Why don't older adults with subjective memory complaints seek help?

Subjective memory complaints and medication adherence among hypertensive Korean older adults with multimorbidity: mediating effect of depression and social support

BACKGROUND & AIM(S)

Medication adherence (MA) is a key factor in maintaining adequate blood pressure and preventing complications. However, some older adults experience difficulties in taking medicine properly due to declines in cognitive function. Although subjective memory complaints (SMC) are recognized as early markers of cognitive impairment, previous studies concerning the relationship between MA and cognitive function have focused only on objective cognitive function. Furthermore, while depression has a high correlation with SMC, low MA, and social support, there is limited evidence on their relationship. This study aims to understand the effect of SMC on MA and the mediating effect of depression and social support.

METHOD(S)

This study is a descriptive cross-sectional investigation. A sample of 195 community-dwelling hypertensive older adults with multimorbidity from 3 community senior centers in Gwangju, South Korea were recruited through convenience sampling. Data was collected through face-to-face survey from January to March 2018. The PROCESS macro v4.2 program [Model 6] was used to analyze the mediating effect of depression and social support in the relationship between SMC and MA. Data analysis was performed using SPSS/WIN 26.0 and STATA MP 17.0.

RESULTS

The average MA was 6.74. There were significant differences in MA according to awareness of prescribed drugs, awareness of side effects, insomnia, and healthcare accessibility. SMC was positively correlated with depression, while social support and MA were negatively correlated. While depression was a significant mediator of the effect of SMC on MA, the mediating effect of social support was not significant. The multiple mediation effect of depression and social support was not significant.

CONCLUSION

The results suggest that medication management of older adults in community settings should be accompanied by a comprehensive health assessment of associated factors. Health professionals should explore strategies to improve memory as well as prevent and alleviate depression to increase MA among hypertensive older adults with multimorbidity.

Patient-provider communication about cognition and the role of memory concerns: a descriptive study

BACKGROUND

Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns.

METHODS

We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory concerns. Questionnaires included measures of subjective memory decline (SMD), memory concerns, past healthcare experiences, as well as open-ended questions regarding patient-provider communication about cognition. Content analysis was used to code open-ended responses. Logistic regression was used to examine differences in facilitators and barriers to communication among three groups: no SMD (n = 130), SMD without memory concerns (n = 143), and SMD with memory concerns (n = 136).

RESULTS

Only 16.6% of participants reported discussing cognition with a healthcare provider. Of the remaining 83.4%, approximately two-thirds would be open to such discussions in certain circumstances, most frequently if they had worsening memory problems. Over half of participants reported that their provider had never offered cognitive testing. Compared to the no SMD and SMD without memory concerns groups, participants reporting SMD with memory concerns were more likely to: (1) discuss cognition if their healthcare provider initiated the conversation, and (2) avoid discussions of cognitive problems due to fears of losing independence.

CONCLUSIONS

We found that most participants, including those reporting SMD with memory concerns, had never discussed cognition with their healthcare providers. Patient-reported barriers and facilitators to communication about cognition differed in several areas based on SMD status and the presence or absence of memory concerns. Consideration of these differences can guide future efforts to improve early identification of subtle cognitive changes that would benefit from further monitoring or intervention.

Race and Personal Exposure to AD Influence Projected Memory Failure Attributions and Help-Seeking Behaviors

OBJECTIVES

Examine race and personal exposure to Alzheimer's Disease (AD) on projected memory failure attributions and medical help-seeking thresholds of pre-morbid adults. The goal is to better understand race discrepancies in help-seeking for those potentially at risk for early-onset AD.

METHODS

498 adults aged 40 to 65 (M = 52.27), screened for current memory failure, completed an online questionnaire exploring their help-seeking intentions and threshold, attributions of hypothetical memory failures, and level of AD concern.

RESULTS

Non-Hispanic Whites (n = 248) were significantly more concerned about AD than African Americans (n = 250) (p =.027). Personal exposure to AD moderated the impact of race on memory failure attributions (p =.036), so that personal exposure was more influential for African Americans. Those who were more likely to attribute hypothetical memory failures to AD had lower projected thresholds for seeking a medical evaluation (p =.010). Memory failure attribution emerged as a potential mediator of the impact of race on projected help-seeking behaviors (p =.057).

CONCLUSIONS

African Americans were more influenced by personal experience when considering the causes of hypothetical memory failures.

CLINICAL IMPLICATIONS

Healthcare providers should emphasize to African American families the value of early AD detection and treatment in terms of quality of life for both patient and caregiver.

Chronic Disease Self-Management of Post-Acute Sequelae of COVID-19 Among Older Adults: A Mixed-Methods Analysis

Introduction

Approximately 20-30% of individuals who contract acute coronavirus disease (COVID-19) infection develop longer term complications of their initial infection, referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC). PASC is characterized by chronic, varying symptomatology.

Methods

Using a mixed methods study design, we aimed to gain insight into individuals' experience with PASC, including cognitive issues, fatigue, and sleep disturbances. We explored whether our previously developed application (app), aimed at improving self-management skills among individuals with chronic diseases, is relevant for individuals with PASC and gained information to adapt the app for individuals with PASC. The study included 19 individuals, aged 40 years and older, recruited from our research participant database, Nova Southeastern University clinics, and community locations. We included this age range because older adults are more likely to have comorbid conditions, allowing us to better understand the impact of COVID-19 infection in these individuals. Participants completed seven standardized self-report questionnaires online, and an individual semi-structured interview via videoconferencing. Quantitative data were assessed using descriptive statistics and calculating individuals' scores in relation to norms. Qualitative data were analyzed using a thematic analysis approach. Triangulation of the data was accomplished by calculating correlations between participants' responses on self-report scales and themes found in semi-structured interviews.

Results

Themes included disruption of everyday life, diverse physical symptoms, and cognitive problems including brain fog, fatigue, coping, and emotional upset. Quantitative analysis demonstrated that participants experienced high levels of fatigue, negative mood, cognitive problems, and overall reduction in health-related quality of life (HRQOL). Correlation analyses revealed that individual interview responses were related to participants' self-report of symptoms on standard questionnaires.

Discussion

Findings indicate that self-report questionnaires may reflect the experience of individuals with PASC and its impact. Additionally, further efforts to expand our prior mobile app are warranted among individuals with PASC.

Association between having a family member with dementia and perceptions of dementia preventability

BACKGROUND

One's experience with dementia may affect their perceptions about dementia preventability, which in turn could influence preventive health behaviors. We aimed to examine how having a family history of dementia and caregiving experience are associated with perceptions about and self-efficacy for dementia preventability.

METHODS

Cross-sectional, self-administered survey. Participants reported whether they have had a family member with dementia and, among those who reported having a family member with dementia, whether they served as a caregiver. Outcomes were perceptions about the likelihood of dementia preventability, self-efficacy for dementia prevention, and benefits of specific dementia prevention strategies. Associations were assessed via partial proportional odds model for ordinal outcome variables and logistic regression for binary outcome variables.

RESULTS

Of 1,575 respondents, 71% had a family member with dementia, of which 42% served as a caregiver. People with a family member with dementia were less likely to believe that dementia is preventable (aOR = 0.75, 95% CI: 0.58, 0.96) and had lower self-efficacy for dementia prevention (aOR = 0.71, 95% CI: 0.56, 0.90). The subgroup analysis among those with caregiving experience was consistent with the primary findings, showing less belief in the likelihood of dementia preventability (aOR = 0.69, 95% CI: 0.46, 1.03) and self-efficacy (aOR = 0.75, 95% CI: 0.56, 1.00).

CONCLUSION

Having a family member with dementia is associated with unfavorable perceptions about dementia preventability. Incorporating family history of dementia into communication efforts about dementia risk reduction may help address potential barriers to preventive health behaviors.

The roles of study setting, response bias, and personality in subjective memory complaints of cognitively normal older adults

OBJECTIVES

This study investigated subjective memory complaints in older adults and the roles of setting, response bias, and personality.

DESIGN

Cognitively normal older adults from two settings completed questionnaires measuring memory complaints, response bias, and personality.

SETTINGS

(A) Neuroimaging study with community-based recruitment and (B) academic memory clinic.

PARTICIPANTS

Cognitively normal older adults who (A) volunteer for research (N = 92) or (B) self-referred to a memory clinic (N = 20).

MEASUREMENTS

Neuropsychological evaluation and adjudication of normal cognitive status were done by the neuroimaging study or memory clinic. This study administered self-reports of subjective memory complaints, response bias, five-factor personality, and depressive symptoms. Primary group differences were examined with secondary sensitivity analyses to control for sex, age, and education differences.

RESULTS

There was no significant difference in over-reporting response bias between study settings. Under-reporting response bias was higher in volunteers. Cognitive complaints were associated with response bias for two cognitive complaint measures. Neuroticism was positively associated with over-reporting in evaluation-seekers and negatively associated with under-reporting in volunteers. The relationship was reversed for Extraversion. Under-reporting bias was positively correlated with Agreeableness and Conscientiousness in volunteers.

CONCLUSION

Evaluation-seekers do not show bias toward over-reporting symptoms compared to volunteers. Under-reporting response bias may be important to consider when screening for memory impairment in non-help-seeking settings. The Memory Functioning Questionnaire was less sensitive to reporting biases. Over-reporting may be a facet of higher Neuroticism. Findings help elucidate psychological influences on self-perceived cognitive decline and help seeking in aging and may inform different strategies for assessment by setting.

The Impact of Study Setting on Clinical Characteristics in Older Chinese Adults with Subjective Cognitive Decline: Baseline Investigation of Convenience and Population-Based Samples

Background

Subjective cognitive decline (SCD) is the earliest symptom stage of Alzheimer's disease (AD). Previous studies have shown that the study setting is an important influence factor of SCD. However, the effect of this factor among a Chinese population with SCD is not clear. Here, we aim to compare the clinical characteristics of SCD between a convenience and a population-based sample in China.

Methods

We included a convenience sample of 212 SCD subjects and a population-based sample of 110 SCD subjects. We performed univariate analysis to evaluate the between-group differences in sociodemographic characteristics, neuropsychological performance, psychiatric conditions, different cognitive domains, and the SCD-plus criteria. Multiple linear regression model was established, adjusted for sex, age, and education, and compared the neuropsychological performance between the groups.

Results

The convenience sample had more years of education, a higher family history of dementia, and higher neuropsychological and anxiety depression score than the population-based sample. Using sex, age, education, group as the independent variables, and neuropsychological score as the dependent variable, multiple linear regression model was established; a statistically significant neuropsychological score difference (MoCA-B, AVLT-H-N4, AVLT-H-N5, AVLT-H-N7, AFT, and STT-B) was found between the two samples. In the SCD cognitive domains, the population-based sample had more complaints about declines in their language and planning domains. For SCD-plus criteria in memory domain, the convenience sample had more complaints, worry, and cognitive decline within the last 5 years, along with medical help-seeking.

Conclusion

There were some different characteristics among SCD individuals between convenience samples and population-based samples in China.

Cognitive problems and their clinical assessment in SLE: contrasting patient and provider views

OBJECTIVE

Systemic lupus erythematosus (SLE) is a complex chronic disease associated with reduced cognitive functioning. Patients with SLE report cognitive symptoms, but cognitive assessment is not routine and little is known about day-to-day cognitive problems and their effect on disease management. As part of a pilot exploring the use of a cognitive functioning report prototype for shared decision making in clinical encounters (Approaches to Positive Patient-Centered Experiences of Aging in Lupus study-APPEAL), we investigated the relevance of cognitive assessments performed using the NIH Toolbox among patients with SLE.

METHODS

We conducted four focus groups, two with SLE patients (n=18) and two with lupus providers (physicians and nurses; n=9) addressing cognitive issues and interest in communicating about cognition. We compared how NIH Toolbox cognitive domains (episodic memory; working memory; processing speed; attention and inhibitory control; cognitive flexibility) matched with patient- and provider-identified cognitive problems and needs.

RESULTS

Patients identified all NIH domains with rich experiential examples; providers identified fewer domains and offered less detail. An unanticipated additional domain was prospective memory, i.e., problems in remembering future actions. Use of technological aids (e.g., smart phone alerts) was mentioned by some patients, but not providers, and represent a potential opportunity for medical care. All participants expressed interest in discussing cognition in clinic.

CONCLUSION

Cognitive assessment using the NIH Cognitive Toolbox is relevant to this population, with the possible addition of a prospective memory assessment. Cognitive problems and indications of communication gaps suggest the appropriateness of more clinical communication about cognition in this population.

Incorporating a Usual Care Comparator into a Study of Meditation and Music Listening for Older Adults with Subjective Cognitive Decline: A Randomized Feasibility Trial

BACKGROUND

Recent studies suggest meditation and music listening (ML) may improve cognitive and psychosocial outcomes in adults with subjective cognitive decline (SCD). However, lack of a usual care group has limited conclusions.

OBJECTIVE

To assess the: 1) feasibility of incorporating an enhanced usual care (EUC) comparator in a trial of Kirtan Kriya meditation (KK) and ML for adults experiencing SCD; and 2) preliminary effects of active treatment (KK/ML) versus an EUC program.

METHODS

Forty participants with SCD were randomized 1:1:2 to a 12-week KK, ML, or EUC program. KK and ML participants were asked to practice 12 minutes/day; EUC participants were given a comprehensive educational packet regarding healthy aging and strategies for improving/maintaining brain health and asked to record any activities or strategies used. Feasibility was assessed using measures of retention, adherence, treatment expectancies, and participant satisfaction, as well as information from exit questionnaires and daily practice/activity logs. Cognitive functioning, stress, mood, sleep-quality, and health-related quality of life (QOL) were measured pre- and post-intervention using well-validated instruments.

RESULTS

Thirty-two participants (80%) completed the 3-month study, with retention highest in the EUC group (p < 0.05). Active treatment participants averaged 6.0±0.4 practice sessions/week, and EUC participants, 7.5±0.6 brain health activities/week. Treatment expectancies were similar across groups. EUC participants indicated high satisfaction with the program and study. Despite limited study power, the active treatment group showed significantly greater gains in subjective memory functioning (ps≤0.025) and nonsignificant improvements in cognitive performance (TMT-B), perceived stress, QOL, and mood (ps≤0.08) compared to the EUC group.

CONCLUSION

Findings of this pilot feasibility trial suggest incorporation of an EUC program is feasible, and that participation in a simple 12-week relaxation program may be helpful for adults with SCD versus engagement in an EUC program.

Discordance Between Subjective and Objective Cognitive Function in Older Korean Americans

Objectives: To examine predictors of membership in discordant groups identified by subjective and objective measures of cognitive function. Methods: Participants in the Study of Older Korean Americans (N = 2046) were classified according to their subjective cognitive ratings (excellent/very good/good vs. fair/poor) and Mini-Mental State Examination scores (normal cognition vs. cognitive impairment), yielding two discordant groups: (1) positive ratings but cognitive impairment and (2) negative ratings but normal cognition. Logistic regression models examined how the discordant group membership was associated with personal resources. Results: Among those with positive cognitive ratings, the odds of belonging to the discordant group were associated with low personal resources (advanced age and lower levels of education, acculturation, and knowledge about Alzheimer's disease). However, an opposite pattern was observed among those with negative ratings. Discussion: The pattern of discordance suggests ways to promote early detection of cognitive impairment and close the gap in cognitive health care.

The Interpersonal Context of Memory Complaints

This mixed-methods study was designed to investigate the interpersonal experience of having memory problems using a community-dwelling sample of 94 adults over the age of 50 (M age = 72.35, SD = 10.51). Participants were asked a series of open-ended questions about their reactions to memory problems and completed questionnaires about memory, personality, and health. Qualitative findings suggest a few clear patterns of response (e.g., admitting the problem, ignoring the problem) to memory failures. In addition, endorsing avoidance of talking to certain people was related to worry and memory anxiety. Correlations showed subjective memory related to conscientiousness, neuroticism, depression, and worry which replicates previous studies about memory complaints. This study adds to the subjective memory literature by enhancing what we know about what people do when they are confronted with a memory challenge as well as to whom they will or will not speak about their complaints.

Barriers to help-seeking for memory problems in older adults

Aim

The aim of this study was to investigate potential barriers to help-seeking for memory problems as well as outreach to providers.

Findings

Participants who endorsed having hearing problems were the most likely to endorse barriers to help-seeking as well as speaking to a physician.

Message

Physicians and healthcare agencies can work to design outreach for persons who experience barriers, particularly hearing loss.

Purpose

Early detection of age- and disease-related cognitive problems affords patients the opportunities to receive medical treatment, engage in research, and plan for the future. Understanding help-seeking behavior has potential to aid both patients and clinicians. This study was designed to identify predictors of endorsed barriers to memory-related help-seeking as well as medical help-seeking endorsement.

Methods

This cross-sectional correlational study used a convenience sample of 97 older adults. The participants answered anonymous questionnaires about subjective memory, mood, and health and several items designed to investigate help-seeking for memory issues.

Results

Persons who endorsed multiple barriers to help-seeking were more likely to also endorse having hearing problems. In addition, participants who reported that they would not talk to a doctor or physician about memory concerns also had significantly worse subjective hearing.

Conclusion

Hearing loss may be a particular risk for not seeking help for memory problems. Physicians and healthcare agencies can work to design outreach for persons who experience barriers, such as hearing loss and the concomitant outcomes.

"I was Confused About How to Take Care of Mom Because this Disease is Different Everyday": Vietnamese American Caregivers' Understanding of Alzheimer's Disease

Family members provide the majority of caregiving to individuals living with Alzheimer's disease (AD) and related dementias. Asian American families are disproportionately impacted by the burden of caregiving due to limited knowledge about the disease in this community. This study explored how Vietnamese American caregivers understand AD and provide care to family members with AD. Twenty caregivers who have provided care to a family member with AD participated in a semi-structured qualitative interview. Data were analyzed using thematic analysis. Several themes were identified in the caregivers' understanding of AD: (a) "Now I know:" the disruptions, shocks and surprises leading up to the initial diagnosis; (b) The frustrations of managing family members' cognitive impairments; (c)"Going with the flow:" challenges in managing personality and behavioral changes; (d) The exhaustion of around-the-clock caregiving; (e)"Taking it day by day" in the face of progressively worsening symptoms. Underlining the participants' descriptions of AD was a shared understanding of the progressively worsening, complex and unpredictable nature of the disease that makes it challenging for family caregivers on a daily basis. Findings provide important implications for healthcare workers' outreach to Vietnamese American families to ease the caregiving experience through culturally-responsive education, thereby enhancing the families' ability to recognize the early symptoms and seek appropriate help.

Subjective Cognitive Impairment in 55-65-Year-Old Adults Is Associated with Negative Affective Symptoms, Neuroticism, and Poor Quality of Life

Although subjective cognitive impairment (SCI) is increasingly recognized clinically and in research as a risk factor for mild cognitive impairment and dementia (particularly Alzheimer’s disease), it is etiologically heterogeneous and potentially treatable. Compared to mild cognitive impairment and Alzheimer’s disease, SCI however remains poorly characterized with debate continuing regarding its clinical relevance. The primary aim of this study was to improve the characterization of SCI within the general public by investigating functions sometimes omitted clinically or in research, namely visual attention-related information processing speed (RT) and its intra-individual variability (IIV_RT), general cognition, depression, anxiety, memory, quality of life (QOL), and neuroticism. Compared to individuals without SCI, those with SCI were more likely to reveal higher scores of anxiety, depression, and neuroticism and poorer perceived physical, psychological, and environmental QOL. Within-group analysis identified no significant relationships between any of the above variables for the non-SCI group whereas for the SCI group, poorer Cognitive Change Index scores were significantly correlated with slower RT, raised IIV_RT, poorer memory, negative affective symptoms, higher neuroticism scores, and poorer QOL. This indicates that reports of perceived memory changes in SCI can also be associated with other characteristics, namely objectively measured detrimental change in other aspects of brain function and behavior. This outcome emphasizes the importance of a multi-function approach to characterizing and understanding SCI. Thus, although the effect of RT and IIV_RT is not strong enough to differentiate SCI from non-SCI at group level, slowing and raised IIV_RT do appear to characterize some people with SCI.

Medical Help-Seekers with Anxiety from Deterioration in Memory are Characterized with Risk Factors for Cognitive Decline

Objectives: Anxiety and subjective memory complaints (SMC) are major risk factors for Mild Cognitive Impairment (MCI) and dementia. However, the association between anxiety, SMC and medical help-seeking due to complaints is not clear. Here, we assessed anxiety which rose specifically by memory examination and compared it between help-seekers in memory clinics (HS) and non-help seekers (NHS).Methods: Twenty HS (60% female) were recruited from a memory Clinic, and 55 NHS (63% female) were recruited from the community. Participants (aged 59-82) completed objective memory assessment, Subjective Memory questionnaire, depression questionnaire and State-Trait Anxiety questionnaire. State-anxiety was assessed immediately following memory testing (indicating anxiety triggered by testing memory). For statistical evaluation, we used non-parametric tests.Results: HS participants reported significantly higher levels of state-anxiety and had more SMC compared to the NHS. No differences in objective memory tests and trait-anxiety were found.Conclusions: People who are seeking help in memory clinics (even those who do not meet any criteria for memory decline) are liable to be at high risk for MCI and dementia.Clinical Implications: We recommend that HS with SMC should be treated as a high-risk group, even if they do not show objective memory deficits.

Predicting current and future anxiety symptoms in cognitively intact older adults with memory complaints

OBJECTIVES

Memory complaints are a common concern for older adults and may co-occur with anxiety symptoms. Although both memory complaints and anxiety are associated with heightened cognitive decline risk, little is known about how these symptoms develop over time. The purpose of this study was to examine the differential concurrent and longitudinal relationships among anxiety symptoms and two types of memory complaints in cognitively intact older adults.

METHODS/DESIGN

The current study sample was drawn from two longitudinal, nationally representative datasets, the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Cognitively intact older adults aged 65 and over were included, representing six (n = 5069; NHATS) and two (n = 5284; HRS) waves of data, respectively. Using multilevel linear modeling, we tested bidirectional relationships between anxiety and two types of memory complaints: current rating of memory performance and perceived memory decline.

RESULTS

Concurrent associations between anxiety symptoms and memory complaints were found in both datasets: At times when current memory performance was rated more poorly or perceived memory decline was reported, anxiety symptoms tended to be higher, and vice versa. A longitudinal relationship was identified in NHATS such that perceived memory decline, and not current memory rating, predicted future anxiety symptoms.

CONCLUSION

This study provides a better understanding of the relationships between memory complaints and anxiety symptoms over time. Cognitively intact older adults with perceived memory decline are at greater risk for current as well as future anxiety symptoms.

Cross-sectional and longitudinal characterization of SCD patients recruited from the community versus from a memory clinic: subjective cognitive decline, psychoaffective factors, cognitive performances, and atrophy progression over time

Background

Subjective cognitive decline (SCD) defines a heterogeneous population, part of which having Alzheimer’s disease (AD). We aimed at characterizing SCD populations according to whether or not they referred to a memory clinic, by assessing the factors associated with increased AD risk.

Methods

Seventy-eight cognitively unimpaired older adults from the IMAP+ study (Caen) were included, amongst which 28 healthy controls (HC) and 50 SCD recruited from the community (SCD-community; n = 23) or from a memory clinic (SCD-clinic; n = 27). Participants underwent cognitive, psychoaffective, structural MRI, FDG-PET, and amyloid-PET assessments. They were followed up over a mean period of 2.4 ± 0.8 years. The groups were compared in terms of baseline and follow-up levels of SCD (self- and informant-reported), cognition, subclinical anxiety and depression, and atrophy progression over time. We also investigated SCD substrates within each SCD group through the correlations between self-reported SCD and other psychometric and brain measures.

Results

Compared to HC, both SCD groups showed similar cognitive performances but higher informant-reported SCD and anxiety. Compared to SCD-community, SCD-clinic showed higher informant-reported SCD, depression score, and atrophy progression over time but similar brain amyloid load. A significant increase over time was found for depression in the SCD-community and for self-reported praxis-domestic activities SCD factor in the SCD-clinic. Higher self-reported SCD correlated with (i) lower grey matter volume and higher anxiety in SCD-community, (ii) greater informant-reported SCD in SCD-clinic, and (iii) lower glucose metabolism in both SCD groups.

Conclusions

Higher subclinical depression and informant-reported SCD specifically characterize the SCD group that refers to a memory clinic. The same group appears as a frailer population than SCD-community as they show greater atrophy progression over time. Yet, both the SCD groups were quite similar otherwise including for brain amyloid load and the SCD-community showed increased depression score over time. Altogether, our findings highlight the relevance of assessing psychoaffective factors and informant-reported SCD in SCD populations and point to both differences and similarities in SCD populations referring or not to a memory clinic.

Electronic supplementary material

The online version of this article (10.1186/s13195-019-0514-z) contains supplementary material, which is available to authorized users.

Illness representations of dementia: a scoping review

As the number of persons with dementia grows, an increasing number of families, professionals, and laypersons will come into contact with persons with cognitive deterioration. Assessing dementia illness representations (IRs) among these groups may have great importance for understanding their responses to dementia. The purpose of this study was to summarize and critically review the literature on dementia IRs. A total of 25 articles that satisfied the inclusion criteria were identified. The review revealed that conceptually, research attention on dementia IRs has increased over the past several years as a result of changes in the notion of IRs and in the dementia discourse. Regardless of the population examined, dementia was mostly described as a chronic condition, presenting more cognitive than behavioral symptoms, and as being caused mainly by age, heredity, and abnormal brain changes. Methodologically, the area of dementia IRs is characterized by design, sample, and data collection weaknesses. Findings suggest that although the literature in the area of dementia and IRs is increasing, several conceptual and methodological limitations still have to be resolved in order to advance knowledge in the area. The research and clinical implications of these findings stress the importance of IRs in the area of dementia.

Older Adults' Attitudes towards Cognitive Testing: Moving towards Person-Centeredness

Background

Research on person-centered cognitive testing is beginning to emerge. The current study is the first to focus on eliciting concrete preferences around the test experience.

Methods

Adults ≥50 years old completed the Attitudes Around Cognitive Testing (AACT) questionnaire on mturk.com. AACT elicits preferences for cognitive tests, the importance attributed to having choices, and willingness to engage in testing.

Results

Data are reported for 289 respondents. The proportion of participants expressing preferences varied by domain (modality [49.5%], location [47.2%], company [80.1%], result delivery [78.3-89.7%]). Importance ratings for all domains had a median of 4 and a range of 1-5 using a Likert scale of agreement. Most participants (85.5%) were willing to engage in testing.

Conclusion

Older adults have preferences for cognitive tests, especially with delivery of results.

Severity of Depressive Symptoms and Volume of Superior Temporal Gyrus in People Who Visit a Memory Clinic Unaccompanied

Background/Aims

Depression and cognitive decline are reported to be interrelated. Depression of older adults with memory complaints who seek medical help have not been well documented. This study was carried out to test the hypothesis that a relatively high level of depressive symptoms associated with brain structure is characteristic of people who visited a memory clinic unaccompanied (UA).

Method

We retrospectively compared Center for Epidemiologic Studies Depression Scale (CES-D, for evaluation of depressive symptoms) scores of UA subjects (n = 21) with those of people who were accompanied (n = 75). Within each groups, we further examined the association between brain morphology and the CES-D scores using FreeSurfer software.

Results

We found that the relatively high CES-D scores of UA subjects were inversely associated with the normalized volumes of bilateral superior temporal gyrus (STG).

Conclusion

Our results suggest that depressive symptoms of UA subjects demonstrated by the relatively high levels of CES-D scores were primary, because of the inverse association with the normalized volume of bilateral STG. Thus, focusing on the depressive symptoms may be a suitable approach to satisfy potential medical needs of UA subjects with or without memory impairment.

How people with dementia and carers understand and react to social functioning changes in mild dementia: a UK-based qualitative study

OBJECTIVES

To analyse people with dementia and their family carers' attribution of social changes in dementia and the consequences of these attributions.

DESIGN

Qualitative study, using a semi-structured interview guide. Individual interviews continued to theoretical saturation. Two researchers independently analysed interview transcripts.

SETTING AND PARTICIPANTS

People with mild dementia and family carers purposively selected from London-based memory services for diverse demographic characteristics to encompass a range of experiences.

PRIMARY AND SECONDARY OUTCOMES

Attribution of social changes experienced by the person with dementia and the consequences of these attributions.

RESULTS

We interviewed nine people with dementia and nine carers, encompassing a range of age, ethnicity and educational backgrounds.Both groups reported that the person with dementia had changed socially. People with dementia tended to give one or two explanations for social change, but carers usually suggested several. People with dementia were often socially embarrassed or less interested in going out, and they or their relatives' physical illness or fear of falls led to reduced social activity. Carers often attributed not going out to a choice or premorbid personality. Carers found that their relative needed more support to go out than they could give and carers needed time to themselves because of carer stress or other problems from which they shielded the person with dementia. Additionally, there was decreased opportunity to socialise, as people were bereaved of friends and family. Participants acknowledged the direct impact of dementia symptoms on their ability to socially engage but sometimes decided to give up socialising when they knew they had dementia. There were negative consequences from social changes being attributed to factors such as choice, rather than dementia.

CONCLUSION

Clinicians should ask about social changes in people with dementia. Explaining that these may be due to dementia and considering strategies to overcome them may be beneficial.

Subjective memory impairment in general practice : Short overview and design of a mixed methods study

BACKGROUND

Public awareness for dementia is rising and patients with concerns about forgetfulness are not uncommon in general practice. For the general practitioner (GP) subjectively perceived memory impairment (SMI) also offers a chance to broach the issue of cognitive function with the patient. This may support GPs' patient-centered care in terms of a broader frailty concept.

OBJECTIVE

What is SMI (definition, operationalization, prevalence and burden)? Which conceptions and approaches do GPs have regarding SMI?

METHODS

Narrative overview of recent SMI criteria and results, selective utilization of results from a systematic literature search on GP dementia care, non-systematic search regarding SMI in general practice, deduction of a study design from the overview and development according to international standards.

RESULTS

Studies revealed that approximately 60% of GP patients aged >74 reported a declining memory, every sixth person had concerns about this aspect and only relatively few seek medical advice. Concerns about SMI are considered a risk factor for future dementia. Specific general practice conceptions about SMI could not be identified in the literature. Using guidelines for mixed methods research, the design of an exploratory sequential mixed methods study is presented, which should reveal different attitudes of GPs towards SMI.

CONCLUSION

Subjective memory impairment (SMI) is a common feature and troubles a considerable proportion of patients. Neuropsychiatric research is progressing, but for the transfer of the SMI concept into routine practice, involvement of GP research is necessary. A new study aims to make a contribution to this.

Concern about developing Alzheimer's disease or dementia and intention to be screened: An analysis of national survey data

OBJECTIVE

Early diagnosis of Alzheimer's disease (AD) or dementia is important so that patients can express treatment preferences, subsequently allowing caregivers to make decisions consistent with their wishes. This study explored the relationship between people's concern about developing AD/dementia, likelihood to be screened/tested, if experiencing changes in cognitive status or functioning, and concerns about sharing the diagnostic information with others.

METHOD

A descriptive study was conducted using Porter Novelli's SummerStyles 2013 online survey data. Of the 6105 panelists aged 18+ who received the survey, 4033 adults responded (response rate: 66%). Chi squares were used with case-level weighting applied.

RESULTS

Almost 13% of respondents reported being very worried or worried about getting AD/dementia, with women more worried than men (p<.001), and AD/dementia caregivers more worried than other types of caregivers (p=.04). Women were also more likely than men to agree to be screened/tested if experiencing changes in memory and/or thinking (p<.001). The greater the worry, the more likely respondents would agree to be screened/tested (p<.001). Nearly 66% of respondents were concerned that sharing a diagnosis would change the way others think/feel about them, with women reporting greater concern than men (p=.003).

CONCLUSION

Findings demonstrate that level of worry about AD/dementia is associated with the reported likelihood that individuals agree to be screened/tested. This information will be useful in developing communication strategies to address public concern about AD/dementia that may increase the likelihood of screening and early detection.

Subjective cognitive decline in cognitively normal elders from the community or from a memory clinic: Differential affective and imaging correlates

INTRODUCTION

Subjective cognitive decline (SCD) could indicate preclinical Alzheimer's disease, but the existing literature is confounded by heterogeneous approaches to studying SCD. We assessed the differential cognitive, affective, and neuroimaging correlates of two aspects of SCD: reporting high cognitive difficulties on a self-rated questionnaire versus consulting at a memory clinic.

METHODS

We compared 28 patients from a memory clinic with isolated SCD, 35 community-recruited elders with similarly high levels of self-reported cognitive difficulties, and 35 community-recruited controls with low self-reported cognitive difficulties.

RESULTS

Increased anxiety and amyloid β deposition were observed in both groups with high self-reported difficulties, whereas subclinical depression and (hippocampal) atrophy were specifically associated with medical help seeking. Cognitive tests showed no group differences.

DISCUSSION

These results further validate the concept of SCD in both community- and clinic-based groups. Yet, recruitment methods influence associated biomarkers and affective symptomatology, highlighting the heterogeneous nature of SCD depending on study characteristics.

Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial

BACKGROUND

Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer's disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention.

OBJECTIVE

In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD.

METHODS

Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments.

RESULTS

Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p's≤0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p's≤0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies.

CONCLUSIONS

Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group.

Routine Check-Ups and Other Factors Affecting Discussions With a Health Care Provider About Subjective Memory Complaints, Behavioral Risk Factor Surveillance System, 21 States, 2011

INTRODUCTION

Most adults reporting subjective memory complaints (SMCs) do not discuss them with a health care provider and miss an opportunity to learn about treatment options or receive a diagnosis. The objective of this study was to describe correlates of discussing memory problems with a health care professional among adults reporting SMCs.

METHODS

Data were from 10,276 respondents aged 45 years or older in 21 states reporting SMCs on the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Odds ratios (ORs) adjusted for demographic and health-related measures were computed for discussing SMCs with a health care professional.

RESULTS

Among all respondents aged 45 or older reporting SMCs, 22.9% reported discussing them with a health care professional; among those reporting a recent routine check-up, this rate was 25.2%. The largest adjusted OR for discussing SMCs with a health care professional was for respondents reporting that SMCs always (vs never) caused them to give up household chores (OR, 3.02) or always (vs never) interfered with work (OR, 2.98). Increasing age reduced the likelihood of discussing SMCs. Among respondents who discussed SMCs, 41.8% received treatment.

CONCLUSION

Routine check-ups may be a missed opportunity for discussions of SMCs that might lead to diagnosis or treatment. The Affordable Care Act requires a cognitive assessment for Medicare recipients during their annual wellness visit, but these results suggest that adults younger than 65 might also benefit from such an assessment.

Subjective memory impairment and well-being in community-dwelling older adults

BACKGROUND

The relationship between subjective memory impairment (SMI), future cognitive decline, and negative health status provides an opportunity for interventions to reduce memory complaints in high-risk groups. This study aimed to examine the relationship between SMI and indicators of well-being in older adults enrolled in an exercise trial. Additionally, the study examined whether two different modes of exercise training, aerobic walking and non-aerobic flexibility, toning, and balance, differentially influenced subjective memory across the trial.

METHODS

Community-dwelling older adults (n = 179, mean age = 66.4 years) were randomly assigned to a walking or flexibility, toning, and balance group for 12 months. Subjective memory, happiness, perceived stress, and symptom reporting were measured at baseline, 6 months, and 12 months.

RESULTS

A main effect of subjective memory indicated that individuals with the fewest memory complaints had lower perceived stress (P < 0.001), lower physical symptom reporting (P < 0.001), and higher happiness levels (P < 0.001) across all measurement occasions. Both main and interaction effects of time and group on SMI were not significant, suggesting SMI remained stable across the intervention and was not significantly impacted by participation in exercise training.

CONCLUSIONS

SMI was not responsive to exercise interventions, and the relationship between SMI and negative well-being demonstrates a need for interventions to reduce memory complaints in high-risk groups.

Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies

Research increasingly suggests that subjective cognitive decline (SCD) in older adults, in the absence of objective cognitive dysfunction or depression, may be a harbinger of non-normative cognitive decline and eventual progression to dementia. Little is known, however, about the key features of self-report measures currently used to assess SCD. The Subjective Cognitive Decline Initiative (SCD-I) Working Group is an international consortium established to develop a conceptual framework and research criteria for SCD (Jessen et al., 2014, Alzheimers Dement 10, 844-852). In the current study we systematically compared cognitive self-report items used by 19 SCD-I Working Group studies, representing 8 countries and 5 languages. We identified 34 self-report measures comprising 640 cognitive self-report items. There was little overlap among measures- approximately 75% of measures were used by only one study. Wide variation existed in response options and item content. Items pertaining to the memory domain predominated, accounting for about 60% of items surveyed, followed by executive function and attention, with 16% and 11% of the items, respectively. Items relating to memory for the names of people and the placement of common objects were represented on the greatest percentage of measures (56% each). Working group members reported that instrument selection decisions were often based on practical considerations beyond the study of SCD specifically, such as availability and brevity of measures. Results document the heterogeneity of approaches across studies to the emerging construct of SCD. We offer preliminary recommendations for instrument selection and future research directions including identifying items and measure formats associated with important clinical outcomes.

Amyloid-β Imaging in Older Adults Presenting to a Memory Clinic with Subjective Cognitive Decline: A Pilot Study

BACKGROUND

Subjective cognitive decline (SCD) in otherwise normal aging may be identified via symptom inventories in a research setting ('questionnaire-discovered complaints') or via patients seeking evaluation/services in a clinical setting ('presenting complainers'). Most studies of SCD and amyloid-β (Aβ) imaging to date have used the former approach, with inconsistent results.

OBJECTIVE

To test whether 'presenting SCD' participants in an academic memory clinic setting show increased brain Aβ deposition on imaging.

METHODS

Fourteen patients (mean age 68.1, SD 4.0 years) diagnosed with subjective cognitive complaints with normal neuropsychological testing were recruited into a Pittsburgh compound B (PiB)-PET study. Detailed self-report inventories and additional cognitive tests were administered. Results were compared to a reference cohort of cognitively normal volunteers (NC) from an independent neuroimaging study (mean age 73.6, SD 5.8 years).

RESULTS

57% (8/14) of SCD participants were PiB-positive by a sensitive, regionally-based definition, compared to 31% (26/84) of the NC cohort. SCD participants had significantly higher PiB retention (SUVR) than NC in three of six regions of interest: frontal cortex (p = 0.02), lateral temporal cortex (p = 0.02), and parietal cortex (p = 0.04). SCD participants showed measurable deviations on questionnaires reflecting high negative affect (i.e., depressive symptoms and neuroticism). Findings were suggestive that deficits on verbal associative binding may be specific to Aβ-positive versus Aβ-negative SCD.

CONCLUSION

Older participants with SCD presenting to a memory clinic in this pilot study sample have higher brain Aβ deposition compared to normal aging study volunteers unselected on complaints. Further study of presenting SCD are warranted to determine the prognostic significance of Aβ deposition in this context.

Prevalence of Dementia and Cognitive Complaints in the Context of High Cognitive Reserve: A Population-Based Study

OBJECTIVES

This study aimed to assess the prevalence of dementia and cognitive complaints in a cross-sectional sample of Luxembourg seniors, and to discuss the results in the societal context of high cognitive reserve resulting from multilingualism.

METHODS

A population sample of 1,377 people representative of Luxembourg residents aged over 64 years was initially identified via the national social insurance register. There were three different levels of contribution: full participation in the study, partial participation, and non-participation. We examined the profiles of these three different samples so that we could infer the prevalence estimates in the Luxembourgish senior population as a whole using the prevalence estimates obtained in this study.

RESULTS

After careful attention to the potential bias and of the possibility of underestimation, we considered the obtained prevalence estimates of 3.8% for dementia (with corresponding 95% confidence limits (CL) of 2.8% and 4.8%) and 26.1% for cognitive complaints (CL = [17.8-34.3]) as trustworthy.

CONCLUSION

Based on these findings, we postulate that high cognitive reserve may result in surprisingly low prevalence estimates of cognitive complaints and dementia in adults over the age of 64 years, which thereby corroborates the longer disability-free life expectancy observed in the Luxembourg population. To the best of our knowledge, this study is the first to report such Luxembourgish public health data.

Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public

Background

Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer’s disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management.

Objectives

To compare help-seeking preferences of family physicians and the lay public in the area of MCI.

Methods

A structured questionnaire was used to collect data from 197 family physicians (self-administered) and 517 persons aged 45 and over from the lay public (face to face). Information regarding familiarity with MCI and help-seeking preferences was assessed.

Results

The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help.

Discussion

There were both similarities and differences between family physicians and the lay public in their preferences regarding help-seeking for a person with MCI. Most prominent is the physicians’ greater tendency to recommend professional sources of help-seeking.

Conclusion

Understanding of help-seeking preferences of both physicians and lay persons might help overcome barriers for establishing diagnosis, receiving care, and improving communication between doctors and patients.

Subjective memory complaints in the elderly: a sign of cognitive impairment?

OBJECTIVES

Cognitive impairment in the elderly is frequently overlooked by general practitioners. The use of subjective memory complaints as a sign of cognitive impairment by the general practice is controversial.

METHODS

Elderly individuals (N = 248) were asked whether they had memory complaints and underwent a cognitive impairment screening. Subjects classified as exhibiting "probable cognitive impairment" underwent a complete cognitive evaluation, and the final diagnoses were established by expert consensus.

RESULTS

A total of 147 patients presented with subjective memory complaints, and 43 were further classified as demented or "cognitively impaired not demented". Subjective memory complaints presented a sensitivity of 100% and a negative predictive value of 100%.

CONCLUSION

Subjective memory complaints are an indicator for cognitive impairment screening.

Causes, coping, and culture: a comparative survey study on representation of back pain in three Swiss language regions

Introduction

This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations–back pain–and a third concept is added to the picture: culture.

Aim

The aim of this study is (a) to explore the causal factors to which persons with back pain attribute the further course of their illness, (b) to find out whether the attributed causes are predictors of coping maxims, and (c) to find out whether cultural factors affect attributions and coping and moderate the relationship between the two.

Methods

A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking).

Results

Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases.

Implications

The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers’ communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations.

Improving access to dementia services for people from minority ethnic groups

PURPOSE OF REVIEW

Only a minority of people with dementia receive a formal diagnosis despite a growing body of evidence highlighting the benefits of early diagnosis and intervention. People from minority ethnic groups are even more disadvantaged, as they tend to access dementia services later in the illness. Studies exploring the reasons behind underuse of dementia services by minority ethnic groups have highlighted the barriers to help-seeking that seem specific to the cultural groups studied. Understanding the barriers to help-seeking should help to identify the targets for interventions to encourage help-seeking in minority ethnic communities. This review sought to highlight the progress in this field and show what interventions have been developed so far.

RECENT FINDINGS

Many countries are carrying out educational campaigns in an effort to increase awareness about dementia and reduce stigma, but none of these have reported any measurable outcomes of their interventions. Studies show that knowledge about dementia has the potential to increase help-seeking, but information should be targeted to the recipient audience.

SUMMARY

Not enough has been done to address the inequality in service use for dementia in minority ethnic groups compared with the majority population. The time has come for the development of targeted and evidence-based interventions in order to improve access and affect outcomes.

The Lay Public's Understanding and Perception of Dementia in a Developed Asian Nation

Background

Early detection of dementia aims to improve treatment outcomes. However, poor perception and understanding of dementia are significant barriers. We aim to investigate the public's perception of dementia and identify variables associated with the different profiles of public perception.

Methods

A custom-designed questionnaire was used to assess laypersons’ knowledge and perception of dementia during a health fair at a public hospital in Singapore, a developed Asian nation. Out of a sample of 370 subjects, 32 declined to participate (response rate = 91.4%). Latent class analysis (LCA) was used to identify meaningful subgroups of subjects from significant associations with multiple indicators of dementia awareness. Multinomial logistic regression was performed exploring variables associated with each of the subgroups derived from LCA.

Results

The majority of the study participants were female (66.9%), 65 years or older (71.1%), and ethnic Chinese (88.1%). LCA classified the study participants into 3 subgroups: Class 1 (good knowledge, good attitude), Class 2 (good knowledge, poor attitude), and Class 3 (poor knowledge, poor attitude), in proportions of 14.28, 63.83, and 21.88%, respectively. Compared to other classes, participants with good knowledge and good attitude towards dementia (Class 1) were more likely to know someone with dementia and understand the effects of the disease, be married, live in private housing, receive higher monthly income, and not profess belief in Buddhism, Taoism, or Hinduism.

Conclusion

Our results show that the public in Singapore may not be ready for screening initiatives and early dementia diagnosis. Education efforts should be targeted at lower socioeconomic groups, singles, and those of certain oriental religions.

Memory complaints associated with seeking clinical care

Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as compared to the memory difficulties reported by subjects in the community. Assessment of subjective memory complaints was done with the subjective memory complaints scale (SMC). The mini-mental state examination was used for general cognitive evaluation and the geriatric depression scale for the assessment of depressive symptoms. Eight-hundred and seventy-one nondemented subjects older than 50 years were included. Participants in the clinical setting had a higher total SMC score (10.3 ± 4.2) than those in the community (5.1 ± 3.0). Item 3 of the SMC, Do you ever forget names of family members or friends? contributed significantly more to the variance of the total SMC score in the clinical sample (18%) as compared to the community sample (11%). Forgetting names of family members or friends plays an important role in subjective memory complaints in the clinical setting. This symptom is possibly perceived as particularly worrisome and likely drives people to seek for clinical help.