Subjective memory complaints and personality traits in normal elderly subjects

Could Temperamental Features Modulate Participation in Clinical Trials?

The prodromal stages of Alzheimer's disease (AD) are the primary focus of research aimed at slowing disease progression. This study explores the influence of affective temperament on the motivation of people with mild cognitive impairment (MCI) and subjective cognitive decline (SCD) to participate in clinical trials. One hundred four subjects with MCI and SCD were screened for participation in pharmacological and non-pharmacological trials. Affective temperament was assessed based on the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (TEMPS) scale. Demographic variables and temperament subscales scores were compared between MCI and SCD patients and among patients participating in the pharmacological trial, the non-pharmacological trial and refusing participation. Twenty-one subjects consented to participate in the pharmacological trial, seventy consented to the non-pharmacological trial and thirteen refused to participate in any trial. Patients with SCD had greater education and more depressive temperamental traits than those with MCI. While older age, higher education and anxious temperament were negatively associated with participation in the pharmacological trial, irritable temperamental positively predicted pharmacological trial participation. In conclusion, temperamental features may affect the willingness of patients with MCI and SCD to take part in clinical trials and, especially, the choice to participate in pharmacological studies.

Test-Retest Reliability and Random Measurement Error of the Multifactorial Memory Questionnaire in Older Adults With Subjective Memory Complaints

To examine the psychometric properties of the Multifactorial Memory Questionnaire (MMQ) in older adults with subjective memory complaints. The three MMQ subscale (Satisfaction, Ability, and Strategy) was administered twice, with a 3-month interval. The test-retest reliability was examined using intraclass correlation coefficients (ICCs). The random measurement error was examined by calculating the standard error of measurement (SEM) and minimal detectable change (MDC95). The test-retest reliabilities of the three MMQ subscales were generally acceptable. The SEM of the three MMQ subscales was higher than the acceptable criterion of 10%. Despite the influence of random measurement error, the change scores of the three MMQ subscales may represent true changes if they are larger than the MDC95 of 13.2 (Satisfaction), 18.4 (Ability), and 16.9 (Strategy). The MMQ appears to be a reliable measure for use in research settings, but may not yet be suitable for clinical use.

Inconsistencies between Subjective Reports of Cognitive Difficulties and Performance on Cognitive Tests are Associated with Elevated Internalising and Externalising Symptoms in Children with Learning-related Problems

Children with learning difficulties are commonly assumed to have underlying cognitive deficits by health and educational professionals. However, not all children referred for psycho-educational assessment will be found to have deficits when their abilities are measured by performance on cognitive tasks. The primary aim of this study was to estimate the prevalence of this inconsistent cognitive profile (ICP) in a transdiagnostic sample of children referred by health and education service providers for problems related to attention, learning and memory (N = 715). A second aim was to explore whether elevated mental health problems were associated with ICPs. Findings suggest that approximately half of this sample could be characterised as having an ICP. Cognitive difficulties, whether identified by parent ratings or task performance, were associated with elevated internalising and externalising difficulties. Crucially, a larger discrepancy between a parent's actual ratings of a child's cognitive difficulties and the ratings that would be predicted based on the child's performance on cognitive tasks was associated greater internalising and externalising difficulties for measures of working memory, and greater externalising difficulties for measures of attention. These findings suggest that subjective cognitive difficulties occurring in the absence of any task-based performance deficits may be a functional problem arising from mental health problems.

Neural correlates and predictors of subjective cognitive decline in patients with Parkinson's disease

BACKGROUND

Subjective cognitive decline (SCD) may occur very early in the course of Parkinson's disease (PD) before the onset of objective cognitive decline. Data on neural correlates and determinants of SCD in PD are rare.

OBJECTIVE

The aim of the present study was to identify neural correlates as well as sociodemographic, clinical, and neuropsychological predictors of SCD in patients with PD.

METHODS

We retrospectively analyzed 30 patients with PD without cognitive impairment (23% female, 66.90 ± 7.20 years, UPDRS-III: 19.83 ± 9.29), of which n = 12 patients were classified as having no SCD (control group, PD-CG) and n = 18 as having SCD (PD-SCD). Neuropsychological testing and 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) were conducted. SCD was assessed using a questionnaire covering multiple cognitive domains.

RESULTS

SCD subscores differed significantly between PD-CG and PD-SCD and correlated significantly with other scales measuring related concepts. FDG-PET whole-brain voxel-wise regression analysis revealed hypometabolism in middle frontal, middle temporal, and occipital areas, and the angular gyrus as neural correlates of SCD in PD. Next to this hypometabolism, depressive symptoms were an independent significant determinant of SCD in a stepwise regression analysis (adjusted R2 = 50.3%).

CONCLUSION

This study strengthens the hypothesis of SCD being an early manifestation of future cognitive decline in PD and, more generally, early pathological changes in PD. The early identification of the vulnerability for future cognitive decline constitutes the basis for successful prevention and delay of this non-motor symptom.

Memory Complaints in Healthy Middle-Aged Adults Are Not Associated with Memory or Sustained Attention Performance

OBJECTIVE

To examine the associations between the number and type of memory complaints with memory and sustained attention performance in healthy middle-aged adults.

METHOD

Sixty-six healthy individuals aged 35-64 years (M_age = 47.73 years) were administered the seven Questions, Rey Auditory Verbal Learning Test, Sustained Attention to Response Task, and Depression Anxiety Stress Scales 21.

RESULTS

The number of memory complaints was not associated with memory or sustained attention performance but was associated with anxiety symptoms. The type of memory complaint was likewise not associated with memory or sustained attention performance. The complaints "recent change in ability to remember things" and "trouble remembering things from one second to the next" were associated with anxiety symptoms.

CONCLUSION

Complaints about memory in otherwise healthy middle-aged adults do not reliably indicate memory or sustained attention performance. Rather, these complaints are more likely to be associated with heightened, but nevertheless subclinical, anxiety.

The diagnostic accuracy of late-life depression is influenced by subjective memory complaints and educational level in an older population in Southern Italy

The prevalence of late-life depression (LLD) depends on the study sample, measurements, and diagnostic approaches. We estimated the 30 item-Geriatric Depression Scale (GDS-30) accuracy against the gold standard LLD diagnosis made with the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, focusing on the prevalence of a late-life major depressive disorder (MDD), in a population-based sample of 843 subjects aged>65 years, subdivided into three groups: normal cognition, subjective memory complaints, and mild cognitive impairment. At the optimal cut-off score (≥4), the GDS-30 showed 65.1% sensitivity and 68.4% specificity for LLD (63% and 66% for late-life MDD, respectively). Using the standard cut-off score (≥10), the GDS-30 specificity reached 91.2%, while sensitivity dropped to 37.7%, indicating a lower screening accuracy [area under the curve(AUC):0.728, 95% confidence interval(CI):0.67-0-78]. The GDS-30 performance was associated with educational level, but not with age, gender, cognition, apathy, and somatic/psychiatric multimorbidity. For subjective memory complaints subjects, at the optimal cut-off score (≥7), the GDS-30 showed better discrimination performances (AUC=0.792,95%CI:0.60-0.98), but again the educational level affected the diagnostic performance. In subjective memory complaints subjects, symptom-based scales like the GDS-30 may feature a better performance for diagnosing depression in older age, but the GDS-30 seems to require adjustment to the patient's educational level.

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.

Amyloid Plaques and Symptoms of Depression Links to Medical Help-Seeking due to Subjective Cognitive Decline

Background:

Subjective cognitive decline (SCD) is associated with an increased risk of Alzheimer’s disease (AD). However, patients reporting SCD to their general practitioner are not always referred to a memory clinic.

Objective:

To investigate whether prior history of medical help-seeking is associated with AD biomarker abnormality, worse cognitive performance, and/or depressive symptoms in SCD.

Methods:

We compared levels of cerebrospinal fluid (CSF) Aβ_1 - 42, cognitive performance, and depressive symptoms (15-item Geriatric Depression Scale, GDS-15) between healthy controls (n = 88), SCD with a history of medical help seeking (SCD-HS, n = 67), and SCD non help-seekers (SCD-NHS, n = 44). Cases with evidence of amyloid plaques (CSF Aβ_1 - 42 ≤708 ng/l) and symptoms of depression (GDS-15≥6) were determined in both SCD groups.

Results:

The SCD-HS group had lower CSF Aβ_1 - 42 (p < 0.01), lower word list learning and memory recall (p < 0.0001), and an increased level of depressive symptoms (p < 0.0001) compared to controls and SCD-NHS cases. The SCD-HS group had more cases with symptoms of depression (n = 12, 18%) and amyloid plaques (n = 18, 27%) compared to SCD-NHS (n = 1, 2% and n = 7, 16%, respectively). None of the SCD-HS cases and only one SCD-NHS case had concurrent symptoms of depression and amyloid plaques. The SCD-HS cases showed equal word list learning and memory performance regardless of amyloid status or symptoms of depression.

Conclusion:

Medical help-seeking in SCD is associated with an increased risk of AD pathology or symptoms of depression. However, subtle memory deficits are seen in SCD help-seekers, also without amyloid plaques or symptoms of depression.

Development of a patient-reported outcome measure for patients who have recovered from a subarachnoid hemorrhage: the "questionnaire for the screening of symptoms in aneurysmal subarachnoid hemorrhage" (SOS-SAH)

Background

Patients who have been successfully treated for an aneurysmal subarachnoid hemorrhage (aSAH) often retain multiple health complaints, including mood disorders, cognitive complaints, fatigue, and problems with social participation. These problems are not always fully addressed during hospital visits or in current outcome measures, such as the modified Rankin score and the Glasgow Outcome Scale. Here, we present the development of the “Questionnaire for the Screening of Symptoms in aneurysmal Subarachnoid Hemorrhage” (SOS-SAH), which screens for the self-reported symptoms of patients with mild disabilities.

Methods

During the development of the SOS-SAH we adhered to the PROM-cycle framework for the selection and implementation of patient-reported outcome measures (PROMs). The SOS-SAH was developed in an iterative process informed by a literature study. Patients and healthcare professionals were involved in the development process through participating in a working group, interviews, and a cognitive validation study.

Results and conclusions

Relevant patient-reported outcomes (PROs) were identified for patients with aSAH. The SOS-SAH was developed primarily using domains and items from existing PROMs and, if necessary, by developing new items. The SOS-SAH consists of 40 items and covers 14 domains: cognitive abilities, hypersensitivity to stimuli, anxiety, depression, fatigue, social roles, personality change, language, vision, taste, smell, hearing, headache, and sexual function. It also includes a proxy measurement for use by family members to assess cognitive functioning and personality change.

Depression and APOEε4 Status in Individuals with Subjective Cognitive Decline: A Meta-Analysis

OBJECTIVE

To evaluate the associative role of depression and apolipoprotein E epsilon 4 allele (APOEε4) in subjective cognitive decline (SCD) and its progression to objective cognitive decline.

METHODS

After literature search in electronic databases, studies were selected by following precise eligibility criteria. Meta-analyses were performed to examine the role of APOEε4 and depression in SCD or its progression to mild cognitive impairment (MCI) or dementia.

RESULTS

APOEε4 positivity was not different between SCD and normal individuals but was significantly higher in individuals with SCD plus than in normal individuals [odds ratio: 2.39 (95% CI: 1.87, 3.05); p<0.00001] and in SCD converters than in non-converters [odds ratio: 5.19 (95% CI: 2.36, 11.42); p<0.00001]. Depression was significantly higher in individuals with SCD [standardized mean difference: 0.63 (0.45, 0.82); p<0.00001] and SCD plus [standardized mean difference: 0.83 (0.43, 1.22); p<0.0001] than in normal individuals. However, depression was not different between SCD and MCI or between SCD converters and non-converters. Age of SCD converters was higher than non-converters [mean difference: 2.95 years (0.58, 5.31)].

CONCLUSION

Whereas APOEε4 positivity was higher in SCD plus and SCD converters, depression was higher in SCD and SCD plus but was not different between SCD and MCI.

Refining the metamemory in adulthood questionnaire: a 20-item version of change and capacity designed for research and clinical settings

Objective: Subjective memory concerns (SMCs) might be an early indicator of future cognitive decline and conversion to dementia. However, a rich history of mixed findings, moderating factors, and heterogenous methods preclude the usefulness of SMCs in both research and clinical settings. The present study aimed to review some of the factors that might cause mixed results and propose a revised version the Metamemory in Adulthood (MIA) Questionnaire that can be easily implemented to more consistently derive estimates of SMCs.Method: We used factor analysis and regression to investigate the utility of a revised 20-item version of the MIA Change and Capacity subscales.Results: Based on two samples of older adults (N = 382 and N = 221), the revised scale showed strong internal reliability and a two-factor structure. Regression analyses supported the incremental validity of the MIA-Revised Change scale in predicting performance on the Rivermead Behavioural Memory Test.Conclusions: By establishing a revised version of a well-known and previously validated questionnaire to assess SMCs, research and clinics can better implement a psychometrically sound measure quickly and easily. Moreover, the revised Change and Capacity subscales provide sufficient divergence to be sensitive to different facets of SMCs in a community dwelling older adult sample.

Functional cognitive disorders: a systematic review

Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.

Anhedonia and Dysphoria Are Differentially Associated with the Risk of Dementia in the Cognitively Normal Elderly Individuals: A Prospective Cohort Study

OBJECTIVE

We investigated the impact of depressed mood (dysphoria) and loss of interest or pleasure (anhedonia)on the risk of dementia in cognitively-normal elderly individuals.

METHODS

This study included 2,685 cognitively-normal elderly individuals who completed the baseline and 4-year follow-up assessments of the Korean Longitudinal Study on Cognitive Aging and Dementia. We ascertained the presence of dysphoria and anhedonia using the Mini International Neuropsychiatric Inventory. We defined subjective cognitive decline as the presence of subjective cognitive complaints without objective cognitive impairments. We analyzed the association of dysphoria and anhedonia with the risk of cognitive disorders using multinomial logistic regression analysis adjusted for age, sex, education, Cumulative Illness Rating Scale score, Apolipoprotein E genotype, and neuropsychological test performance.

RESULTS

During the 4-year follow-up period, anhedonia was associated with an approximately twofold higher risk of mild cognitive impairment (OR=2.09, 95% CI=1.20-3.64, p=0.008) and fivefold higher risk of dementia (OR=5.07, 95% CI=1.44-17.92, p=0.012) but was not associated with the risk of subjective cognitive decline. In contrast, dysphoria was associated with an approximately twofold higher risk of subjective cognitive decline (OR=2.06, 95% CI=1.33-3.19, p=0.001) and 1.7-fold higher risk of mild cognitive impairment (OR=1.75, 95% CI=1.00-3.05, p=0.048) but was not associated with the risk of dementia.

CONCLUSION

Anhedonia, but not dysphoria, is a risk factor of dementia in cognitively-normal elderly individuals.

Correlates of Subjective Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender Older Adults

BACKGROUND

Little is known about subjective cognitive decline (SCD) in lesbian, gay, bisexual, and transgender (LGBT) older adults.

OBJECTIVES

To examine SCD and its association with dementia risk factors, other physical and psychosocial health factors in LGBT older adults.

METHODS

A cross-sectional study of SCD was conducted with LGBT older adults, aged 50 and older (n = 210). SCD was categorized based on endorsement of memory problems and one other cognitive domain. Hierarchical logistic regression examined the associations between demographic factors, dementia risk factors, other health and psychosocial factors, and SCD.

RESULTS

Nearly 25% of LGBT older adults were classified as having SCD. LGBT older adults who were people of color (OR = 2.5; 95% CI = 1.1- 7.8), depressed (OR = 2.9; 95% CI = 1.3- 6.9), or reported having functional impairment (OR = 2.6; 95% CI = 1.1- 6.5) were significantly more likely to be classified as having SCD (Nagelkerke pseudo R2 = 0.27).

CONCLUSION

Depression and functional impairment should be considered when screening LGBT older adults for cognitive impairment and dementia. Future research on the cognitive impairment and dementia risk in LGBT older adults is needed.

Neurocognitive Disorders: Importance of Early/Timely Detection in Daily Clinical Practice

Neurocognitive disorders create important challenges for patients, their families, and clinicians who provide their health care. Early/timely detection in daily clinical practice allows for diagnosis and adequate treatment, psychosocial support, education, and engagement in shared decision-making related to health care, life planning, involvement in research, and financial matters. However, neurocognitive disorders, when present, are not detected or not diagnosed and not documented, in more than half of patients seen by primary care physicians. The aim of this paper is to highlight the strategies and the perspectives to improve the early/timely detection of neurocognitive disorders in daily clinical practice.

Longitudinal Associations Among Older Adults' Neurocognitive Performance, Psychological Distress, and Self-Reported Cognitive Function

Subjective cognitive complaints increase with age. Although subjective cognitive difficulties have been linked to cognitive impairment and psychological distress, some studies have failed to establish a link between subjective cognitive complaints and present or future cognitive impairment. The present study examined the interactive, longitudinal effects of age, psychological distress, and objective cognitive performance on subjective cognitive function. Older adults (N=147, Mage = 74.17) were assessed biannually for up to six years. Subjective cognitive function, psychological distress, and neuropsychological testing were obtained at each assessment. In multilevel models with single predictors, age, poorer average task-switching and poorer memory predicted worse subjective cognitive functioning. Both average levels and within-person deviations in distress predicted worse subjective cognitive function. There were two significant interactions: one between average distress and chronological age, and the other between average memory and within-person distress. Task switching performance and distress had an additive effect on subjective cognitive function. Both individual differences (i.e., between-person differences) and fluctuations over time (i.e., within-person changes) contributed to worse subjective cognitive function. Psychological distress may help explain the relationship between objective cognitive performance and subjective cognitive function and should be assessed when patient concerns about cognitive functioning arise.

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).

Subjective memory complaints and future depression in primary care patients: A four-year follow-up study

OBJECTIVE

To investigate the predictive value of subjective memory complaints (SMCs) for having a hospital-based diagnosis of a single depressive episode over a four-year follow-up period.

METHODS

A prospective register-based cohort study in general practice. All 17 practices in Inner city Copenhagen participated in the study. They had 40,865 registered patients, 2934 aged 65 years or older. Information on SMCs and socio-demographics was collected during two months at enrolment in primary care. Diagnoses of single depressive episodes were retrieved from the Danish Psychiatric Central Research Register. Cox proportional hazard regression models were used to examine risk factors for a hospital-based diagnosis of a single depressive episode.

RESULTS

758 patients aged 65 years or older consulted their GP in October and November 2002. According to our definition, 177 (23%) had SMCs at enrolment, 12 (6.9%) of whom received a diagnosis of a single depressive episode within the follow-up period. In three multivariate models, SMCs were significantly associated with single depressive episodes. In the fully controlled model SMCs had a hazard ratio (HR) of 2.59 for receiving a subsequent depression diagnosis.

CONCLUSIONS

In an older general practice population, SMCs are associated with increased risk of receiving a hospital-based diagnosis of a single depressive episode.

Sleep and subjective cognitive decline in cognitively healthy elderly: Results from two cohorts

Subjective cognitive decline may reflect a dementia prodrome or modifiable risk factor such as sleep disturbance. What is the association between sleep and subjective cognitive decline? Cross-sectional design, from two studies of older adults: the WHICAP in the USA and the HELIAD in Greece. A total of 1,576 WHICAP and 1,456 HELIAD participants, without mild cognitive impairment, dementia or severe depression/anxiety, were included. Participants were mostly women, with 12 (WHICAP) and 8 (HELIAD) mean years of education. Sleep problems were estimated using the Sleep Scale from the Medical Outcomes Study. Subjective cognitive decline was assessed using a structured complaint questionnaire that queries for subjective memory and other cognitive symptoms. Multinomial or logistic regression models were used to examine whether sleep problems were associated with complaints about general cognition, memory, naming, orientation and calculations. Age, sex, education, sleep medication, use of medications affecting cognition, co-morbidities, depression and anxiety were used as co-variates. Objective cognition was also estimated by summarizing neuropsychological performance into composite z-scores. Sleep problems were associated with two or more complaints: WHICAP: β = 1.93 (95% confidence interval: 1.59-2.34), p ≤ .0001; HELIAD: β = 1.48 (95% confidence interval: 1.20-1.83), p ≤ .0001. Sleep problems were associated with complaints in all the cognitive subcategories, except orientation for the WHICAP. The associations were noted regardless of objective cognition. At any given level of objective cognition, sleep disturbance is accompanied by subjective cognitive impairment. The replicability in two ethnically, genetically and culturally different cohorts adds validity to our results. The results have implications for the correlates, and potential aetiology of subjective cognitive decline, which should be considered in the assessment and treatment of older adults with cognitive complaints.

Can a Novel High-Density EEG Approach Disentangle the Differences of Visual Event Related Potential (N170), Elicited by Negative Facial Stimuli, in People with Subjective Cognitive Impairment?

BACKGROUND

Studies on subjective cognitive impairment (SCI) and neural activation report controversial results.

OBJECTIVE

To evaluate the ability to disentangle the differences of visual N170 ERP, generated by facial stimuli (Anger & Fear) as well as the cognitive deterioration of SCI, mild cognitive impairment (MCI), and Alzheimer's disease (AD) compared to healthy controls (HC).

METHOD

57 people took part in this study. Images corresponding to facial stimuli of "Anger" and "Fear" were presented to 12 HC, 14 SCI, 17 MCI and 14 AD participants. EEG data were recorded by using a HD-EEG HydroCel with 256 channels.

RESULTS

Results showed that the amplitude of N170 can contribute in distinguishing the SCI group, since statistically significant differences were observed with the HC (p < 0.05) and the MCI group from HC (p < 0.001), as well as AD from HC (p = 0.05) during the processing of facial stimuli. Noticeable differences were also observed in the topographic distribution of the N170 amplitude, while localization analysis by using sLORETA images confirmed the activation of superior, middle-temporal, and frontal lobe brain regions. Finally, in the case of "Fear", SCI and HC demonstrated increased activation in the orbital and inferior frontal gyrus, respectively, MCI in the inferior temporal gyrus, and AD in the lingual gyrus.

CONCLUSION

These preliminary findings suggest that the amplitude of N170 elicited after negative facial stimuli could be modulated by the decline related to pathological cognitive aging and can contribute in distinguishing HC from SCI, MCI, and AD.

Prevalence and correlates of subjective memory complaints in Vietnamese adults

ABSTRACTBackground:Low- and middle-income countries such as Vietnam are home to a majority of the world's population with dementia, yet little is known regarding how individuals in these countries perceive memory problems that might be indicative of cognitive impairment. This study examined the prevalence and correlates of subjective memory complaints (SMCs) in Vietnamese adults in Da Nang, Vietnam.

METHODS

A stratified sample of 600 adults (aged ≥ 55 years) living in Da Nang, Vietnam, and surrounding areas were recruited to participate in a cross-sectional study. Students and faculty from the National Technical Medical College Number 2 administered questionnaires in participants' homes regarding socio-demographic characteristics, functional health, social support, cognitive and mental health, and SMCs. Descriptive and stepwise regression analyses examined the prevalence and correlates of SMCs.

RESULTS

Approximately 64% of the sample reported at least poor memory and 39% said that memory interfered with their daily life at least somewhat. Multivariate regression analyses (adjusted for all covariates) showed that depressive symptoms, cognitive impairment, self-rated health and pain, and material hardship were associated with SMCs.

CONCLUSIONS

Prevalence of SMCs as well as depressive symptoms was high in this Vietnamese population. Although future research using more detailed measures of subjective memory and which include longitudinal data are required, the need for physicians to routinely assess Vietnamese patients for depression, SMCs, and cognitive impairment may be warranted.

Prevalence, Risk Factors, and Complaints Screening Tool Exploration of Subjective Cognitive Decline in a Large Cohort of the Chinese Population

BACKGROUND

Substantial studies have reported the prevalence and the affecting factors of subjective cognitive decline (SCD). The complaints screening scale has also been used for probing. However, little is known in China.

OBJECTIVE

To investigate the prevalence and risk factors of SCD, and explore an SCD complaints screening scale in China.

METHODS

Stratified cluster random sampling was conducted. 2,689 residents aged 60-80 years completed questionnaire 1. 814 residents were included for clinical and neuropsychological evaluations. Two standards were used to make the diagnosis of mild cognitive impairment (MCI) and SCD, and a preliminary screening rate comparison was carried out. Finally, we assessed the risk factors of SCD and the correlation between the SCD-questionnaire 9 (SCD-Q9) and the Auditory Verbal Learning Test-Long Delay Free Recall (AVLT-LR).

RESULTS

1) Standard 1 (ADNI2): the prevalence of SCD was 18.8% (95% CI = 14.7-22.9%) and zero conformed to six criteria (SCD plus). 2) Standard 2 (Jak/Bondi): the prevalence of SCD was 14.4% (95% CI = 10.7-18.1%). 3) Standard 1 had a relatively higher "false" positive rate, whereas Standard 2 had higher "false" negative rate. 4) Age, low education, fewer close friends, and daily drinking were independent risk factors for SCD progressing to MCI. 5) Total points of SCD-Q9 were negatively correlated to the value of AVLT-LR.

CONCLUSIONS

The prevalence of SCD is high in the ShunYi District in Beijing, China. Age, low education, less social support, and daily drinking are independent risk factors. The brief SCD-Q9 can be used as a reference.

Association between subjective memory assessment and associative memory performance: Role of ad risk factors

Decline in associative memory abilities is a common cognitive complaint among older adults and is detectable in both normal aging and in prodromal Alzheimer's disease (AD). Subjective memory (SM) complaints may serve as an earlier marker of these mnemonic changes; however, previous research examining the predictive utility of SM to observed memory performance yielded inconsistent results. This inconsistency is likely due to other sources of variance that occur with memory decline such as mood/depression issues, presence of apolipoprotein E (APOE ε4) genotype, or beta-amyloid deposition. Here we examine the relationship between SM and associative memory ability in the context of factors that increase susceptibility to AD in 195 healthy adults (79 men) aged 20-94 years. Participants completed an SM questionnaire, a mood/depression scale, two associative memory tests (a word-pair and a name-face test), and were genotyped for APOE ε4. PET-amyloid imaging data were collected for a subset of those over 50 years of age (N = 74). We found that SM predicted performance on both associative memory tests even after covarying for age, sex, mood, and APOE ε4 status. Interestingly, for the name-face associative task, increased SM concerns predicted memory performance selectively in participants over the age of 60, with the APOEε4 risk group showing the strongest effect. Finally, men with higher beta-amyloid deposition reported more memory complaints. Our findings suggest that SM reliably tracks memory performance, even in cognitively healthy adults, and may reflect an increased risk for AD. (PsycINFO Database Record

Subjective Memory Change, Mood, and Cerebrovascular Risk Factors in Older African Americans

OBJECTIVE

Subjective memory change (SMC) in older individuals may represent a harbinger of cognitive decline. This study examined the factors associated with SMC in older African Americans (AA), who have greater risk of developing dementia. We predicted that symptoms of depression and anxiety, as well as the total number of cerebrovascular risk factors (tCVRFs), but not performances on objective memory measures, would be positively associated with SMC.

METHODS

Ninety-six AA completed brief cognitive testing and answered questions about mood and memory at their primary care appointment. Vascular data were obtained from medical records.

RESULTS

Symptoms of depression and anxiety, but not performances on objective memory measures, were positively associated with SMC, t(χ²(1) = 16.55 and 12.94, respectively, both P < .001). In nondepressed participants, the tCVRF was important in distinguishing between those with and without SMC.

CONCLUSIONS

In older AA, symptoms of depression or anxiety were associated with SMC. In nondepressed AA, the tCVRFs were important in distinguishing between those with and without SMC.

Association of subjective memory complaint and depressive symptoms with objective cognitive functions in prodromal Alzheimer's disease including pre-mild cognitive impairment

BACKGROUND

Subjective memory complaints (SMC) and depressive symptoms (SDS) are common in the elderly population. However, the relationship among SMC, SDS, and cognitive function remains unclear. We investigated these associations in the elderly from cognitively normal (CN), pre-mild cognitive impairment (MCI), and amnestic MCI (aMCI) groups.

METHODS

Participants (CN, 299; pre-MCI, 106; aMCI, 267) underwent comprehensive clinical and neuropsychological assessment. and self-report SMC and SDS questionnaires. SMC and SDS were administered in a self-report format. For each neuropsychological test z-score, stepwise multiple linear regressions were performed to assess the relative contribution of SMC, SDS, and their interactions.

RESULTS

SMC are associated with lower objective memory, while SDS are associated with lower psychomotor speed. Interactions between SMC and SDS were significant for tests of memory, executive function, psychomotor speed, and global cognition. Additional analyses revealed that SDS moderated the SMC-cognition relationship such that only individuals with higher SDS showed significant SMC-cognition associations.

LIMITATIONS

Due to the cross-sectional design, associations among SMC, SDS, and cognitive function was rather weak, albeit significant. Additionally, future biomarker studies, such as those assessing amyloid burden, are needed to explore the mechanisms underlying the relationship among SMC, SDS, and cognitive function.

CONCLUSION

Early identification of individuals at risk for developing abnormal cognitive changes is critical. Our findings from the study involving a large sample of carefully selected participants suggest that SMC and SDS could be used as early detection markers of Alzheimer's disease.

Association between child maltreatment and prospective and retrospective memory in adolescents: The mediatory effect of neuroticism

The purpose of this study was to examine the relationship between child maltreatment and prospective and retrospective memory in children/adolescents by investigating the mediating role of neuroticism. In total, 662 children/adolescents aged 10-16 years were recruited from a middle school in China, and they completed questionnaires comprising the Childhood Trauma Questionnaire, Prospective and Retrospective Memory Questionnaire, and the Neuroticism subscale of the NEO Five-Factor Inventory. The severity of maltreatment was positively associated with the severity of impairment of memory (prospective and retrospective considered together) in children/adolescents. Children/adolescents exposed to maltreatment tended to display higher levels of neuroticism. Neuroticism partially mediated the association between child maltreatment and memory in all the subjects. The results of multigroup analyses showed neuroticism fully mediated the relationship between child maltreatment and memory for boys, in which the effect size of indirect effect was 0.52, and partially mediated the association for girls with 0.44 effect size of indirect effect. Early intervention aimed to reduce neuroticism might contribute to a better prognosis in children/adolescences with poor memory function.

Subjective Evaluation of Mood and Cognitive Functions in a General Neurology Clinic: Patients versus Informants

Background and Purpose

We aimed to determine the correlation between subjective evaluations of mood and cognitive functions by patients and informants, and the findings of a battery of neuropsychological tests.

Methods

We analyzed 74 subjects recruited from a general neurology clinic, comprising 37 patients with cognitive complaints and 37 informants (either relatives or caregivers in close contact with the patients). Four ordinal scales concerning recent memory, verbal expression, initiative, and mood were correlated with the findings of a series of neuropsychological tests and questionnaires using the tau b coefficient.

Results

The scores for the patients on the scales were most strongly correlated with scores on the 15-item Geriatric Depression Scale (GDS-15), while the scores for the informants were most strongly correlated with scores on GDS-15, the Informant Questionnaire on Cognitive Decline, and the Functional Activities Questionnaire (FAQ). The most significant correlation was between the initiative scale from informants and FAQ (tau b=-0.591, p<0.001), and it was the only one that remained significant after correcting for multiple testing (p Holm=0.013).

Conclusions

Cognitive complaints from patients mainly reflect their mood, whilst informant reports mainly reflect both the functional ability and mood of the patients.

Subjective memory complaints in elderly: relationship with health status, multimorbidity, medications, and use of services in a population-based study

BACKGROUND

This study examines the associations between subjective memory complaints (SMC) and health variables: multimorbidity, presence of certain diseases, health perceived state, difficulties seeing and hearing, pain, and use of medications and health services. Furthermore, we aim to identify risk groups based on multimorbidity and calculate the effect size for each of these relationships.

METHODS

Cross-sectional epidemiological study using a face-to-face interview with a structured questionnaire.

SAMPLE SIZE

1,342 people aged 65 years and older taken from a random sample of the census tracts. SMC were studied using questions regarding memory complaints.

RESULTS

Multimorbidity and polypharmacy are associated with SMC, so are impaired vision and hearing. SMC are more frequently present in people who use health services more intensively and exhibit reduced functional activity as a result of diseases. With respect to specific diseases, only cerebrovascular accidents and chronic constipation were associated with SMC. In regression analysis, predictors of SMC were vision and hearing impairment, poor self-perceived health, pain, and general practitioner visits. However, the effect size of these factors is low. The variables that indicate risk groups are number of diseases, reduced functional activity, hearing impairment, and poor self-perceived health.

CONCLUSIONS

Memory complaints are a heterogeneous phenomenon. Our results confirm that multimorbidity, polypharmacy, greater use of health services, pain, and poor self-perceived health are associated with SMC. We identified two risk groups with a high percentage of complaints and a healthy group with a low percentage. Detecting these factors and these risk and healthy groups is useful in achieving proper patients management.

Influence of Sampling and Recruitment Methods in Studies of Subjective Cognitive Decline

Subjective cognitive decline (SCD) has been proposed as a marker of neurodegeneration in cognitively normal elderly. This idea is supported by the growing evidence that SCD is associated with Alzheimer's disease (AD) biomarkers and increases the risk of future cognitive impairment. Nevertheless, this evidence is not complete, since other studies have not found these associations. This discrepancy could have a methodological basis. It is well known that across the broad spectrum of degenerative disease from healthy controls to dementia, the research setting affects key characteristics of the sample such as age, educational level, or family history of dementia. However, virtually no studies have specifically tested the influence of sampling and recruitment methods in SCD research. Population-based samples are less biased and therefore they probably are more suitable for the study of memory complaints as a symptom at the population level. On the other hand, the memory clinic setting could introduce a set of biases that make these patients more likely to develop cognitive impairment. Thus, memory clinic would be the most cost-effective context in which to study the phenomenology of SCD due to AD and eventually recruit patients for secondary prevention trials. However, this general hypothesis needs to be tested. Studies that compare samples of patients with SCD from different settings are necessary. Sometimes it is difficult for patients with subtle forms of cognitive impairment to access specialized diagnostic centers. Based in our experience we state that Open House type initiatives may be useful for attracting these individuals to memory clinics.

Factors influencing discrepancies in self-reported memory and performance on memory recall in the Canadian Community Health Survey-Healthy Aging, 2008-09

OBJECTIVE

the objectives of this study were: (i) to estimate the rate of discrepancy between participant single-item self-reports of good memory and poor performance on a list-learning task and (ii) to identify the factors including age, gender and health status that influence these discrepant classifications.

STUDY DESIGN AND SETTINGS

in total, 14,172 individuals, aged 45-85, were selected from the 2008-09 Canadian Community Health Survey on Healthy Aging. We examined the individual characteristics of participants with and without discrepancies between memory self-reports and performance with a generalised linear model, adjusting for potential covariates.

RESULTS

the mean age of respondents was 62.9 years with 56.7% being female, 53.8% having post-secondary graduation and 83% being born in Canada. Higher discrepant classification rates we observed for younger people (6.77 versus 3.65 for lowest and highest group), female (5.90 versus 3.68) and with higher education (6.17 versus 3.52). Discrepant classification rates adjusted with all covariates were higher for those without chronic diseases (5.37 [95% Confidence Interval (CI): 4.16, 6.90] versus 4.05 95% CI: 3.38, 4.86; P = 0.0127), those who did not drink alcohol (5.87 95% CI: 4.69, 7.32 versus 3.70 95% CI: 3.00, 4.55; P < 0.0001), lonely participants (5.45 95% CI: 4.20, 7.04 versus 3.99 95% CI: 3.36, 4.77; P = 0.0081) and bilingual participants (5.67 95% CI: 4.18, 7.64 versus 3.83 95% CI: 3.27, 4.50; P = 0.0102).

CONCLUSION

the findings of this study suggest that the self-reported memory and memory performance differ in a substantial proportion of the population. Therefore, relying on a self-reported memory status may not accurately capture those experiencing memory difficulties.

Memória em idoso: relação entre percepção subjetiva e desempenho em testes objetivos

Resumo A relação entre a percepção subjetiva de memória e o desempenho em testes objetivos tem sido alvo de diversos estudos em vista de sua utilidade no diagnóstico do declínio cognitivo. Dada a ausência de consenso em relação ao tema, avaliou-se o desempenho de idosos em testes objetivos de memória, correlacionando-o com a percepção subjetiva dos participantes acerca de sua memória. Cento e cinquenta e dois idosos preencheram uma ficha de dados sociodemográficos, na qual foi incluída uma questão para avaliar a percepção subjetiva acerca de sua memória. Dados objetivos foram coletados a partir do Mini-Exame do Estado Mental, dos subtestes de Memória do Instrumento de Avaliação Neuropsicológica Breve, da Escala de Depressão Geriátrica e do Inventário Beck de Ansiedade. Correlações parciais significativas foram verificadas nas tarefas de memória de trabalho, memória episódica verbal e memória semântica de longo prazo, fornecendo evidências acerca da utilidade clínica da medida de percepção subjetiva de memória.

The cross-sectional association between severity of non-cognitive disability and self-reported worsening memory

BACKGROUND

Research has demonstrated a clear association between cognitive decline and non-cognitive disability; however, all of these studies focus on disability as a correlate or result of some level of cognitive impairment or dysfunction. The relationship between disability and cognition is likely a complex one, that is currently incompletely described in the literature.

OBJECTIVES

Our objective was to estimate the prevalence of long-term, non-cognitive disability using a population-representative sample of adults aged 18 and older, and then estimate the association between long-term, non-cognitive disability and self-reported worsening memory.

METHODS

Using the 2009 Florida Behavioral Risk Factor Surveillance System (BRFSS), we measured the relationship between non-cognitive disability and worsening memory using multivariable logistic regression analysis weighted to account for the complex sampling design of the BRFSS. We also estimated the adjusted odds of worsening memory by disability severity, classified according to the types of assistance needed.

RESULTS

Approximately 18% (95% confidence interval = (16%, 19%)) of Floridians were living with a long-term, non-cognitive disability in 2009. Among adults with no disability during or prior to the last year, only 5% reported worsening memory. The proportion of Floridians reporting worsening memory increases with increasing severity of disability-related limitations. In a multivariable logistic regression model, odds of worsening memory increased significantly with severity of disability-related limitations.

CONCLUSIONS

These results highlight the association between non-cognitive disability and subsequent increased odds of worsening memory, independent of several other known risk factors, and a dose-response association with disability-related limitations.

Psychological factors are associated with subjective cognitive complaints 2 months post-stroke

The aim of this study was to investigate which psychological factors are related to post-stroke subjective cognitive complaints, taking into account the influence of demographic and stroke-related characteristics, cognitive deficits and emotional problems. In this cross-sectional study, 350 patients were assessed at 2 months post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24) to identify cognitive complaints. Psychological factors were: proactive coping, passive coping, self-efficacy, optimism, pessimism, extraversion, and neuroticism. Associations between CLCE-24 cognition score and psychological factors, emotional problems (depressive symptoms and anxiety), cognitive deficits, and demographic and stroke characteristics were examined using Spearman correlations and multiple regression analyses. Results showed that 2 months post-stroke, 270 patients (68.4%) reported at least one cognitive complaint. Age, sex, presence of recurrent stroke(s), comorbidity, cognitive deficits, depressive symptoms, anxiety, and all psychological factors were significantly associated with the CLCE-24 cognition score in bivariate analyses. Multiple regression analysis showed that psychological factors explained 34.7% of the variance of cognitive complaints independently, and 8.5% (p < .001) after taking all other factors into account. Of all psychological factors, proactive coping was independently associated with cognitive complaints (p < .001), showing that more proactive coping related to less cognitive complaints. Because cognitive complaints are common after stroke and are associated with psychological factors, it is important to focus on these factors in rehabilitation programmes.

Long-term and short-term predictors of worries about getting Alzheimer's disease

Cumulative stresses associated with concerns about cognitive functioning and worries about developing Alzheimer's disease (AD) have been shown to be related to poorer health and lower psychological well-being. Among older persons, AD also generates higher levels of fear than any other disease. But much remains to be learned about predictors of worries and fears, especially from a temporal perspective. Thus, the principal objective of the current research is to examine long-term effects of self-perceptions of cognitive functioning on worries about developing AD. Data for the study are drawn from the University of Michigan's Health and Retirement Study. We use up to ten measurements of self-perceived cognitive functioning collected from 1992 to 2010 for respondents 50 years of age and older at the time of their entrance into the study. Demographics (marital status, age, education, and gender); beliefs about the role of genetics, personal knowledge of someone with AD, and their interaction; and depression and health are other variables included in the model. The data are analyzed using the full information maximum likelihood procedure and latent growth curve modeling to account for the long-term effects. The analysis shows evidence of both short-term effects of depression, age, beliefs, and the interaction of beliefs and personal familiarity and long-term effects of cognitive self-assessment on worries about getting AD. Further analyses of these relationships and inclusion of these items in other studies are recommended.

Memory Complaints in Older Adults: Prognostic Value and Stability in Reporting over Time

Objective:

The purpose of this longitudinal study was to examine the prognostic value of subjective memory complaints in 156 cognitively intact community-dwelling older adults with a mean age of 83 years.

Methods:

Participants were assessed for subjective memory complaints, cognitive performance, functional status, and mood at annual evaluations with a mean follow-up of 4.5 years.

Results:

Subjective memory complaint at entry (n = 24) was not associated with impaired memory performance and did not predict memory decline or progression to incipient dementia. Memory complaints were inconsistent across examinations for 62% of participants who reported memory problems.

Conclusion:

Memory complaints by older adults are inconsistent over time. Memory complaints’ value as a research criterion for selecting people at risk of dementia is weak among community-dwelling older adults. Age, length of follow-up, and other population characteristics may affect the implication of self-reported memory problems.

Are depressive symptomatology and self-focused attention associated with subjective memory impairment in older adults?

BACKGROUND

Subjective memory impairment (SMI) refers to conditions in which people complain of memory problems despite intact cognition. The primary purpose of the present study was to examine the roles of self-focused attention and depressive symptomatology in subjective memory complaints.

METHODS

One hundred and eight patients who visited a memory disorder clinic with complaints of memory decline, but who were found on subsequent neuropsychological assessment to have normal cognitive function, were recruited to participate in the study. The severity of subjective memory complaints was measured with the modified Multifactorial Memory Questionnaire. In addition, neuropsychological functions, self-focused attention, and depressive symptomatology were also assessed.

RESULTS

The results showed that the severity of SMI was not significantly correlated with any of the neuropsychological test scores except for the complex figure copy. The severity of SMI, however, was significantly correlated with self-focused attention and depressive symptomatology. Hierarchical regression analysis revealed that self-focused attention and depressive symptomatology significantly contributed to the severity of subjective memory complaints over and above the neuropsychological test performance. The interaction effects between self-focused attention/depressive symptomatology and objective memory performance on the severity of SMI were not significant.

CONCLUSIONS

In conclusion, self-focused attention and depressive symptomatology appear to play important roles in the severity of SMI, even though it is not clear how these factors interact with objective memory performance. Clinical implications as well as limitations of the present study were discussed.

The sensitivity and specificity of subjective memory complaints and the subjective memory rating scale, deterioration cognitive observee, mini-mental state examination, six-item screener and clock drawing test in dementia screening

BACKGROUND

The effectiveness of dementia screening depends on the availability of suitable screening tools with good sensitivity and specificity to confidently distinguish normal age-related cognitive decline from dementia. The aim of this study was to evaluate the discriminant validity of 7 screening measures for dementia.

METHODS

A sample of 140 participants aged ≥60 years living in a residential facility for the aged were assessed clinically and assigned caseness for dementia using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised diagnostic criteria. Sensitivity and specificity of a selection of the following screening measures were tested using receiver operating characteristic (ROC) analysis for individual and combined tests: the Mini-Mental State Examination (MMSE), Six-Item Screener (SIS), Subjective Memory Complaint, Subjective Memory Complaint Clinical (SMCC), Subjective Memory Rating Scale (SMRS), Deterioration Cognitive Observee (DECO) and the Clock Drawing Test (CDT).

RESULTS

Using ROC analyses, the SMCC, MMSE and CDT were found to be 'moderately accurate' in screening for dementia with an area under the curve (AUC) >0.70. The AUCs for the SIS (0.526), SMRS (0.661) and DECO (0.687) classified these measures as being 'less accurate'. At recommended cutoff scores, the SMCC had a sensitivity of 90.9% and specificity of 45.7%; the MMSE had a sensitivity of 63.6% and a specificity of 76.0%, and the CDT had a sensitivity of 44.4% and a specificity of 88.9%. Combining the SMCC and MMSE did not improve their predictive power except for a modest increase when using the sequential rule.

CONCLUSION

The SMCC is composed of valid screening questions that have high sensitivity, are simple to administer and ideal for administration at the community or primary health care level as a first level of 'rule-out' screening. The MMSE can be included at a second stage of screening at the general hospital level and the CDT in specialist clinical settings. Sequential use of the SMCC and MMSE will improve the specificity of the former and the sensitivity of the latter.

Subjective memory complaints, cognitive performance, and psychological factors in healthy older adults

OBJECTIVE

To determine whether subjective memory complaints (SMCs) are associated with performance on objective cognitive measures and psychological factors in healthy, community-dwelling older adults.

METHOD

The cohort was composed of adults, 65 years and older with no clinical evidence of cognitive impairment (n = 125). Participants were administered: CogState computerized neurocognitive battery, Prospective Retrospective Memory Questionnaire, personality and meaning-in-life measures.

RESULTS

SMCs were associated with poorer performance on measures of executive function (p = 0.001). SMCs were also associated with impaired delayed recall (p = 0.006) but this did not remain significant after statistical adjustment for multiple comparisons. SMCs were inversely associated with conscientiousness (p = 0.004) and directly associated with neuroticism (p < 0.001). Higher scores on SMCs were associated with higher perceived stress (p = 0.001), and ineffective coping styles (p = 0.001). Factors contributing to meaning-in-life were associated with fewer SMCs (p < 0.05).

CONCLUSIONS

SMCs may reflect early, subtle cognitive changes and are associated with personality traits and meaning-in-life in healthy, older adults.

Subjective cognitive decline predicts future deterioration in cognitively normal patients with Parkinson's disease

Increasing evidence suggests that subjective cognitive decline (SCD) is a potential predictor of future cognitive decline or dementia. We investigated whether SCD in patients with Parkinson's disease (PD) is a predictor of future cognitive decline. Forty-six cognitively normal patients with PD were selected using comprehensive neuropsychological tests, and classified depending on the presence (PD-SCD(+), n = 25) or absence of SCD (PD-SCD(-), n = 21). After a mean follow-up of 2.4 years, we repeated the cognitive assessments with the same subjects. The clinical characteristics and cognitive performance of the 2 groups did not differ at baseline. At the follow-up assessment, 11 patients in the PD-SCD(+) group (44.0%) and 2 in the PD-SCD(-) group (9.5%) were diagnosed with mild cognitive impairment (MCI), and the PD-SCD(+) patients showed more rapid decline in semantic fluency and visuospatial memory tasks than those in the PD-SCD(-) group. A multivariate logistic regression analysis showed that presence of SCD (odds ratio, 8.378; 95% confidential interval, 1.472-47.683, p = 0.017) and higher Unified PD Rating Scale motor score of 20 or more (odds ratio, 4.539; 95% confidential interval, 1.004-20.528; p = 0.049) were risk factors for incident MCI. Present results demonstrate that SCD in cognitively normal patients with PD is an independent risk factor for incident MCI and acts as a predictor for future cognitive decline.

Neuropsychological differential diagnosis of mild traumatic brain injury

The diagnosis and evaluation of mild traumatic brain injury (mTBI) is reviewed from the perspective of meta-analyses of neuropsychological outcome, showing full recovery from a single, uncomplicated mTBI by 90 days post-trauma. Persons with history of complicated mTBI characterized by day-of-injury computed tomography or magnetic resonance imaging abnormalities, and those who have suffered prior mTBIs may or may not show evidence of complete recovery similar to that experienced by persons suffering a single, uncomplicated mTBI. Persistent post-concussion syndrome (PCS) is considered as a somatoform presentation, influenced by the non-specificity of PCS symptoms which commonly occur in non-TBI samples and co-vary as a function of general life stress, and psychological factors including symptom expectation, depression and anxiety. A model is presented for forensic evaluation of the individual mTBI case, which involves open-ended interview, followed by structured interview, record review, and detailed neuropsychological testing. Differential diagnosis includes consideration of other neurologic and psychiatric disorders, symptom expectation, diagnosis threat, developmental disorders, and malingering.

The default mode network may be the key substrate of depressive symptom-related cognitive changes

Depressive symptoms are associated with an increased risk of Alzheimer's disease (AD) but the mechanism(s) involved has not been well established. In a convenience sample of participants in the University of Kansas' Brain Aging Project, we use structural equation modeling (SEM) to explicitly distinguish depressive symptom-related variance in cognitive task performance (i.e., DEPCOG) from that which is unrelated to a depressive symptoms. DEPCOG is strongly associated with the cognitive correlates of functional status (δ), which we previously associated with elements of the Default Mode Network (DMN). Both δ and DEPCOG map to a posterior cingulate seeded network that has recently been associated with amyloid-β deposition and includes elements of the DMN. Both contribute significantly to clinical dementia status and dementia severity, as measured by the Clinical Dementia Rating Scale Sum of Boxes. These findings suggest that the cognitive correlates of depressive symptoms, even in the absence of a major depressive episode, may contribute to dementia in their own right, and could be responsible for some cases of incident clinical "AD". This conclusion suggests new opportunities for the latter's diagnosis, prevention, and treatment.

The default mode network and related right hemisphere structures may be the key substrates of dementia

We have employed structural equation models to explicitly distinguish dementia-relevant variance in cognitive task performance (i.e., δ) from the variance that is unrelated to a dementing process (i.e., g'). Together g' and d comprise Spearman's "g". Although d represents only a minor fraction of the total variance in cognitive task performance, it is more strongly associated with dementia severity than is g'. In this analysis, we replicate δ in a new dataspace, the University of Kansas Brain Aging Project, and associate it specifically with regional grey matter atrophy by voxel-based morphometry of magnetic resonance imaging data. The latent variable d localizes to elements of the default mode network and related structures in the R hemisphere.

Multigroup Confirmatory Factor Analysis of the Cognitive Dysfunction Questionnaire: instrument refinement and measurement invariance across age and sex

The study adopted Confirmatory Factor Analysis (CFA) to investigate the factorial structure and reduce the number of items of the Cognitive Dysfunction Questionnaire (CDQ). The analyses were based on data for a total of 1,115 participants from population based samples (mean age: 63.0 ± 14.5 years, range: 25-95) randomly split into a refinement (N = 569) and a cross-validation (N = 546) sample. Equivalence of the measurement and structural portions of the refined model was demonstrated across the refinement and cross-validation samples. Among competing models the best fitting and parsimonious model had a hierarchical factor structure with five first-order and one second-order general factor. For the final version of the CDQ, 20 items within five domains were selected (Procedural actions, Semantic word knowledge, Face recognition, Temporal orientation, and Spatial navigation). Internal consistency reliabilities were adequate for the total scale and for the subscales. Multigroup CFAs indicated measurement invariance across age and sex up to the scalar level. Finally, higher levels of cognitive dysfunction as reflected by CDQ scores were predicted by advancing age, fewer years of education, and with deficits in general cognitive functioning as reflected by scores on the Mini-Mental State Examination. In conclusion, the CDQ appears to be psychometrically sound and shows the expected relationships with variables known to be associated with cognitive dysfunction and dementia. Future studies should apply it among clinical groups to further test its usefulness.

Subjective memory complaints in primary care patients and death from all causes: a four-year follow-up

OBJECTIVE

To investigate the prognostic value of subjective memory complaints for all-cause mortality in order to determine whether elderly persons with subjective memory complaints may be regarded as a group of vulnerable patients who need close follow-up.

DESIGN

Prospective cohort study. Setting. Primary care units in the central district of Copenhagen, Denmark.

SUBJECTS

758 community-dwellers aged 65 years and older consulting their general practitioner in October and November 2002.

MAIN OUTCOME MEASURES

Information on subjective memory complaints, socio-demographics, and health-related quality of life were collected at the enrolment primary care consultation. Dates of death from all causes occurring during the four-year follow-up were retrieved from the national databases. Cox proportional hazard regression models on time to death (censored after four years) were used to examine the influence of subjective memory complaints on all-cause mortality.

RESULTS

88 patients died during the four-year follow-up. The association between subjective memory complaints and mortality had a statistically not significant hazard ratio (HR) of 0.91, adjusting for known confounders. Statistically significant predictors for mortality were Age (HR = 1.43 for 75-84 years and HR = 3.39 for 85 + years), Sex (HR = 0.51 for women), Mobility (HR = 2.39 for some problems), Self-care (HR = 2.34 for some problems) and Comorbidity (HR = 2.06, 3.19 and 5.89 for a Charlson comorbidity index of 1, 2, or ≥ 3 respectively).

CONCLUSION

In an elderly population presenting for primary care the presence of subjective memory complaints was not significantly associated with an increase in all-cause mortality.

Subjective memory complaints in general practice predicts future dementia: a 4-year follow-up study

OBJECTIVE

Many older patients in general practice have subjective memory complaints (SMC); however, not all share this information with their general practitioner (GP). The association between SMC and future cognitive decline or dementia is not clear, especially in a general practice population. The aim of this study was to determine the risk for receiving a subsequent hospital-based dementia diagnosis on the basis of patients' reports of SMC in a primary care setting.

METHODS

Prospective cohort survey with 4-year register-based follow-up in general practice. All 17 practices with a total of 24 GPs working in the inner district of Copenhagen municipality, Denmark. A total of 40 865 patients were listed, and 2934 were 65 years or older. Cox proportional hazard models were used to examine the influence of risk factors for hospital-based dementia diagnosis.

RESULTS

A total of 758 non-nursing home residents aged 65 years and older consulted their GP in October and November 2002, and, when asked, 177 (24%) reported memory problems, and 50 (6.6%) received a hospital-based dementia diagnosis within the 4-years follow-up. SMC had an adjusted Hazard Ratio (HR) of 2.27 for subsequent dementia diagnosis. Other statistical significant covariates were Mini Mental State Examination < 24 (HR 3.97), age (HR 2.73 for 75-84 years and HR 3.75 for 85+ years) and receiving home care (HR 3.24)

CONCLUSIONS

This study indicates that the presence of SMC in an older general practice population is a significant independent predictor for subsequent hospital-based dementia diagnosis. Thus, the GP could consider inquiring for memory complaints to identify vulnerable older patients.