Memory complaint and performance in normal and depressed older adults

Characterizing Longitudinal Patterns in Cognition, Mood, And Activity in Depression With 6-Week High-Frequency Wearable Assessment: Observational Study

BACKGROUND

Cognitive symptoms are an underrecognized aspect of depression that are often untreated. High-frequency cognitive assessment holds promise for improving disease and treatment monitoring. Although we have previously found it feasible to remotely assess cognition and mood in this capacity, further work is needed to ascertain the optimal methodology to implement and synthesize these techniques.

OBJECTIVE

The objective of this study was to examine (1) longitudinal changes in mood, cognition, activity levels, and heart rate over 6 weeks; (2) diurnal and weekday-related changes; and (3) co-occurrence of fluctuations between mood, cognitive function, and activity.

METHODS

A total of 30 adults with current mild-moderate depression stabilized on antidepressant monotherapy responded to testing delivered through an Apple Watch (Apple Inc) for 6 weeks. Outcome measures included cognitive function, assessed with 3 brief n-back tasks daily; self-reported depressed mood, assessed once daily; daily total step count; and average heart rate. Change over a 6-week duration, diurnal and day-of-week variations, and covariation between outcome measures were examined using nonlinear and multilevel models.

RESULTS

Participants showed initial improvement in the Cognition Kit N-Back performance, followed by a learning plateau. Performance reached 90% of individual learning levels on average 10 days after study onset. N-back performance was typically better earlier and later in the day, and step counts were lower at the beginning and end of each week. Higher step counts overall were associated with faster n-back learning, and an increased daily step count was associated with better mood on the same (P<.001) and following day (P=.02). Daily n-back performance covaried with self-reported mood after participants reached their learning plateau (P=.01).

CONCLUSIONS

The current results support the feasibility and sensitivity of high-frequency cognitive assessments for disease and treatment monitoring in patients with depression. Methods to model the individual plateau in task learning can be used as a sensitive approach to better characterize changes in behavior and improve the clinical relevance of cognitive data. Wearable technology allows assessment of activity levels, which may influence both cognition and mood.

Dissociating self-reported cognitive complaint from clinical insight in schizophrenia

Whereas new pharmacological treatments are developed for cognitive impairments in schizophrenia, self-assessment of cognitive dysfunctioning besides their objective validity could be of interest in evaluating patients' motivation to engage in rehabilitation program. Nevertheless insight into symptoms is severely impaired in schizophrenia and is negatively linked with poor compliance. But it is yet unknown if patients with poor insight into their symptoms could have some insight into their cognitive impairments. The aim of this study was to explore the relationships existing between the cognitive complaint and the level of awareness of the disease in patients with schizophrenia. A total of 101 patients with DSM-IV schizophrenia or schizoaffective disorder and 60 control participants were recruited. Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD) and cognitive complaint intensity was assessed with the Scale to Investigate Cognition in Schizophrenia (SSTICS). Participants with schizophrenia displayed the same level of cognitive complaint when compared to healthy controls. Strong correlations were observed between SSTICS total score and duration of illness, levels of depression and state anxiety. Patients with a good insight into the therapeutic effects achieved with medication expressed a more important cognitive complaint. No correlations were found between the four others SUMD insight dimensions and total SSTICS score. The partial overlap of insight into illness and cognitive complaint suggests that insight is modular in schizophrenia. Assessment of cognitive complaint and awareness of illness need to be assessed before engagement in rehabilitation program.

Wearable Technology for High-Frequency Cognitive and Mood Assessment in Major Depressive Disorder: Longitudinal Observational Study

BACKGROUND

Cognitive symptoms are common in major depressive disorder and may help to identify patients who need treatment or who are not experiencing adequate treatment response. Digital tools providing real-time data assessing cognitive function could help support patient treatment and remediation of cognitive and mood symptoms.

OBJECTIVE

The aim of this study was to examine feasibility and validity of a wearable high-frequency cognitive and mood assessment app over 6 weeks, corresponding to when antidepressant pharmacotherapy begins to show efficacy.

METHODS

A total of 30 patients (aged 19-63 years; 19 women) with mild-to-moderate depression participated in the study. The new Cognition Kit app was delivered via the Apple Watch, providing a high-resolution touch screen display for task presentation and logging responses. Cognition was assessed by the n-back task up to 3 times daily and depressed mood by 3 short questions once daily. Adherence was defined as participants completing at least 1 assessment daily. Selected tests sensitive to depression from the Cambridge Neuropsychological Test Automated Battery and validated questionnaires of depression symptom severity were administered on 3 occasions (weeks 1, 3, and 6). Exploratory analyses examined the relationship between mood and cognitive measures acquired in low- and high-frequency assessment.

RESULTS

Adherence was excellent for mood and cognitive assessments (95% and 96%, respectively), did not deteriorate over time, and was not influenced by depression symptom severity or cognitive function at study onset. Analyses examining the relationship between high-frequency cognitive and mood assessment and validated measures showed good correspondence. Daily mood assessments correlated moderately with validated depression questionnaires (r=0.45-0.69 for total daily mood score), and daily cognitive assessments correlated moderately with validated cognitive tests sensitive to depression (r=0.37-0.50 for mean n-back).

CONCLUSIONS

This study supports the feasibility and validity of high-frequency assessment of cognition and mood using wearable devices over an extended period in patients with major depressive disorder.

Different Cognitive Complaint Profiles in Memory Clinic and Depressive Patients

OBJECTIVE

Cognitive complaints are considered early indicators of incipient Alzheimer's disease (AD) but are very common in geriatric patients, especially in patients with major depressive disorder (MDD). The clinical assessment of cognitive complaints is still poorly operationalized. Recent qualitative research suggests that certain phenomenologic complaint themes may have some specificity for prodromal AD. The aim of the study was to replicate and explore their occurrence in a clinical setting.

METHODS

In a cross-sectional, case-control study using a mixed-methods approach, 23 memory clinic (cognitive complainers [CC]) patients, 21 psychiatric inpatients with MDD, and 21 healthy control subjects, aged 55-86 years, were assessed at the Department of Psychiatry and Psychotherapy and German Center for Neurodegenerative Diseases, Bonn. A newly developed semistructured interview addressing 12 complaint themes was used, and transcribed open format responses were coded by qualitative expert rating (theme absent versus present) and compared between the groups.

RESULTS

Seven complaint themes (e.g., sense of predomination, progression) were significantly more often endorsed by the CC group, together with a novel theme of "distractible speech." Complaint themes in those with depression aligned with the depressive symptoms and appeared to be partly different from the complaint pattern of the CC group.

CONCLUSION

Previously established themes were found to be feasible for conversion into a semistructured interview. Several complaint phenotypes were confirmed and previous themes significantly expanded by providing first evidence for a qualitatively different complaint profile in MDD compared with CC. Future investigations may benefit from better characterizing the phenomenologic and qualitative characteristics of AD-related complaints.

Assessing Self-Rated Memory Impairment in Persons with Posttraumatic Headache

Forty-two patients with persistent posttraumatic headache and postconcussion symptomatology following a motor vehicle accident completed the Self-Rating Scale of Memory Functions (SRSM), the Beck Depression Inventory (BDI), and brief memory testing. SRSM scores indicated that patients rated their memory as significantly impaired relative to their preinjury status. SRSM scores were not affected by such factors as age, education, gender, and loss of consciousness. However, significantly depressed patients rated their memory as more impaired on 14 of 18 SRSM items when compared with nondepressed patients. After controlling for depression, SRSM scores correlated significantly with objective performance on several memory tests. The implications of these findings are discussed.

Cognitive Processes, Self-Reports of Memory Functioning, and Mental Health Status in Older Adults

A battery of cognitive tasks was administered to a group of community-dwelling older adults. They also completed questionnaires assessing their cognitive and memory functioning and mental health status. A person familiar with the participant completed the same set of questionnaires. Little or no association was observed among the laboratory-type cognitive tasks and the self-assessments of cognition and memory, but significant relationships were observed between self-reported mental health and both the cognitive tasks and the subjective memory assessments. However, significant others' assessments of the participants' cognitive and memory functioning were related to laboratory-assessed cognitive functioning. These results suggest that mental health status and both cognitive performance and self-reports of cognitive and memory functioning are linked. Results also suggest that significant others may be better judges of actual cognitive performance than are elders themselves.

Memory Complaints and Memory Performance: The Relationship Reexamined

The present study examined memory complaints among older adults. A review of the literature and reanalysis of data. suggests that the correspondence of memory complaints and memory performance differs as a function of an individual's affective state and degree of concern about memory functioning. Depressed older adults and those seeking memory training were found to evidence lower levels of correlation between self-reported memory complaints and memory performance than were non-depressed elders not actively seeking memory training. These results suggest that elders with high levels of concern about their memory functioning may hold special expectations or beliefs about their cognitive abilities. These results further suggest that memory training programs for elders must be multi-faceted in nature, including instruction in memory skills and examination of participants' beliefs and attitudes about their cognitive abilities.

Is a patient-administered depression rating scale valid for detecting cognitive deficits in patients with major depressive disorder?

AIMS

Although cognitive deficits are a common and potentially debilitating feature of major depressive disorder (MDD), such subjective declines in cognitive function are seldom validated by objective methods as a clinical routine. The aim of this study was to validate the Taiwanese Depression Questionnaire (TDQ) for detecting cognitive deficits in a sample of drug-free patients with MDD.

METHODS

The subjects consisted of 40 well-characterized medication-free patients with MDD and 40 healthy controls. Clinical and neuropsychological assessments, including the Wisconsin Card Sorting Test, the Wechsler Memory Scale-Revised, the Continuous Performance Test, and the Finger-Tapping Test, were administered at the time of recruitment.

RESULTS

Factor analyses of the TDQ yielded three factors. Memory, attention and psychomotor performance were significantly poorer in patients with MDD. The performances of verbal and delayed memory of the Wechsler Memory Scale-Revised were correlated with the cognitive domains of the TDQ. Generalization of our results must be undertaken with caution considering the relatively small sample size, which could lead to increased β-error.

CONCLUSION

Cognitive subdomains might be considered important for including in patient-administered questionnaires used to measure symptoms of MDD when developing a new scale.

Defining and measuring functional recovery from depression

Depression is associated with significant functional impairment and reduced quality of life. Disruptions occur both globally as well as in specific functional areas such as work, interpersonal relationships and cognitive function. From both a clinical and research perspective, much focus has been given to the resolution of symptoms associated with depression, while relatively little attention has been given to functional improvements. Definitions of remission in depression are most frequently based on achieving a cut-off score on clinical rating scales of depressive symptoms. Research in this area has sparsely included psychosocial function or health-related quality of life as a primary outcome measure in clinical trials. However, the need to fully understand the impact of depression and its treatments on functioning is great, given the existing evidence of the profound effect that depression has on function. Even mild depressive symptoms and subsyndromal depression result in functional impairment and reduced quality of life, and untreated residual depressive symptomatology can result in an increased likelihood for relapse of the fully symptomatic disorder (i.e. major depressive disorder). Therefore, clinicians and researchers alike need to broaden the focus of treatment to encompass not only the specific symptoms of depression, but the functional consequences as well. Many tools have been developed to assess function and quality of life, both globally as well as within specific domains. In addition, the effect of residual symptoms associated with functional impairment (i.e. insomnia, fatigue, pain [somatic] symptoms and cognition) in depression, even independently of depressive symptoms, warrants evaluation and monitoring. Recommendations for evaluating functional outcomes include: (i) adequately assessing functional impairment; (ii) identifying and/or developing treatment plans that will target symptoms associated with functional impairments; and (iii) monitoring functional impairments and associated symptoms throughout the course of treatment. The development of treatments that specifically target improvements in functional impairments is needed, and may require the use of novel treatment strategies.

Are cognitively intact seniors with subjective memory loss more likely to develop dementia?

BACKGROUND

Subjective memory loss (SML) is common in elderly persons. It is not clear if SML predicts the development of dementia.

OBJECTIVES

(1) to determine if SML in those with normal cognition predicts dementia or cognitive impairment without dementia (CIND); (2) to determine if an association is independent of the effect of age, gender and depressive symptoms.

METHODS

Secondary analysis of the Manitoba Study of Health and Aging (MSHA), a population-based prospective study. Data were collected in 1991, and follow-up was done 5 years later. Community-dwelling seniors sampled randomly from a population-based registry in the Canadian province of Manitoba, stratified on age and region. Only those scoring in the normal range of the Modified mini-mental state examination (3MS) were included. Predictor variables were self-reported memory loss, 3MS, Center for epidemiological studies-depression scale (CES-D), age, gender, and education. Outcomes were mortality and cognitive impairment five years later.

RESULTS

In bivariate analyses, SML was associated with both death and dementia. In multivariate models, SML did not predict mortality. After adjusting for age, gender, and depressive symptoms, SML predicted dementia. However, after adjusting for baseline 3MS score, SML did not predict dementia.

CONCLUSIONS

Memory complaints predict the development of dementia over five years, and clinicians should monitor these persons closely. However, the proportion of persons developing dementia was small, and SML alone is unlikely to be a useful clinical predictor of dementia.

Selbstbeurteilung von Aufmerksamkeitsdefiziten bei Alzheimer-Kranken mit sehr leichter Demenz

Zusammenfassung: Die Selbstbeurteilung von Aufmerksamkeitsdefiziten wurde bei 14 Patienten mit Alzheimer-Demenz in einem sehr frühen Stadium (MMST > 24) und 14 hinsichtlich Geschlecht, Alter und Schulbildung gematchten sowie hinsichtlich der Depressivität vergleichbaren Kontrollpersonen psychometrisch erfaßt. Als Meßinstrument wurde der “Fragebogen Erlebter Defizite der Aufmerksamkeit (FEDA)” ( Zimmermann, Messner, Poser & Sedelmeier, 1991 ) eingesetzt. Es zeigte sich, daß die nicht-depressiven Patienten mit beginnender Alzheimer-Demenz signifikant stärker ausgeprägte Beschwerden angaben als gesunde Ältere. Mit Hilfe des FEDA-Gesamtwertes konnten 12 Patienten und 11 Kontrollpersonen richtig zugeordnet werden, die Trefferquote betrug somit 82 %. Die Ergebnisse dieser explorativen Studie weisen darauf hin, daß die psychometrisch erfaßte Selbstbeurteilung von Aufmerksamkeitsdefiziten in der Früherkennung einer Demenz bei Alzheimer-Krankheit neben anderen Befunden diagnostisch relevante Information beitragen kann.

Neuropsychological functioning and MRI signal hyperintensities in geriatric depression

OBJECTIVE

The purpose of this study was to examine the relationship between signal hyperintensities--a probable marker of underlying pathology--on T2-weighted magnetic resonance brain scans and neuropsychological test findings in elderly depressed and normal subjects.

METHOD

Elderly subjects with a DSM-III-R diagnosis of major depression (N=41) and normal elderly comparison subjects (N=38) participated in a magnetic resonance imaging study (1.0-T) of signal hyperintensities in periventricular, deep white matter, and subcortical gray matter. Hard copies of scans were rated in random order by research psychiatrists blind to diagnosis; the modified Fazekas hyperintensity rating scale was used. Cognitive performance was independently assessed with a comprehensive neuropsychological battery. Clinical and demographic differences between groups were assessed by t tests and chi-square analysis. Relationships between neuropsychological performance and diagnosis and hyperintensities and their interaction were analyzed by using analysis of covariance, with adjustment for age and education.

RESULTS

Elderly depressed subjects manifested poorer cognitive performance on several tests than normal comparison subjects. A significant interaction between hyperintensity location/severity and presence/absence of depression on cognitive performance was found: depressed patients with moderate-to-severe deep white matter hyperintensities demonstrated worse performance on general and delayed recall memory indices, executive functioning and language testing than depressed patients without such lesions and normal elderly subjects with or without deep white matter changes.

CONCLUSIONS

Findings validate cognitive performance decrements in geriatric depression and suggest possible neuroanatomic vulnerabilities to developing particular neuropsychological dysfunction in depressed subjects.

Relation between intellectual dysfunctioning and mortality in community-residing older people

OBJECTIVE

To examine the relationship between intellectual dysfunctioning and mortality in a community-residing older population.

DESIGN

Of the 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, 1405 were contacted. Data for assessment of intellectual dysfunctioning were obtained from 1383 people (98.4%), who constituted the study cohort. Follow-up for 42 months was completed for 1300 subjects (94.0%; 1117 living, 183 deceased).

MEASURES

Data on general health status, history of health management, psychosocial conditions, and intellectual dysfunctioning were collected by means of interviews during home visits at the time of enrollment. Intellectual dysfunctioning was determined with the assessment instrument developed by the Social Survey Division of the Office of Population Censuses (OPCS) in Great Britain.

RESULTS

The Kaplan-Meier analysis indicated that the estimated survival rates for men and women decreased with a decline in intellectual function in two age groups: 65 to 74 and 75 years and older. For both sexes, the log rank test showed that the curves among the four groups based on intellectual dysfunctioning (intact, mild, moderate, and severe) achieved statistical significance for the age group of 75 years and older. For both age groups and each of the levels of intellectual dysfunctioning, the estimated survival rate for men was lower than that for women. Application of the Cox proportional hazards model resulted in unadjusted hazard ratios of mild, moderate, and severe intellectual dysfunctioning for mortality of 1.68, 2.44, and 5.37, respectively. Multivariate analysis on the other hand, yielded adjusted hazard ratios of mild, moderate, and severe intellectual dysfunctioning of 1.19, 1.12, and 1.74, respectively, leaving severe dysfunctioning as the only statistically significant factor associated with mortality. Other factors such as sex, age, general health status, history of management, and psychosocial conditions were controlled.

CONCLUSION

Intellectual dysfunctioning, as measured by an assessment instrument developed by OPCS, represents an increased risk factor for mortality among community-residing older people.

Depression and memory in the elderly: a meta-analysis

A meta-analysis (N = 40) of the effects of depression on memory in the elderly (sample mean age > or = 55 years) examined variables potentially accounting for divergent findings in the literature. The distribution of effects was bimodal and the effect sizes were heterogeneous. Compared to controls, groups containing unipolar subjects only were significantly less impaired than were mixed unipolar-bipolar; five of six studies mixing depression subtype were associated with the more negative mode. Samples containing younger depressed subjects (< 45 years) were significantly more impaired and were associated with the more negative mode. Significant group differences were found between studies matching their comparison groups reasonably well on years of education and those that did not. Thoroughness of dementia screening yielded no group differences. Although correlated observations precluded significance tests, larger effects were found for (1) figural (vs. verbal) memory; (2) delayed (vs. immediate) memory; and (3) recognition (vs. free recall and incidental or cued recall; incidental and cued recall effects were nearly identical). Similar effects were found for composite memory scores versus constituent and for various presentation paradigms (e.g., single presentation, selective reminding). Effect sizes for these categories were in the moderate range. Difficulties synthesizing this literature are discussed as are suggested remedies and directions for future research.

A preliminary profile of neuropsychological deficits associated with major depression

A profile of neuropsychological deficits of clinically depressed (major depression) but otherwise unimpaired individuals is presented, based on a meta-analysis of all studies published since 1975 and meeting stringent methodological and sample selection criteria. Deficits are discussed separately for different cognitive areas in terms of mean size of deficit, variability between studies, variability of individual scores in depressed populations relative to that of controls, and expected proportion of depressed individuals scoring two standard deviations or more below the mean of controls. The neuropsychological deficits of individuals with major depression are shown to be consistent with a global-diffuse impairment of brain functions with particular involvement of the frontal lobes. Recent neuro-imaging studies also indicating frontal dysfunction in clinical (functional) depression are referred to. Both the severity and the profile of cognitive deficiencies in depression are postulated to be similar to those seen in moderately severe traumatic brain injury.

The influence of depression on memory and metamemory in the elderly

This study aimed to assess the relationships among depression level, memory and metamemory scores on a large sample of elderly subjects (139 men and 147 women). Preliminary examination showed that none of the sampled subjects had intellectual impairment (as assessed by means of the Mini-Mental State Examination) or neuropsychiatric symptoms. Each subject was administered the Randt Memory Test (RMT), the Sehulster Memory Scale (SMS) and the Geriatric Depression Scale (GDS). A Multivariate Analysis of Covariance revealed a negative influence of depression on the two RMT measures (Acquisition-Recall: AR; Delayed Memory: DM) and on the three SMS measures (Set1: self-comparison; Set2: memory complaints; Set3: peer comparison), and of age on AR and DM, and Set1 and Set2. A Multivariate Regression Analysis showed that DM scores were positively correlated with Set2 in men and women, and with Set1 in women and Set3 in men, whereas AR scores related to Set2 and Set3 in men and Set1 in women. In addition, depression influenced negatively Set1, Set2 and AR scores in both men and women and DM scores only in men. On the whole, the results suggest that depression, memory and metamemory are rather closely related in non-severely depressed older individuals, albeit with slightly different patterns in men and women, and that some areas of metamemory are congruent with objective functioning regardless of the level of depressive symptoms.

Food identification, taste complaints, and depression in younger and older adults

The relationships among the ability to identify food stimuli, self-assessed taste complaints and taste acuity, and depression were examined in younger and older adults. Subjects smelled, tasted, and subsequently identified 10 pureed foods while blindfolded. Subjects also completed a demographic questionnaire, the Beck Depression Inventory, and the Wechsler Adult Intelligence Scale-Revised Vocabulary subtest. Although an age difference in taste complaints was not found, older adults were poorer at identifying food items, rated their taste acuity as lower, and had higher depression scores than the younger adults. However, the age difference in identifying food items was not due to the age difference in depression, because depression was unrelated to food identification scores for both age groups.

Memory Self-Appraisal and Cerebral Glucose Metabolism in Age-Associated Memory Impairment

The authors used positron emission tomography to measure cerebral glucose metabolism in 43 people with age-associated memory impairment to determine relationships between memory self-appraisal and brain function. People with lower frontal metabolism during a resting state reported more frequent prior mnemonics usage, a measure of memory self-appraisal. A multiple regression analysis indicated that reported mnemonics usage was the most significant predictor of left (P = 0.0004) and right (P = 0.0014) frontal metabolism. These models indicated that mnemonics usage, along with depression ratings, accounted for 39% of left frontal lobe function and, along with visual spatial memory, accounted for 40% of right frontal metabolism. These results suggest that mnemonics usage may compensate for subtle frontal dysfunction or reflect greater efficiency of memory processing.

Effects of major depression on the cognitive function of younger and older subjects

The effects of age and depression on cognitive function were investigated in two groups of in-patient major depressives aged under and over 60 years who were tested when depressed and after recovery. The majority of the tests showed impaired performance during depression with improvement after recovery, and also differences between the two age-groups in both the depressed and recovered phases. However, the older subjects were not more severely affected by depression than the younger subjects. The pattern of impairment associated with depression was different to that associated with older age: depression affected performance on more 'complex tasks', whereas age was associated particularly with slowing on timed tests. This study did not suggest that the impairment from baseline due to the depression is greater in the elderly than in younger subjects.

Effects of hypericum extract on the sleep EEG in older volunteers

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.

The effects of depression, health status, and stressful life-events on self-reported memory problems among aged blacks

A sample of 1,250 Black elderly individuals was examined to assess the prevalence and correlates of self-reported memory problems. More than 48.3 percent of the sample reported poor memory and forgetfulness as either a very (17.9%) or somewhat (30.4%) serious problem. Multivariate logistic regression was employed to detect the significant predictors of self-reported memory problems. According to our data, those Black elderly individuals who have hearing problems, who report a higher number of stressful life-events, who experience a higher level of depression, and who suffer from poorer health are more likely to complain of memory problems.

Memory complaint, memory performance, and psychiatric diagnosis: a community study

This study examined the prevalence of memory complaint and poor memory performance on brief screening measures within a community sample of 810 adults. All individuals received an extensive household interview and a clinical psychiatric evaluation. Overall, 22% indicated that they currently had trouble with their memory. This percentage increased with age, rising to 43% for those 65 to 74 years old, 51% for those 75 to 84 years old, and 88% for those 85 years of age and older; the percentage indicating memory problems decreased with educational attainment. The prevalence of poor memory performance was 11%, also increasing with less education and increased age, rising to 26% for those 65 to 74 years old and to 40% for those older then 75. Those who complained of memory trouble were twice as likely to show poor memory performance (29%) compared with those who did not complain (15%). Multivariate analysis found age, emotional distress, and physical illness to be independent predictors of memory complaint; age, functional disability, education, and physical illnesses proved to be independently associated with poor memory performance. A higher prevalence of complaints of memory trouble was found not only for those with affective disorders, as might be expected, but also among those with schizophrenic, cognitive, anxiety, and adjustment disorders. However, only individuals with cognitive disorders showed a higher prevalence of poor memory performance.

Dimensions of self-report about everyday memory in young and older adults

This study investigated the relationship between several aspects of memory self-report, objective memory, attitude toward intellectual aging, self-rated health, and self-rated depression in young and older adults. Participants completed a self-report depression scale, and then rated their discomfort with eight categories of everyday forgetting and their attitudes toward intellectual aging. One week later, they rated how frequently they experience the same categories of forgetting, and then completed a battery of objective memory tests analogous to those categories. Ten days later, they rated their willingness to participate in both memory improvement classes and nonmemory classes. Older adults reported significantly more frequent failures but less discomfort with the failures than the young adults. Frequency, discomfort, and self-reported depression were all positively correlated in the older group, but not the young group. Young and old adults were equally positive about participating in memory classes, which both age groups preferred to nonmemory classes; the correlation between willingness to participate in memory classes and objective memory approached significance in the young, but not in the old. Attitude toward intellectual aging was correlated with frequency of and discomfort with forgetting in the older group.

The association of memory complaint with computer-simulated everyday memory performance

The relationship of memory self-report to self-rated depression and to actual performance on computer-simulated everyday memory tasks was investigated in 125 normal adults. Canonical correlation analyses demonstrated that self-rated memory performance and objective computer-simulated everyday memory performance shared from 27.9% to 29.4% of common variance. These data provide initial concurrent validity for a new memory self-report scale, the MAC-S. Results are discussed in relation to psychometric factors important in the design and validation of self-report memory scales.

Self-rating and objective memory testing of normal and depressed elderly

This study aimed to assess the relationships between the scores of subjective assessment (metamemory) and those of performance testing for memory, on the one hand, and the level of depression, on the other. A hundred and eighty elderly subjects (102 women and 78 men; mean age 65.7 years) were selected for the study. They showed neither intellectual impairment (as assessed through Mini Mental State test: MMS) nor neuropsychiatric symptoms. Each subject was administered the Randt Memory Test (RMT) for performance testing, the Sehulster Memory Scale (SMS) for the subjective assessment, and the Geriatric Depression Scale (GDS). A MULTCOVA analysis showed that both age and the depression level are negatively correlated with both the measures (Acquisition-Recall: AR; Delayed Memory: DM) of the RMT. The scores of the second (memory complaints) of the three sets of SMS were positively correlated with those of AR and DM indices. A Multivariate Regression Analysis showed that in males age and the depression level were significant regressors for both AR and MD scores while in females only the depression level was a significant regressor for AR and only age was a significant regressor for DM. Our results suggest that a) the relationships between the depression level and memory functioning are close, although not fully homogeneous in men and women; and b) that the scores in some areas of metamemory parallel, independently of the level of depression, the performance outcomes of memory functioning.

Memory complaints and memory deficits in young and old psychiatric inpatients

Memory complaints and memory deficits were investigated in 206 consecutively admitted psychiatric inpatients at the University of Iowa Psychiatric Hospital. Forty-five percent of patients over age 60 years and 29% of patients less than 60 years old had severe memory complaints. Patients with complaints of memory loss were no more likely than patients without such complaints to have a memory deficit. In patients over age 60 years, memory complaint was more common in depression than in dementing and amnestic disorders (73% v 43%), while in younger patients memory complaint was slightly more common in dementing and amnestic disorders than in depression (57% v 41%). Increasing age was significantly correlated with increasing likelihood of memory complaint for depressed patients but not for nondepressed patients. As a result of these findings, memory complaint was found to be a statistically significant marker for depression in the elderly (sensitivity = 73%, specificity = 75%) but not in younger patients. Our results confirm the clinical observation that memory complaints are a useful marker for depressed states in the elderly.

Signal detection analysis of recognition memory in depressed elderly

The purpose of this study was to examine the relationship of late-life depression to memory complaint and objective performance in a recognition memory task. Fifty-seven individuals between the ages of 58 and 88 were evaluated for depression using the Beck Depression Inventory (short form). They were then shown two stimulus lists, each consisting of high-imagery and low-imagery words. Recognition for these words was subsequently tested. Error rates and nonparametric signal detection measures were analyzed as indices of performance. Respondents gave global self-assessments of memory and, during the recognition task, also made self-ratings of performance. Depressed individuals showed more conservative response biases than nondepressed respondents, reflected in a higher false-negative error rate but a lower false-positive rate. Neither overall memory sensitivity as assessed by signal detection analysis nor self-ratings of performance were related to depression, though global memory self-ratings were. Elderly depressed individuals thus presented a pattern of greater memory complaint and unwillingness to venture responses in spite of showing small or no information-processing deficits.

The link between memory performance, self-assessment, and affective status

To investigate the relationship between memory performance, self-assessment of memory, and affective status, 67 elderly females were administered a self-assessment memory questionnaire and multiple measures of affect and laboratory memory tet performance. Canonical correlations indicated that the memory performance scores were not related to the affective measures nor to the scales of self-assessed memory ability. Affective status and self-assessment of memory skill were related, suggesting that investigations of memory performance which rely on self-assessment should also measure affective status.