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Badham SP, Atkin C, Stacey JE, Henshaw H, Allen HA, Roberts KL. Age Deficits in Associative Memory Are Not Alleviated by Multisensory Paradigms. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae063. [PMID: 38661446 PMCID: PMC11157628 DOI: 10.1093/geronb/gbae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES Age deficits in memory are widespread, this affects individuals at a personal level, and investigating memory has been a key focus in cognitive aging research. Age deficits occur in memory for an episode, where information from the environment is integrated through the senses into an episodic event via associative memory. Associating items in memory has been shown to be particularly difficult for older adults but can often be alleviated by providing support from the external environment. The current investigation explored the potential for increased sensory input (multimodal stimuli) to alleviate age deficits in associative memory. Here, we present compelling evidence, supported by Bayesian analysis, for a null age-by-modality interaction. METHODS Across three preregistered studies, young and older adults (n = 860) completed associative memory tasks either in single modalities or in multimodal formats. Study 1 used either visual text (unimodal) or video introductions (multimodal) to test memory for name-face associations. Studies 2 and 3 tested memory for paired associates. Study 2 used unimodal visual presentation or cross-modal visual-auditory word pairs in a cued recall paradigm. Study 3 presented word pairs as visual only, auditory only, or audiovisual and tested memory separately for items (individual words) or associations (word pairings). RESULTS Typical age deficits in associative memory emerged, but these were not alleviated by multimodal presentation. DISCUSSION The lack of multimodal support for associative memory indicates that perceptual manipulations are less effective than other forms of environmental support at alleviating age deficits in associative memory.
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Affiliation(s)
| | | | | | - Helen Henshaw
- Hearing Sciences, Mental Health, and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
| | - Harriet A Allen
- School of Psychology, University of Nottingham, Nottingham, UK
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Martyr A, Nelis SM, Morris RG, Marková IS, Roth I, Woods RT, Clare L. Exploring longitudinal changes in implicit awareness of dementia: An investigation of the emotional Stroop effect in healthy ageing and mild dementia. J Neuropsychol 2024; 18:226-238. [PMID: 37658549 DOI: 10.1111/jnp.12344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
The aim of the study was to investigate responses to dementia-relevant words in healthy older people and to investigate changes in response over 20-months in people with early-stage dementia. An emotional Stroop task, using colour-naming dementia-relevant words, was used as an indicator of implicit awareness of dementia. Overall, 24 people with dementia and 24 healthy older people completed an emotional Stroop task (T1). People with dementia completed the same task again after 12 (T2) and 20 (T3) months. For people with dementia emotional Stroop performance was contrasted with ratings of explicit awareness based on a detailed interview at T1 and at T2. For healthy older people and people with dementia response times to dementia-relevant words were significantly longer than those for neutral words. The effect was absent for people with dementia at T3. This decline in the emotional Stroop effect was not associated with cognitive decline as measured by the MMSE. Ratings of explicit awareness showed no significant change over time. There was no association between explicit awareness and implicit awareness. Implicit awareness of the condition is evident in early-stage dementia and can be elicited even where there is reduced explicit awareness. The emotional Stroop effect for dementia-relevant words in people with dementia appears to decline over time, independently of changes in MMSE score, suggesting that implicit awareness fades as time progresses.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ivana S Marková
- Hull York Medical School, Allam Medical Building University of Hull, Hull, UK
| | - Ilona Roth
- School of Life, Health and Chemical Sciences, STEM Faculty, The Open University, Milton Keynes, UK
| | - Robert T Woods
- Dementia Services Development Centre (DSDC) Wales, School of Medical & Health Sciences, Bangor University, Bangor, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Smith AJ, Bisby JA, Dercon Q, Bevan A, Kigar SL, Lynall ME, Dalgleish T, Hitchcock C, Nord CL. Hot metacognition: poorer metacognitive efficiency following acute but not traumatic stress. Transl Psychiatry 2024; 14:133. [PMID: 38438352 PMCID: PMC10912213 DOI: 10.1038/s41398-024-02840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
Aberrations to metacognition-the ability to reflect on and evaluate self-performance-are a feature of poor mental health. Theoretical models of post-traumatic stress disorder propose that following severe stress or trauma, maladaptive metacognitive evaluations and appraisals of the event drive the development of symptoms. Empirical research is required in order to reveal whether disruptions to metacognition cause or contribute to symptom development in line with theoretical accounts, or are simply a consequence of ongoing psychopathology. In two experiments, using hierarchical Bayesian modelling of metacognition measured in a memory recognition task, we assessed whether distortions to metacognition occur at a state-level after an acute stress induction, and/or at a trait-level in a sample of individuals experiencing intrusive memories following traumatic stress. Results from experiment 1, an in-person laboratory-based experiment, demonstrated that heightened psychological responses to the stress induction were associated with poorer metacognitive efficiency, despite there being no overall change in metacognitive efficiency from pre- to post-stress (N = 27). Conversely, in experiment 2, an online experiment using the same metamemory task, we did not find evidence of metacognitive alterations in a transdiagnostic sample of patients with intrusive memory symptomatology following traumatic stress (N = 36, compared to 44 matched controls). Our results indicate a relationship between state-level psychological responses to stress and metacognitive alterations. The lack of evidence for pre- to post-stress differences in metamemory illustrates the importance for future studies to reveal the direction of this relationship, and consequently the duration of stress-associated metacognitive impairments and their impact on mental health.
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Affiliation(s)
- Alicia J Smith
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - James A Bisby
- Division of Psychiatry, University College London, London, UK
| | - Quentin Dercon
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Division of Psychiatry, University College London, London, UK
| | - Anna Bevan
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Stacey L Kigar
- Department of Psychiatry, Herchel Smith Building of Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- Department of Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Mary-Ellen Lynall
- Department of Psychiatry, Herchel Smith Building of Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Caitlin Hitchcock
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Camilla L Nord
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Herchel Smith Building of Brain & Mind Sciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
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Silverberg ND, Rush BK. Neuropsychological evaluation of functional cognitive disorder: A narrative review. Clin Neuropsychol 2024; 38:302-325. [PMID: 37369579 DOI: 10.1080/13854046.2023.2228527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Objective: To critically review contemporary theoretical models, diagnostic approaches, clinical features, and assessment findings in Functional Cognitive Disorder (FCD), and make recommendations for neuropsychological evaluation of this condition. Method: Narrative review. Results: FCD is common in neuropsychological practice. It is characterized by cognitive symptoms that are not better explained by another medical or psychiatric disorder. The cognitive symptoms are associated with distress and/or limitations in daily functioning, but are potentially reversible with appropriate identification and treatment. Historically, a variety of diagnostic frameworks have attempted to capture this condition. A contemporary conceptualization of FCD positions it as a subtype of Functional Neurological Disorder, with shared and unique etiological factors. Patients with FCD tend to perform normally on neuropsychological testing or demonstrate relatively weak memory acquisition (e.g. list learning trials) in comparison to strong attention and delayed recall performance. Careful history-taking and behavioral observations are essential to support the diagnosis of FCD. Areas of ongoing controversy include operationalizing "internal inconsistencies" and the role of performance validity testing. Evidence for targeted interventions remains scarce. Conclusions: Neuropsychologists familiar with FCD can uniquely contribute to the care of patients with this condition by improving diagnostic clarity, richening case formulation, communicating effectively with referrers, and leading clinical management. Further research is needed to refine diagnosis, prognosis, and treatment.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Beth K Rush
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida, USA
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Farina FR, Regan J, Marquez M, An H, O'Loughlin P, Pavithra P, Taddeo M, Knight RC, Bennett M, Lenaert B, Griffith JW. Reducing fear and avoidance of memory loss improves mood and social engagement in community-based older adults: a randomized trial. BMC Geriatr 2023; 23:786. [PMID: 38030988 PMCID: PMC10688470 DOI: 10.1186/s12877-023-04470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life. METHODS Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up). RESULTS Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants' ability to participate in social activities and well-being were also observed. CONCLUSIONS Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04821960 .
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Affiliation(s)
- Francesca R Farina
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - John Regan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Melissa Marquez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Hosanna An
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | | | | | - Michelle Taddeo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Rachel C Knight
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Marc Bennett
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Bert Lenaert
- Faculty of Psychology, Open University, Heerlen, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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Farina FR, Pavithra P, An H, Marquez M, O'Loughlin P, Regan J, Taddeo M, Bennett M, Lenaert B, Griffith JW. Validation of the Fear and Avoidance of Memory Loss scale in community-based older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12432. [PMID: 37101711 PMCID: PMC10123382 DOI: 10.1002/dad2.12432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023]
Abstract
Introduction Alzheimer's disease and related dementias (ADRD) are among the most feared conditions. However, research around ADRD-specific fear and avoidance behaviors is lacking. Here, we validated a novel measure of fear and avoidance specific to memory loss, the Fear and Avoidance of Memory Loss (FAM) scale, and examined associations between fear avoidance and psychosocial functioning in older adults. Methods We assessed FAM Scale internal reliability and concurrent validity, and candidate subscales across two samples (total N = 813). We then examined associations between fear avoidance and memory performance, anxiety, depressive symptoms, sleep, social functioning, and quality of life. Results We identified two subscales: fear and avoidance, which yielded strong psychometric validity. Higher fear was associated with memory failures and sleep disturbance. Higher avoidance was associated with memory failures, poorer verbal memory, reduced social functioning, and quality of life. Discussion We present the first measure of fear avoidance specific to memory loss. We propose that targeting fear avoidance can promote ADRD risk reduction and resiliency.
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Affiliation(s)
- Francesca R. Farina
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
- Global Brain Health InstituteTrinity College DublinDublinIreland
- School of PsychologyTrinity College DublinDublinIreland
| | | | - Hosanna An
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Melissa Marquez
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | | | - John Regan
- School of PsychologyTrinity College DublinDublinIreland
| | - Michelle Taddeo
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Marc Bennett
- School of PsychologyUniversity College DublinDublinIreland
| | - Bert Lenaert
- Faculty of PsychologyOpen UniversityHeerlenthe Netherlands
- Faculty of Health, Medicine and Life Sciences, Limburg Brain Injury CentreMaastricht UniversityMaastrichtthe Netherlands
| | - James W. Griffith
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
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Pérez‐Blanco L, Rodríguez‐Salgado D. Neuropsychological approach to subjective cognitive complaints in cognitively unimpaired older people: A systematic review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5728. [PMID: 35607814 PMCID: PMC9321195 DOI: 10.1002/gps.5728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE A systemized approach to subjective cognitive complaints (SCCs) in elderly people is needed owing to the high prevalence of such complaints and their impact on the psychosocial well-being of those affected. The aim of this study was to carry out a systematic review of the characteristics and effectiveness of intervention programmes that use a neuropsychological approach to target SCCs in cognitively unimpaired older people and that are tested in randomized controlled trials. METHODS The search included a time-unlimited query of Scopus, PsycInfo and Medline, yielding 215 articles, of which only 7 met the inclusion/exclusion criteria. RESULTS The number of intervention programmes was very limited (11 interventions), but diverse, with cognitive stimulation, physical exercise, psychoeducation and cognitive restructuring all used to address SCCs. CONCLUSIONS Interventions including only cognitive stimulation were not effective in reducing SCCs, but interventions including cognitive stimulation and psychoeducation, physical exercise, and group sessions and discussions reinforced by the therapist were effective.
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Affiliation(s)
- Lucía Pérez‐Blanco
- Department of Developmental Psychology and EducationFaculty of PsychologyUniversidade de Santiago de CompostelaSantiago of CompostelaSpain
| | - Dolores Rodríguez‐Salgado
- Department of Clinical Psychology and PsychobiologyFaculty of PsychologyUniversidade de Santiago de CompostelaSantiago of CompostelaSpain
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O'Loughlin P, Pavithra P, Regan J, Bennett M, Knight R, Lenaert B, Marquez M, Taddeo M, Griffith J, Shapiro R, Farina F. A Randomized Controlled Trial Investigating the Feasibility of a Low-Intensity Psychological Intervention for Fear of Memory Loss and Quality of Life in Older Adults: Protocol for the Reducing Fear and Avoidance of Memory Loss (REFRAME) Study. JMIR Res Protoc 2021; 10:e30514. [PMID: 34328428 PMCID: PMC8367123 DOI: 10.2196/30514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022] Open
Abstract
Background Dementia is the most feared disease associated with aging. Prolonged fears about memory loss and dementia can have harmful consequences even in the absence of cognitive decline. Fear of dementia is associated with poorer health outcomes and psychological well-being and increased memory failures in older adults. Objective We will conduct a randomized controlled trial to determine the feasibility of a tailored, web-based mindfulness program to reduce fear of memory loss and increase quality of life in older adults experiencing heightened fear. Methods Eighty participants will be recruited and divided into 2 groups (40 in each group). One group will receive psychoeducation plus mindfulness training. A second group will receive psychoeducation, mindfulness training, and additional modules targeting maladaptive behavioral avoidance (ie, social and cognitive withdrawal). Results Our recent etiological model posits that maladaptive behavioral avoidance strategies critically underlie psychosocial dysfunction associated with fear of memory loss. Thus, we predict better outcomes in the second group, including reduced fear of memory loss (primary outcome), Alzheimer disease, anxiety, and subjective memory failures, and increased quality of life (secondary outcomes). Outcome measures will be applied at 5 time points (before, baseline, interim, and after the intervention, and at 3-month follow-up). Data will be analyzed using mixed models and correlations. Conclusions Results from this study will contribute to the current literature on dementia-related fear and improve our understanding of how to effectively address and reduce these fears. Trial Registration ClinicalTrials.gov NCT04821960; https://clinicaltrials.gov/ct2/show/NCT04821960. International Registered Report Identifier (IRRID) PRR1-10.2196/30514
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Affiliation(s)
| | | | - John Regan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Marc Bennett
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Rachel Knight
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Bert Lenaert
- Faculty of Health, Medicine and Life Sciences, Limburg Brain Injury Centre, Maastricht University, Netherlands
| | - Melissa Marquez
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michelle Taddeo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Griffith
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rita Shapiro
- VA Chicago Health Care System, Chicago, IL, United States
| | - Francesca Farina
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
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