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.     

Do memory complaints represent impaired memory performance in patients with major depressive disorder?

Memory complaints are found to be associated with depression. However, the question is, “How much these subjective complaints indicate objective memory impairments?” The aim of this study is to determine whether subjective memory complaints represent objective memory impairments and to establish the demographic and clinical characteristics of patients with major depressive disorder (MDD) and subjective memory complaints. Sixty‐four patients with MDD were assessed for objective memory performance through subtests of the Wechsler Memory Scale‐III. Memory complaints also were assessed in these patients with a structured interview. Thirty healthy controls were also included in the study to compare memory performance among groups. The Hamilton Rating Scale for Depression was used to measure the severity and characteristics of depression. Patients with MDD who had longer duration and earlier onset of depression reported more memory complaints. MDD patients with memory complaints had more hypochondriac concerns but not more depression severity compared with those without memory complaints. There was no relationship between subjective memory complaints and objective memory performance in MDD patients. Patients with MDD with and without memory complaints had lower scores on the Wechsler Memory Scale‐III than the control group. Subjective memory complaints are not a valid indictor of objective memory impairments, and the diagnostic value of self‐reported memory is being questioned in patients with MDD. The cognitive status of MDD patients should be assessed routinely, regardless of the patient awareness of his or her cognitive deficits. Depression and Anxiety, 2008. © 2007 Wiley‐Liss, Inc.     

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program

OBJECTIVE: To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. METHOD: The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. RESULTS: Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. CONCLUSION: These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.     

Subjective memory complaints in an elderly sample: a cross-sectional study

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.     

HIV-infected persons with bipolar disorder are less aware of memory deficits than HIV-infected persons without bipolar disorder

Episodic memory deficits are common in HIV infection and bipolar disorder, but patient insight into such deficits remains unclear. Thirty-four HIV-infected individuals without bipolar disorder (HIV+/BD-) and 47 HIV+ individuals with comorbid bipolar disorder (HIV+/BD+) were administered the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised to examine objective learning/memory functioning. Subjective memory complaints were assessed via the memory subscale of the Patient's Assessment of Own Functioning Inventory. HIV+/BD+ individuals performed poorer on tests of visual learning and visual/verbal recall than did HIV+/BD- participants (ps < .05). Memory complaints only predicted verbal learning (at a trend level, p = .10) and recall (p = .03) among the HIV+/BD- individuals. Memory complaints were not associated with memory performance within the HIV+/BD+ group (ps > .10). Memory complaints were associated with depressive symptoms in both groups (ps < 0.05). These complaints were also predictive of immunosuppression, higher unemployment, and greater dependence on activities of daily living among the HIV+/BD+ individuals (ps < .05). Awareness of memory abilities was particularly poor among HIV+/BD+ individuals (i.e., objective learning/memory did not correspond to reported complaints), which has important implications for the capacity of these individuals to engage in error-monitoring and compensatory strategies in daily life. Memory complaints are associated with depressed mood regardless of group membership. Among HIV+/BD+ individuals, these complaints may also signify worse HIV disease status and problems with everyday functioning. Clinicians and researchers should be cognizant of what these complaints indicate in order to lead treatment most effectively; use of objective neurocognitive assessments may still be warranted when working with these populations.     

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.     

Memory complaints and APOE-epsilon4 accelerate cognitive decline in cognitively normal elderly.

OBJECTIVE: To investigate to what extent subjective memory complaints and APOE-epsilon4 allele carriage predict future cognitive decline in cognitively intact elderly persons, by evaluating both their separate and combined effects. METHODS: We selected 1,168 subjects from the population-based Longitudinal Aging Study Amsterdam who were 62 to 85 years of age and had no obvious cognitive impairment at baseline (Mini-Mental State Examination [MMSE] score, > or =27). Memory complaints and APOE phenotypes were assessed at baseline. MMSE, the Auditory Verbal Learning Test (memory: immediate recall and delayed recall), and the Alphabet Coding Task-15 (information processing speed) were used to study cognitive decline. Follow-up data were collected after 3 and 6 years. Data were analyzed with generalized estimating equations, adjusted for age, sex, education, and depression. RESULTS: Baseline memory complaints were reported by 25.5% of the cognitively intact elderly persons. Overall, 25.3% of the subjects were carriers of at least one APOE-epsilon4 allele. Memory complaints were associated with a greater rate of decline in all cognitive measures, except immediate recall. In addition, APOE-epsilon4 allele carriers had a greater rate of cognitive decline shown by MMSE scores and slower information processing speeds after 6 years. The effects of both memory complaints and APOE-epsilon4 allele carriage were additive: subjects with both factors had a two times higher cognitive decline than did subjects without both factors. CONCLUSIONS: Both memory complaints and APOE-epsilon4 allele carriage predict cognitive decline at an early stage. This finding highlights the importance of subjective memory complaints, which are important even at an early stage when objective tests are still unable to detect cognitive deficits and are especially important for elderly carriers of the APOE-epsilon4 allele because they have an additional risk.     

Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients

Memory complaints are common after stroke, yet there have been very few studies of the outcome of memory rehabilitation in these patients. The present study evaluated the effectiveness of a new manualised, group-based memory training programme. Forty outpatients with a single-stroke history and ongoing memory complaints were enrolled. The six-week course involved education and strategy training and was evaluated using a wait-list crossover design, with three assessments conducted 12?weeks apart. Outcome measures included: tests of anterograde memory (Rey Auditory Verbal Learning Test: RAVLT; Complex Figure Test) and prospective memory (Royal Prince Alfred Prospective Memory Test); the Comprehensive Assessment of Prospective Memory (CAPM) questionnaire and self-report of number of strategies used. Significant training-related gains were found on RAVLT learning and delayed recall and on CAPM informant report. Lower baseline scores predicted greater gains for several outcome measures. Patients with higher IQ or level of education showed more gains in number of strategies used. Shorter time since onset was related to gains in prospective memory, but no other stroke-related variables influenced outcome. Our study provides evidence that a relatively brief, group-based training intervention can improve memory functioning in chronic stroke patients and clarified some of the baseline factors that influence outcome.     

The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy.

OBJECTIVE: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. METHODS: From three epilepsy centers in the USA, 138 patients were recruited. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Mood States, POMS). RESULTS: Memory performance scores were weakly correlated with perceived cognitive functioning (r =0.22, P < 0.01). Perceived cognitive functioning was strongly correlated with mood (r = - 0.75, P < 0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (P < 0.02); however, the explained variance for RBMT and POMS combined (R2 = 0.58) is only slightly higher than the predictive value for the POMS score alone (R2 = 0.56). CONCLUSIONS: Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.     

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.     

An unblinded comparison of the clinical and cognitive effects of switching from first-generation antipsychotics to aripiprazole, perospirone or olanzapine in patients with chronic schizophrenia

The objective of this study, the effect of aripiprazole on clinical symptoms and cognitive function in patients with chronic schizophrenia was compared to that of perospirone and olanzapine. The subjects were 31 patients, they were diagnosed with schizophrenia on the basis of the criteria of the DSM-IV. Clinical symptoms were assessed using Brief Psychiatric Rating Scale (BPRS), and cognitive function was assessed using the Wisconsin Card Sorting Test (Keio Version: KWCST) and the St. Marianna University School of Medicine's Computerized Memory Test (STM-COMET) as executive function and memory/attention function tests at baseline and 8 weeks after switching. As a result, comparison of the BPRS mean total score revealed no significant difference between aripiprazole and the other medications. Aripiprazole resulted in significant changes in the number of categories achieved (CA) and difficulty maintaining set (DMS) compared to olanzapine at the second level of the KWCST. Comparison thus revealed no difference in clinical effect between aripiprazole and the other medications, but might suggest possible differences between aripiprazole and olanzapine in the profiles of the improvement effects on executive function, memory, and attention function.     

Fatigue – but not mTBI history,PTSD, or sleep quality – directly contributes to reduced prospective memory performance in Iraq and Afghanistan era Veterans

Abstract

Objective: Memory problems that affect daily functioning are a frequent complaint among Veterans reporting a history of repetitive mild traumatic brain injury (mTBI), especially in cohorts with comorbid PTSD. Here, we test the degree to which subjective sleep impairment and daytime fatigue account for the association of PTSD and self-reported mTBI history with prospective memory. Method: 82 Veterans with and without personal history of repeated blast-related mTBI during deployment were administered the Clinician Administered PTSD Scale (CAPS), Memory for Intentions Test (MIST), Patient Health Questionnaire-9 (PHQ-9), Neurobehavioral Symptom Inventory (NSI), and the Pittsburgh Sleep Quality Index (PSQI). Relationships between self-reported mTBI, PTSD, self-reported poor sleep and daytime fatigue, and MIST performance were modeled using partial least squares structural equation modeling (PLS-SEM). Results: Reported daytime fatigue was strongly associated with poorer prospective memory performance. Poor subjective sleep quality was strongly and positively associated with reported daytime fatigue, but had no significant direct effect on prospective memory performance. PTSD diagnosis and self-reported mTBI history were only associated with prospective memory via their impact on subjective sleep quality and daytime fatigue. Conclusions: Results suggest that daytime fatigue may be a mediating factor by which both mTBI and PTSD can interfere with prospective memory. Additional attention should be given to complaints of daytime fatigue, independent of subjective sleep quality, in the clinical care of those with a self-reported history of mTBI, and/or PTSD. Further research into whether interventions that decrease daytime fatigue lead to improvement in prospective memory and subjective cognitive functioning is warranted.     

Memory Complaints Before and After Temporal Lobectomy: Do They Predict Memory Performance or Lesion Laterality?

Summary: The relationships among self-report of memory, actual memory performance on objective tasks, and lesion laterality were examined in this longitudinal study. Right-handed adults (n = 47) with medically intractable seizures were assessed both preoperatively and 1 year after a left or right temporal lobectomy. Memory complaints remained stable or diminished postoperatively, whereas performance on material-specific memory tasks declined. Regression analyses showed that dosage of medications, seizure frequency and self-reported depression were predictive of postoperative memory complaints, although size of resection and age were not. Together, these data suggest that many patients have a positive though mistaken impression that their memory functions improved after temporal lobectomy, an impression influenced by their positive surgical outcomes. Memory complaints did not predict laterality of the lesion. Sex-laterality interactions were evident for both subjective and objective memory measures.     

Memory self-appraisal in middle-aged and older adults with the apolipoprotein E-4 allele.

OBJECTIVE: Because subjective memory complaints may indicate subtle functional brain abnormalities, the authors studied the influence of the major genetic risk for Alzheimer's disease, the apolipoprotein E-4 (APOE-4) allele, on self-reports of memory performance in middle-aged and older adults. METHOD: Subjective and objective assessments of memory performance were compared in relation to the presence or absence of the APOE-4 allele in 39 cognitively intact persons with mild memory complaints. RESULTS: Subjects with the APOE-4 allele had lower scores on objective verbal memory and on the subjective memory measure for retrospective functioning. Among the subjects in the age range where APOE-4 has its greatest influence on the risk of Alzheimer's disease (55-74 years), the APOE-4 group had lower scores on the subjective memory measure for frequency of forgetting. Moreover, the standardized difference in retrospective functioning scores between the two genetic risk groups increased when the mid-age-range group was examined rather than the whole study group. CONCLUSIONS: The APOE-4 allele is associated with increased subjective memory impairment in middle-aged and older adults. Longitudinal studies of age-related memory loss should include genetic risk and subjective memory measures as potential predictors of decline.     

Validity of cognitive complaints in substance-abusing patients and non-clinical controls: The Patient's Assessment of Own Functioning Inventory (PAOFI)

To determine the validity of substance-abusing (SA) patients' self-reports of cognitive impairments, we assessed the independent contributions of depression, actual neurocognitive performance and an index of cognitive decline, in predicting cognitive complaints in groups of SA patients and normal controls. The SA sample comprised 74 veterans enrolled in day treatment. The non-clinical sample consisted of 150 English-speaking adults. Assessment instruments were as follows: A modified version of the Patient's Assessment of Own Functioning Inventory (PAOFI) containing three subscale on: Memory, Language and Communication, and Higher Cognitive Functions; the Beck Depression Inventory; a battery of neuropsychological tests that measured domains of executive function, processing speed, verbal fluency and verbal and visual memory; and a measure of premorbid intellectual functioning. SA patients reported twice as many PAOFI complaints as non-clinical controls. SA patients' neuropsychological performance was lower than that of non-clinical controls. A higher percentage of SA patients had significant cognitive decline. The SA sample reported more depression. There was no association between PAOFI scores and neuropsychological performance for either group. PAOFI results were not associated with cognitive decline. BDI scores accounted for 12% of the variance in PAOFI total score for the SA sample and 44% for the non-clinical sample in multiple regression analysis. Cognitive complaints were related more to depression than cognitive performance for both SA and non-clinical samples. The results do not support self-report as a valid means of neuropsychological assessment in SA samples, although self-reports may provide other information about perceived cognitive difficulties that may be relevant to clinical evaluation.     

Neuropsychological impairment in fibromyalgia: relation to depression, fatigue, and pain

OBJECTIVE: The present study assessed the relationship of depression, pain, and fatigue to subjective cognitive complaints and objective impairment in patients with fibromyalgia (FM), patients with other chronic pain disorders, and healthy controls. METHOD: Neuropsychological assessment was conducted on 28 FM patients, 27 chronic pain patients, and 21 healthy controls. Five FM patients and five chronic pain patients were excluded due to poor effort on cognitive tasks. Assessment included measures of depression, pain, fatigue, subjective cognitive complaints, memory, executive functioning, intellect, attention, and psychomotor speed. Analysis of covariance was used to assess group differences in cognitive complaints and cognitive test performance, after controlling for depression, pain, and fatigue. Hierarchical regression was used to assess whether objective test performance was related to subjective cognitive complaints, after controlling for depression, pain, and fatigue. RESULTS: FM patients had more memory complaints and reported more fatigue, pain, and depression than other groups. Groups were not different in cognitive performance, after controlling for fatigue, pain, and depression; depression was related to memory performance and fatigue was related to psychomotor speed. Neuropsychological test results did not add significantly to the variance accounted for in subjective cognitive complaints, after accounting for depression, pain, and fatigue. CONCLUSION: Psychological factors, particularly effort, depression, and fatigue, are important in understanding both subjective cognitive complaints and objective cognitive impairment in FM and other chronic pain disorders.     

Memory complaints in older adults. Fact or fiction?

Complaints of poor memory by patients may be an early symptom of a pathologic process like Alzheimer's disease. It is therefore important to determine if patients' complaints of memory impairments are an accurate reflection of real memory disturbance. The relationship between memory complaints (metamemory) and objective memory performance, mood, age, verbal intelligence, and sex was examined in a group of 199 healthy, community dwelling adults (39 to 89 years old). Memory complaints demonstrated a stronger association with depressed mood than with performance on memory tests. Increasing reports of depressive symptoms were associated with more overall memory complaints. Verbal intelligence, age, and sex also contributed to memory complaints. Patients with higher verbal intelligence reported fewer complaints and placed less emphasis on forgetting. Older individuals reported greater frequency of forgetting and greater frequency of using memory techniques. Specific types of memory complaints, seriousness of forgetting, and types of memory aids employed are also described. These results showed that self-rating of memory disturbance by older adults may be related more to depressed mood than to poor performance on memory tests.     

Lateralization of deficit in self-awareness of memory in patients with intractable epilepsy

PURPOSE: Memory disorders are prominent among patients with intractable epilepsy. It has, however, been frequently observed that subjective memory complaints of these patients did not match their performance on objective memory tests. This discrepancy may reflect emotional, cognitive, or self-awareness deficits among these individuals. The aim of the current study was to explore the interference of cerebral dysfunction on accuracy of self-appraisal for memory. METHODS: The degree of concordance between self-perception of memory function, as measured by a visual analogue scale, and actual performance on memory tests was computed in 35 patients who were candidates for epilepsy surgery and demographically matched normal control subjects. The difference between the self-estimated memory ability and performance on memory tests and its relation to the laterality of an epileptogenic lesion, cognitive factors, and affective status was then examined. RESULTS: The results show that the discrepancy between the self-estimated memory ability and performance on memory tests in patients with right hemisphere epileptogenic lesions was significantly larger in magnitude compared with that in patients with left hemisphere lesions and demographically matched control subjects (p = 0.001). Furthermore, whereas patients with left hemisphere lesions and normal controls had about an equal number of positive and negative discrepancy scores, all patients with right hemisphere lesions had positive discrepancy scores, suggesting a tendency for overestimation of memory abilities. CONCLUSIONS: These results suggest that right hemisphere lesions may introduce a systematic bias in self-awareness for memory. This bias may color patients' perceptions of self and others, affecting their perceptions of the quality of life, and necessitating an adjustment of the treatment goals and procedures.     

Differential sensitivity of the Response Bias Scale (RBS) and MMPI-2 validity scales to memory complaints

The MMPI-2 Response Bias Scale (RBS) is designed to detect response bias in forensic neuropsychological and disability assessment settings. Validation studies have demonstrated that the scale is sensitive to cognitive response bias as determined by failure on the Word Memory Test (WMT) and other symptom validity tests. Exaggerated memory complaints are a common feature of cognitive response bias. The present study was undertaken to determine the extent to which the RBS is sensitive to memory complaints and how it compares in this regard to other MMPI-2 validity scales and indices. This archival study used MMPI-2 and Memory Complaints Inventory (MCI) data from 1550 consecutive non-head-injury disability-related referrals to the first author's private practice. ANOVA results indicated significant increases in memory complaints across increasing RBS score ranges with large effect sizes. Regression analyses indicated that the RBS was a better predictor of the mean memory complaints score than the F, F(B), and F(P) validity scales and the FBS. There was no correlation between the RBS and the CVLT, an objective measure of verbal memory. These findings suggest that elevated scores on the RBS are associated with over-reporting of memory problems, which provides further external validation of the RBS as a sensitive measure of cognitive response bias. Interpretive guidelines for the RBS are provided.     

No association between subjective memory complaints and apolipoprotein E genotype in cognitively intact elderly

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.