scales), gender (females reporting higher Experientiality, males higher Rationality), and Big Five variables largely followed previous findings, demonstrating concurrent validity. The study demonstrates that the REIm-13 provides sound measurement of thinking style.

Are subjective memory complaints indicative of objective cognitive decline or depressive symptoms? Findings from the English Longitudinal Study of Ageing

Older adults often complain about their memory ability, but it is not clear to what extent subjective memory complaints accurately reflect objective cognitive dysfunctions. The concordance between objective and subjective cognitive performance may be affected by depressive symptoms and by declining insight into cognitive deficits. This study aims to examine longitudinal associations between subjective memory complaints, objective cognitive performance and depressive symptoms. 11,092 participants aged 50 years and above from the English Longitudinal Study of Ageing were followed-up every 2 years over a 6-year period. Two processes latent growth curve models (LGCM) examined associations between levels and changes in several cognitive abilities and subjective memory complaints, unadjusted for depression symptoms. Then three processes LGCM examined associations between levels and changes in depressive symptoms, subjective memory complaints and objective cognitive abilities in the overall sample, and separately among persons with mild cognitive impairment at baseline. More subjective memory complaints were associated with poorer performance in all cognitive domains at baseline. Steeper decline in immediate recall, verbal fluency and processing speed performance was associated increasing subjective memory complaints both in the overall sample and among persons with mild cognitive impairment. Increasing depressive symptoms were associated with both objective and subjective cognitive decline in the overall sample, and only with subjective memory decline among cognitively impaired persons. Self-reported memory complaints may have the potential to identify decline in objective cognitive performance that cannot be explained by depressive symptoms. Among cognitively impaired persons depressive symptoms may amplify subjective but not objective cognitive decline.

Talk or Walk? Gait Speed over Self-Report in Association with Cognitive Speed in Healthy Older Adults

Abstract. This study explores the relative value of both subjectively reported cognitive speed and gait speed in association with objectively derived cognitive speed. It also explores how these factors are affected by psychological and physical well-being. A group of 90 cognitively healthy older adults ( M = 73.38, SD = 8.06 years, range = 60–89 years) were tested in a three-task cognitive battery to determine objective cognitive speed as well as measures of gait speed, well-being, and subjective cognitive speed. Analyses indicated that gait speed was associated with objective cognitive speed to a greater degree than was subjective report, the latter being more closely related to well-being than to objective cognitive speed. These results were largely invariant across the 30-year age range of our older adult sample.

Depressed mood and cognitive deficits as distinct mechanisms of subjective memory and executive complaints

Background

Subjective cognitive decline (SCD) is the sense of deterioration in cognitive functioning in terms of memory, executive function, attention, etc. SCD is reported by nearly 70% of the population. Very intensive research on the predictive role of SCD in the development of dementia and determinants SCD did not bring common solutions. For exploration of the phenomenon, studies were undertaken in order to identify: a) on the basis of which factors a high level of SCD can be predicted, and b) whether these factors have similar prognostic value for two types of SCD, i.e. concerning executive function (SED) and memory (SMD).

Participants and procedure

The study involved 274 Polish people aged 18 to 84 years (M = 53.23, SD = 16.8). For the evaluation of SCD three methods were used: memory self-assessment scales (ProCog and MARS), and an executive functions self-assessment scale (DEX-S). Subtests of the WAIS-PL to assess cognitive function were used, and GDS-15 or BECK II to assess the severity of depressive mood. In the first stage, two separate cluster analyses (k-means method) were performed: the first related to the results of the memory self-assessment scale (ProCog and MARS), the second to the subjective difficulty of executive functions (DEX-S). In step II a logistic regression analysis of the forward selection with the likelihood ratio and interaction effects was performed – separately for the two types of self-reports.

Results

The results indicate that higher depressed mood increases the likelihood of both the SMD and SED. Higher efficiency attention-al processes reduce the possibility of formulating the SED, and higher efficiency of the delayed memory, abstract thinking, or certain aspects of language functions reduces the possibility of SMD.

Conclusions

There are two independent mechanisms of SCD – emotional and cognitive.

Developmental cognitive neuroscience using latent change score models: A tutorial and applications

Assessing and analysing individual differences in change over time is of central scientific importance to developmental neuroscience. However, the literature is based largely on cross-sectional comparisons, which reflect a variety of influences and cannot directly represent change. We advocate using latent change score (LCS) models in longitudinal samples as a statistical framework to tease apart the complex processes underlying lifespan development in brain and behaviour using longitudinal data. LCS models provide a flexible framework that naturally accommodates key developmental questions as model parameters and can even be used, with some limitations, in cases with only two measurement occasions. We illustrate the use of LCS models with two empirical examples. In a lifespan cognitive training study (COGITO, N = 204 (N = 32 imaging) on two waves) we observe correlated change in brain and behaviour in the context of a high-intensity training intervention. In an adolescent development cohort (NSPN, N = 176, two waves) we find greater variability in cortical thinning in males than in females. To facilitate the adoption of LCS by the developmental community, we provide analysis code that can be adapted by other researchers and basic primers in two freely available SEM software packages (lavaan and Ωnyx).

Amyloid-associated increases in longitudinal report of subjective cognitive complaints

Introduction

To investigate whether baseline subjective cognitive complaints (SCCs) predict longitudinal decline on neuropsychological testing and whether SCC increases longitudinally, in the setting of high levels of amyloid burden.

Methods

Two hundred seventy-nine clinically normal older participants (mean age = 73.7 ± 6.1 years) from the Harvard Aging Brain Study, a cohort of community-dwelling individuals, were followed longitudinally (4.27 ± 1.35 years) with annual subjective memory questionnaires and neuropsychological assessment. ¹¹C Pittsburgh compound-B positron emission tomography was used to measure cortical amyloid and to classify status (Aβ+/Aβ−) at baseline.

Results

Higher baseline SCC predicted more rapid cognitive decline on neuropsychological measures among those with elevated amyloid (t = −2.18, P < .0001). In addition, longitudinal report of SCC significantly increased over time, with SCC progression most pronounced among Aβ+ individuals (t = 2.24, P = .0005).

Discussion

SCC may inform risk for future cognitive decline and track progression of self-perceived decline, particularly in those along the AD trajectory, providing potentially important indicators of clinical meaningfulness in AD prevention trials.

Memory complaints, dementia, and neuropathology in older blacks and whites

OBJECTIVE

To determine relationships of memory complaints to cognitive function and decline, incident dementia, and neurodegenerative and other neuropathologies, as well as the population-attributable risk for dementia in older black and white persons.

METHODS

A total of 4,015 community-based persons (28% black; 74% women; mean baseline age = 78 years) were enrolled in 1 of 4 longitudinal cohort studies, and another 2,937 in a population-based cohort. Memory scores, assessed using 2 questions (5-point Likert scales) were categorized as complaints present or absent. Global cognition and 5 cognitive domains were derived from annual neuropsychological tests. Dementia was assessed from these tests and additional data. Neuropathologic data were available for 1,350 deceased subjects with brain autopsies. Regression and mixed effects models were used to examine relationships of memory complaints to cognition and neuropathology.

RESULTS

Baseline memory complaints (n = 1,310; 33% of 4,015) were associated with lower cognition and faster decline in all domains (global score estimate = -0.032, standard error = 0.004, p < 0.0001), during a mean follow-up of 6 (standard deviation = 2) years. Persons with memory complaints had higher dementia risk (hazard ratio = 1.64, 95% confidence interval [CI] = 1.42-1.89) and odds of pathologic Alzheimer disease (odds ratio [OR] = 1.96, 95% CI = 1.51-2.54), neocortical Lewy bodies (OR = 2.47, 95% CI = 1.54-3.96), and other neurodegenerative pathologies. Results for dementia risk were similar among blacks and whites. Among 2,937 older persons in a population-based cohort with similar data, the population-attributable risk for incident dementia due to memory complaints was 14.0% (95% CI = 2.6-23.0), and did not vary between the black and white groups.

INTERPRETATION

Memory complaints are common in older black and white persons, and relate to cognitive decline, dementia risk, and neurodegenerative pathologies. Ann Neurol 2018;83:718-729.

Longitudinal Assessment of Self- and Informant-Subjective Cognitive Complaints in a Sample of Healthy Late-Middle Aged Adults Enriched with a Family History of Alzheimer's Disease

OBJECTIVES

The purpose of this study was to investigate the longitudinal trajectory of self- and informant-subjective cognitive complaints (SCC), and to determine if SCC predict longitudinal changes in objective measures (OM) of cognitive function.

METHODS

The study included healthy and cognitively normal late middle-aged adults enriched with a family history of AD who were evaluated at up to three visits over a 4-year period. At each visit (Visit 1-3), self- and informant-SCC and OM were evaluated. Linear mixed models were used to determine if the longitudinal rate of change of self- and informant-SCC were associated with demographic variables, depressive symptoms, family history (FH), and apolipoprotein epsilon 4 (APOE4) status. The same modeling approach was used to examine the effect of Visit 1 SCC on longitudinal cognitive change after controlling for the same variables.

RESULTS

At Visit 1, more self-SCC were associated with fewer years of education and more depressive symptoms. SCC were also associated with poorer performance on cognitive measures, such that more self-SCC at Visit 1 were associated with poorer performance on memory and executive functioning measures at Visit 1, while more informant-SCC were associated with faster rate of longitudinal decline on a measure of episodic learning and memory. FH and APOE4 status were not associated with SCC.

DISCUSSION

Self- and informant-SCC showed an association with OM, albeit over different time frames in our late middle-aged sample. Additional longitudinal follow-up will likely assist in further clarifying these relationships as our sample ages and more pronounced cognitive changes eventually emerge. (JINS, 2017, 23, 617-626).

Selective impact of disease on short-term and long-term components of self-reported memory: a population-based HUNT study

BACKGROUND

Subjective memory is commonly considered to be a unidimensional measure. However, theories of performance-based memory suggest that subjective memory could be divided into more than one dimension.

OBJECTIVE

To divide subjective memory into theoretically related components of memory and explore the relationship to disease.

METHODS

In this study, various aspects of self-reported memory were studied with respect to demographics and diseases in the third wave of the HUNT epidemiological study in middle Norway. The study included all individuals 55 years of age or older, who responded to a nine-item questionnaire on subjective memory and questionnaires on health (n=18 633).

RESULTS

A principle component analysis of the memory items resulted in two memory components; the criterion used was an eigenvalue above 1, which accounted for 54% of the total variance. The components were interpreted as long-term memory (LTM; the first component; 43% of the total variance) and short-term memory (STM; the second component; 11% of the total variance). Memory impairment was significantly related to all diseases (except Bechterew's disease), most strongly to brain infarction, heart failure, diabetes, cancer, chronic obstructive pulmonary disease and whiplash. For most diseases, the STM component was more affected than the LTM component; however, in cancer, the opposite pattern was seen.

CONCLUSIONS

Subjective memory impairment as measured in HUNT contained two components, which were differentially associated with diseases.

The influence of demographic factors on subjective cognitive concerns and beta-amyloid

BACKGROUND

Converging evidence suggests that subjective cognitive concerns (SCC) are associated with biomarker evidence of Alzheimer's disease (AD) prior to objective clinical impairment. However, the sensitivity of SCC reports in early AD may be biased by demographic factors. Here, we sought to investigate whether age, education, and sex influence the relationship between SCC and amyloid (Aβ) burden.

METHODS

In this cross-sectional study, we examined 252 clinically normal (CN) individuals (57.7% females) enrolled in the Harvard Aging Brain Study, ages 63-90 years (mean 73.7±6) with 6-20 years of education (mean 15.8±3). SCC was assessed as a composite score comprising three questionnaires. Cortical Aβ burden was assessed with Pittsburgh compound B positron emission tomography imaging. A series of linear regression models assessed the potential modifying role of demographic variables with respect to Aβ burden and SCC. A post-hoc mediation model was implemented to further understand the relationship between Aβ burden and SCC via their relationship with education.

RESULTS

Age (β = -0.84, p = 0.36) and sex (β = -0.55, p = 0.22) did not modify the relationship between SCC and Aβ burden. Fewer years of education was correlated with greater SCC (r = -0.12, p = 0.05), but the relationship between Aβ burden and SCC was stronger in those with more education (β = 1.16, p < 0.05). A partial mediation effect was found of Aβ burden on SCC via education (b = -0.12, 95% CI [-0.31, -0.02]).

CONCLUSIONS

These findings suggest that the association between SCC and Aβ burden becomes stronger with greater educational attainment. Thus, SCC may be of particular importance in highly educated CN individuals harboring amyloid pathology.

A 'Disease Severity Index' to identify individuals with Subjective Memory Decline who will progress to mild cognitive impairment or dementia

Subjective memory decline (SMD) is a heterogeneous condition. While SMD might be the earliest sign of Alzheimer’s disease (AD), it also occurs in aging and various neurological, medical, and psychiatric conditions. Identifying those with higher risk to develop dementia is thus a major challenge. We tested a novel disease severity index generated by multivariate data analysis with numerous structural MRI measures as input. The index was used to identify SMD individuals with high risk of progression to mild cognitive impairment (MCI) or AD. A total of 69 healthy controls, 86 SMD, 45 MCI, and 38 AD patients were included. Subjects were followed up for 7.5 years. Clinical, cognitive, PET amyloid imaging and APOE ε4 data were used as outcome variables. The results showed that SMD evidenced cognitive performance intermediate between healthy controls and MCI. The disease severity index identified eleven (13%) SMD individuals with an AD-like pattern of brain atrophy. These individuals showed lower cognitive performance, increased CDR-SOB, higher amyloid burden and worse clinical progression (6.2 times higher likelihood to develop MCI, dementia or die than healthy controls). The current disease severity index may have relevance for clinical practice, as well as for selecting appropriate individuals for clinical trials.

Implementation of subjective cognitive decline criteria in research studies

INTRODUCTION

Subjective cognitive decline (SCD) manifesting before clinical impairment could serve as a target population for early intervention trials in Alzheimer's disease (AD). A working group, the Subjective Cognitive Decline Initiative (SCD-I), published SCD research criteria in the context of preclinical AD. To successfully apply them, a number of issues regarding assessment and implementation of SCD needed to be addressed.

METHODS

Members of the SCD-I met to identify and agree on topics relevant to SCD criteria operationalization in research settings. Initial ideas and recommendations were discussed with other SCD-I working group members and modified accordingly.

RESULTS

Topics included SCD inclusion and exclusion criteria, together with the informant's role in defining SCD presence and the impact of demographic factors.

DISCUSSION

Recommendations for the operationalization of SCD in differing research settings, with the aim of harmonization of SCD measurement across studies are proposed, to enhance comparability and generalizability across studies.

A Conceptualization of the Utility of Subjective Cognitive Decline in Clinical Trials of Preclinical Alzheimer's Disease

This commentary outlines a conceptual model for subjective cognitive decline (SCD) in relation to Alzheimer's disease (AD) biomarkers in the preclinical stages of disease and a framework for effectively utilizing SCD in secondary prevention clinical trials. Mounting evidence supports the notion that SCD is sensitive to encroaching Aβ-amyloid and neurodegeneration. SCD has also been shown to provide additive information of AD-dementia risk beyond what is known about the biomarker status of the individual. Thus, we provide recommendations for the implementing SCD measurement in clinical trials. We argue that SCD can be measured at three catch points within the course of the clinical trial: firstly, at the initial recruitment and screening phase; secondly, to create more robust estimates of rates of AD-dementia progression; and finally, to measure subjective experiences of cognitive change and quality of life over the course of the trial as a proxy of clinically meaningful functional improvement. We provide recommendations of how SCD can be approached at each of these points. SCD is an important component of the preclinical AD-dementia trajectory. Future studies need to elucidate the interactive influence of Aβ-amyloid and tau on SCD from a spatiotemporal perspective. Even as this evidence accrues, it is clear that SCD can provide unique and additive information about rates of progression and subjectively experienced cognitive change within clinical trials.

Long-term trajectories of self-reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

BACKGROUND

The number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals.

METHODS

A cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group.

RESULTS

Survivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline.

CONCLUSIONS

Trajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society

Among older survivors of breast cancer who were followed for up to 7 years, approximately 42% reported maintaining high cognitive function, but receipt of chemotherapy (with or without hormonal therapy) appeared to double the odds of being in the group that reported accelerated cognitive decline (vs maintaining high function), compared with receiving hormonal treatment alone. Further research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline.