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1.
Background: For long-term stroke survivors, objective neuropsychological impairments and subjective cognitive difficulties are common, and may contribute to ongoing difficulties in community reintegration. However, subjective cognitive complaints have been as much associated with low mood as with actual cognitive performance.

Objective: The objective of our study was to investigate the extent to which subjective cognitive complaints predicted community reintegration following a stroke, and whether this relationship would be mediated by emotional status.

Methods: Using a cross-sectional design, patients with a primary diagnosis of stroke (n = 102; age range 25–89 years) were recruited from the register of a neurological rehabilitation service if they were at least 6 months post-stroke and had been discharged home following the stroke. Exclusions included history of dementia, co-morbid psychiatric or neurological disorder, or significant aphasia. Assessments included the Subjective Cognitive Complaints Questionnaire, the Community Integration Questionnaire, and the Depression Anxiety and Stress Scale.

Results: Subjective cognitive complaints were common, with moderate to high levels of complaint most frequent for working memory (58.9%), and information processing speed (53%). Subjective cognitive complaints were significantly associated with social integration (r = ?.23, p < .05). However, examination of relationships using statistical mediation revealed that depressive symptoms fully mediated the relationship between subjective cognitive complaints and social integration.

Conclusions: Subjective cognitive complaints are common in long-term outcome following stroke and predict difficulty in community reintegration. However, this relationship is mediated by variation in emotional status. Therefore, addressing cognitive complaints through cognitive rehabilitation programs that include components to improve mood (for example, building self-efficacy or confidence) may also improve community reintegration post-stroke.  相似文献   

2.
BACKGROUND: Community based studies show that neurological or psychiatric symptoms are very frequent among the elderly population, with poor memory complaints being the most common. However, the relationship between poor memory complaints and objective memory performance is unclear. We designed this study to evaluate whether subjective memory complaints (SMC) are associated with objective cognitive performance or depression amongst the elderly Brazilian generation. METHODS: A cross-sectional study was carried out in 114 patients who were 50+, with or without SMC having no obvious cognitive impairment at its baseline (this was screened by the Mini-Mental State Examination with cut-off values adapted according to the subjects' educational background). Subjects were assessed regarding memory difficulty complaints, demographic data and underwent a neuropsychological assessment made up of nine cognitive tests (Rey Auditory Verbal Learning Test, Visual Reproduction Test, Logic Memory--History A, Free and Cued Selective Reminding Test, Stroop Test, Digit Span, Digit Symbol, Trail Making Test, fluency tests: naming animals and fruits) and the Geriatric Depression Scale. RESULTS: Twenty-one percent of the subjects had subjective memory complaints. The scores in the cognitive assessment of subjects with SMC did not differ from the scores of subjects without SMC. However, patients with subjective memory complaints had lower scores in the fluency test--category animals and the Geriatric Depression Scale. CONCLUSIONS: These results support the finding from other cross-sectional studies showing that subjective memory complaints are associated with depressive symptoms rather than objective cognitive performance.  相似文献   

3.
OBJECTIVE: To examine the relationship between subjective cognitive function and subsequent cognitive decline among individuals with psychometrically defined amnestic mild cognitive impairment (MCI), and to determine whether the presence of depressive symptoms modifies this relationship. METHOD: Fifty-five individuals met psychometric criteria for amnestic mild cognitive impairment (MCI). Cognitive decline was measured using the Mini-Mental State Examination (MMSE), which was administered at baseline and at follow-up two years later. Subjective cognitive function was examined using two different one-item memory complaints, as well as a scale focused on current level of cognitive function relative to past function and a scale focused on forgetting in specific everyday situations. RESULTS: In multiple regression analyses, the one-item complaint of change in memory at baseline predicted future cognitive decline. There was a significant interaction effect whereby this association was stronger in participants who endorsed fewer symptoms of depression. CONCLUSION: Individuals showing memory deficits consistent with amnestic MCI have at least some insight regarding cognitive decline and the extent to which subjective cognitive function is useful in predicting future decline may depend on what particular questions are asked as well as presence of depressive symptoms.  相似文献   

4.
BackgroundSubjective cognitive complaints are common but it is unclear whether they indicate an underlying pathological process or reflect affective symptoms.Method800 community-dwelling older adults were drawn from the Whitehall II cohort. Subjective cognitive complaint inquiry for memory and concentration, a range of neuropsychological tests and multimodal MRI were performed in 2012–2016. Subjective complaints were again elicited after 1 year. Group differences in grey and white matter, between those with and without subjective complaints, were assessed using voxel-based morphometry and tract-based spatial statistics, respectively. Mixed effects models assessed whether cognitive decline or depressive symptoms (over a 25-year period) were associated with later subjective complaints. Analyses were controlled for potential confounders and multiple comparisons.ResultsMean age of the sample at scanning was 69.8 years (±5.1, range: 60.3–84.6). Subjective memory complaints were common (41%) and predicted further similar complaints later (mean 1.4 ± 1.4 years). There were no group differences in grey matter density or white matter integrity. Subjective complaints were not cross-sectionally or longitudinally associated with objectively assessed cognition. However, those with subjective complaints reported higher depressive symptoms (“poor concentration”: odds ratio = 1.12, 95% CI 1.07–1.18; “poor memory”: odds ratio = 1.18, 1.12–1.24).ConclusionsIn our sample subjective complaints were consistent over time and reflected depressive symptoms but not markers of neurodegenerative brain damage or concurrent or future objective cognitive impairment. Clinicians assessing patients presenting with memory complaints should be vigilant for affective disorders. These results question the rationale for including subjective complaints in a spectrum with Mild Cognitive Impairment diagnostic criteria.  相似文献   

5.
Background: In the context of suspected cognitive disorders, the validity of memory complaints is subject to considerable debate. This investigation documents the prevalence of memory complaints and assesses the validity of memory complaints for detecting cognitive impairment. Methods: The sample comprises 349 randomly selected non-institutionalized individuals, aged 75 and over living in the city of Leipzig. Twenty individuals who suffer from moderate and severe dementia according to DSM-III-R were excluded. Memory complaints were measured by means of a single item question. The Mini-Mental State Examination (MMSE) and a wider range of cognitive tests which constitute the short neuropsychological battery of the SIDAM (Structured Interview for the Diagnosis of dementia of Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-III-R) were used to test cognitive performance. Results: One in three individuals aged 75 and over complained about memory deficits. The MMSE is not significantly related to memory complaints, whereas poorer performance on 2 out of 8 tests regarding specific areas of cognitive function (immediate recall, short-term memory) were found to be significantly associated with memory complaints. Despite these statistically significant associations, it is shown that memory complaints do not have diagnostic validity in detecting cognitive impairment on the individual level. Conclusion: Memory self-assessment should not be used as a substitute measure of cognitive performance. Initiation of further diagnostic and therapeutic steps should be based on cognitive performance testing. Relaying solely on memory complaints would miss individuals in need and allocate resources to worried but cognitively healthy persons. Received: 27 July 1998 / Accepted: 16 April 1999  相似文献   

6.
Objectives: The association between sleep disturbances and cognitive decline in the elderly has been putative and controversial. We evaluated the relation between subjective sleep quality and cognitive function in the Korean elderly.

Method: Among 459 community-dwelling subjects, 352 subjects without depression or neurologic disorders (mean age 68.2?±?6.1) were analyzed in this study. All the participants completed the Korean version of the consortium to establish a registry for Alzheimer's disease neuropsychological battery (CERAD-KN) as an objective cognitive measure and subjective memory complaints questionnaire (SMCQ). Based on the Pittsburgh sleep quality index, two types of sleepers were defined: ‘good sleepers’ and ‘poor sleepers’.

Results: There were 192 good sleepers (92 men) and 160 poor sleepers (51 men). Poor sleepers reported more depressive symptoms and more use of sleep medication, and showed higher SMCQ scores than good sleepers, but there was no difference in any assessments of CERAD-KN. In the regression analysis, depressive symptoms and subjective sleep quality were associated with subjective memory complaints (β = 0.312, p < 0.001; β = 0.163, p = 0.005).

Conclusion: In the elderly without depression, poor sleep quality was associated with subjective memory complaints, but not with objective cognitive measures. As subjective memory complaints might develop into cognitive disorders, poor sleep quality in the elderly needs to be adequately controlled.  相似文献   

7.
Background The aim was to examine associations between memory complaints, cognitive performance and mood in 174 adult, clinically depressed, neurologically healthy patients at baseline and during six months of follow-up. Methods Subjective memory disturbance was assessed using the Memory Complaint Questionnaire (MCQ). Levels of cognitive function, including memory, were assessed using a battery of neuropsychological tests. Mood and personality traits were assessed using rating scales, including the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS) and the 90-item Symptom Check List (SCL-90). Results At baseline, patients complaining of memory disturbances had higher BDI and HDRS scores than patients not complaining of memory problems. They also did less well in objective memory performances but not in other cognitive functions. Complaints of memory problems decreased during the follow-up. This change was associated with mood improvement and with reductions in other mental symptoms but not with changes in cognitive performance. In logistic regression analysis factors independently associated with MCQ change were age (OR 0.96) and BDI change (OR 1.06). Conclusions Subjective memory problems usually decline if depression is alleviated. Received: 3 February 2000 / Accepted: 26 October 2000  相似文献   

8.
OBJECTIVE: This cross-sectional study examined the relationship between subjective memory complaints and the apolipoprotein epsilon 4 allele (epsilon4), a genetic risk factor for Alzheimer's disease (AD), among cognitively normal subjects identified from a community memory screening. DESIGN: The sample comprised 232 consecutive white non-Hispanic older adults who presented to a free community-based memory-screening program at a University affiliated memory disorders center. Participants were classified as cognitively normal based on scores on the age and educated adjusted Folstein Mini-Mental Status Exam (MMSAdj) and a brief Delayed Verbal Recall Test (DRT). Subjects were assessed for APOE genotype, subjective memory complaints (Memory Questionnaire, MQ), depressive symptoms (Hamilton Depression Rating Scale, HDRS), and history of four major medical conditions that have been associated with memory loss (stroke/transient ischemic attack [TIA], atherosclerotic heart disease, hypertension, and diabetes). A hierarchical regression analysis was performed to examine the association between APOE genotype and memory complaints after controlling for a host of potential confounding factors. RESULTS: The APOE epsilon4 allele frequency for cognitively normal subjects was 0.13. Subjective memory complaints were predicted by depressive symptoms and a history of stroke/TIA. They were not associated with APOE genotype, MMSAdj score, DRT score, age, education, gender, and reported history of atherosclerotic heart disease, hypertension, or diabetes. CONCLUSION: The results did not suggest an association between subjective memory complaints and the APOE epsilon4 allele in this sample of cognitively intact subjects. This indicates that memory complaints may confer risk for future dementia through pathways independent of APOE genotype. The results also show that older adults with memory complaints are at increased risk for underlying depression.  相似文献   

9.
BACKGROUND: Subjective memory loss (SML) is common in elderly persons. It is not clear if SML predicts the development of dementia. OBJECTIVES: (1) to determine if SML in those with normal cognition predicts dementia or cognitive impairment without dementia (CIND); (2) to determine if an association is independent of the effect of age, gender and depressive symptoms. METHODS: Secondary analysis of the Manitoba Study of Health and Aging (MSHA), a population-based prospective study. Data were collected in 1991, and follow-up was done 5 years later. Community-dwelling seniors sampled randomly from a population-based registry in the Canadian province of Manitoba, stratified on age and region. Only those scoring in the normal range of the Modified mini-mental state examination (3MS) were included. Predictor variables were self-reported memory loss, 3MS, Center for epidemiological studies-depression scale (CES-D), age, gender, and education. Outcomes were mortality and cognitive impairment five years later. RESULTS: In bivariate analyses, SML was associated with both death and dementia. In multivariate models, SML did not predict mortality. After adjusting for age, gender, and depressive symptoms, SML predicted dementia. However, after adjusting for baseline 3MS score, SML did not predict dementia. CONCLUSIONS: Memory complaints predict the development of dementia over five years, and clinicians should monitor these persons closely. However, the proportion of persons developing dementia was small, and SML alone is unlikely to be a useful clinical predictor of dementia.  相似文献   

10.
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?p?相似文献   

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