Cognitive complaints in elderly depressed and pseudodemented patients

The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.     

The psychological nature of subjective memory complaint in non-demented older adults: The respective predictive values of psycho-affective,lifestyle, and cognitive inhibition variables

Introduction/ObjectiveThe aim of this study was to investigate, using path analysis (Lisrel 8.52), the relationships between subjective memory complaint and cognitive inhibition, lifestyle, and psycho-affective variables on a sample of non-demented older adults.MethodOur sample was composed of 109 older adults, who were required to undertake two cognitive inhibition tasks (stroop and verbal fluency) and to respond to scales designed to measure individuals’ psycho-affective status (depression/subjective health) and subjective memory complaint level (Mac Nair). Lifestyle predictors (education and activity levels) were also assessed.Results/ConclusionThis study highlights the importance of adopting a multifactorial approach to the study of subjective memory complaint. In addition to executive variables (verbal fluency task), predictors such as subjective health and activity levels seem to be crucial in our understanding of the psychological nature of subjective memory complaint.     

Predictors of Subjective Memory in Young Adults

While the nature of memory complaints during older adulthood has been studied extensively, the meaning of subjective memory concerns in younger adults has not been fully addressed. Using a sample of 95 younger adults, this study examined the role of personality, health, and depression in predicting objective and subjective memory. For objective memory, openness and self-rated health were unique predictors. For subjective memory ability, only self-rated health was predictive. Finally, similar to studies with older adults, neuroticism and conscientiousness were predictive of both perceived frequency of forgetting and global memory. Using subjective memory concerns as an indicator of actual memory functioning may be inappropriate given the extent to which personality traits and health predict memory concerns.     

Ask and ye shall receive: behavioural specificity in the accuracy of subjective memory complaints

A cross‐sectional sample of adults completed an extensive set of cognitive tasks and a set of questionnaires measuring depressive affect, memory complaint, and other variables. During an interview about their prescribed medications, the participants also reported whether they were having problems remembering to take the medication as prescribed (an everyday prospective memory problem). Their medication adherence at home was then monitored for one month using pill bottles which microelectronic caps. Cognitive tasks correlated with memory complaints, as measured by the Memory Functioning Questionnaire, but not with problems in remembering to take medications. The highest correlations were with a free recall task. Conversely, reported problems with medication adherence during the interview had good predictive validity for subsequent adherence problems, but not for cognitive tasks, including a measure of prospective memory. Depressive affect was related to both the questionnaire and the interview complaints about medication adherence, but a structural equation model showed that the relationships of cognition and medication adherence to the different memory complaints were independent of depressive affect. The results are interpreted in terms of a behavioural specificity hypothesis, which states that adults' self‐reports of memory problems are valid when they focus directly on specific memory‐related behaviours in everyday contexts. Copyright © 2000 John Wiley & Sons, Ltd.     

Interactive effects of subjective memory complaints and hypertension on learning and memory performance in the elderly

This study evaluated whether the relation between subjective memory complaints and cognitive performance is influenced by the presence of hypertension in the elderly. One hundred and five healthy older adults, 70–89 years of age, with and without hypertension treatment or diagnosis, completed a scale of subjective memory complaints. Participants were divided into those with mild memory concerns and those with minimal or no complaints. All participants completed a battery of neuropsychological tests including measures of verbal and nonverbal memory. After controlling for differences in age, gender, education, and overall intellectual ability, there were significant main effects for memory concerns and significant interactions for memory complaints and hypertension on several measures of memory performance. There were no main effects for hypertension on memory performance. Simple effects analyses of the interactions showed that the hypertensive complainers demonstrated poorer performance on measures of long-term memory and greater reliance on short-term recall than the hypertensive non-complainers. There were no differences in memory performance for the non-hypertensive groups. Among healthy elderly community-dwelling adults, those with mild subjective memory complaints in the context of hypertension demonstrated greater objective cognitive difficulties than those without hypertension as well as a greater reliance on a less efficient learning strategy. These findings suggest that memory concerns in the presence of hypertension may be important when evaluating treatment efficacy in these individuals and for identifying differences in cognitive aging.     

Depressive symptoms, cortisol, and cognition during human aging: the role of negative aging perceptions

Depressive symptoms and memory impairments are associated with heightened stress hormone levels during aging. A factor that is related to memory deficits during aging is internalized negative aging stereotypes; the idea people have about the process of aging. In this study, we assessed the associations between internalized negative aging stereotypes, depressive symptoms, subjective and objective memory assessments, and cortisol concentration among older adults. Forty older adults aged between 58 and 85 years (18 females and 22 males; mean age?±?SD: 71.25?±?8.80 years) were assessed in this study. Measures of internalized negative aging stereotypes, depressive symptoms, and both subjective and objective memory performance were assessed. Salivary samples were obtained for measurement of cortisol concentration. Stepwise linear regressions were executed in our main analyses. Internalized negative aging stereotypes were associated with increased depressive symptoms and subjective memory complaints. No significant differences were observed for objective memory performance, or cortisol concentration. Internalized negative aging stereotypes are associated with increased depressive symptomatology and subjective complaints of memory; however, they do not predict increased cortisol concentration nor objective memory performance during aging. These results indicate that the mechanism underlying the association between internalized negative aging stereotypes and cognitive impairments may not be related to dysregulations of cortisol secretion among older adults.     

Diurnal cycle of salivary cortisol in older adult men and women with subjective complaints of memory deficits and/or depressive symptoms: relation to cognitive functioning

In populations of young and older adults, it has been shown that individuals may be categorized into one of three diurnal subgroups when salivary cortisol levels are assessed over a 2-day period and compared for their consistency across days: a typical subgroup, a flat subgroup, and an inconsistent subgroup. Interestingly, recent studies have reported that the typical subgroup represents the majority of the young and older adult population, a finding that is difficult to reconcile with previous studies showing increased cortisol levels in older adults with depression or cognitive impairments. In order to assess whether a typical diurnal cortisol profile is representative across different subgroups of older adults, we assessed diurnal cortisol cycle representation in a sample of older adults with subjective complaints of depression and/or memory problems. Furthermore, given the robust relationship between cortisol and cognitive function, the present study examined the association between the three diurnal subgroups and cognitive performance. Forty-two older individuals were recruited on the basis of reporting subjective complaints of either memory problems and/or depressive mood. Participants were asked to sample their saliva over a 2-day period and were then asked to undergo a neuropsychological evaluation that taps into short-term memory, declarative memory and language. The results showed that 69% of the sample presented a Flat cycle of salivary cortisol over a 2-day period while 19% presented an inconsistent pattern and 12% presented a typical pattern. Participants in the flat subgroup were significantly impaired on letter verbal fluency. Furthermore, a relationship was found between diurnal cortisol subgroup representation and subjective complaint profile. These findings show that older adults with complaints of memory problems and/or depressive symptoms do not present the typical profile of the diurnal cortisol cycle, and they provide a preliminary view of how diurnal cortisol profile relates to cognitive function during human aging.     

Decomposing the relationship between cognitive functioning and self-referent memory beliefs in older adulthood: what’s memory got to do with it?

With advancing age, episodic memory performance shows marked declines along with concurrent reports of lower subjective memory beliefs. Given that normative age-related declines in episodic memory co-occur with declines in other cognitive domains, we examined the relationship between memory beliefs and multiple domains of cognitive functioning. Confirmatory bi-factor structural equation models were used to parse the shared and independent variance among factors representing episodic memory, psychomotor speed, and executive reasoning in one large cohort study (Senior Odyssey, N = 462), and replicated using another large cohort of healthy older adults (ACTIVE, N = 2802). Accounting for a general fluid cognitive functioning factor (comprised of the shared variance among measures of episodic memory, speed, and reasoning) attenuated the relationship between objective memory performance and subjective memory beliefs in both samples. Moreover, the general cognitive functioning factor was the strongest predictor of memory beliefs in both samples. These findings are consistent with the notion that dispositional memory beliefs may reflect perceptions of cognition more broadly. This may be one reason why memory beliefs have broad predictive validity for interventions that target fluid cognitive ability.     

Effects of age on metacognitive efficiency

Humans have a capacity to become aware of thoughts and behaviours known as metacognition. Metacognitive efficiency refers to the relationship between subjective reports and objective behaviour. Understanding how this efficiency changes as we age is important because poor metacognition can lead to negative consequences, such as believing one is a good driver despite a recent spate of accidents. We quantified metacognition in two cognitive domains, perception and memory, in healthy adults between 18 and 84 years old, employing measures that dissociate objective task performance from metacognitive efficiency. We identified a marked decrease in perceptual metacognitive efficiency with age and a non-significant decrease in memory metacognitive efficiency. No significant relationship was identified between executive function and metacognition in either domain. Annual decline in metacognitive efficiency after controlling for executive function was ∼0.6%. Decreases in metacognitive efficiency may explain why dissociations between behaviour and beliefs become more marked as we age.     

Complainer Profile Identification (CPI): properties of a new questionnaire on subjective cognitive complaints

Subjective cognitive complaints (SCC) and their role as a possible indicator for subsequent dementia became of growing interest in recent research. In contrast to studies that focused primarily on memory complaints, we aimed to (a) evaluate a questionnaire to register SCC in multiple cognitive domains (Complainer Profile Identification, CPI), (b) assess the association between SCC and psychosocial variables, and (c) assess whether complainer types can be differentiated. Confirmatory factor analysis to evaluate construct validity was computed based on a sample of 734 healthy participants (mean [M] = 43.15 years). On a subsample of 644 participants, the relationship between the total level of SCC with age, depression, social integration, and aging stereotypes was assessed utilizing multiple regression analysis. Differences in complainer types were assessed by multivariate analysis of variance. The results indicate sound psychometric properties of the CPI. The overall level of SCC is largely influenced by depressiveness, whereas executive complainers show the highest level of depressive affect, being overall younger and less socially integrated.     

Neuropsychological performance in older insomniacs

ABSTRACT

The purpose of this study was to examine daytime performance in older adults fulfilling the diagnostic criteria for DSM-IV Insomnia, using a comprehensive battery of neuropsychological tests, and to compare these objective findings with measures of self-reported cognitive functioning. A total of 121 participants (69% women) with a mean age of 64.0 were part of a thorough neuropsychological examination at a University-based neuropsychological clinic in Western Norway. Twenty-five percent of the participants fulfilled the diagnostic criteria for insomnia. In sum, the insomnia patients were not different from the good sleepers on any neuropsychological test measure, and none of the results on the performance measures were associated with the sleep-related daytime complaints. However, the insomniacs did rate their subjective memory performance as significantly worse than the good sleepers, and they also reported more depressive symptoms. We conclude that DSM-IV defined insomnia was not associated with any performance based measure; only with self-reported symptoms.     

Perceived stress and everyday memory complaints among older adult women

Abstract

Memory complaints among older adults are often influenced by depression and anxiety, but the association of stress to memory complaints has received little attention. We examined the associations of perceived stress, life events, and activity level to everyday memory complaints among healthy older women, while controlling for the influence of depression and anxiety. Participants (N=54) completed self-report questionnaires on memory complaints, perceived stress, recent life events, activity level, depression, and anxiety. Partial correlation analyses indicated that higher levels of perceived stress were associated with higher levels of memory complaints when controlling for the influence of depression and anxiety, but that life events and activity level were not related to memory complaints. This study highlights that perceived stress, like depression and anxiety, is a psychological factor that influences the appraisal of cognitive ability; however, larger and more heterogeneous samples will be needed to better understand the multifactorial nature of memory complaints in older adulthood.     

The relationship between cognitive function and life space: the potential role of personal control beliefs

We examined the relationship of cognitive and functional measures with life space (a measure of spatial mobility examining extent of movement within a person's environment) in older adults, and investigated the potential moderating role of personal control beliefs. Internal control beliefs reflect feelings of competence and personal agency, while attributions of external control imply a more dependent or passive point of view. Participants were 2,737 adults from the ACTIVE study, with a mean age of 74 years. Females comprised 76% of the sample, with good minority representation (27% African American). In multiple regression models controlling for demographic factors, cognitive domains of memory, reasoning, and processing speed were significantly associated with life space (p < .001 for each), and reasoning ability appeared most predictive (B = .117). Measures of everyday function also showed significant associations with life space, independent from the traditional cognitive measures. Interactions between cognitive function and control beliefs were tested, and external control beliefs moderated the relationship between memory and life space, with the combination of high objective memory and low external control beliefs yielding the highest life space (t = -2.07; p = .039). In conclusion, older adults with better cognitive function have a larger overall life space. Performance-based measures of everyday function may also be useful in assessing the functional outcome of life space. Additionally, subjective external control beliefs may moderate the relationship between objective cognitive function and life space. Future studies examining the relationships between these factors longitudinally appear worthwhile to further elucidate the interrelationships of cognitive function, control beliefs, and life space.     

Factors of Cognitive Complaints in Adults With HIV: A Structural Equation Model Analysis

The objective of this study was to use structural equation modeling (SEM) to examine the relationships between factors of cognitive complaints in 427 adults with HIV receiving care from an AIDS service organization (ASO) in Alabama. A face-to-face interview assessed cognitive complaints, mood, self-perceived health status, and substance use. Direct and indirect paths were specified between years with HIV (chronicity) age, education, stress, self-perceived health status, substance use, and cognitive complaints. The final model fit the data well (GFI = .95; AGFI = .92), revealing that age, education, substance use, self-perceived health status, and stress contributed directly or indirectly to cognitive complaints. Chronicity was only related to age, suggesting that duration of HIV may be of limited value in predicting cognitive complaints. These results demonstrate the complexity between the factors that influence cognitive complaints and offer possible solutions that health professionals can use to mitigate cognitive complaints in this population.     

The relationship between memory complaints,activity and perceived health status

Subjective memory complaints (SMC) is a possible symptom of mild cognitive impairment which may progress to dementia. The present study examines the relationship of physical activity (PA), cognitive activity (CA), social activity (SA), and perceived health status (HS) with SMC for middle age and older adults. Participants were from the MIDUS II study (Midlife in the United States) recruited in 2004–2006 (Mean age = 55.99; N = 3030). Hierarchical multiple regression was performed with SMC as the dependent variable, along with PA, CA, SA, and HS as the independent variables. The study revealed that SMC was strongly related to PA, CA, and HS, while controlling covariates. Further, HS had the strongest link with SMC among these predictors while interaction effects (PA × HS, CA × HS, and SA × HS) were insignificant. In addition, different results were achieved in younger versus older groups. Participants with more CA, PA and perception of better health had lower frequency of memory complaints.     

Social and non‐social measures of cognition for predicting self‐reported and informant‐reported functional outcomes in early psychosis

The main aim of this study was to investigate the individual contributions of neurocognitive and social‐cognitive domains to self‐reported and informant‐reported functional outcome in early psychosis. We also sought to further characterize the nature of cognitive impairments in this sample and explore the interrelationships between the social‐cognitive measures and how they correlate with measures of neurocognition and clinical symptoms. In this study, 70 patients (mean age: 24.1; 87.1% males) with primary psychotic disorder diagnosed in the previous 5 years were assessed on multiple neurocognitive (processing speed, attention, working memory, immediate verbal memory, delayed recall, visual reasoning, inhibition, planning, cognitive flexibility), and social‐cognitive domains (theory of mind (ToM), emotion recognition, attributional style, metacognitive overconfidence) as well as measures of clinical symptoms. Functional outcome was assessed with three self‐reports and two informant‐reports. On average, patients performed one or more SD below healthy controls on measures of delayed recall, ToM and metacognitive overconfidence. Emotion recognition and ToM were intercorrelated and correlated with multiple neurocognitive domains and negative symptoms. Attributional style correlated with positive symptoms. In the context of multiple variables, self‐reported functional outcomes were predicted by attributional style, whereas emotion recognition and immediate verbal memory predicted variance in informant‐reported community functioning. These results support the suggestion of a likely distinction between the predictive factors for self‐reported and informant‐reported functional outcome in early psychosis and suggest that consideration of self‐assessment of functional outcome is critical when attempting to evaluate the effects attributional style has on functional disability.     

Is working memory necessary for implementation intentions to enhance prospective memory in older adults with cognitive problems?

Implementation intentions are an effective strategy for improving prospective memory in older adults. However, their efficacy has never been assessed in older individuals with cognitive problems (i.e., individuals with subjective memory complaints or objective memory impairments). Furthermore, although most authors consider implementation intentions to depend on automatic processes, some studies have shown the necessity of residual preserved controlled processes for implementation intentions to be efficient. We examined the efficacy of implementation intentions in prospective memory in 45 older participants consulting a memory clinic. Half of the participants were instructed to form an implementation intention, the other half receiving standard instructions. Analyses showed that working memory moderated the efficacy of implementation intentions, which were efficient only in individuals with better working memory. These results corroborate the claim that a minimal level of cognitive resources is required for the technique, although implementation intentions might depend principally on automatic processes.     

Within-person variability in response speed as an indicator of cognitive impairment in older adults

Within-person variability may be an important indicator of central nervous system compromise. In this study, within-person variability in response speed was examined in community-dwelling older adults, ages 64-92 years, using a new framework that takes into account both the extent (single versus multiple domains affected) and nature (amnestic versus non-amnestic) of the cognitive impairment. Those with multiple domains of impairment were more variable than those who showed an isolated area of impairment, regardless of whether memory was one of the domains affected. Further, for those with difficulties in two or more non-memory domains, increased variability was most evident in more cognitively demanding situations, when individuals had to manipulate information held briefly in mind, switch cognitive set or inhibit an automatic response. Finally, group differentiation was better achieved when within-person variability as opposed to mean speed of performance was considered.     

Social Network Size and Cognitive Functioning in Middle-Aged Adults: Cross-Sectional and Longitudinal Associations

The objective of the present study was to examine relations between social network size and three cognitive abilities (episodic memory, semantic memory, visuospatial ability) in middle-aged adults. We analyzed cross-sectional data on social network size and cognitive functioning that were available for 804 participants aged 40–60 years. In addition, we examined 5- and 10-year follow-up measurements of cognitive functioning that were available for 604 and 255 participants, respectively. Cross-sectional analyses revealed a positive association between social network size and each of the three cognitive abilities. Baseline network size was positively related to 5-year changes in semantic memory, and to 10-year changes in semantic as well as episodic memory, but was unrelated to changes in visuospatial performance. A minor portion of the sample (n = 131) had 10-year follow-up data on network size. Cross-lagged panel correlations revealed that baseline network size was associated with follow-up measurement in cognitive functioning (episodic memory, semantic memory), whereas baseline cognitive performance was unrelated to future network size. Together, the results demonstrate a small but positive relation between network size and declarative memory abilities, in line with models proposing a cognitive reserve built up by factors such as the increased cognitive stimulation associated with a more extensive social network.     

Within-Person Variability in Response Speed as an Indicator of Cognitive Impairment in Older Adults

ABSTRACT

Within-person variability may be an important indicator of central nervous system compromise. In this study, within-person variability in response speed was examined in community-dwelling older adults, ages 64–92 years, using a new framework that takes into account both the extent (single versus multiple domains affected) and nature (amnestic versus non-amnestic) of the cognitive impairment. Those with multiple domains of impairment were more variable than those who showed an isolated area of impairment, regardless of whether memory was one of the domains affected. Further, for those with difficulties in two or more non-memory domains, increased variability was most evident in more cognitively demanding situations, when individuals had to manipulate information held briefly in mind, switch cognitive set or inhibit an automatic response. Finally, group differentiation was better achieved when within-person variability as opposed to mean speed of performance was considered.