Subjective memory beliefs and cognitive performance in normal and mildly impaired older adults

Previous research suggests that subjective perceptions of memory may be related to objective memory performance. In the present study, healthy community-dwelling elders (N = 73, mean age = 75.25 years, education = 16.2 years) completed a neuropsychological assessment, including two questionnaires of subjective memory beliefs. Each participant was identified, via consensus conference, as belonging to either an amnestic mild cognitive impairment (MCI, n = 16) or no mild cognitive impairment (noMCI, n = 57) group. Results indicated that subjective memory capacity beliefs were significantly related to verbal memory performance in the MCI group, but not in the noMCI group. This differential relationship persisted even after controlling for depressive symptoms, and was not reflective of unequal variances in the two groups. Thus, results indicate that subjective memory beliefs may be better indicators of performance in those with possible incipient cognitive impairment than normal older adults, perhaps because persons with MCI have heightened insight into their memory functioning, and that this relationship is not due to group differences in depressive symptoms.     

Linking depressive symptoms and functional disability in late life

We hypothesized that the relationship of depressive symptoms to functional disability might be mediated by cognitive processes such as memory and problem-solving. The study sample consisted of 147 community-dwelling older adults (mean age = 74.0 years, SD = 5.9). In regression models that included terms for age, gender, and years of education, depressive symptoms were significantly inversely associated with two performance-based measures of functioning: everyday problems test (beta = -0.15, p = 0.04) and observed tasks of daily living (beta = -0.14, p = 0.02). When memory and problem-solving ability were added to the model, the relationship of depressive symptoms with function was attenuated. A structural equation model based on our conceptual framework revealed that both memory and problem-solving abilities were important mediators in the relationship of depressive symptoms and functional disability. The results suggest that intervention studies intended to limit functional disability secondary to depression among older adults may need to consider the effect of depression on cognition.     

Prospective memory complaints can be predicted by prospective memory performance in older adults

Background/Aims: The aim of this study was to explore if prospective memory complaints reflect actual prospective memory performance in older adults. Methods: Three hundred and sixty-four older adults aged 65-80 years were investigated with regard to prospective memory complaints, prospective memory test performance, self-reported depressive symptoms, and self-reported memory capacity. Results: Separate analyses revealed that about half of the participants showed a significant relation between subjective and objective prospective memory. Conclusion: Older adults appear to be heterogeneous with regard to the association between objective and subjective prospective memory. For older adults with relatively few depressive symptoms and memory concerns, prospective memory complaints may serve as a valid criterion in the assessment of prospective memory ability.     

The moderating effect of subjective age on the association between depressive symptoms and cognitive functioning in Korean older adults

Objectives: Depressive symptoms are greatly associated with cognitive impairment in older adults. Recent growing body of literature has reported that the subjective perception of one's own age (subjective age) predicts both cognitive performance and mental well-being in old age. This study aims to examine whether subjective age moderates the association between depressive symptoms and cognitive functioning in a representative sample of Korean older adults. To address this research question, we employed the Stereotype-Embodiment Theory as a theoretical guide.

Method: Data are from the 2016 Dementia Literacy Survey collected by Kyung Hee University, and 526 community-dwelling Korean older adults (ages 60–79) completed the questionnaire about depressive symptoms, cognitive functioning, and subjective age.

Results: According to the hierarchical regression analysis, both higher levels of depressive symptoms and older subjective age were associated with poorer cognitive functioning. Further analyses showed that subjective age attenuated the effect of depressive symptoms on cognitive functioning: when older adults have a higher level of depression, those with younger subjective age reported a higher level of cognitive functioning than those with older subjective age.

Conclusion: Based on the findings from this study, both theoretical and practical implications were discussed.     

Predictors of subjective cognitive difficulties in older adults with atherosclerotic vascular disease.

OBJECTIVE: The objective of this study was to describe the relationship among cognitive test performance, psychological symptoms, and subjective cognitive difficulties in older adults with atherosclerotic vascular disease. METHOD: Participants were 80 adults over the age of 55 with an unequivocal diagnosis of atherosclerotic vascular disease. Participants completed measures of neuropsychological functioning, psychological symptoms, and two measures of subjective cognitive difficulties. RESULTS: Psychological symptoms were most strongly associated with higher levels of reported cognitive difficulties. Overall neuropsychological functioning was modestly related to subjective cognitive difficulties but did not remain significant after controlling for psychological symptoms. CONCLUSIONS: In this sample of older adults with atherosclerotic vascular disease, self-reported cognitive difficulties were most strongly related to overall level of psychological distress and not to actual cognitive test scores. Therefore, psychological factors may play an important role in the phenomenon of self-perceived cognitive decline in geriatric populations.     

Subjective and objective quality of life in schizophrenia

OBJECTIVE: Quality of life (QOL) is considered an important outcome in the treatment of schizophrenia, but the determinants of QOL are poorly understood in this population. Furthermore, previous studies have relied on combined measures of subjective QOL (usually defined as life satisfaction) and objective QOL (usually defined as participation in activities and relationships). We examined separately the clinical, functional, and cognitive predictors of subjective and objective QOL in outpatients with schizophrenia. We hypothesized that better subjective QOL would be associated with less severe negative and depressive symptoms, better objective QOL, and greater everyday functioning capacity, and that better objective QOL would be associated with less severe negative and depressive symptoms, better cognitive performance, and greater functional capacity. METHOD: Participants included 88 outpatients with schizophrenia or schizoaffective disorder who completed a comprehensive series of assessments, including measures of positive, negative, and depressive symptoms; performance-based functional skills; a neuropsychological battery; and an interview measure of subjective and objective QOL. RESULTS: In the context of multiple predictor variables, more severe depressive symptoms and better neuropsychological functioning were independent predictors of worse subjective QOL. More severe negative symptoms predicted worse objective QOL. Functional capacity variables were not associated with subjective or objective QOL. CONCLUSION: Treatments to improve QOL in schizophrenia should focus on negative symptoms and depressive symptoms.     

The association between depressive mood and cognitive performance in an elderly general population - the MEMO Study

The aim of this study was to analyse the influence of the severity of depressive symptoms on different domains of cognitive function in the elderly. In a population-based cross-sectional study, 385 participants aged 65-83 years were interviewed with the Center for Epidemiologic Studies Depression Scale (CES-D) and performed a standardized neuropsychological test assessing attention, memory, cognitive speed and motor function. Multivariate linear regression analyses revealed a significant effect of depressive symptoms on a single test (Stroop test 1) and two summary scores (memory and motor function). After full adjustment for education and Mini Mental State Examination, the memory score was partly attenuated. Stratified analysis showed that an increase in CES-D scores led to a larger decline of cognitive test results in participants with mild to moderate depressive symptoms, compared to those with a high degree of depressive symptoms. Our results suggest that depressive mood in older adults is primarily associated with decreased processing speed and motor functioning, but not executive control functions. According to our results depressive mood is not necessarily associated with memory deficits in older adults. Changes in depressive symptoms in milder forms of depressive mood are associated with a larger decline in cognitive function than in severer forms of depressive mood.     

Cognitive complaints in women with fibromyalgia: Are they due to depression or to objective cognitive dysfunction?

Introduction: Cognitive complaints are common in fibromyalgia, but it is unclear whether they represent an objective cognitive dysfunction or whether they could be explained by depressive symptoms. Here, we aim to elucidate the frequency of subjective cognitive complaints in a sample of women with fibromyalgia, in addition to analyzing associations between these subjective complaints and objective measures linked to the attention and executive cognitive domains. Finally, we aim to investigate the ability of demographic, clinical, and psychological variables to explain the subjective complaints observed. Method: One hundred and five women aged 30–55 years diagnosed with fibromyalgia completed a neuropsychological assessment, which included measures of attention and executive functions. They also completed self-report inventories of subjective cognitive complaints, depression, anxiety, intensity of pain, sleep quality, everyday physical functioning, and quality of life. Results: Eighty-four percent of the patients reported subjective cognitive complaints. Depression scores, everyday physical functioning, and working memory performance were most strongly associated with subjective cognitive complaints. These three variables were significant predictors for subjective cognitive complaints with a final model explaining 32% of the variance. Conclusions: Cognitive complaints are very frequent in patients with fibromyalgia, and these are related to functional and cognitive impairment as well as to depressive symptoms.     

Understanding reported cognitive dysfunction in older adults with cardiovascular disease

Older adults with cardiovascular disease (CVD) often report experiencing significant cognitive dysfunction in everyday life and exhibit deficits on neuropsychological testing. However, the relationship between subjective and objective cognitive dysfunction is inconsistent across studies and requires closer examination. Participants included 84 older adults with documented CVD and no history of neurological or severe psychiatric disorder. All participants underwent echocardiogram and neuropsychological assessment and completed self-report measures of perceived cognitive dysfunction, depression, and health-related quality of life. Results showed that concerns regarding distractibility and sustained attention were most common. Level of reported cognitive dysfunction was significantly related to depressive symptoms, quality of life, and performance on multiple cognitive tests. Exploratory regression analyses showed that depressive symptoms, physical health-related quality of life, and speeded sustained attention predicted reports of cognitive dysfunction, whereas demographic variables, cardiac output, and other cognitive tests did not. Should they be replicated, these findings suggest that reports of cognitive dysfunction in older adults with CVD largely reflect depressive symptoms and reduced quality of life.     

Social support and cognitive functioning as resources for elderly persons with chronic arthritis pain

Objective: Arthritis pain and depression are prevalent physical and psychological disorders in late life and co-occur frequently. We explored the stability and covariation of arthritis pain and depressive symptoms. We also addressed the influence of cognitive functioning and social support on the relationship between pain and depressive symptoms among community-dwelling older individuals.

Method: This longitudinal study utilized a sample of 299 residents of Florida retirement communities who participated in a long-term panel study using yearly assessments across 4 years. Using multilevel modeling, we modeled the individual differences as well as stability in arthritis pain and depressive symptoms simultaneously. Further, we tested the role of cognitive functioning and social support in the association between arthritis pain and depressive symptoms.

Results: We found substantial within-person variation in both pain and depressive symptoms (between 58% and 65%) across 4 years even after controlling for a time effect. After controlling for arthritis pain, persons with higher social support and higher cognitive functioning reported lower levels of depressive symptoms.

Discussion: Findings suggest that fluctuations in pain and depressive symptoms are common for older adults. Furthermore, social support and intact cognitive functioning may serve as useful resources, as they buffer the negative impact of arthritis pain on depressive symptoms.     

Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: a mixed-methods study

ABSTRACT

Objectives: In a rapidly aging world population, an increasingly large group faces age-related decline in cognitive functioning. Cognitive complaints of older adults are often related to worries and concerns associated with age-related functional decline. Mindfulness-Based Stress Reduction (MBSR) can successfully target stress, worry and ruminative thinking, but the applicability of this method in middle-aged and older adults with memory complaints is unclear.

Method: Patients of a university hospital memory clinic (n = 13), aged 45–85 years, with memory complaints but no diagnosis of cognitive disorder, participated in a standard 8-week MBSR program, consisting of weekly group meetings and a one-day silent retreat. After completion, semi-structured qualitative interviews were conducted. Questionnaires (administered before, one week after and five weeks after the intervention) assessed quality of life, psychological distress (stress, anxiety and depressive symptoms), mindfulness, self-compassion, and subjective memory functioning. Neurocognitive functioning was assessed online, before and after the intervention.

Results: The qualitative analysis showed positive effects of the training (e.g. increased serenity), many participants worrying less about memory complaints. The self-reported measures were in line with the results of the qualitative analysis.

Conclusion: This exploratory mixed-methods study suggests that MBSR is feasible and well received among older individuals with cognitive complaints.     

Memory self-appraisal and depressive symptoms in people at genetic risk for Alzheimer's disease.

OBJECTIVES: A previous study found that subjective memory loss in middle-aged and older persons is associated with the major genetic risk for Alzheimer's disease, the apolipoprotein E-4 (APOE-4) allele. No previous study has focused on subjective memory complaints and depressive symptoms in the same subject population at genetic risk for Alzheimer's disease. METHOD: Sixty-six persons (mean age = 64 years, range = 43 to 82 years) without major depression or dementia but with mild age-related memory complaints were rated for severity of depressive symptoms, using the Hamilton Depression Rating Scale, and assessed for the presence of the APOE-4 allele. Severity of subjective memory loss was assessed using the Memory Functioning Questionnaire, which measures four memory domains: frequency of forgetting, seriousness of forgetting, retrospective functioning, and mnemonics usage. RESULTS: Depressive symptoms were significantly associated with subjective memory loss in subjects without the APOE-4 allele, for retrospective functioning (perceived change in memory) and mnemonics usage, but not in APOE-4 carriers. The same significant associations were found when the analysis was limited to the 44 subjects in the mid-age range (55-74 years), wherein APOE-4 confers its greatest effects on risk for Alzheimer's disease. CONCLUSION: These results confirm that mild depressive symptoms are related to subjective memory loss, but for some forms of memory complaint, the relationship holds true only for people without the major known genetic risk for Alzheimer's disease.     

The association between depressive and cognitive symptoms in amnestic mild cognitive impairment

BACKGROUND: Depressive symptoms are frequently observed in older adults with mild cognitive impairment (MCI). However, little is known regarding the cognitive characteristics of this important subgroup. METHODS: We examined executive functions (controlled inhibition) and verbal episodic memory in 33 healthy older adults (control group), 18 older adults with amnestic MCI plus subclinical depressive symptoms (a-MCI/D+ group), and 26 older adults with amnestic MCI but no depressive symptoms (a-MCI group). RESULTS: Compared to the a-MCI and control groups, patients with a-MCI/D+ showed poor controlled inhibition. Moreover, in verbal episodic memory these patients recalled fewer words than control participants on immediate free, delayed free, and delayed total (free plus cued) recall. Performance on immediate recall suggested a self-retrieval deficit, but delayed performance also revealed the existence of an encoding impairment. In the a-MCI group, participants exhibited normal performance on the executive task, but pervasive memory impairment; the memory deficit concerned free and total recall on both immediate and delayed tasks, suggesting the existence of encoding and self-retrieval disturbances. CONCLUSIONS: This study reveals differences between the pattern of cognitive impairment for a-MCI/D+ and a-MCI subgroups particularly at the level of executive capacities. In terms of memory functioning, the differences between the subgroups were more subtle; more studies are needed in order to better characterize the memory impairment of a-MCI/D+ and a-MCI patients.     

What do subjective cognitive complaints in persons with aging-associated cognitive decline reflect?

BACKGROUND: Subjective cognitive complaints have been included in diagnostic concepts such as Aging-Associated Cognitive Decline (AACD) aiming to identify older adults with cognitive impairments at high risk of developing dementia. Although several studies in normal aging have found that subjective cognitive complaints are related to depressive affect and personality factors, little is known as to whether this is also true for older adults with AACD. METHODS: In 123 older adults diagnosed with AACD and 291 controls, the role of actual cognitive performance, depressive affect, neuroticism and conscientiousness in predicting subjective cognitive complaints was investigated. In separate ordinary least squares regression analyses for both groups with gender, age, years of schooling, cognitive performance, depressive affect, neuroticism and conscientiousness as predicting variables, in the control participants, gender, age, depressive affect and neuroticism were related to subjective cognitive complaints, whereas in the AACD participants only gender and neuroticism accounted for variance in subjective cognitive complaints. Testing for group differences in predictive power, revealed differential effects for gender, depressive affect and neuroticism. CONCLUSIONS: As subjective cognitive complaints in the AACD group were related to neuroticism and gender rather than to cognitive performance, their inclusion in diagnostic concepts such as AACD should be revaluated. However, the nature of subjective cognitive complaints might be qualitatively different in persons diagnosed with AACD compared to those stated by normal older adults.     

Cerebral infarctions and the relationship of depression symptoms to level of cognitive functioning in older persons.

OBJECTIVE: Recent studies report an association between depressive symptoms and cognitive impairment in old age. The neurobiologic basis of this association is unknown. The authors examined whether cerebral infarcts (present in 55 persons) accounted for the association of depressive symptoms with cognitive impairment in a group of 153 older Catholic nuns, priests, and brothers (67 with dementia and 86 without dementia). METHODS: Subjects underwent detailed clinical evaluations and brain autopsy at death. RESULTS: Mean values for depressive symptoms during the time of participation were associated with level of cognitive functioning proximate to death in analyses that controlled for age, sex, education, and Alzheimer disease (AD) pathology. The association of depressive symptoms with cognitive functioning was essentially unchanged after controlling for cerebral infarctions, which suggests that depressive symptoms, cerebral infarctions, and AD pathology were independently related to cognitive function. Similar results were found in analyses with episodic memory, semantic memory, working memory, perceptual speed, and visual-spatial ability. The results did not change in analyses examining the volume or location of cerebral infarctions. CONCLUSIONS: These data suggest that cerebral infarctions do not account for the association of depressive symptoms with level of cognitive functioning. The neurobiologic basis for this association remains to be elucidated.     

Chronic medical conditions and wishes to die among older primary care patients

OBJECTIVE: To determine the prevalence of wishes to die and the medical correlates of wishes to die among primary care patients aged 65 years and older. METHOD: Three-hundred and fifty-five adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate completed a baseline in-home assessment. Participants were interviewed using standardized measures of medical conditions, functional status, and psychological status. Thoughts of death and wishes to die were assessed with standard questions from the Composite International Diagnostic Interview (CIDI) Depression Section. RESULTS: The weighted point prevalence of thoughts of death was 9.7% and 6.1% for the wish to die. Several medical conditions were associated with a wish to die, for example myocardial infarction (MI). In multivariate models that adjusted for potentially influential characteristics, the association between a history of MI and the wish to die remained statistically significant (odds ratio (OR) = 3.32, 95% confidence interval (CI) (1.26, 8.75). CONCLUSIONS: Thoughts of death and a wish to die are common in older primary care patients and were more likely among persons with chronic medical conditions. Persons with a history of myocardial infarction may be particularly vulnerable to a wish to die.     

Neuropsychological correlates of self-reported depression and self-reported cognition among patients with mild cognitive impairment

Patients with mild cognitive impairment (MCI) frequently experience significant depressive symptomatology and report cognitive disturbances. To date, no studies have examined the relationship between MCI patients' neuropsychologic functioning, self-reported depressive symptoms, and self-reported cognitive difficulties. In this study, 82 MCI patients completed a comprehensive neuropsychological evaluation that included the Beck Depression Inventory (BDI). A subset of 41 patients and informants also completed a measure of cognitive difficulties. Poorer memory functioning was associated with fewer self-reported depressive symptoms and fewer cognitive complaints.     

Memory complaints in young and elderly subjects.

OBJECTIVE: To compare the quantitative and qualitative aspects of memory complaints in cognitively normal subjects aged under and above 50 years. SETTING: A memory clinic located in a general hospital in a suburb of Paris offering direct access to subjects. DESIGN: Retrospective review of the files of consecutive patients who attended the clinic during one year. PARTICIPANTS: Subjects were included if (a) they presented with memory complaints, (b) they had normal general cognitive functioning according to age and educational level, (c) they were devoid of present or past history of neurologic or psychiatric disorders. METHODS: Subjects rated the severity of memory complaints as major or minor and filled in a 8-item questionnaire assessing various memory difficulties in everyday life. Relationship between severity of memory complaints and demographic data, memory performance and affective status was compared in 183 non-depressed, non-cognitively impaired healthy adults aged 50 years and over, and in 77 younger adults. RESULTS: Semiologic aspects and correlates of memory complaints were similar in younger and older adults. No close relationship was found between severity of memory complaints and memory performance. In both age groups, memory complaints were strongly related to affective status, mainly to the severity of anxious symptomatology. Memory complaints were related to gender in younger subjects, and to subjective assessment of well-being in older. CONCLUSION: Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age.     

Psychopathology and cognition in schizophrenia spectrum disorders: the role of depressive symptoms.

The cognitive correlates of five symptom dimensions based on PANSS ratings were examined in a group of 50 recent onset psychotic patients, using both objective and subjective cognitive measures. We were particularly interested in the depression dimension, since it has not been studied extensively thus far. The depression dimension showed a high number of correlations with both objective and subjective cognitive measures, such as problems with simple and divided attention, psychomotor slowing and subjectively experienced distractibility, overload and diminished attentional control. The other dimensions, including negative symptoms, have less cognitive correlates. It is possible that previous studies based on a three-dimensional model confounded correlates of negative symptoms with correlates of depressive symptoms. The results of this study suggest the need for more research into the mechanisms underlying the relationship between depressive symptoms and cognitive functioning in schizophrenia, and that patients with depressive symptoms are less efficient in information processing, but can compensate by investing more mental effort. Because subjective cognitive measures were related to mental effort in previous research, they can be a useful tool in future research.     

Subjective memory complaints: a review of patient self-assessment of memory after electroconvulsive therapy

Interest in patients' subjective complaints about the adverse cognitive effects of electroconvulsive therapy (ECT) spans several decades. This article reviews the major areas that have been examined in relation to patients' subjective assessment of memory function: 1) technical aspects in the administration of ECT; 2) objective tests of cognitive function; and 3) clinical state. For the most part, subjective assessments of memory following ECT have relied on a single instrument, the Squire Subjective Memory Questionnaire (SSMQ). While older reports of the impact of the technical aspects of ECT on subjective memory assessment following ECT suggest a detectable negative influence with certain forms of treatment, most recent studies indicate that subjective memory improves following ECT. This shift in findings may be due to the change in practice from sine wave to brief-pulse ECT. While the impact of ECT on objective tests of memory is clear and reproducible, the relationship of objective findings to subjective memory assessment appears to be weak. Instead, subjective reports of cognitive function are strongly influenced by mood state. Current batteries of objective tests of memory may not include components that are most affected in reports about subjective memory. In addition, the literature mainly reports group effects, and sample sizes have been small. We lack data on the number of individuals who believe ECT has had a markedly negative effect on memory functioning, and on the characteristics of memory function in this subgroup of patients who complain of severe impairment. Furthermore, there is a paucity of information relating patient characteristics to subjective memory outcomes with ECT.