Assessing Self-Rated Memory Impairment in Persons with Posttraumatic Headache

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

Predictors of Memory in Young-old and Old-old Adults

A contextualist approach was adopted to assess cognitive functioning and psychological well-being in a representative sample of young-old (60-74 years, n = 107) and old-old (75-92 years, n = 58) women and men in an effort to: (1) delineate age and gender similarities and differences within this elderly cohort; and (2) identify individual differences predictive of remembering. Measures of subjective well-being included morale, depression, and perceived control. Cognitive measures included intentional story recall and incidental symbol memory, rate of information processing, and cognitive flexibility. Health status, gender, and education were also investigated. Decrements were observed in intentional and incidental memory, rate of information processing, solution of Raven's Coloured Progressive Matrices, and Mini-Mental Status Examination, but not on accuracy of information processing, estimates of intelligence, well-being measures, education, or health status. The intentional story memory of women was more accurate than that of men. Education and gender, along with processing speed and mental ability, as indexed by the Raven coloured matrices, predicted story memory. These results of a representative sample validate recurrent trends seen in previous convenience samples. They extend the understanding of the relationship between ageing and cognition by identifying the role of processing resource, psychosocial, and demographic factors in modulating memory performance and highlighting methodological factors which must temper interpretation of these relationships.

Subjective Cognitive Impairment and Affective Symptoms: A Systematic Review

PURPOSE OF STUDY

Subjective cognitive impairment (SCI) has been argued to reflect affective symptoms (i.e., depression and anxiety) rather than actual cognitive issues. Although a number of studies exist that look at the associations between SCI and affective symptoms, no review is available to aggregate this disparate literature. We addressed this gap by conducting a systematic review to better understand the relationships among SCI and affective symptoms among older adults in both community and clinical settings.

DESIGN AND METHODS

We reviewed available literature per the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Weight of evidence (WoE) ratings and narrative synthesis were completed for 58 articles.

RESULTS

A majority of studies focused on community-based samples (n = 40). Approximately half (53%) of the articles reviewed met high WoE criteria for the current review. Cross-sectional findings consistently identified a positive relationship among SCI and affective symptoms. Findings from available longitudinal studies (n = 9) were mixed but suggested a possible reciprocal relationship among SCI and depression. The relationship between SCI and anxiety appeared to be driven by fears over loss of function. Following consultation with health professionals, the association between SCI and anxiety was diminished or eliminated.

IMPLICATIONS

Although SCI is consistently related to affective symptoms in older adults cross-sectionally, more longitudinal work is needed to understand their temporal relationship. Improved measurement of SCI would support a deeper understanding of the impact of SCI on psychological well-being.

The nature of cognitive complaints in healthy older adults with and without objective memory decline

Cognitive and memory complaints were assessed in 100 healthy older adults on two occasions over 2.5 years as part of a 6-year study assessing cognition, mood, and general health factors. Diminished memory for names and actions and lapses in concentration were common complaints, regardless of the individuals' actual cognitive status. No change in cognitive complaints occurred over time, even for individuals whose memory had declined over 6 years. Cognitive complaints correlated with anxiety, depression, and general mental health but not with objectively measured memory or cognition, education or age. Complaints did not differ with gender, apolipoprotein E epsilon4 genotype, cardiovascular risk factors, or intake of sedating medications. Thus, cognitive complaints could not differentiate memory-declining older adults from cognitively normal older adults and were more closely associated with mood and general mental health than actual cognitive status, age, or potential risk factors for Alzheimer's disease. Thus, the evaluation of cognitive complaints must be broad and must consider the correspondence of complaints not only to relevant measurable cognitive abilities but also to the affect of the individual.

The influence of lifetime depression on self-reported memory and cognitive problems: results from the National Comorbidity Survey-Replication

The current study investigated the association between lifetime major depressive disorder (MDD) and self-reported memory and cognitive problems in a general population sample. The study was based on data from the National Comorbidity Survey-Replication (n = 5692). The relationship between lifetime MDD and self-reported memory and cognitive problems was examined while controlling for other 1-year and lifetime psychiatric disorders. We found a lifetime history of depression, but no other lifetime psychiatric disorder, to be associated with self-reported memory and cognitive problems. We review the results in relation to theories regarding the comorbidity of depression and cognitive problems. A history of depression increases the likelihood that individuals will make negative evaluations of their memory and cognitive functioning. Though depression is highly comorbid with other disorders, our results are unique in demonstrating the specificity of depression in its association with self-reported memory and cognitive problems. The observed association between depression and self-reported memory and cognitive problems may reflect that depression increases the risk for cognitive decline or may reflect that individuals with a history of depression tend to rate their memory as poor, or both.

Linking obsessional beliefs to OCD symptoms in older and younger adults

There are many open questions about the phenomenology of obsessive-compulsive disorder (OCD) in the elderly, and theories about the development of OCD have rarely been applied to older populations. The current study uses structural equation models to evaluate the relationship between obsessional beliefs and OCD symptoms across young and older adult age groups in a large community sample (aged 18-93; N=335), and to examine whether subjective concerns about cognitive decline partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relationships among subjective cognitive concerns, obsessional beliefs and OCD symptoms is invariant for younger and older adults, but older adults report relatively greater levels of subjective cognitive concerns.

The nature of subjective cognitive complaints of older adults

The current study investigated the nature of subjective cognitive complaints of older adults in relation to a broad array of individual cognitive functions known to decline with age. A 60-item questionnaire was developed to examine: (1) whether older adults experience problems with these cognitive functions (problems with cognition); (2) the extent to which these problems have changed over time (changes in cognition); and (3) whether these cognitive decrements interfere with their daily functioning (difficulties with cognition). The cognitive functions examined were attention, processing speed, working memory, executive function, and memory. One hundred eight-two community-dwelling adults (aged 65-92 years) completed the questionnaire. While participants reported problems with, and changes in, each cognitive function, working memory was recorded as most problematic and demonstrated the most change. Yet, although older adults experience problems with cognition and report changes in cognitive functioning over time, these did not necessarily produce difficulties in daily life. This points to the existence of support mechanisms that may assist older adults in cognitively demanding situations.

Aging and negative affect: The rise and fall and rise of anxiety and depression symptoms

The relationship between aging and negative affect is dynamic and complex. Although prior studies have often cited lower prevalence rates of anxiety and mood disorders among older individuals, these studies may miss the dynamic relationship between symptoms and aging. To evaluate a nonlinear model of the relationship between aging and negative affect, the author examined measures of neuroticism, anxiety, and depression symptoms in a cross-sectional, community sample (N = 335), ages 18 to 93. Results indicated a curvilinear relationship, with mean symptom levels increasing during early adulthood (until the mid-30s) and then showing a small decline until older adulthood (the mid-70s), when symptoms again increase with age.

A 10-item Rasch modeled memory self-efficacy scale

A 10-item scale to measure memory self-efficacy was developed from responses to the 33-item Frequency of Forgetting scale of the Memory Functioning Questionnaire (MFQ). Responses to the MFQ from 565 participants in the 1994-1995 wave of the Long Beach Longitudinal Study were analyzed. Rasch scaling procedures were used to select items that discriminated individuals' scoring patterns and that provided non-redundant information about responses. A set of 10 items provided a scale that was reliable across items and persons. Female gender, conscientiousness score, depression score, and list recall predicted individual differences in participants' scores on the scale. Age, education, neuroticism, and text recall were also reliably correlated with scores but were suppressed by the other covariates. The shortened test is predicted by the same covariates as the long version, indicating that it has similar construct validity.

Neuropsychological impairment in fibromyalgia: relation to depression, fatigue, and pain

OBJECTIVE

The present study assessed the relationship of depression, pain, and fatigue to subjective cognitive complaints and objective impairment in patients with fibromyalgia (FM), patients with other chronic pain disorders, and healthy controls.

METHOD

Neuropsychological assessment was conducted on 28 FM patients, 27 chronic pain patients, and 21 healthy controls. Five FM patients and five chronic pain patients were excluded due to poor effort on cognitive tasks. Assessment included measures of depression, pain, fatigue, subjective cognitive complaints, memory, executive functioning, intellect, attention, and psychomotor speed. Analysis of covariance was used to assess group differences in cognitive complaints and cognitive test performance, after controlling for depression, pain, and fatigue. Hierarchical regression was used to assess whether objective test performance was related to subjective cognitive complaints, after controlling for depression, pain, and fatigue.

RESULTS

FM patients had more memory complaints and reported more fatigue, pain, and depression than other groups. Groups were not different in cognitive performance, after controlling for fatigue, pain, and depression; depression was related to memory performance and fatigue was related to psychomotor speed. Neuropsychological test results did not add significantly to the variance accounted for in subjective cognitive complaints, after accounting for depression, pain, and fatigue.

CONCLUSION

Psychological factors, particularly effort, depression, and fatigue, are important in understanding both subjective cognitive complaints and objective cognitive impairment in FM and other chronic pain disorders.

Longitudinal hierarchical linear models of the memory functioning questionnaire

Three hypotheses about the nature of self-rated memory as measured by the Memory Functioning Questionnaire (MFQ; M. J. Gilewski, E. M. Zelinski, & K. W. Schaie, 1990) were tested: that ratings reflect memory performance, that personality traits underlie ratings, and that ratings reflect implicit theories of memory change. Baseline scores and 19 year change slopes for the 4 MFQ factor ratings of a sample of 97 participants aged 30-81 were investigated. There were significant mean declines for all MFQ ratings except Frequency of Forgetting and significant individual differences in slopes for Frequency, Retrospective Functioning, and Mnemonics. Personality predicted baseline Frequency and Seriousness ratings and list and text recall slopes predicted Mnemonics slopes. Different mechanisms may underlie baseline ratings and changes in ratings for different factors.