Complainer Profile Identification (CPI): properties of a new questionnaire on subjective cognitive complaints

Neuropsychiatric symptoms and metamemory across the life span: psychometric properties of the German Multifactorial Memory Questionnaire (MMQ)

OBJECTIVE

We assessed the psychometric properties, established normative data for the German Multifactorial Memory Questionnaire (MMQ), and analyzed its association with neuropsychiatric factors across the life span to provide a validated metamemory assessment for a German-speaking population.

METHODS

The three MMQ scales (memory satisfaction, self-rated ability, and strategy application) were translated into German, considering cultural, linguistic, and conceptual aspects. To validate the MMQ and assess associations with neuropsychiatric factors, the Complainer Profile Identification, Geriatric Depression Scale, Beck Anxiety Inventory, Pittsburgh Sleep Quality Index, and Short-Form-Health Survey were applied in an online study in 336 healthy participants with follow-up after 8 months.

RESULTS

Psychometric evaluation of the German MMQ showed normal distribution of all scales and good to excellent validity, internal consistency, and retest reliability. We provide percentiles and normative data for z-score conversion. Importantly, even subclinically elevated scores in depressiveness and anxiety were associated with decreased memory satisfaction and self-rated ability. Furthermore, although the influence of age on the German MMQ scales was minimal, effects of neuropsychiatric factors such as sleep quality, anxiety, and depressiveness on MMQ Satisfaction and Ability varied across the life span.

CONCLUSIONS

Our study provides a validated German translation of the MMQ with normative data and reliability measures, including reliable change scores. We show the impact of neuropsychiatric factors on the MMQ scales across the life span and emphasize the relevance of a multifactorial approach to metamemory as a measure of individualized everyday functionality and the importance of including neuropsychiatric factors into both research and clinical assessments of metamemory.

Psychometric properties and normative data of the Italian version of the Cognitive Function at Work Questionnaire: a screening tool for detecting subjective cognitive complaints at work

INTRODUCTION

Considering the extension of working life due to socioeconomic and political factors, many people may experience cognitive complaints (CC) at their workplace, with severe consequences on their quality of life. The identification of workers reporting significative SCC is crucial to eventually address them to an objective neuropsychological evaluation and implement cognitive interventions to guarantee workers' well-being. Since no Italian questionnaires for detecting CC were designed for occupational settings, the aim of the study was to validate the Italian version of the Cognitive Function at Work Questionnaire (CFWQ) and to provide its normative data.

MATERIALS AND METHODS

Internal consistency, convergent and divergent validity, and factorial structure of the CFWQ were evaluated. A regression-based procedure served to compute percentiles of CFWQ and its subscales.

RESULTS

Four hundred twenty-one participants without psychiatric and/or neurological disorders completed the survey. We found that the Italian CFWQ included 26 items, with a good internal consistency (Cronbach's alpha = 0.897) and a six-factor structure (memory, language, processing speed, abstract thinking/behavioral control, behavioral inertia, planning ability). CFWQ score did not correlate with empathy but correlated strongly with memory scores and moderately with anxiety and depression scores.

CONCLUSIONS

The Italian CFWQ showed good psychometric properties, in analogy with the original English scale. Therefore, it can be successfully employed in organizational contexts to possibly identify workers with CC and therefore with possible co-occurrent psychological, behavioral, and cognitive consequences.

Translating spatial navigation evaluation from experimental to clinical settings: The virtual environments navigation assessment (VIENNA)

Spatial navigation abilities are frequently impaired in neurological disorders and they also decline with normal aging. Researchers and clinicians therefore need valid and easy-to-use spatial navigation assessment tools to study the impact of different neuropathologies and prevent relevant cognitive impairments from going undetected. However, current experimental paradigms rarely address which cognitive processes they recruit, often have resource-intensive setups, and usually require active navigation, e.g., using a joystick or keyboard, thus confounding cognitive performance with fine motor skills. Yet, for clinical feasibility, time-efficient paradigms are needed that are informative and easy to administer in participants with limited technical experience and diverging impairments. Here, we introduce the virtual environments navigation assessment (VIENNA), a virtual adaptation of a brief, standardized, and intuitive spatial navigation paradigm ( https://osf.io/kp4c5/ ). VIENNA is designed to assess spatial navigation without episodic memory demands, requires no interface device, and takes about 16 min to complete. We evaluated VIENNA in 79 healthy middle-aged to older participants (50-85 years) and provide evidence for its feasibility and construct validity. Tests of visuospatial and executive functions, but not episodic memory or selective attention, were identified as cognitive correlates of VIENNA, even when controlling for participant age and overall cognitive performance. Furthermore, VIENNA scores correlated with subjective navigation ability and age, but not with depressiveness, cognitive complaints, or education. The straightforward administration of VIENNA allows for its integration into routine neuropsychological assessments and enables differentiated evaluation of spatial navigation performance in patients with motor impairments and episodic memory deficits.

Programme Dementia Prevention (pdp): A Nationwide Program for Personalized Prevention in Luxembourg

BACKGROUND

With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease.

OBJECTIVE

The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process.

METHODS

In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested.

RESULTS

A total number of 450 participants (Mean age = 69.5 years; SD = 10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria.

CONCLUSIONS

We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.

Uncovering mnestic problems in help-seeking individuals reporting subjective cognitive complaints

In individuals with subjective cognitive impairments (SCI) the risk for the development of a neurodegenerative disease is assumed to be increased. However, it is not clear which factors contribute to the expression of SCI: Is it related to the cognitive resources already challenged, or is the psycho-affective state of more relevance? Using a novel online assessment combining self-report questionnaires and neuropsychological psychometric tests, significant predictors for the level of complaints were identified in two samples of elderly individuals: Help-seekers (HS, n = 48) consulting a memory clinic and a matched sample of non-help-seekers (nHS, n = 48). Based on the results of the online assessment, the SCI level was found to be significantly determined by the psycho-affective state (depressive mood) in the nHS group, whereas cognitive performance (cued recall) was the main predictor in the HS group. The predictive value of recall performance, however, is more-strongly expressed in memory tests which reduce the impact of compensatory strategies (face-name-association vs. word lists). Our results indicate that the problem-focused behavior of help-seeking individuals is also associated with a higher sensitivity for cognitive deficits-which can be uncovered with an appropriate psychometric test. Considering these factors, the conversion risk in individuals with SCI can probably be determined more reliably.

Intuitive assessment of spatial navigation beyond episodic memory: Feasibility and proof of concept in middle-aged and elderly individuals

Deficits in spatial navigation in three-dimensional space are prevalent in various neurological disorders and are a sensitive cognitive marker for prodromal Alzheimer’s disease, but are also associated with non-pathological aging. However, standard neuropsychological tests used in clinical settings lack ecological validity to adequately assess spatial navigation. Experimental paradigms, on the other hand, are often too difficult for seniors or patients with cognitive or motor impairments since most require operating a human interface device (HID) or use complex episodic memory tasks. Here, we introduce an intuitive navigation assessment, which is conceptualized using cognitive models of spatial navigation and designed to account for the limited technical experience and diverging impairments of elderly participants and neurological patients. The brief computer paradigm uses videos of hallways filmed with eye tracking glasses, without employing an episodic memory task or requiring participants to operate a HID. Proof of concept data from 34 healthy, middle-aged and elderly participants (56–78 years) provide evidence for the assessment’s feasibility and construct validity as a navigation paradigm. Test performance showed normal distribution and was sensitive to age and education, which needs to be considered when investigating the assessment’s psychometric properties in larger samples and clinical populations. Correlations of the navigation assessment with other neuropsychological tests confirmed its dependence on visuospatial skills rather than visual episodic memory, with age driving the association with working memory. The novel paradigm is suitable for a differentiated investigation of spatial navigation in elderly individuals and promising for experimental research in clinical settings.

Evaluating measurement properties of subjective cognitive decline self-reported outcome measures: a systematic review

BACKGROUND

Subjective cognitive decline (SCD) is present in the early stage of preclinical Alzheimer's disease (AD) and is associated with an increased risk of further cognitive decline and AD dementia later in life. Early detection of at-risk groups with subjective complaints is critical for targeted dementia prevention at the earliest. Accurate assessment of SCD is crucial. However, current measures lack important psychometric evaluations and or reporting.

OBJECTIVES

To systematically evaluate measurement properties of self-reported outcome measures (PROMs) used to assess SCD in the older adult population with or at risk of AD.

METHODS AND ANALYSIS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 Checklist for reporting. We conducted a literature search, screened, and included validation studies of SCD based on self-reported questionnaires from both population-based and clinical studies, conducted in older adults (≥ 55). We critically appraised the included primary studies using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines.

RESULTS

Sixteen studies met the inclusion criteria. The included studies reported psychometric properties of 17 SCD self-reported questionnaires. We extracted data on the structural validity, internal consistency, test-retest reliability, and cross-cultural validity and found a widespread proneness to bias across studies, and a marked heterogeneity is assessed and reported measurement properties that prevented the consolidation of results.

CONCLUSION

Our findings suggest that available SCD questionnaires lack content validity evaluation. Currently available measurements of SCD lack development and validation standards. Further work is needed to develop and validate SCD self-reported measurement with good quality measurement properties.

The Challenge of Subjective Cognitive Complaints and Executive Functions in Middle-Aged Adults as a Preclinical Stage of Dementia: A Systematic Review

Subjective cognitive complaints correspond to a heterogeneous construct that frequently occurs in the early stages of older adult life. Despite being a common source of worry for middle-aged people, it can be underestimated when clinical and neuropsychological assessments discard any underlying pathological processes. Negative age stereotyping but also self-stereotyping can contribute to doing so. Although its diagnosis is a challenge, its implication as a possible predictor of mild cognitive impairment or dementia increases the interest in its early diagnosis and intervention. The present systematic review analyzes the empirical data on the relationship between these complaints and early executive dysfunction with possible predictive value for preclinical stages of dementia. The sixteen papers obtained from the PubMed and Embase databases were exploratory, cross-sectional and prospective in scope. The studies corroborated the relationship between subjective cognitive complaints and some executive processes, which is noteworthy since many people with subjective executive complaints progress to dementia. The relational studies confirmed that impaired executive performance is associated with CSF biomarkers and reduced cortical volume in specific brain regions. However, the heterogeneity of reports in these studies demands stronger efforts in future research with specific tools applied in clinical and neuropsychological assessments and analyzed under a gender perspective.

The role of disability and depressive symptoms in the relation between objective cognitive performance and subjective cognitive decline

BACKGROUND

Subjective cognitive decline (SCD) and subjective memory decline (SMD) are common among older people. Evidence linking SCD and SMD with cognitive and memory impairment is inconsistent. Moreover, little is known about the associations of SCD and SMD with disability. We aimed to explore the associations of SCD and SMD with objective cognitive and memory performance, disability, and depressive symptoms.

MATERIALS AND METHODS

In a cross-sectional study we conducted face to face interviews in a randomized sample of people aged ≥65 years living in the Canton of Ticino, southern Switzerland, between May 2021 and April 2022. We measured subjective cognitive decline with the MyCog, a subsection of the Subjective Cognitive Decline Questionnaire (SCD-Q); cognitive functioning with the Community Screening Instrument for Dementia; memory with the consortium to establish a registry for alzheimer's disease (CERAD) 10-word list learning task; and disability and depressive symptoms with the world health organization disability assessment schedule 2.0 (WHO-DAS 2.0) and the Euro-Depression (EURO-D) scales, respectively.

RESULTS

Of the 250 participants 93.6% reported at least one cognitive difficulty, and 40.0% SMD. Both SCD and SMD were associated with poorer objective cognitive/memory performance, and independently with greater disability, and more depressive symptoms. But in participants with high disability and depressive symptoms subjective and objective cognition were no longer associated. Disability fully mediated the associations of poorer objective cognitive and memory performance with subjective cognitive and memory decline.

CONCLUSION

Routine clinical assessments of cognitive function should include formal enquires about SCD and SMD, and also account for disability and depressive symptoms.

Associations of subjective cognitive and memory decline with depression, anxiety, and two-year change in objectively-assessed global cognition and memory

Research studies exploring the association of cognitive complaints with objectively assessed cognitive decline report inconsistent results. However, many of these have methodological limitations. We investigated whether 1) more severe subjective cognitive decline (SCD) and subjective memory decline (SMD) predict change in objectively assessed global cognition, remote memory, recent memory, learning; 2) the predictive value of more severe SMD over change in objectively assessed remote memory, recent memory, and learning is stronger for individuals that report an SMD that started within the past five years than for those that report an SMD that started five or more years previously and/or stronger for those that experienced SMD within the past two years than for those who had not; and 3) greater depression and anxiety are associated with more severe SCD and SMD. We used two-year longitudinal data from the CFAS-Wales study (N = 1,531; mean (SD) age = 73.0 (6.0) years). We fitted linear regression models. More severe SCD and SMD did not predict change in objectively assessed global cognition, remote memory, and recent memory but predicted lower scores in learning. The prediction of SMD over change in learning was not stronger when individuals reported an SMD that started within the past five years compared to when they reported an SMD that started five or more years previously nor when individuals reported an SMD that started within the past two years than those who did not. Greater depression and anxiety were associated with more severe SCD and SMD. More severe SMD may be useful for predicting lower learning ability and for identifying individuals experiencing depression and anxiety.

Prevalence and psychosocial correlates of subjectively perceived decline in five cognitive domains: Results from a population-based cohort study in Germany

OBJECTIVE

Subjective cognitive decline (SCD) was frequently investigated for memory in healthy aging or in relation to diseases like dementia. It was found to be related to sociodemographic and psychological variables as well as cognitive abilities. The prevalence of SCD in other cognitive domains and their relation to these variables is largely unknown to date. The present study aimed to fill this gap.

METHODS

A total of 807 subjects (18-85 years of age, M = 57.8 years, female: 43%) completed the Juelich Questionnaire on Subjective Cognitive Decline, to investigate SCD in memory, attention, language, motor, and executive functions. Logistic regression analyses were used to estimate association of depressive symptomatology, emotionality, and general cognitive performance as well as age, gender, and educational attainment with domain-specific SCD.

RESULTS

The highest prevalence rate was obtained for the memory domain (65.9%), followed by the attention (54.6%), motor (52.9%), executive (39.7%), and language domain (31.5%). Of the psychosocial factors, only age, depressive symptomatology and emotionality were consistently and strongly associated with domain-specific SCD prevalence.

CONCLUSIONS

SCD is prevalent not only in the memory domain, but also in other major cognitive domains. Our results also suggest that the suspicion from previous research, that subjective memory decline might be more strongly associated with depressive symptomatology and emotionality than with actual decline of cognitive performance, might also apply to the attention, motor, executive, and language domain. Further investigations using neuropsychological testing for specific cognitive functions and employing longitudinal designs are required for substantiating this suspicion.

Subjective Cognitive Decline Below and Above the Age of 60: A Multivariate Study on Neuroimaging, Cognitive, Clinical, and Demographic Measures

Subjective cognitive complaints in cognitively normal individuals are a relevant predictor of Alzheimer's disease (AD), cerebrovascular disease, and age-related tauopathy. Complaints starting after the age of 60 increase the likelihood of preclinical AD. However, this criterion is arbitrary and current data show that neurodegenerative disorders likely start before that age. Further, data on the role of subjective complaints below the age of 60 in individuals qualifying for subjective cognitive decline (SCD) are lacking. We investigated the association of subjective cognitive complaints with an extensive number of neuroimaging, demographic, clinical, and cognitive measures in individuals fulfilling criteria for SCD below and above the age of 60. Nine complaints were scored in 416 individuals. Complaints were related to a higher load of white matter signal abnormalities, and this association was stronger the more subclinical changes in personality, interest, and drive were reported. In individuals <60 years, complaints were associated with lower global cognitive performance. In individuals ≥60 years, complaints were related to greater global brain atrophy and smaller total intracranial volume, and this association was stronger the more subclinical difficulties in activities of daily living were reported. Also, complaints were associated with increased depressive symptomatology irrespective of age. We conclude that complaints below the age of 60 may be associated with subtle signs of brain pathology. In the community, screening for risk of future cognitive decline should include subjective cognitive complaints, depressive symptomatology, and subclinical reduced cognition (<60 years)/activities of daily living (≥60 years), supported by basic neuroimaging examinations.

Psychosocial and Cognitive Performance Correlates of Subjective Cognitive Complaints in Help-Seeking Versus Non-Help-Seeking Community-Dwelling Adults

The clinical use of subjective cognitive complaints (SCCs) has been questioned, especially when considering the influence of depression. Further problems describe the registration of SCCs with a focus on memory and different sample selections, with only few studies that directly compare those who seek help because of SCCs and community-dwelling adults. The present study aimed to (1) evaluate differences in psychosocial variables in help-seeking adults and community-dwelling adults with a lower level of complaints and (2) to further explore the relationship between SCCs and cognitive performance in help-seekers. Fifty-five help-seeking adults (HS) were compared to 55 age-, sex-, and education-matched non-help-seeking adults (NHS). Multiple regression analyses revealed that depressive symptoms were linked to experiencing more SCCs mainly in NHS. Altogether, less variance was explained by psychosocial variables in HS, whereas adding cognitive variables-especially divided attention performance-led to a substantial increase in explained variance. Mediation analysis further revealed a possible mediation of depressive symptoms on SCC by divided attention performance. Taken together, our results underpin the importance of assessing SCCs comprehensively to detect a functional relationship between cognitive performance and complaints, especially in HS. In this group, it is likely that depression precedes problems in divided attention, which in turn lead to SCC. Therefore, future studies should further investigate the link between SCC and cognitive functions which rely on more cognitive resources, as these might be first to be affected by cognitive decline.

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

Background

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

Participants and procedure

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

Results

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

Conclusions

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