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Kim S, Lee K. A Network Analysis of Depressive Symptoms in the Elderly with Subjective Memory Complaints. J Pers Med 2022; 12:jpm12050821. [PMID: 35629243 PMCID: PMC9145813 DOI: 10.3390/jpm12050821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Subjective memory complaints (SMCs) are common among the elderly and are important because they can indicate early cognitive impairment. The factor with the greatest correlation with SMCs is depression. The purpose of this study is to examine depressive symptoms among elderly individuals with SMCs through a network analysis that can analyze disease models between symptoms; (2) Methods: A total of 3489 data collected from elderly individuals in the community were analyzed. The Subjective Memory Complaints Questionnaire and Patient Health Questionnaire-9 were evaluated. For statistical analysis, we investigated the features of the depressive symptoms network, including centrality and clustering; (3) Results: Network analysis of the SMC group showed strong associations in the order of Q1–Q2 (r = 0.499), Q7–Q8 (r = 0.330), and Q1–Q6 (r = 0.239). In terms of centrality index, Q2 was highest in strength and expected influence, followed by Q1 in all of betweenness, strength, and expected influence; (4) Conclusions: The network analysis confirmed that the most important factors in the subjective cognitive decline group were depressed mood and anhedonia, which also had a strong correlation in the network pattern.
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Wereszczyński M, Niedźwieńska A. Dementia-Free Older Adults with Subjective Cognitive Impairment Show Lower Mood and No Deficits of Spontaneous Memory Retrieval. Int J Aging Hum Dev 2021; 95:372-394. [PMID: 34918550 DOI: 10.1177/00914150211066561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the present study was to investigate whether spontaneous retrieval deficits could be found in individuals with Subjective Cognitive Impairment (SCI). The sample consisted of 52 participants over 65 years of age (mean age = 76.00; SD = 7.48) with 11 males. We asked 26 individuals with SCI and 26 individuals without SCI to perform a prospective memory (PM) task that had previously demonstrated spontaneous retrieval deficits in individuals with Mild Cognitive Impairment. The results did not demonstrate the expected differences in a PM task based on spontaneous retrieval [t(50) = -.05; p = .964, d = .01]. However, participants' mood did predict their subjective memory complaints (β = -.51; p < .001) and their subjective assessment of their future memory performance (r = -.38; p < .01). The findings are in line with numerous studies which have shown that SCI is more related to mood disturbance than to objective cognitive functioning.
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Affiliation(s)
- Michał Wereszczyński
- Applied Memory Research Laboratory, Institute of Psychology, 37799Jagiellonian University, Cracow, Poland
| | - Agnieszka Niedźwieńska
- Applied Memory Research Laboratory, Institute of Psychology, 37799Jagiellonian University, Cracow, Poland
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Torres IJ, Hidiroglu C, Mackala SA, Ahn S, Yatham LN, Ozerdem E, Michalak EE. Metacognitive knowledge and experience across multiple cognitive domains in euthymic bipolar disorder. Eur Psychiatry 2021; 64:e36. [PMID: 34082855 PMCID: PMC8204590 DOI: 10.1192/j.eurpsy.2021.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Metacognitive knowledge (MK; general awareness of cognitive functioning) and metacognitive experience (ME; awareness of cognitive performance on a specific cognitive task) represent two facets of metacognition that are critical for daily functioning, but are understudied in bipolar disorder. This study was conducted to evaluate MK and ME across multiple cognitive domains in individuals diagnosed with bipolar disorder and unaffected volunteers, and to investigate the association between metacognition and quality of life (QoL). Methods Fifty-seven euthymic participants with bipolar disorder and 55 demographically similar unaffected volunteers provided prediction and postdiction ratings of cognitive task performance across multiple cognitive domains. Self-ratings were compared to objective task performance, and indices of MK and ME accuracy were generated and compared between groups. Participants rated QoL on the Quality of Life in Bipolar Disorder Scale (QoL.BD). Results Metacognitive inaccuracies in both MK and ME were observed in participants with bipolar disorder, but only in select cognitive domains. Furthermore, most metacognitive inaccuracies involved underestimation of cognitive ability. Metacognitive indices were minimally associated with medication variables and mood symptoms, but several indices were related to QoL. Conclusions Individuals with bipolar disorder demonstrate inaccuracies in rating their cognitive functioning and in rating their online cognitive task performance, but only on select cognitive functions. The tendency to underestimate performance may reflect a negative information processing bias characteristic of mood disorders. Metacognitive variables were also predictive of QoL, indicating that further understanding of cognitive self-appraisals in persons with bipolar disorder has significant clinical relevance.
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Affiliation(s)
- Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Ceren Hidiroglu
- Department of Psychology, Dokuz Eylul University, Izmir, Turkey
| | - Sylvia A Mackala
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Ahn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Van Camp L, Sabbe BGC, Oldenburg JFE. Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design. Compr Psychiatry 2019; 92:7-12. [PMID: 31202082 DOI: 10.1016/j.comppsych.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 05/08/2019] [Accepted: 06/01/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Metacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown. METHODS The current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience). RESULTS Bipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general. CONCLUSION Maladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.
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Affiliation(s)
- L Van Camp
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, 2570 Duffel, Belgium.
| | - B G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, 2570 Duffel, Belgium
| | - J F E Oldenburg
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, 2570 Duffel, Belgium
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Azar M, Bertrand E, Louis ED, Huey E, Collins K, Rohl B, Cosentino S. Awareness of cognitive impairment in individuals with essential tremor. J Neurol Sci 2017; 377:155-160. [PMID: 28477687 DOI: 10.1016/j.jns.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The extent to which individuals with ET who have clinically significant cognitive impairment are aware of their cognitive changes is unclear. Reduced awareness has important implications for everyday function and decision-making. METHODS 150 individuals with ET (109 Normal Cognition (ET-NC group), and 30 with MCI and 11 dementia (ET-CI group)) completed self-ratings and objective assessments of memory, language, and executive functioning. Discrepancy scores were calculated to assess awareness of cognitive functioning. One sample t-tests evaluated whether mean discrepancy scores in each group were comparable to zero (i.e., accurate). Analyses of covariance (ANCOVA) compared discrepancy scores across two groups controlling for age and education. RESULTS In the ET-NC group, discrepancy scores for language (M=-0.08, SD=1.10) and executive functioning (M=-0.01, SD=0.99) were comparable to zero. Memory discrepancy scores (M=0.32, SD=1.22) were greater than zero. In the ET-CI group, memory, (M=0.78, SD=1.01), language, (M=0.46, SD=0.95), and executive (M=0.39, SD=1.14) discrepancy scores were all greater than zero. Discrepancy scores were larger in ET-CI group than in ET-NC group for memory: F(1,148)=4.02, p=0.047, language: F(1,148)=6.16, p=0.014, and executive: F(1,148)=4.51, p=0.035. CONCLUSIONS Individuals with ET and normal cognition accurately assessed their language and executive abilities, demonstrating mild overconfidence in memory function. Individuals with ET and cognitive impairment overestimated their performance in all domains of functioning. Since ET is linked to increased risk for cognitive impairment, and such impairment may not be accurately perceived, cognitive functioning should be proactively and regularly screened in ET.
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Affiliation(s)
- Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA
| | - Elodie Bertrand
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Edward Huey
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA
| | - Kathleen Collins
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Brittany Rohl
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, NY, USA.
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Torres IJ, Mackala SA, Kozicky JM, Yatham LN. Metacognitive knowledge and experience in recently diagnosed patients with bipolar disorder. J Clin Exp Neuropsychol 2016; 38:730-44. [PMID: 27144722 DOI: 10.1080/13803395.2016.1161733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Metacognition, which refers to an individual's ability to assess their own cognitive ability or performance, is poorly understood in bipolar disorder. This study was conducted to evaluate two aspects of metacognitive ability in recently diagnosed patients with bipolar disorder: (a) metacognitive knowledge, pertaining to awareness of one's own general cognitive functioning; and (b) metacognitive experience, referring to awareness of one's cognitive performance on a specific, online cognitive task. METHOD Participants consisted of 50 clinically euthymic patients recently diagnosed with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) bipolar I disorder who were within three months of resolution of their first manic episode, and a comparison group of 38 demographically similar healthy volunteers. To assess metacognitive knowledge, participants provided a general rating of their estimated cognitive ability prior to completing a neuropsychological battery, and self-ratings were compared to actual ability based on a composite score of overall cognitive functioning. To assess metacognitive experience, subjects provided a postdiction rating of their perceived memory performance after completing a list learning verbal memory test, and self-ratings were compared to actual memory performance. Measures of both relative and absolute accuracy of ratings were obtained. RESULTS Results indicated that patients showed diminished accuracy in rating their general cognitive ability, implying deficits in metacognitive knowledge. In contrast, patients were accurate in rating their online memory performance, suggesting intact metacognitive experience. CONCLUSIONS Findings suggest that in patients with bipolar disorder, intact task-specific cognitive self-appraisals may fail to generalize to or to modify inaccurate global cognitive self-appraisals. Further research using more comprehensive metacognitive tasks is warranted in bipolar disorder.
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Affiliation(s)
- Ivan J Torres
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.,b BC Psychosis Program: British Columbia Mental Health and Substance Use Services , Vancouver , BC , Canada
| | - Sylvia A Mackala
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Jan-Marie Kozicky
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Lakshmi N Yatham
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
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Clare L, Whitaker CJ, Roberts JL, Nelis SM, Martyr A, Marková IS, Roth I, Woods RT, Morris RG. Memory awareness profiles differentiate mild cognitive impairment from early-stage dementia: evidence from assessments of performance monitoring and evaluative judgement. Dement Geriatr Cogn Disord 2013; 35:266-79. [PMID: 23548548 DOI: 10.1159/000346735] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measures of memory awareness based on evaluative judgement and performance monitoring are often regarded as equivalent, but the Levels of Awareness Framework suggests they reflect different awareness phenomena. Examination of memory awareness among groups with differing degrees of impairment provides a test of this proposition. METHOD Ninety-nine people with dementia (PwD), 30 people with mild cognitive impairment (PwMCI), and their relatives completed isomorphic performance monitoring and evaluative judgement measures of memory awareness and were followed up at 12 and (PwD only) 20 months. In addition to the resulting awareness indices, comparative accuracy scores were calculated using the relatives' data to establish whether any inaccuracy was specific to self-ratings. RESULTS When making evaluative judgements about their memory in general, both PwD and PwMCI tended to overestimate their own functioning relative to informant ratings made by relatives. When monitoring performance on memory tests, PwD again overestimated performance relative to test scores, but PwMCI were much more accurate. Comparative accuracy scores indicated that, unlike PwD, PwMCI do not show a specific inaccuracy in self-related appraisals. CONCLUSIONS The results support the proposition that awareness indices at the levels of evaluative judgement and performance monitoring should be regarded as reflecting distinct awareness phenomena.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor LL57 2AS, UK.
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Larrabee GJ, Rohling ML. Neuropsychological differential diagnosis of mild traumatic brain injury. BEHAVIORAL SCIENCES & THE LAW 2013; 31:686-701. [PMID: 24105915 DOI: 10.1002/bsl.2087] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
The diagnosis and evaluation of mild traumatic brain injury (mTBI) is reviewed from the perspective of meta-analyses of neuropsychological outcome, showing full recovery from a single, uncomplicated mTBI by 90 days post-trauma. Persons with history of complicated mTBI characterized by day-of-injury computed tomography or magnetic resonance imaging abnormalities, and those who have suffered prior mTBIs may or may not show evidence of complete recovery similar to that experienced by persons suffering a single, uncomplicated mTBI. Persistent post-concussion syndrome (PCS) is considered as a somatoform presentation, influenced by the non-specificity of PCS symptoms which commonly occur in non-TBI samples and co-vary as a function of general life stress, and psychological factors including symptom expectation, depression and anxiety. A model is presented for forensic evaluation of the individual mTBI case, which involves open-ended interview, followed by structured interview, record review, and detailed neuropsychological testing. Differential diagnosis includes consideration of other neurologic and psychiatric disorders, symptom expectation, diagnosis threat, developmental disorders, and malingering.
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Affiliation(s)
- Glenn J Larrabee
- Independent Practice, 2650 Bahia Vista Street, Suite 308, Sarasota, FL, 34239, U.S.A
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Antoine P, Nandrino JL, Billiet C. Awareness of deficits in Alzheimer's disease patients: analysis of performance prediction discrepancies. Psychiatry Clin Neurosci 2013; 67:237-44. [PMID: 23683154 DOI: 10.1111/pcn.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 08/31/2012] [Accepted: 01/09/2013] [Indexed: 11/27/2022]
Abstract
AIM Unawareness has been operationalized in terms of a discrepancy between the patient's self-reports and three main categories of standards: judgment of a relative, clinical assessment, and objective test performance. The purpose of this study was to develop a new measure of deficit unawareness based on multidimensional, isomorphic, simple tasks and to examine the relationship between this measure and neuropsychological tests. METHODS : Analysis was conducted on cognitive performance prediction discrepancies in a sample of Alzheimer's disease (AD) patients and a matched comparison group. RESULTS Patients rated their cognitive functioning more highly than their performance, but their overall self-reports were lower than the overall self-reports of the comparison group. AD patients performed significantly lower than their predicted scores in all Dementia Rating Scale (DRS) domains, in contrast to comparison participants, who did not consistently perform significantly lower across domains. All unawareness scores were moderately inter-correlated, except for memory, and all unawareness scores with the exception of memory were correlated with overall neuropsychological functioning. CONCLUSION A methodological and conceptual difficulty has been identified, and this raises the issue of the generalizability of studies with a focus on memory unawareness. The method proposed seems a good tool to assess the relationships between unawareness and several different aspects of cognitive functioning, in particular executive functioning.
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Affiliation(s)
- Pascal Antoine
- URECA, University of Lille Nord de France, Villeneuve d'Ascq, France.
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10
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Subjective cognitive-affective status following thalamic stroke. J Neurol 2012; 260:386-96. [DOI: 10.1007/s00415-012-6635-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/06/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
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Ossher L, Flegal KE, Lustig C. Everyday memory errors in older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2012; 20:220-42. [PMID: 22694275 PMCID: PMC3443516 DOI: 10.1080/13825585.2012.690365] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite concern about cognitive decline in old age, few studies document the types and frequency of memory errors older adults make in everyday life. In the present study, 105 healthy older adults completed the Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983 , Journal of Verbal Learning and Verbal Behavior, 22, 341), indicating what memory errors they had experienced in the last 24 hours, the Memory Self-Efficacy Questionnaire (MSEQ; West, Thorn, & Bagwell, 2003 , Psychology and Aging, 18, 111), and other neuropsychological and cognitive tasks. EMQ and MSEQ scores were unrelated and made separate contributions to variance on the Mini Mental State Exam (MMSE; Folstein, Folstein, & McHugh, 1975 , Journal of Psychiatric Research, 12, 189), suggesting separate constructs. Tip-of-the-tongue errors were the most commonly reported, and the EMQ Faces/Places and New Things subscales were most strongly related to MMSE. These findings may help training programs target memory errors commonly experienced by older adults, and suggest which types of memory errors could indicate cognitive declines of clinical concern.
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Affiliation(s)
- Lynn Ossher
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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Clare L, Whitaker CJ, Nelis SM, Martyr A, Markova IS, Roth I, Woods RT, Morris RG. Multidimensional assessment of awareness in early-stage dementia: a cluster analytic approach. Dement Geriatr Cogn Disord 2011; 31:317-27. [PMID: 21508642 DOI: 10.1159/000327356] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Research on awareness in dementia has yielded variable and inconsistent associations between awareness and other factors. This study examined awareness using a multidimensional approach and applied cluster analytic techniques to identify associations between the level of awareness and other variables. METHODS Participants were 101 individuals with early-stage dementia (PwD) and their carers. Explicit awareness was assessed at 3 levels: performance monitoring in relation to memory, evaluative judgement in relation to memory, everyday activities and socio-emotional functioning, and metacognitive reflection in relation to the experience and impact of the condition. Implicit awareness was assessed with an emotional Stroop task. RESULTS Different measures of explicit awareness scores were related only to a limited extent. Cluster analysis yielded 3 groups with differing degrees of explicit awareness. These groups showed no differences in implicit awareness. Lower explicit awareness was associated with greater age, lower MMSE scores, poorer recall and naming scores, lower anxiety and greater carer stress. CONCLUSION Multidimensional assessment offers a more robust approach to classifying PwD according to level of awareness and hence to examining correlates and predictors of awareness.
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Affiliation(s)
- Linda Clare
- Bangor University, UK. l.clare @ bangor.ac.uk
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Clare L, Wilson BA, Carter G, Roth I, Hodges JR. Assessing awareness in early-stage Alzheimer's disease: Development and piloting of the Memory Awareness Rating Scale. Neuropsychol Rehabil 2010. [DOI: 10.1080/09602010244000129] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Clare L, Whitaker CJ, Nelis SM. Appraisal of Memory Functioning and Memory Performance in Healthy Ageing and Early-Stage Alzheimer's Disease. AGING NEUROPSYCHOLOGY AND COGNITION 2010; 17:462-91. [DOI: 10.1080/13825580903581558] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rouch I, Anterion CT, Dauphinot V, Kerleroux J, Roche F, Barthelemy JC, Laurent B. Cognitive complaints, neuropsychological performance and affective disorders in elderly community residents. Disabil Rehabil 2009; 30:1794-802. [DOI: 10.1080/09638280701667825] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Clare L, Wilson BA. Longitudinal assessment of awareness in early-stage Alzheimer's disease using comparable questionnaire-based and performance-based measures: a prospective one-year follow-up study. Aging Ment Health 2006; 10:156-65. [PMID: 16517491 DOI: 10.1080/13607860500311888] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Few studies of awareness in dementia have taken a longitudinal perspective, yet exploring the ways in which awareness changes over time may offer important information about the processes involved and the relationship between awareness and other variables. The present study explored in detail the patterns of change in awareness scores over time for a group of 12 participants with early-stage Alzheimer's disease using a multi-dimensional measure giving comparable participant-carer and post diction-performance discrepancy scores. There were small, non-significant increases in mean discrepancy scores for each of these components of the assessment, with similar patterns for questionnaire-based and performance-based ratings. The small changes that were observed reflected both participant and informant factors. The majority of participants showed only very minor changes; others showed changes in the direction of either reduced or increased awareness. There was no significant association between change in mean discrepancy score and change in MMSE score over time, although there was a significant decline in MMSE scores at follow-up. The observation of different longitudinal trajectories for awareness scores, reflecting increased or decreased awareness or no change, may indicate the operation of different processes affecting the expression of explicit awareness that can be understood within a biopsychosocial formulation of this complex construct.
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Affiliation(s)
- L Clare
- University of Wales Bangor, Bangor, Wales, UK.
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Abstract
A comprehensive range of literature on awareness in dementia published in peer-reviewed journals during the last 15 years was reviewed with the aim of extracting details of the methods and measurement instruments adopted for the purposes of assessing awareness. Assessment approaches fell into five categories: clinician rating methods, questionnaire-based methods, performance-based methods, phenomenological methods, and multidimensional or combined methods. Ranges of objects of awareness assessment were identified both within and across domains. Strengths and limitations of methods in each category were identified. Reasons for the inconclusive findings from research using the methods described here were considered, and suggestions for future directions were made.
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Affiliation(s)
- Linda Clare
- School of Psychology, University of Wales Bangor, UK.
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Abstract
A number of issues critical to the development of computer-based neuropsychological testing systems that remain continuing challenges to their widespread use in occupational and environmental health are reviewed. Several computer-based neuropsychological testing systems have been developed over the last 20 years, and they have contributed substantially to the study of neurologic effects of a number of environmental exposures. However, many are no longer supported and do not run on contemporary personal computer operating systems. Issues that are continuing challenges for development of computer-based neuropsychological tests in environmental and occupational health are discussed: (1) some current technological trends that generally make test development more difficult; (2) lack of availability of usable speech recognition of the type required for computer-based testing systems; (3) implementing computer-based procedures and tasks that are improvements over, not just adaptations of, their manually-administered predecessors; (4) implementing tests of a wider range of memory functions than the limited range now available; (5) paying more attention to motivational influences that affect the reliability and validity of computer-based measurements; and (6) increasing the usability of and audience for computer-based systems. Partial solutions to some of these challenges are offered. The challenges posed by current technological trends are substantial and generally beyond the control of testing system developers. Widespread acceptance of the "tablet PC" and implementation of accurate small vocabulary, discrete, speaker-independent speech recognition would enable revolutionary improvements to computer-based testing systems, particularly for testing memory functions not covered in existing systems. Dynamic, adaptive procedures, particularly ones based on item-response theory (IRT) and computerized-adaptive testing (CAT) methods, will be implemented in new tests that will be more efficient, reliable, and valid than existing test procedures. These additional developments, along with implementation of innovative reporting formats, are necessary for more widespread acceptance of the testing systems.
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Affiliation(s)
- Richard Letz
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA.
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Schmidt IW, Berg IJ, Deelman BG. Relations between subjective evaluations of memory and objective memory performance. Percept Mot Skills 2001; 93:761-76. [PMID: 11806600 DOI: 10.2466/pms.2001.93.3.761] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several explanations for the weak relations between subjective memory judgements and objective memory performance were investigated in two groups of normal older adults. Group 1 sampled a general population (mean age 61.6 yr., range 46-89), while Group 2 sampled subjects who were on a waiting list for memory training (mean age 63.0 yr., range 45-85 years). In both groups, subjective memory judgments were assessed with global ratings of memory capacity and with ratings of frequency of forgetting in specific memory situations. Memory performance was assessed with several well-known tests and with recently developed tests for domain-specific aspects of memory. Most tests concerned episodic memory. Study 1 also included measures of semantic, incidental and working memory. Study 2 further examined the influence of the domain-specificity of objective and subjective measures for remembering names, intentions, and texts. Relations between memory self-reports and performance were weak in both groups and for all kinds of tests. Against expectations, the low correlations could not be explained by differences between ecological and laboratory tests or incidentally and intentionally remembered information, or by differences between specific failures compared to global, stereotyped judgments. Surprisingly, correlations did not increase when subjective and objective measures assessed the same ability, like remembering names. Also noncognitive variables (mood and lifestyle) did not influence the relations. The (weak) relations between subjective and objective memory measures were comparable for subjects over and under 65 years of age. Furthermore, relations were comparable for the general population sample and the memory compliant group.
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Affiliation(s)
- I W Schmidt
- Department of Neuropsychology and Gerontology, University of Groningen, The Netherlands.
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21
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Svenmarker S, Sandström E, Karlsson T, Häggmark S, Jansson E, Appelblad M, Lindholm R, Aberg T. Neurological and general outcome in low-risk coronary artery bypass patients using heparin coated circuits. Eur J Cardiothorac Surg 2001; 19:47-53. [PMID: 11163560 DOI: 10.1016/s1010-7940(00)00625-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The clinical significance of heparin coating in cardiopulmonary bypass has previously been investigated. However, few studies have addressed the possible influence on brain function and memory disturbances. METHODS Three hundred low-risk patients exposed to coronary bypass surgery were randomised into three groups according to type of heparin coating: Carmeda Bioactive Surface, Baxter Duraflo II and a control group. Outcome was determined from a number of clinically oriented parameters, including a detailed registry of postoperative deviations from the normal postoperative course. Brain damage was assessed through S100 release and memory tests, including a questionnaire follow-up. RESULTS Clinical outcome was similar for all groups. Blood loss (Duraflo only), transfusion requirements and postoperative creatinine elevation were reduced in the heparin-coated groups. A lower incidence of atrial fibrillation was noted in the Duraflo group. Heparin coating did not uniformly attenuate the release of S100 or the degree of memory impairment. CONCLUSIONS Cardiopulmonary bypass (CPB) with heparin coating and a reduced dose of heparin seems to be safe. Clinical outcome and neurological injury seem not to be associated with type of heparin coating used for CPB. However, blood loss and transfusion requirements may be reduced.
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Affiliation(s)
- S Svenmarker
- Department of Surgery and Perioperative Science, University of Umeå, Umeå, Sweden
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22
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Hertzog C, Park DC, Morrell RW, Martin M. Ask and ye shall receive: behavioural specificity in the accuracy of subjective memory complaints. APPLIED COGNITIVE PSYCHOLOGY 2000. [DOI: 10.1002/(sici)1099-0720(200005/06)14:3<257::aid-acp651>3.0.co;2-o] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Perez Garcia M, Godoy Garcia JF, Vera Guerrero N, Laserna Triguero JA, Puente AE. Neuropsychological evaluation of everyday memory. Neuropsychol Rev 1999; 8:203-27. [PMID: 9951711 DOI: 10.1023/a:1021622319851] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The evaluation of everyday memory (EM) was reviewed and reconceptualized. EM has established new objectives of study and the development of new methods to reach these objectives. At the basic level, this approach has already produced important discoveries and the development of new principles about memory and functioning. At the clinical level, this new area of investigation has resulted in evaluating deficits of EM, which is defined as what daily life functions remain impaired after a deficit pathology has occurred. A type of evaluation has evolved that is oriented toward treatment and extremely useful in designing rehabilitation programs for individuals with alterations in memory.
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Affiliation(s)
- M Perez Garcia
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicologia, Universidad de Granada, Spain
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24
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Kinsella G, Murtagh D, Landry A, Homfray K, Hammond M, O'Beirne L, Dwyer L, Lamont M, Ponsford J. Everyday memory following traumatic brain injury. Brain Inj 1996; 10:499-507. [PMID: 8806010 DOI: 10.1080/026990596124214] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Residual memory deficits may represent a problem to the everyday functioning of a large number of people, including those who have sustained traumatic brain injury (TBI). The present exploratory study sought to investigate the interrelationships between subjective memory reports, performance on traditional memory tests, and performance on tests of prospective memory. These interrelationships were contrasted between a group of 24 adults who had sustained TBI and a group of 24 matched control subjects. Prospective memory was hypothesized to be indicative of everyday memory functioning. The results provided preliminary evidence that prospective memory tests are sensitive to TBI-related neurological impairment and, in comparison to traditional tests, may be better indicators of functional memory capacity. This pattern was particularly true for control subjects, possibly because TBI subjects had difficulties in evaluating their memory functioning.
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Affiliation(s)
- G Kinsella
- School of Psychology, La Trobe University, Victoria, Australia
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25
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Larrabee GJ. Age-associated memory impairment: Definition and psychometric characteristics. AGING NEUROPSYCHOLOGY AND COGNITION 1996. [DOI: 10.1080/13825589608256617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The effects of treatment with high doses (300 mg three times daily) of hypericum extract LI 160 on sleep quality and well-being were investigated over a 4-week period. The double-blind, placebo-controlled study was conducted with 12 older, healthy volunteers in a cross-over design, which included a 2-week wash-out phase between both treatment phases. A hypostatic influence of the REM sleep phases, which is typical for tricyclic antidepressants and MAO inhibitors, could not be shown for this phytopharmacon. Instead, LI 160 induced an increase of deep sleep during the total sleeping period. This could be shown consistently in the visual analysis of the sleeping phases 3 and 4, as well as in the automatic analysis of slow-wave EEG activities. The continuity of sleep was not improved by LI 160; this was also the case for the onset of the sleep, the intermittent wake-up phases, and total sleep duration.
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Affiliation(s)
- H Schulz
- AFB-Parexel GmbH, Klinische Pharmakologie, Berlin, Germany
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28
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McGlone J. Memory complaints before and after temporal lobectomy: do they predict memory performance or lesion laterality? Epilepsia 1994; 35:529-39. [PMID: 8026399 DOI: 10.1111/j.1528-1157.1994.tb02473.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The relationships among self-report of memory, actual memory performance on objective tasks, and lesion laterality were examined in this longitudinal study. Right-handed adults (n = 47) with medically intractable seizures were assessed both preoperatively and 1 year after a left or right temporal lobectomy. Memory complaints remained stable or diminished postoperatively, whereas performance on material-specific memory tasks declined. Regression analyses showed that dosage of medications, seizure frequency and self-reported depression were predictive of postoperative memory complaints, although size of resection and age were not. Together, these data suggest that many patients have a positive though mistaken impression that their memory functions improved after temporal lobectomy, an impression influenced by their positive surgical outcomes. Memory complaints did not predict laterality of the lesion. Sex-laterality interactions were evident for both subjective and objective memory measures.
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Affiliation(s)
- J McGlone
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
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Seidenberg M, Haltiner A, Taylor MA, Hermann BB, Wyler A. Development and validation of a Multiple Ability Self-Report Questionnaire. J Clin Exp Neuropsychol 1994; 16:93-104. [PMID: 8150893 DOI: 10.1080/01688639408402620] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present results from three studies on the development and validation of the Multiple Ability Self-Report Questionnaire (MASQ), a self-report measure comprising items from five cognitive domains; language, visuo-perceptual, verbal memory, visual memory, and attention. In Study 1, we determined the content relevance of the questionnaire items. In Study 2, we assessed the basic psychometric properties (i.e., internal consistency and test-retest reliability) of the MASQ in 118 individuals without neurologic or psychiatric disorder, aged 25 to 88 years. In Study 3 we provide validity data for the MASQ by comparing the ratings of normals to people with unilateral temporal-lobe epilepsy, and examining the relationship of self-report to objective test performance. The potential use of the MASQ to study the neurologic and psychological correlates of accuracy and unawareness in self-appraisal across different cognitive domains and various clinical groups is discussed.
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Affiliation(s)
- M Seidenberg
- Department of Psychology, University of Health Sciences/Chicago Medical School, IL 60064
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30
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Hänninen T, Reinikainen KJ, Helkala EL, Koivisto K, Mykkänen L, Laakso M, Pyörälä K, Riekkinen PJ. Subjective memory complaints and personality traits in normal elderly subjects. J Am Geriatr Soc 1994; 42:1-4. [PMID: 8277103 DOI: 10.1111/j.1532-5415.1994.tb06064.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states. DESIGN Cross-sectional two-group comparison. SETTING The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland. PARTICIPANTS Originally 403 subjects aged 67-78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis. MEASUREMENTS Screening and follow-up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired-associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale. RESULTS Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging. CONCLUSIONS The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people.
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Affiliation(s)
- T Hänninen
- Department of Neurology, University of Kuopio, Finland
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Allen CC, Ellinwood EH, Logue PE. Construct validity of a new computer-assisted cognitive neuromotor assessment battery in normal and inpatient psychiatric samples. J Clin Psychol 1993; 49:874-82. [PMID: 8300876 DOI: 10.1002/1097-4679(199311)49:6<874::aid-jclp2270490615>3.0.co;2-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The construct validity of a computer-assisted battery of neuropsychological tests (CNT) was explored with psychiatric inpatients and normal volunteers. A principal components analysis of inpatient scores revealed simple reaction time, response accuracy, visuomotor skill, and complex processing and memory components. A similar factorial structure was found in normal subjects. However, complex processing and memory measures emerged as separate vigilance and memory components in volunteers. CNT tasks were correlated with nine subtests of the Neurobehavioral Cognitive Status Examination (NCSE). Simple reaction time, and complex processing and memory measures discriminated impaired from nonimpaired inpatients as defined by the NCSE. Recommendations for research on CNT, and computer-assisted tests in general, are made.
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Affiliation(s)
- C C Allen
- Duke University Medical Center, Durham, NC 27710
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32
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Feher EP, Larrabee GJ, Crook TH. Factors attenuating the validity of the Geriatric Depression Scale in a dementia population. J Am Geriatr Soc 1992; 40:906-9. [PMID: 1512387 DOI: 10.1111/j.1532-5415.1992.tb01988.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The validity of the Geriatric Depression Scale (GDS) in cognitively impaired patients has been questioned. We investigated possible factors (memory loss, dementia severity, unawareness of illness) attenuating the validity of the GDS in patients with dementia. PATIENTS Eighty-three patients who met research diagnostic criteria for "probable Alzheimer's disease." Subjects with major depressive disorder were excluded. Dementia severity ranged from mild to moderate. SETTING Outpatient clinics, including institutional settings and private research settings. MEASUREMENTS Depression--GDS; Hamilton Depression Scale. Memory--Wechsler Memory Scale; Benton Visual Retention Test. Dementia severity--Mini-Mental State Examination. Self-awareness of cognitive deficits--Difference score between a self-report memory questionnaire and an informant-rated memory questionnaire. RESULTS Multiple regression analysis revealed that Hamilton scores were the major predictor of GDS scores. Memory scores and self-awareness scores were also significant predictors. Dementia severity scores were not a significant predictor. CONCLUSIONS The GDS is a valid measure of mild-to-moderate depressive symptoms in Alzheimer patients with mild-to-moderate dementia. However, Alzheimer patients who disavow cognitive deficits also tend to disavow depressive symptoms, and the GDS should be used with caution in such patients. Finally, the argument that memory impairment precludes accurate self-report of recent mood is negated by our finding that many patients accurately reported depressive symptoms and that worse memory was associated with more self-reported depressive symptoms.
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Affiliation(s)
- E P Feher
- Memory Assessment Clinics, Bethesda, MD 20814
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