The relationship between memory complaints, activity and perceived health status

The Cognitive Function at Work Questionnaire (CFWQ): A new scale for measuring cognitive complaints in occupational population

Cognitive functioning is a relevant work and health related topic, however, validated methods to assess subjective cognitive complaints (SCC) at work are lacking. We introduce the Cognitive Function at Work Questionnaire (CFWQ) for measuring SCC in occupational settings. 1-year follow-up data of 418 employees from a Finnish public media service company was analyzed. Participants completed web-based CFWQ, cognitive tests and a broad set of questionnaires for evaluating depression, anxiety, insomnia, daytime sleepiness, burnout, stress, mental job burden, work ability, cognitive errors, and perceived health. The factor analysis yielded a model with the CFWQ subdomains: Memory, Language, Executive Function, Speed of Processing, Cognitive Control and Name Memory. The internal consistency (Cronbach's alpha = .87) and the test-retest constancy (ICC = .84) reflected good reliability. Correlation between the CFWQ and cognitive errors at work ranged from .25 to .64 indicating adequate concurrent validity. Employees with depression, insomnia and burnout symptoms had higher (p < .001) CFWQ scores than participants without these symptoms. Depression and burnout symptom severity as well as accumulation of mood, sleep, and psychosocial stressors were associated with higher CFWQ scores (p < .001 in all). The CFWQ appears psychometrically sound measure for the assessment of SCC in occupational population.

The Cognitive Function at Work Questionnaire in memory clinic setting: a validation study

INTRODUCTION

As there is a trend toward more people seeking medical help due to cognitive symptoms, validated and targeted questionnaires are increasingly important in the clinical evaluation process. The Cognitive Function at Work Questionnaire (CFWQ) was developed to identify and rate subjective cognitive symptoms of individuals active in working life. However, its psychometric characteristics have not been previously studied in a memory clinic setting.

METHOD

The factorial structure, internal consistency, test-retest reliability, and convergent validity of the CFWQ were studied in a memory clinic setting (N = 113). We also investigated the instrument's ability to identify cognitive symptoms in a cohort of early-onset dementia (EOD, N = 22), mild cognitive impairment-neurological (MCI-n, N = 18), MCI due to mood, sleep, or other physical health problems (MCI-o, N = 59), and subjective cognitive decline (SCD, N = 14) patients.

RESULTS

Based on factor analysis, eight cognitive subscales were identified covering main cognitive domains: Memory, Language, Executive Function, Speed of Processing, Cognitive Control, Name Memory, Visuospatial/Praxis and Attention. The internal consistency (α = .93) and the test-retest reliability (ICC = .91) were high. Several correlations (r = .19 - .33, p < .05) were documented between neuropsychological impairment level and CFWQ scores. EOD, MCI-n, MCI-o, and SCD groups did not differ statistically significantly in the levels of cognitive symptoms as measured by the CFWQ Total score. EOD group scored higher (p = .009) than other patient groups on the Visuospatial/Praxis subscale, but the difference between EOD and MCI-o groups turned insignificant after correcting for multiple testing.

CONCLUSIONS

The results of the study support the validity and reliability characteristics of the CFWQ in a memory clinic setting. The instrument is easy-to-use and has clinical utility in capturing the subjective cognitive symptoms of patients active in working life and who need a referral to a more detailed evaluation.

The Relationship Between Social Support and Subjective Cognitive Functioning Across Adulthood

Subjective cognitive functioning (SCF) is the self-appraisal of one's objective cognition, including both perceived cognitive ability and perceived cognitive impairment. Research has demonstrated perceived subjective cognitive impairment to be an important precursor to objective cognitive declines associated with increased age. Although previous work has shown a consistent positive relationship between social support and objective cognition throughout adulthood, few studies have examined the relationship between social support and SCF. Participants (N  =  1,877; age range: 18-99) from the Virginia Cognitive Aging Project completed assessments of multiple domains of SCF and social support. Results demonstrated a significant association between negative support interactions and poorer SCF, beyond the influence of sociodemographic, well-being, and health factors. Exploratory analyses indicated that the magnitude of the relationships between social support and SCF were generally the same across age. These findings suggest that negative interactions may adversely impact an individual's self-appraisals of cognition.

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.

The Relationship between Life Course Socioeconomic Conditions and Objective and Subjective Memory in Older Age

While objective memory performance in older adults was primarily shown to be affected by education as indicator of life course socioeconomic conditions, other life course socioeconomic conditions seem to relate to subjective memory complaints. However, studies differ in which life course stages were investigated. Moreover, studies have explored these effects in an isolated way, but have not yet investigated their unique effect when considering several stages of the life course simultaneously. This study, therefore, examined the respective influence of socioeconomic conditions from childhood up to late-life on prospective memory (PM) performance as an objective indicator of everyday memory as well as on subjective memory complaints (SMC) in older age using structural equation modeling. Data came from two waves of the Vivre-Leben-Vivere aging study (n=993, Mage=80.56). The results indicate that only socioeconomic conditions in adulthood significantly predicted late-life PM performance. PM performance was also predicted by age and self-rated health. In contrast, SMC in older age were not predicted by socioeconomic conditions at any stage of the life course but were predicted by level of depression. In line with the cognitive reserve hypothesis, present results highlight the significance of education and occupation (adulthood socioeconomic conditions) for cognitive functioning in later life.

Is Achieving the Guidelines of Four Forms of Physical Activity Associated with Less Self-Reported Health Complaints? Cross-Sectional Study of Undergraduates at the University of Turku, Finland

Very little research has assessed the physical activity (PA) of university students in in Finland, and their associations with self-reported health complaints (HCs), whilst simultaneously accounting for a range of other potential confounders. Students at the University of Turku (1177) completed an online health and wellbeing questionnaire that assessed 22 physical and somatic HCs, and students' achievement of the international guidelines of four forms of PA (moderate, vigorous, moderate-to-vigorous and muscle strengthening PA; MPA, VPA, MVPA, MSPA respectively). We also explored the associations between HCs and PA, controlling for sociodemographic and health confounders (age, sex, year of study, marital status, accommodation during semesters, health awareness). Factor analysis reduced the HCs into three factors (psychological, pains/aches, circulatory/breathing). Bivariate relationships (no controlling for confounders) between these 3 factors and four forms of PA guideline achievement showed significant effects of achieving the PA guidelines against various groups of HCs, where more strenuous PA was associated with significantly less HCs in a step-ladder pattern. Multiple regression analyses (controlling for confounders) showed that achievement of PA guidelines was significantly independently associated with self-reported HCs scores in most cases. Psychological HCs were negatively associated with achieving any type of PA; pains/aches were negatively associated with achieving two types of PA or with achieving MSPA guidelines; and circulatory/breathing HCs were negatively associated with achieving the VPA guidelines only. This is the first study in Finland to examine such relationships, and highlights the critical role of PA for the health of these young adults. Programs and policies to strengthen and improve the PA of university students would be beneficial, recognizing the benefits of instilling life-long PA habits among this group of young adults.

Subjective cognitive impairment, cognitive disorders and self-perceived health: The importance of the informant

There is great divergence of results in the literature regarding the clinical relevance and etiology of subjective cognitive impairment (SCI). Currently, SCI is studied as a pre-clinical symptom of Alzheimer's disease, before establishing a possible diagnosis of mild cognitive impairment (MCI). The hypothesis was that SCI is associated with low cognitive performance and poor self-perceived health.

Effects of Subjective Memory Complaints (SMCs) and Social Capital on Self-Rated Health (SRH) in a Semirural Malaysian Population

Subjective memory complaints (SMCs) and social capital were known to be related to self-rated health (SRH). Despite this, no studies have examined the potential interaction of SMC and social capital on SRH. Using data from a cross-sectional health survey of men and women aged 56 years and above (n = 6,421), we examined how SMCs and social capital explained SRH in a population of community-dwelling older adults in a semirural area in Malaysia. We also evaluated whether SRH's relationship with SMCs is moderated by social capital. The association of SMC and social capital with poor SRH was investigated using multivariable logistic regression. Social capital (OR = 0.86, 95% CI = 0.82–0.89), mild SMC (OR = 1.70, 95% CI = 1.50–1.94), and moderate SMC (OR = 1.90, 95% CI = 1.63–2.20) were found to be associated with poor SRH after adjustment for sociodemographic factors and depression in the initial regression model. SMC was found to have partial interaction effects with social capital which was included in the subsequent regression model. Unlike individuals with no SMC and mild SMC, those who reported moderate SMC did not show decreasing probabilities of poor SRH despite increasing levels of social capital. Nevertheless, this analysis suggests that social capital and SMC are independent predictors of poor SRH. Further research needs to be targeted at improving the understanding on how social capital and SMC moderate and interact with the perception of health in older adults.

Associations between Prospective and Retrospective Subjective Memory Complaints and Neuropsychological Performance in Older Adults: The Finger Study

OBJECTIVES

Subjective memory complaints (SMCs) are among the key concerns in the elderly, but their role in detecting objective cognitive problems is unclear. The aim of this study was to clarify the association between SMCs (both prospective and retrospective memory complaints) and neuropsychological test performance in older adults at risk of cognitive decline.

METHODS

This investigation is part of the FINGER project, a multicenter randomized controlled trial aiming at preventing cognitive decline in high-risk individuals. The cognitive assessment of participants was conducted at baseline using a modified neuropsychological test battery (NTB). SMCs were evaluated with the Prospective and Retrospective Memory Questionnaire (PRMQ) in a sub-sample of 560 participants (mean age, 69.9 years).

RESULTS

Having more prospective SMCs was associated with slower processing speed, but not with other NTB domains. Retrospective SMCs were linked to poorer function on NTB total score, processing speed, and memory. Executive function domain was not associated with any PRMQ ratings. Depressive symptoms and poor quality of life diluted the observed associations for NTB total score and memory. However, the association between PRMQ and processing speed remained even after full adjustments.

CONCLUSIONS

Our results indicate that self-reported memory problems, measured with PRMQ, are associated with objectively measured cognitive performance. Such complaints in healthy elderly people also seem to reflect reduced mental tempo, rather than memory deficits. Slowing of processing speed may thus be negatively related to memory self-efficacy. It is also important to consider affective factors among those who report memory problems. (JINS, 2018, 24, 1099-1109).

Alzheimer's disease risk factors as mediators of subjective memory impairment and objective memory decline: protocol for a construct-level replication analysis

Background

Subjective memory impairment (SMI), or the perception of memory problems in the absence of objective memory deficits, is associated with negative outcomes of individual and societal significance, including a substantially increased risk of Alzheimer’s disease (AD). However, little is known regarding the mediators that link SMI and memory decline in some individuals, or which older adults with SMI are at greatest risk for memory decline. In this study, we will examine modifiable AD risk factors (specifically affective symptoms and activity participation) as mediators underlying linkages among SMI and memory decline over time; furthermore, we will characterize SMI subgroups at highest risk for memory decline via this pathway.

Methods

This study utilizes a series of construct-level replication analyses across four large longitudinal datasets to maximize the unique aspects of each dataset as well as test the reproducibility of findings across multiple populations to establish generalizability. The current study’s sample (n > 40,000) is drawn from the Einstein Aging Study, Health and Retirement Study, Minority Aging Research Study, and National Health and Aging Trends Study. Participants must meet the following basic criteria for inclusion: age 55 or older and no evidence of cognitive impairment at baseline. We will use multilevel modeling to determine whether higher levels of SMI are related to increased affective symptoms and decreased activity participation, as well as whether this relationship is moderated by neuroticism, family history of AD, and race/ethnicity. Finally, we will test our full conceptual model that examines whether changes in affective symptoms and activity participation mediate the relationship between SMI and objective memory decline. Specifically, we will test moderated mediation as we hypothesize these relationships to hold among subgroups of older adults.

Discussion

Discovery of modifiable AD risk factors that mediate the association between SMI and memory decline (the earliest and most central deficit in AD) will provide explicit, and potentially novel, targets for intervention. Additionally, identifying individuals at highest risk for negative reactions to SMI will serve to enrich samples for future research as well as to help guide the development of SMI assessment tools to identify older adults at greatest risk for debilitating outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0954-5) contains supplementary material, which is available to authorized users.

Incongruence of subjective memory impairment ratings and the experience of memory problems in older adults without dementia: a mixed methods study

OBJECTIVES

The objective of this study was to describe the experiences of older adults living with subjective memory impairment (SMI) and examine the extent to which SMI severity was associated with impact of SMI on daily life.

METHOD

A mixed methods convergent design was utilized. Participants with SMI (n = 19, mean age 80.7 years) were recruited from community settings. Semi-structured interviews were analyzed using thematic analysis; these findings were integrated with descriptive statistics from questionnaire and cognitive status data.

RESULTS

The impact of SMI varied depending on the personal meaning individuals attributed to the experience. Older adults with normal cognition reported episodic memory problem compared to more pervasive problems reported by participants with mild cognitive deficits. The impact of memory problems ranged from frustration/embarrassment to avoidance of social activities, but the degree of emotional impact was not reflected in SMI severity or cognitive status.

CONCLUSION

SMI is common in older adults without dementia but the impact on function and well-being is variable and does not seem to be associated with objective cognition. Future research is needed to validate these associations and to inform the development of SMI measures that accurately reflect older adults' experiences.

Health Conditions and Memory Performance: a study with older adult women

Objective

to verify the correlation between health condition and memory performance of older adult women in the community.

Method

Analytical cross-sectional study developed with 28 older adult women living in Cuiabá-MT. They answered the Mini-Mental State Examination (MMSE), and a shortened Geriatric Depression Scale (GDS-15) to screen for dementia and depression symptoms. Memory skills were assessed through Rey Auditory Verbal Learning Test (RAVLT).

Results

The mean age was 66.36 years and 75% of the participants had educational level higher than 7 years. The MMSE mean score was 28.45. The correlations found were: educational level and immediate memory (r = 0.49; p = 0.008); delayed recall and immediate memory (r = 0.71; p < 0.001); memory recognition and immediate memory (r = 0.43; p = 0.021) and recognition memory with delayed recall (r = 0.47; p = 0.012).

Conclusion

High scores in the MMSE and a satisfactory health perception among the participants were evident. There was no correlation between memory performance and health perception.

Leisure-Time Physical Activity, Subjective Age, and Self-Rated Memory in Middle-Aged and Older Adults

Memory concerns are common in middle-aged and older adults. This study investigated the relation of leisure-time physical activity to self-rated memory and the possible mediating role of subjective age in this relationship in middle-aged and older adults. Cross-sectional analyses were conducted with a sample of 1,608 middle-aged and older adults from the second wave of the National Survey of Midlife Development in the United States (MIDUS2). In a path analysis conducted with Mplus, a higher level of leisure-time physical activity was associated with a more positive appraisal of memory compared to others of one's age; younger subjective age partially mediated this relationship. Neither gender nor age-group moderated the association. Age, race, education, marital status, health status, and negative affect were controlled for in the analyses. These findings suggest a possible role of physical activity in countering the effects of age stereotypes on perceived memory.

A Link between Subjective Perceptions of Memory and Physical Function: Implications for Subjective Cognitive Decline

Subjective impairment in memory is a frequently defining feature of subjective cognitive decline (SCD), a state hypothesized to precede objectively apparent cognitive symptoms of Alzheimer's disease (AD) and to hold promise as a non-invasive, inexpensive, preclinical indicator of AD. However, a full model of the factors that contribute to subjective memory (SM), and therefore to SCD, has yet to be articulated. While SM impairment is widely known to be associated with negative affect, the extent to which SM functioning may also reflect other factors, particularly subjective beliefs or perceptions about one's health, is not known. To examine the extent to which SM is associated with subjective perceptions of health more broadly, the current study investigated the link between SM and subjective physical functioning (independent of depressive affect, and objective cognitive and physical function) in an ethnically diverse sample of 471 older adults enrolled in the population-based Northern Manhattan Aging Project. 199 (42%) participants endorsed no difficulty on a 5-point SM index while 272 (58%) endorsed some degree of difficulty. As hypothesized, SM correlated with both depression and subjective physical function, but not with age, education, global cognition, or objective physical function. When objective and subjective physical function were entered in two separate, adjusted linear regressions predicting SM, only subjective physical function and depressive affect independently predicted SM. Subjective perceptions of memory appear to reflect individuals' broader health perceptions in part. Articulating the various correlates of SM will improve identification of SCD specific to preclinical AD.

The relationship between social functioning and subjective memory complaints in older persons: a population-based longitudinal cohort study

OBJECTIVE

Poor social functioning is associated with cognitive decline in older adults. It is unclear whether social functioning is also associated with subjective memory complaints (SMC). We investigated the association between social functioning and incident SMC and SMC recovery.

METHODS

A population-based sample of 8762 older adults (aged ≥65 years) with good objective cognitive functioning at baseline (MMSE ≥26) from the LifeLines Cohort Study were followed for 1.5 years. Self-reported SMC were measured at baseline and after 1.5 years follow-up. Aspects of social functioning included marital status, household composition, social network size, social activity, quality of social relationships, social support, affection, behavioral confirmation, and status.

RESULTS

Thirteen percent (513/3963) developed SMC during follow-up (incident SMC). Multivariate logistic regression analyses (adjusted for age, gender, education level, physical activity, alcohol use, smoking status, depression, arrhythmia, myocardial infarction, heart failure, stroke) showed that participants with better feelings of affection, behavioral confirmation and stable good social support had a lower risk of incident SMC. Thirty-four percent (1632/4799) reported recovery. Participants with good social functioning at baseline on all determinants reported more SMC recovery. People who remained stable in a relationship, stable in good quality of social relationships or increased in quality of social relationships more often report SMC recovery.

CONCLUSIONS

Good social functioning is associated with less incident SMC and more SMC recovery over a follow-up period of 1.5 years. Albeit future confirmative studies are needed, we argue for targeting also social functioning when designing multidomain interventions to prevent or slow down cognitive decline. Copyright © 2016 John Wiley & Sons, Ltd.

Control beliefs level and change as predictors of subjective memory complaints

OBJECTIVE

Low control beliefs (CB) are related to objective cognitive functions, but the link between CB and subjective memory complaints (SMC) is unclear. The aim of this study was to investigate the associations between CB (level and change) and SMC over a 10-year span.

METHODS

The study utilized a large national sample of participants (N = 3272, M = 56.52, SD = 11.84) from the Midlife in the US Study (MIDUS) to examine if both level (mean of Time 1 and Time 2) and change (Time 2 minus Time 1) of CB (personal mastery and perceived constraints) longitudinally predict SMC.

RESULT

Both the level of personal mastery and perceived constraints predicted SMC. Long-term changes in perceived constraints, but not in personal mastery, also predicted SMC. No age difference was found for the effects of CB (age × CB) on SMC.

CONCLUSION

The findings support the notion that the risk of SMC is related to low CB, and full consideration of CB level and change is needed for intervention development to combat memory loss.

A Joyful Heart is Good Medicine: Positive Affect Predicts Memory Complaints

OBJECTIVE

Positive affect (PA) systematically improves cognitive performance on a wide range of cognitive tasks, but the link between PA and subjective memory complaints (SMCs) is unclear. The aim of this study was to investigate the associations between PA (level and change) and SMCs over a 10-year span.

METHODS

Current data included participants who completed all measures in the Midlife in the US Study (N = 2,214; age range: 50-84 years; mean: 62.81; standard deviation [SD]: 8.98). The level (mean of Time 1 and Time 2) and change (Time 2 minus Time 1) of PA was examined longitudinally to determine if PA predicts SMCs.

RESULTS

The long-term level and change of PA predicted SMCs. No age and education differences were found for the effects of PA (PA × age and PA × education) on SMCs. Additional comparison analysis found high PA (+1 SD) differs from low PA (-1 SD) on age, financial condition and depression, and physical activity.

CONCLUSION

This study provides longitudinal evidence that further supports PA is associated with a key cognitive aging outcome, SMCs. Effective cognitive-health programs may need to pay more attention to PA intervention.

The Relieving Effects of BrainPower Advanced, a Dietary Supplement, in Older Adults with Subjective Memory Complaints: A Randomized, Double-Blind, Placebo-Controlled Trial

Subjective memory complaints (SMCs) are common in older adults that can often predict further cognitive impairment. No proven effective agents are available for SMCs. The effect of BrainPower Advanced, a dietary supplement consisting of herbal extracts, nutrients, and vitamins, was evaluated in 98 volunteers with SMCs, averaging 67 years of age (47-88), in a randomized, double-blind, placebo-controlled trial. Subjective hypomnesis/memory loss (SML) and attention/concentration deficits (SAD) were evaluated before and after 12-week supplementation of BrainPower Advanced capsules (n = 47) or placebo (n = 51), using a 5-point memory questionnaire (1 = no/slight, 5 = severe). Objective memory function was evaluated using 3 subtests of visual/audio memory, abstraction, and memory recall that gave a combined total score. The BrainPower Advanced group had more cases of severe SML (severity ⩾ 3) (44/47) and severe SAD (43/47) than the placebo group (39/51 and 37/51, < 0.05, < 0.05, resp.) before the treatment. BrainPower Advanced intervention, however, improved a greater proportion of the severe SML (29.5%)(13/44) (P < 0.01) and SAD (34.9%)(15/43)(P < 0.01) than placebo (5.1% (2/39) and 13.5% (5/37), resp.). Thus, 3-month BrainPower Advanced supplementation appears to be beneficial to older adults with SMCs.

Subjective memory complaints in Italian elderly with mild cognitive impairment: implication of psychological status

Subjective cognitive and memory complaints (SMC) are common in later life and are considered an indicator for progression to cognitive decline. The aim of the present study was to identify the relationship among SMC, neuropsychiatric symptoms and psychological aspects in elderly subjects with mild cognitive impairment (MCI) as well as to analyse the effect on SMC of a comprehensive cognitive training. Data from a sample of 94 patients enrolled in ‘My Mind Project’ (Grant No. 154/GR-2009-1584108) were collected. The study evidenced that depression was a significant predictor of SMC and that after the training, the number of subjects with SMC was significantly reduced in the experimental group in comparison to the control one. These results suggest that the participation in cognitive stimulation protocols may improve the perception of SMC in subjects with MCI.

Education modifies the type of subjective memory complaints in older people

OBJECTIVE

The aim of the study is to analyze the relationship between the level of education and the profile of subjective memory complaints (SMC).

METHODS

Participants were healthy volunteers aged >50 years old, from a community-based sample. Educational attainment was self-reported, and participants were subsequently assembled in four groups, according to the highest grade achieved in school. Additionally, they were questioned about their own memory abilities using an SMC scale (total score 0-21) and assessed for the presence of depressive symptoms.

RESULTS

A total of 841 participants aged 50-92 years old were included. The mean total score on the SMC scale was 5.3 ± 3.2, and 80.4% of the subjects reported at least one minor complaint about their memory. There was no correlation between total SMC score and higher educational level, even after accounting for the presence of depressive symptoms. However, regarding specific SMC, the use of notes to avoid forgetting was more frequent in higher levels of education, whereas the opposite trend was observed for complaints of transient confusion.

CONCLUSION

Educational attainment possibly modulates the frequency and type of SMC in normal aging. Because these complaints are a major symptom for the diagnosis of cognitive decline, it seems relevant to consider the level of education when interpreting subjective reports on memory.

Assessment of subjective cognitive impairment among older adults

Subjective cognitive impairment (SCI) refers to an individual's everyday concerns related to cognitive functioning, which can exist even in the absence of objectively assessed impairment. SCI is common among older adults, and although symptoms may be mild, SCI is associated with subsequent cognitive decline as well as significant negative effects on everyday functional ability, mood, and social engagement. Despite the potential consequences, SCI is often underreported and undetected. Thus, it is critical to consider assessing for SCI among older adults to determine cognitive impairment risk and support early intervention to promote functional well-being and health management. The current article reviews factors related to SCI, evaluates existing methods for the assessment of SCI, and proposes a person-centered framework for enhancing assessment. Application of the framework is further illustrated through the use of clinical examples.

Awareness of Memory Ability and Change: (In)Accuracy of Memory Self-Assessments in Relation to Performance

Little is known about subjective assessments of memory abilities and decline among middle-aged adults or their association with objective memory performance in the general population. In this study we examined self-ratings of memory ability and change in relation to episodic memory performance in two national samples of middle-aged and older adults from the Midlife in the United States study (MIDUS II in 2005-06) and the Health and Retirement Study (HRS; every two years from 2002 to 2012). MIDUS (Study 1) participants (N=3,581) rated their memory compared to others their age and to themselves five years ago; HRS (Study 2) participants (N=14,821) rated their current memory and their memory compared to two years ago, with up to six occasions of longitudinal data over ten years. In both studies, episodic memory performance was the total number of words recalled in immediate and delayed conditions. When controlling for demographic and health correlates, self-ratings of memory abilities, but not subjective change, were related to performance. We examined accuracy by comparing subjective and objective memory ability and change. More than one third of the participants across the studies had self-assessments that were inaccurate relative to their actual level of performance and change, and accuracy differed as a function of demographic and health factors. Further understanding of self-awareness of memory abilities and change beginning in midlife may be useful for identifying early warning signs of decline, with implications regarding policies and practice for early detection and treatment of cognitive impairment.