Subjective memory loss in age-associated memory impairment: Family history and neuropsychological correlates

Cognitive Functioning of Unaffected First-degree Relatives of Individuals With Late-onset Alzheimer's Disease: A Systematic Literature Review and Meta-analysis

First-degree relatives of individuals with late-onset Alzheimer's disease (LOAD) are at increased risk for developing dementia, yet the associations between family history of LOAD and cognitive dysfunction remain unclear. In this quantitative review, we provide the first meta-analysis on the cognitive profile of unaffected first-degree blood relatives of LOAD-affected individuals compared to controls without a family history of LOAD. A systematic literature search was conducted in PsycINFO, PubMed /MEDLINE, and Scopus. We fitted a three-level structural equation modeling meta-analysis to control for non-independent effect sizes. Heterogeneity and risk of publication bias were also investigated. Thirty-four studies enabled us to estimate 218 effect sizes across several cognitive domains. Overall, first-degree relatives (n = 4,086, mean age = 57.40, SD = 4.71) showed significantly inferior cognitive performance (Hedges' g = -0.16; 95% CI, -0.25 to -0.08; p < .001) compared to controls (n = 2,388, mean age = 58.43, SD = 5.69). Specifically, controls outperformed first-degree relatives in language, visuospatial and verbal long-term memory, executive functions, verbal short-term memory, and verbal IQ. Among the first-degree relatives, APOE ɛ4 carriership was associated with more significant dysfunction in cognition (g = -0.24; 95% CI, -0.38 to -0.11; p < .001) compared to non-carriers (g = -0.14; 95% CI, -0.28 to -0.01; p = .04). Cognitive test type was significantly associated with between-group differences, accounting for 65% (R23 = .6499) of the effect size heterogeneity in the fitted regression model. No evidence of publication bias was found. The current findings provide support for mild but robust cognitive dysfunction in first-degree relatives of LOAD-affected individuals that appears to be moderated by cognitive domain, cognitive test type, and APOE ɛ4.

How Does Exposure to Dementia Relate to Subjective Cognition? A Systematic Review

Background and Objectives

Subjective cognitive decline (SCD) may be indicative of future objective cognitive decline. However, factors other than objective cognitive performance may influence SCD. This review addresses whether family history or close, nonfamilial exposure to dementia is associated with self-reported SCD.

Research Design and Methods

Searches were conducted in PubMed, PsycINFO, Web of Science, and the Dissertations and Theses database. Eligible articles included measures of self-reported cognition for community-dwelling middle-aged or older adults (40+ years) not diagnosed with dementia, and who had either a family history of dementia, a family member, spouse, or close friend with dementia. The quality of evidence was evaluated using the LEGEND Appraisal Tool. Evidence was synthesized narratively.

Results

A total of 32 articles were included, with 28 rated as good quality. Across studies, the relationship between dementia exposure and SCD was inconsistent. A significant association between exposure and SCD was found in 6 studies; however, 17 reviewed studies found no evidence of a relationship. The remaining 9 studies found mixed associations. Modifying factors that could potentially influence these associations were exploratorily identified among studies to provide context to our results. These factors included dementia worry, emotional closeness, and measurement sensitivity.

Discussion and Implications

Findings of this review suggest that both first-degree relatives and spouses of persons with dementia may have an increased likelihood of reporting SCD, although the current heterogeneity in definitions of exposure to dementia and SCD may influence these findings. In addition to the relationship between dementia exposure and SCD, future research should examine potential modifiers, including meaning attributed to exposure, as identifying how these perceptions affect cognition may promote early intervention.

Family History of Dementia in Old-Age Participants with Subjective Memory Complaints Predicts Own Risk for Dementia in a Longitudinal Multi-Center Cohort Study

BACKGROUND

Subjective memory complaints and family history of dementia are possibly intertwined risk factors for the own subsequent dementia risk and Alzheimer's disease. However, their interaction has rarely been studied.

OBJECTIVE

To study the association between subjective memory complaints and family history of dementia with regard to the own subsequent risk of dementia.

METHODS

Cross-sectional and longitudinal analyses over a follow-up period of up to 13 years were conducted in a population sample of participants without dementia at baseline (n = 3,256, mean age = 79.62 years), using group comparisons and Cox proportional hazards models.

RESULTS

Cross-sectionally, participants with subjective memory complaints were significantly more likely to report family history of dementia. Longitudinally, family history of dementia (FH) was significantly associated with subsequent dementia in the subjective memory complaints (SMC) group, but not in those without SMC. A relative excess risk due to interaction analysis confirmed a significant FHxSMC-interaction.

CONCLUSIONS

Family history of dementia was a predictor of incident dementia in those with SMC, which can serve as an additional, clinically relevant criterion to gauge the risk of dementia in older-aged subjects with SMC with and without objective cognitive impairment.

Subjective cognitive decline and anxious/depressive symptoms during the COVID-19 pandemic: what is the role of stress perception, stress resilience, and β-amyloid?

BACKGROUND

The COVID-19 pandemic may worsen the mental health of people reporting subjective cognitive decline (SCD) and therefore their clinical prognosis. We aimed to investigate the association between the intensity of SCD and anxious/depressive symptoms during confinement and the underlying mechanisms.

METHODS

Two hundred fifty cognitively unimpaired participants completed the Hospital Anxiety and Depression Scale (HADS) and SCD-Questionnaire (SCD-Q) and underwent amyloid-β positron emission tomography imaging with [18F] flutemetamol (N = 205) on average 2.4 (± 0.8) years before the COVID-19 confinement. During the confinement, participants completed the HADS, Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), and an ad hoc questionnaire on worries (access to primary products, self-protection materials, economic situation) and lifestyle changes (sleep duration, sleep quality, eating habits). We investigated stress-related measurements, worries, and lifestyle changes in relation to SCD. We then conducted an analysis of covariance to investigate the association of SCD-Q with HADS scores during the confinement while controlling for pre-confinement anxiety/depression scores and demographics. Furthermore, we introduced amyloid-β positivity, PSS, and BRS in the models and performed mediation analyses to explore the mechanisms explaining the association between SCD and anxiety/depression.

RESULTS

In the whole sample, the average SCD-Q score was 4.1 (± 4.4); 70 (28%) participants were classified as SCD, and 26 (12.7%) were amyloid-β-positive. During the confinement, participants reporting SCD showed higher PSS (p = 0.035) but not BRS scores (p = 0.65) than those that did not report SCD. No differences in worries or lifestyle changes were observed. Higher SCD-Q scores showed an association with greater anxiety/depression scores irrespective of pre-confinement anxiety/depression levels (p = 0.002). This association was not significant after introducing amyloid-β positivity and stress-related variables in the model (p = 0.069). Amyloid-β positivity and PSS were associated with greater HADS irrespective of pre-confinement anxiety/depression scores (p = 0.023; p < 0.001). The association of SCD-Q with HADS was mediated by PSS (p = 0.01).

CONCLUSIONS

Higher intensity of SCD, amyloid-β positivity, and stress perception showed independent associations with anxious/depressive symptoms during the COVID-19 confinement irrespective of pre-confinement anxiety/depression levels. The association of SCD intensity with anxiety/depression was mediated by stress perception, suggesting stress regulation as a potential intervention to reduce affective symptomatology in the SCD population in the face of stressors.

Parental dementia and subjective memory impairment in the health and retirement study

OBJECTIVES

To examine relationships between subjective memory impairment (SMI) and parental dementia among in older adults while considering the interactive influence of depressive symptoms, ethnicity, and race.

METHOD

The sample was drawn from the Health and Retirement Study, a nationally representative longitudinal study of aging (n = 3,809; Mage = 66.09; SD = 1.88; 84.20% White; 12.23% Black; 7.88% Hispanic). Biennial assessments included two measures of SMI (current memory problems and perceived memory decline), depressive symptoms, and parental dementia, over periods of up to sixteen years. Multilevel modeling analyses examined longitudinal relationships between parental dementia and SMI and whether depressive symptoms, ethnicity, and race interactively influenced this association.

RESULTS

Results showed that when older adults reported parental dementia, they were more likely to report a decline in memory in the past two years. They also reported poorer current memory problems, especially when they experienced increased depressive symptoms. Associations of parental dementia were consistent across ethnicity and race.

CONCLUSIONS

Results demonstrate the importance of considering parental dementia as a factor that may contribute to SMI in older adults.

Association Between Cognitive Test Performance and Subjective Cognitive Decline in a Diverse Cohort of Older Adults: Findings From the KHANDLE Study

BACKGROUND

Subjective cognitive decline (SCD) may represent a low-burden indicator of dementia risk. The value of SCD as a proxy marker, however, depends on the consistency of associations between subjective and objective cognitive measures across sociodemographic and psychological factors.

METHODS

We evaluated baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study (n=1615). SCD was measured using the 12-item Everyday Cognition (ECog) scale. Using linear regression models with interaction terms, we evaluated 6 potential modifiers (age, sex, race/ethnicity, educational attainment, family history of dementia, and depressive symptoms) of the association between cognitive performance (episodic memory, executive function) and SCD.

RESULTS

Lower episodic memory and executive function scores were associated with higher log(ECog scores) (more SCD). Older age and elevated depressive symptoms were associated with higher log(ECog scores). Age (interaction P=0.002) and education (interaction P=0.01) modified the association between executive function and log(ECog scores). Specifically, associations between executive function and log(ECog scores) were stronger among participants with more education and less pronounced among older participants.

CONCLUSIONS

The association between cognitive performance and log(ECog scores) differed little across sociodemographic and psychological factors. SCD as measured by the ECog may be a valuable proxy for cognitive performance in diverse older adults.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Implementation of subjective cognitive decline criteria in research studies

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

Memory Self-Efficacy and Memory Performance in Older Adults

Abstract. The present research examined the role persistence plays in mediating the positive impact of memory self-efficacy (MSE, i.e., one’s confidence in one’s own memory abilities) on older adults’ memory performance. In three studies, 81 to 264 older adults completed an MSE scale and carried out an explicit episodic memory task, during which we recorded their study time as an indicator of task persistence. We found that higher MSE was indirectly related to better memory performance through greater persistence during encoding, as measured by longer study time. Indirect effects were of medium size, with point estimates ranging from 0.64 to 0.85. This mediation effect was independent of factors that could be confounded with study time: chronological age, memory span, prior level of memory performance, episodic memory ability, and use of learning strategies (encoding strategies and self-testing). When confronted with difficult memory tasks, older adults who lack confidence in their memory abilities cease their efforts prematurely, which contributes to a decrease in their performance. Encouraging older adults to persist in the face of difficulties during encoding and retrieval may help alleviate the negative impact of low MSE on memory performance and allow researchers and clinicians to more accurately estimate older adults’ true memory abilities.

The link between depressive symptoms, negative cognitive bias and memory complaints in older adults

OBJECTIVES

We sought to examine the relationship between depressive symptoms and subjective memory problems. We hypothesized that the relationship between depressive symptoms and poor subjective memory functioning is mediated by negative cognitive bias that is associated with hopelessness, a wish to die and low self-esteem.

METHODS

Complete data were available for 299 older adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate, completed a baseline in-home assessment. Subjective memory functioning and psychological status was assessed with commonly used, validated standard questionnaires.

RESULTS

In regression models that included terms for age, gender and cognitive measures, depressive symptoms were significantly inversely associated with the global self-assessment of memory (beta=-0.019; p=0.006). When components of negative cognitive bias were included in the model (hopelessness, low self-esteem, a wish to die), the relationship of depressive symptoms with subjective memory problems was attenuated, consistent with mediation.

CONCLUSIONS

Our results suggest that assessment and successful interventions for memory complaints in non-demented older adults need to account for negative cognitive bias as well as depressive symptoms. Longitudinal research is needed to confirm our findings before a mediator relationship can be presumed.

Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach

The question of whether and how subjective cognitive complaints are related to actual cognitive performance represents a central issue in applied cognitive aging research. Until recently, however, many studies have failed to find a strong association between subjective cognitive complaints and actual cognitive performance. In our study, we examine two alternative explanations: a) for methodological reasons, strong associations exist only when latent changes rather than differences are examined, and b) strong associations exist only between changes in depression and complaints, not between changes in cognitive performance and complaints. With 427 participants (M = 63 years) and two measurements, we examine both the relation between functioning, complaints, and depressive affect at each measurement point, and the relation between changes in functioning, changes in complaints, and changes in depressive affect between the measurement points with latent difference variables. The results indicate that there are substantial relations between changes in functioning, changes in depression, and changes in complaints.

Memory self-appraisal and depressive symptoms in people at genetic risk for Alzheimer's disease

OBJECTIVES

A previous study found that subjective memory loss in middle-aged and older persons is associated with the major genetic risk for Alzheimer's disease, the apolipoprotein E-4 (APOE-4) allele. No previous study has focused on subjective memory complaints and depressive symptoms in the same subject population at genetic risk for Alzheimer's disease.

METHOD

Sixty-six persons (mean age = 64 years, range = 43 to 82 years) without major depression or dementia but with mild age-related memory complaints were rated for severity of depressive symptoms, using the Hamilton Depression Rating Scale, and assessed for the presence of the APOE-4 allele. Severity of subjective memory loss was assessed using the Memory Functioning Questionnaire, which measures four memory domains: frequency of forgetting, seriousness of forgetting, retrospective functioning, and mnemonics usage.

RESULTS

Depressive symptoms were significantly associated with subjective memory loss in subjects without the APOE-4 allele, for retrospective functioning (perceived change in memory) and mnemonics usage, but not in APOE-4 carriers. The same significant associations were found when the analysis was limited to the 44 subjects in the mid-age range (55-74 years), wherein APOE-4 confers its greatest effects on risk for Alzheimer's disease.

CONCLUSION

These results confirm that mild depressive symptoms are related to subjective memory loss, but for some forms of memory complaint, the relationship holds true only for people without the major known genetic risk for Alzheimer's disease.

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.