Subjective memory assessment and test performance in elderly adults

The everyday memory of a group of elderly adults was assessed using techniques developed for use with younger head-injured people (Sunderland et al., 1983). The participants completed a memory questionnaire and a daily checklist; their spouses gave their assessment using a separate questionnaire. These subjective methods showed only moderate agreement, and the questionnaire had low test-retest reliability. It appears that these methods of subjective memory assessment have little validity when used with normal elderly adults. Two positive findings did emerge: As in previous studies, a story recall test was the strongest predictor of reported memory performance; and despite a universal belief among elderly adults that their memory had deteriorated with age, very few of them felt that they were at all handicapped by forgetfulness in everyday life.     

Refining memory assessment of elderly people with cognitive impairment: Insights from the short-term memory binding test

Alzheimer's disease (AD) affects temporary memory for bound features more remarkably than for individual features. Such selective impairments manifest from presymptomatic through dementia stages via titration procedures. A recent study suggested that without titration and with high memory load the binding selectivity may disappear in people at risk of AD such as those with Mild Cognitive Impairment (MCI). We compared data from two studies on temporary binding which assessed people with MCI and controls using different memory loads (2 or 3 items). Selective binding impairments were found in MCI, but relative to controls, such selectivity was contingent upon memory load (i.e., present with 2 items). Further analysis with MCI people who tested positive to neuroimaging biomarkers (i.e., hippocampal atrophy) confirmed that this specific binding impairments are a feature of prodromal AD. The temporary binding task has been recently suggested by consensus papers as a potential screening tool for AD. The results presented here inform on task properties that can maximize the reliability of this new assessment tool for the detection of memory impairments in prodromal cases of AD.     

Problems in the clinical assessment of memory

The purpose of this paper is to examine the current state of clinical memory testing in the light of recent theoretical and experimental advances in the study of human memory. It recounts some of the purposes of memory testing and inadequacies in the tests currently available. A brief review of information processing theory and experimental findings with Korsakoff patients and aged normals provides a number of considerations that must be attended to in developing more adequate memory tests in the future.     

Issues in clinical trials with the depressed elderly

Despite the fact that there is a high prevalence of depression among the elderly, little research on the efficacy of psychotherapy or pharmacotherapy with the elderly has been reported in the literature. This paper describes a sample of 18 elderly patients who received both psychotherapy and pharmacotherapy for the treatment of depression. Psychotherapy involved weekly 30-50 minutes sessions of interpersonal psychotherapy with a treating psychiatrist. The drug treatment consisted of random assignment, double-blind, to either alprazolam, imipramine, or pill-placebo for six weeks. The focus of therapy was on the attendance, compliance, and symptomatic relief in elderly depressed patients, as well as on the major life problems identified by these patients in psychotherapy. Results indicated that elderly patients respond to community publicity regarding a psychotherapy treatment program. However, the majority are inappropriate referrals for diagnostic reasons. If accepted, elderly patients showed good compliance with drugs, and attendance was comparable to that in younger populations. The elderly patients responded well to treatment, with immediate and marked improvement on the Hamilton and Raskin Depression Scales, which was maintained after treatment. Grief and role transitions specific to life changes were frequent antecedents to depression in this elderly population and thus were the major foci in psychotherapy.     

Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men

Circulating testosterone (T) levels have behavioral and neurological effects in both human and nonhuman species. Both T concentrations and neuropsychological function decrease substantially with age in men. The purpose of this prospective, longitudinal study was to investigate the relationships between age-associated decreases in endogenous serum T and free T concentrations and declines in neuropsychological performance. Participants were volunteers from the Baltimore Longitudinal Study of Aging, aged 50-91 yr at baseline T assessment. Four hundred seven men were followed for an average of 10 yr, with assessments of multiple cognitive domains and contemporaneous determination of serum total T, SHBG, and a free T index (FTI). We administered neuropsychological tests of verbal and visual memory, mental status, visuomotor scanning and attention, verbal knowledge/language, visuospatial ability, and depressive symptomatology. Higher FTI was associated with better scores on visual and verbal memory, visuospatial functioning, and visuomotor scanning and a reduced rate of longitudinal decline in visual memory. Men classified as hypogonadal had significantly lower scores on measures of memory and visuospatial performance and a faster rate of decline in visual memory. No relations between total T or the FTI and measures of verbal knowledge, mental status, or depressive symptoms were observed. These results suggest a possible beneficial relationship between circulating free T concentrations and specific domains of cognitive performance in older men.     

Imagery pretraining and memory training in the elderly

Two groups of elderly subjects were taught a standard mnemonic to improve a common memory complaint among elders, face-name recall. One group (imagery group) was first taught techniques to improve visual imagery ability before learning the mnemonic while the other group (control group) was taught a nonspecific method to improve attitudes before learning the mnemonic. Overall performance on face/name recall was significantly better in the imagery group than in the control group. These results may have implications for the use of imagery based mnemonics for memory training in elderly populations.     

老年人的记忆障碍及治疗

记性不好或健忘是老年人经常碰到的问题。许多老年朋友抱怨记忆不如以前好，有前事后忘的感觉。不少人因此而忧虑，担心是否患有老年期痴呆症。这种担心并非没有道理，的确，记忆减退特别是近记忆减退往往是老年痴呆的最早表现。痴呆是一种脑功能障碍综合征，指既往已获得的认知功能的减退或丧失。记忆只是认知功能的重要组成部分之一。因此，老年人记性不好并不一定就意味着患有痴呆，应视具体情况具体分析。     

Geriatric assessment in the elderly cancer patient

Lost and remaining functions are of special importance in geriatric medicine. The level of functional deficits ultimately determines the remaining quality of life and the patient's ability to continue independently. In contrast, the actual severity of a disease measured by common standards becomes less important. Geriatric assessment is increasingly used to describe the impact of disease and to focus on the functional losses and problems that are particularly relevant to the individual elderly patient. When developing a treatment plan for older cancer patients, it is essential to consider the functional deficits caused by age-related changes or comorbidity, the remaining compensation mechanisms and the patient's expectations. Cancer treatment has to be adapted to the individual needs of elderly patients. As the number of cancer patients is rising in all areas of medical practice, a close collaboration between oncologists and geriatricians will become increasingly important. Received: 12 January 2000 / Accepted: 25 January 2000     

Medical assessment of the elderly patient

The major differences in evaluation of old individuals arise in the way one collects data, the attention to detail in physical examination, and the high suspicion for disease required when nonspecific complaints are made. There is no doubt that it takes longer to assess an old person, but the clinician who is familiar with evaluating old people watches in every interaction for subtle clues that might point toward diagnosis. The successful therapeutic interventions in many old people, especially when disease is detected early, should be adequate incentive to take the extra steps necessary for proper evaluation of the elderly individual.     

The assessment of cognitive function in the elderly

Evidence of impaired cognitive function requires careful evaluation to arrive at correct diagnosis and, possibly, treatment. Steps in this evaluation that might be undertaken in primary care are enumerated and discussed. The role of brief formal tests of cognitive functions in such an evaluation is emphasized.     

Echocardiographic assessment of aortic stenosis in the elderly

Aortic stenosis is one of the most common valvular conditions affecting the elderly population. This article reviews the echocardiographic assessment of aortic stenosis in the elderly including the advantages and limitations of different modalities and the potential role of 3-dimensional echocardiography in this special population.     

不同年龄健康人项目记忆和源记忆变化的比较研究

目的研究国人儿童、青年人和老年人项目记忆及源记忆的变化,探索源记忆与项目记忆相互分离的证据,检验额叶参与源记忆加工的假说。方法选用实义词和实物简图,分别测试健康儿童、青年人和健康老年人的项目记忆及源记忆每组40名。结果青年组和儿童组项目记忆成绩差异无统计学意义[记忆区别度(Pr)值分别为0．73±0．14和0．74±0．11,P＞0．05],源记忆成绩差异有统计学意义[源记忆正确度(Ⅰ值)分别为0．87±0．08和0．73±0．1 3,P＜0．01]。与青年组比较,老年组虽有项目记忆减退(Pr值为0．66±0．15,P＜0．05),但源记忆的减退更为显著(Ⅰ值为0．68±0．1 3,P＜0．01)。在儿童和老年组中项目记忆和源记忆成绩存在双分离。结论项目记忆和源记忆双分离的结果支持其为情景记忆的双通道假说。推测额叶参与了源记忆的执行。老年人源记忆较项目记忆损伤明显的结果提示,源记忆测查可能有助于轻度认识障碍(MCI)的诊断。     

老年人记忆衰退的神经生物学基础研究进展

衰老是不可逆的生命过程,伴随衰老个体生理功能逐渐衰减和退化。随着年龄的增长,老年人将经历包括记忆在内的众多认知功能的进行性衰退。老年人记忆衰退通常与脑内细胞生理过程受损相关。能量代谢障碍将直接损伤老年人记忆能力,神经炎症的过度发生及异常代谢物的积累等都将对老年人大脑微环境产生严重的损伤,从而导致记忆衰退。本文从能量代谢、神经炎症等众多与记忆相关的生理过程的角度出发,对近年来有关老年人记忆衰退的神经生物学基础相关研究展开综述与讨论。     

Characteristics of instrumental activities of daily living and everyday memory in elderly women--method for assessment of abilities in early dementia

AIM: To demonstrate the characteristics of the Instrumental Activities of Daily Living (IADL), assessed by the Assessment of Motor and Process Skills (AMPS), and everyday memory functions (memory necessary function for daily life) assessed by the Rivermead Behavioral Memory Test (RBMT) in elderly people with dementia. To compare the ability and the function between them and community-dwelling normal subjects. METHODS: We divided the RBMT result into three categories: prospective memory, retrospective memory, and prospective memory+retrospective memory. The study was performed in102 women (68-92 years old) with dementia who lived in a healthcare facility or three group homes (n=52) and cognitively normal subjects who lived in their own homes (n=50). RESULTS: There were no associations between AMPS motor and prospective memory, retrospective memory, and prospective memory+retrospective memory in both groups. There were associations between the AMPS process and retrospective memory in both groups, but no associations between the AMPS process and prospective memory in either groups and a scatter chart revealed some subjects with a prospective memory deficit even though they had a normal IADL performance ability level. From those results, we found that IADL performance ability and everyday memory were not simultaneously damaged. CONCLUSION: When assessing elderly people, it is necessary to assess both IADL performance and everyday memory, including prospective memory. According to these methods, mild cognitive impairment may be screened more accurately.     

Risk assessment for falls in the elderly population

Objective:   To evaluate whether a simple questionnaire composed of 22 items, including several environmental factors, could establish predictive validity for identifying fallers.
Patients and methods:   The study included 2439 community-dwelling elderly people (76.3 ± 7.4 years old). Scores on the questionnaire containing only dichotomous questions (yes or no) were compared between fallers and non-fallers. A multivariate analysis was performed to identify independent risk factors for falls in a longitudinal study ( n  = 342).
Results:   A logistic regression analysis revealed that advanced age, a history of falls, cognitive dysfunction, a round back and knee joint pain were independent risks for falls. On the other hand, no environmental factors were found as independent risks for falls.
Conclusion:   A simple fall predicting score is useful for identifying high-risk individuals in clinical settings.     

Oral assessment of the dentulous elderly patient

The percentage of elderly persons retaining natural teeth is increasing. Although many of these individuals cannot be convinced to see a dentist regularly, they are generally seen by a physician or nurse relatively frequently. The physician or nurse can provide a vital service for these patients by performing oral screening examinations. A technique is described for accomplishing this.