Assessment of subjective cognitive impairment among older adults

Perceived Quality of Online Music Therapy Sessions by Older Adults Aging at Home

Online delivery is new to the field of music therapy (MT). This research investigated older adults' perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals' suggestions for further development of VMT sessions, and (c) individuals' personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.

Disparities in Subjective Cognitive Impairment by Sexual Orientation and Gender in a National Population Based Study of U.S. Adults, 2013-2018

Objectives: This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods: Using the National Health Interview Survey (2013-2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, applying logistic regressions adjusting for age, income, education, race/ethnicity, and survey years. Results: Sexual minorities (24.5%) were more likely to have subjective cognitive impairment than heterosexuals (19.1%). Sexual minority women had higher odds of greater severity, frequency, and extent of subjective cognitive impairment. Sexual minorities were also more likely to report activity limitations resulting from cognitive impairment and were no more likely to attribute limitations to dementia or senility. Discussion: Cognitive health disparities are of particular concern in this historically and socially marginalized population. The investigation of explanatory factors is needed, and targeted interventions and policies are warranted to address cognitive challenges faced by sexual minorities.

Emerging directions of cognitive aging with HIV: practice and policy implications for social work

Cognitive impairments have been endemic to the HIV epidemic since its beginning and persist to this day. These impairments are attributed to HIV-induced neuroinflammation, the long-term effects of combination antiretroviral therapy, lifestyle factors (e.g., sedentary behavior, substance use), neuro-comorbidities (e.g., depression), age-associated comorbidities (e.g., heart disease, hypertension), and others causes. Normal aging and lifestyle also contribute to the development of cognitive impairment. Regardless of the etiology, such cognitive impairments interfere with HIV care (e.g., medication adherence) and everyday functioning (e.g., driving safely, financial management). With more than half of people with HIV (PWH) 50 years and older, and ~45% of all PWH meeting the criteria for HIV-Associated Neurocognitive Disorder (HAND), those aging PWH are more vulnerable for developing cognitive impairment. This article provides an update to a social work model to identify and monitor PWH for cognitive impairment. Within this update, the state of the science on protecting brain health and cognitive reserve within the context of neuroHIV is also presented. From this, implications for practice and policy to promote successful cognitive functioning in older PWH are provided.

Predictors of Subjective Cognitive Decline Among People With Diabetes: Data From the Behavioral Risk Factor Surveillance System

PURPOSE

The purpose of this study was to examine the prevalence of subjective cognitive decline (SCD) and SCD-related functional limitations among people with diabetes and to identify socioeconomic and comorbidity risk factors associated with SCD.

METHODS

This study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) with background variables (race, gender, education, and age), health-related factors (self-rated health, BMI, insurance, and comorbid conditions), and health behaviors (smoking, exercise, alcohol consumption) entered simultaneously to estimate logistic regression models of SCD.

RESULTS

Within the sample (n = 5263 adults with diabetes), 48% were age ≥65 years; 50% were male; 55% were non-Hispanic White; and of the 15% who reported having SCD, 57% had functional limitations. Increased odds of reporting SCD were observed among individuals who were Hispanic (odds ratio [OR] = 2.21, P < .001), male (OR = 1.47, P < .01), depressed (OR = 3.85, P < .001), or had arthritis (OR = 1.43, P < .03). Participants with better self-rated health had a reduced likelihood of SCD (OR = 0.51, P < .001).

CONCLUSIONS

Health care providers should assess high-risk patients for self-rated cognitive dysfunction and offer early interventions.

The Factor Structure of Items Assessing Subjective Memory: Between-Persons and Within-Persons across Time

INTRODUCTION

Current understanding of the psychometric properties of items intended to assess the multidimensional construct of subjective memory (SM) is limited, as longitudinal studies of aging commonly use single items or brief sets of items to assess SM. Investigating how SM items cluster within individuals over time would increase the understanding of how combining these items impacts their utility as an early indicator of cognitive change in the aging trajectory. To address this need, the current study examined the factor structure of a brief set of SM items in an existing longitudinal study focused on cognitive aging at both the within-person and between-person levels.

METHODS

Data were drawn from the Einstein Aging Study, a longitudinal cohort study of aging (N = 1,239, Mage = 77.51, SD = 5.03; 69.50% white; 24.27% black; 6.23% other). Community-dwelling older adults from an urban area of New York City were interviewed annually. At each wave, participants responded to 6 items intended to assess SM. Items assessed participants' perceived memory decline as well as current memory ability. Multilevel exploratory factor analyses examined which factor solution best fit the data at between-person and within-person levels.

RESULTS

Factor structure of the SM items varied at the two levels. At the within-person level, two factors emerged, whereas at the between-person level, a single factor best represented the SM items. Items assessing perceived declines in memory functioning tended to have similar trajectories, while items assessing current memory ability were less related to change over time.

CONCLUSION

Items appeared to assess two different dimensions of SM when examining within-person changes in SM across time; however, the item structure suggested no other items covaried systematically within persons over time. In contrast to the conceptualization of SM as a multidimensional construct, our findings suggest that when measuring SM between individuals, SM items tend to capture a single dimension underlying SM. This may be due to the long retrospection period of items assessing perceived memory ability. A single item assessing perceived memory decline in older adults without evidence of objective cognitive impairment may be sufficient to monitor memory change in clinical or research settings.

Distinct Profile Differences in Subjective Cognitive Decline in the General Public Are Associated with Metacognition, Negative Affective Symptoms, Neuroticism, Stress, and Poor Quality of Life

Background:

Subjective cognitive decline (SCD) is increasingly recognized in both the clinical and research arenas as a risk factor for mild cognitive impairment (MCI) and dementia. Although SCD is etiologically heterogeneous and potentially treatable, in comparison to MCI and Alzheimer’s disease, SCD remains poorly characterized with its clinical relevance often questioned.

Objective:

This study’s aim was to improve the characterization of SCD within the general public.

Methods:

Individuals with SCD were compared to those without via a battery of measures.

Results:

Both the SCD and the non-SCD group correlational analysis identified significant relationships between worse SCD, worse metacognitive dysfunction, negative affective symptoms, and greater levels of stress. The SCD group displayed additional correlational relationships between Cognitive Change Index (Self report) (CCI-S) scores, higher neuroticism scores, and poorer quality of life (QoL). Partial correlation analysis in the SCD group suggests CCI-S scores, anxiety, depression, and metacognition are intercorrelated. Ad hoc analyses using metacognition as the grouping variable found that those experiencing worse metacognitive dysfunction were significantly more likely to experience poorer SCD, psychological and social QoL, greater levels of anxiety, depression, stress, and neuroticism.

Conclusion:

The emerging pattern from the analysis indicates that SCD appears associated with sub-clinical negative affective difficulties, metacognitive, and other psycho-social issues, and poorer QoL. Dysfunctional cognitive control at a meta-level may impact someone’s ability to rationally identify cognitive changes, increase worry about cognitive changes, and allow such changes to impact their lives more than those with superior metacognitive control. Findings could impact SCD assessment, monitoring, early intervention, and ultimately reducing risk of further decline.

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.

Time frame, problem specificity, and framing: the implicit structures of questions about memory in older adults

Objective: Self-reported memory complaints in older adults are common and may be an early indicator of future cognitive decline or dementia. However, there is wide variety in self-reported memory items that lack consensus on what they intend to measure. This study explored the perspectives of older adults on items currently used to assess self-reported memory.Method: A convenience sample of community dwelling older adults (n = 51) completed a free card sorting task of 16 commonly used items assessing self-reports of memory problems. Multidimensional scaling (MDS) was used to extract dimensions that describe the similarities among the self-reported items. Visual maps were created to interpret the content of each dimension and validity of the dimensions was checked using the labels provided by the participants.Results: Three underlying dimensions describing the items were identified: time frame, problem specificity, and framing. These dimensions were supported by participant provided labels.Conclusion: The three identified dimensions suggest that the commonly used self-reported memory items assess substantively different aspects of the same broad concept. To avoid inconsistencies in assessing self-reported memory problems in older adults, we recommend researchers specify the aspects of memory problems that they are interested in and link their items to those aspects. In addition, they should develop items that are a good match to their research question rather than simply selecting items that are commonly used or appear to have high face validity.

Combined Influences of Dementia Exposure and Personality on Self-Reported Memory Problems

The current study investigated whether having a first-degree relative with dementia influenced older adults' self-reported memory, if personality traits moderated these associations, and whether these associations differed by the type of item asked (ie, frequency of memory problems vs perceived memory decline). Data drawn from the Einstein Aging study included 454 older adults (Mage = 76.64, standard deviation = 4.77, 66.96% white, and 63% female). Multilevel modeling analyses showed participants who had a first-degree relative with dementia reported more frequent memory problems and were more likely to report memory decline over the past year. Among participants with a first-degree relative with dementia, higher levels of neuroticism were related to reports of more frequent memory problems at baseline, whereas higher levels of conscientiousness and lower levels of extraversion were related to reports of more frequent memory problems over time. Future research should consider personality traits and family history of dementia as potential contributors to self-reported memory problems.

Relationships Between Subjective Cognitive Impairment and Personality Traits: A Systematic Review

This systematic review examined the relationships between personality traits and subjective cognitive impairment (SCI) in older adults without dementia. A comprehensive literature search conducted according to PRISMA guidelines identified empirical investigations of SCI and at least one of the big five personality traits among adults age 60 or older. All articles were critically appraised using the weight of evidence framework and findings were compared, contrasted, and synthesized across studies. Sixteen of the 797 studies initially identified met eligibility criteria. A higher level of SCI was associated with higher neuroticism in 88% of the studies reviewed. In addition, a consistent negative association was identified between conscientiousness and SCI (57% of studies). No consistent relationships between openness, extraversion, or agreeableness and SCI were identified. Overall, this review supports the oft-cited association between higher neuroticism and greater self-reports of cognitive problems; however, the complexity of the relationship between SCI and personality is not yet fully understood. Future research should examine the extent to which different personality traits predispose individuals to report symptoms versus those traits that are associated with increased sensitivity to early indicators of pathological change. [Journal of Gerontological Nursing, 45(2), 27-34.].

The factors associated with subjective cognitive decline and cognitive function among older adults

AIMS

To explore the risk factors for subjective cognitive decline and cognitive function among older adults in South Korea.

DESIGN

This study employed a descriptive cross-sectional design.

METHODS

A convenience sample of 182 patients was recruited from a senior welfare center in Seoul. The mean age of the participants was 78.4 years (SD 5.91). Among them, 64.3% were women. The data were collected by a trained research assistant using structured questionnaires from September 2016-February 2017. Demographic characteristics, comorbidities, depression, physical and cognitive activity levels, instrumental activities of daily living, subjective cognitive decline, and cognitive function were assessed. Student's t tests, chi-square tests, and hierarchical multiple regression analyses were used for statistical analyses.

RESULTS

The findings revealed that 37.4% of the participants were not cognitively intact. Depression, perceived health status, and cognitive function were significantly associated with subjective cognitive decline (F = 7.10, p < .001, adjusted R²  = 25.3). Age, educational level, perceived health status, and subjective cognitive decline were significantly related to cognitive function (F = 20.98, p < .001, adjusted R²  = 47.0). After controlling for these variables, cognitive activity was significantly and independently related to cognitive function.

CONCLUSION

The results suggest that for the maintenance of cognitive function, cognitive activity should be encouraged. In addition, older adults who complain of subjective cognitive decline and have risk factors such as depression need therapeutic interventions to prevent actual decrease of cognitive function.

IMPACT

The present findings advance prior knowledge by considering variables such as physical and cognitive activity levels to provide novel evidence that can be used to develop interventions for community-dwelling older adults. Thus, to be effective, nursing interventions must seek to improve cognitive function through intellectual stimulation.

An Overview of Systematic Reviews of Ginkgo biloba Extracts for Mild Cognitive Impairment and Dementia

Ginkgo biloba extracts (GBEs) have been recommended to improve cognitive function and to prevent cognitive decline, but earlier evidence was inconclusive. Here, we evaluated all systematic reviews of GBEs for prevention of cognitive decline, and intervention of mild cognitive impairment (MCI) and dementia. Six databases from their inception to September 2015 were searched. Ten systematic reviews were identified, including reviews about Alzheimer's disease (n = 3), about vascular dementia (n = 1), about both Alzheimer's disease and vascular dementia (n = 2), about Alzheimer's disease, vascular dementia and mixed dementia (n = 3), and a review about MCI (n = 1). Based on the overview quality assessment questionnaire, eight studies were scored with at least 5 points, while the other two scored 4 points and 3 points, respectively. Medication with GBEs showed improvement in cognition, neuropsychiatric symptoms, and daily activities, and the effect was dose-dependent. Efficacy was convincingly demonstrated only when high daily dose (240 mg) was applied. Compared with placebo, overall adverse events and serious adverse events were at the same level as placebo, with less adverse events in favor of GBE in the subgroup of Alzheimer's disease patients, and fewer incidences in vertigo, tinnitus, angina pectoris, and headache. In conclusion, there is clear evidence to support the efficacy of GBEs for MCI and dementia, whereas the question on efficacy to prevent cognitive decline is still open. In addition, GBEs seem to be generally safe.

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.