Effects of Question Framing on Self-Reported Memory Concerns across the Lifespan

Background/Study Context: Evidence regarding whether there is an age-related increase in subjective memory concerns is mixed. The goal of this study was to investigate whether calling to mind specific instances of memory failures affects the likelihood that individuals report being concerned about their memory.

Methods: Young, middle-aged, and older individuals responded to statements that probed general memory concerns (e.g., I am concerned about my memory) before or after probing the frequency of memory difficulties in specific everyday situations (e.g., I forget appointments).

Results: We found no relationship between age and memory concern, and older compared to younger adults reported having fewer everyday memory failures. Furthermore, individuals of all ages were more likely to report being concerned about their memory if asked before relative to after rating the frequency of specific everyday memory failures.

Conclusion: Increasing age is associated with fewer reported difficulties with specific everyday memory situations, but people of all ages display anchoring effects on memory concern based on realistic occurrences of remembering. Our findings have implications for the measurement of self-reported memory as they show that the order of questions can influence responding.     

Association of perceived health and depression with older adults’ subjective memory complaints: contrasting a specific questionnaire with general complaints questions

The objectives of this paper were to evaluate the association of subjective memory complaints (SMC) with perceived state of health, mood and episodic memory (associative and everyday memory). We studied these areas using two different complaint assessment methods (three general questions and a validated scale). The study included 269 older adults (aged 65–87) with age-related memory changes, but without cognitive impairment. They were evaluated with Mini-cognitive Exam, Rivermead Behavioural Memory Test (a test of everyday memory), Paired Associates Learning Test, Memory Failures of Everyday Questionnaire, three memory complaints questions, Nottingham Health Profile and Geriatric Depression Scale. The results indicated that memory for everyday performance, mood and perceived health were independent predictors of SMC, with mood and perceived health being stronger predictors than actual memory performance. Age was not associated with subjective memory and, with regard to level of education, only the illiterate level was associated with SMC. A specific questionnaire on subjective memory was found to be preferable to an aggregate of complaints questions on self-reported memory; only health profile was found to predict the outcomes on memory complaints questions. Our conclusion is that a group of underlying factors other than everyday memory were playing a role in SMC; these SMC of subjects with age-related memory changes were mainly associated with subjective evaluations of their health.     

Comparing two different approaches to measuring drug use within the same survey

Respondents to the National Population Health Survey in Canada (1996 97) were asked two types of questions about drug use that allowed a comparison of the responses. The first question was about self-reported drug use categories: "In the past month, did you take [e.g., antidepressants]?" The second asked about specific drugs: "What specific medications did you take over the last two days?" Responses to the latter were coded according to the main chemical entity and then grouped in specific drug product categories similar to the first question's self- reported categories. The two sets of drug use categories were cross-tabulated for the 62,588 respondents who were 20 years of age and older. The proportion of persons who reported taking specific drugs who had not previously answered "yes" to the question related to the corresponding self-reported drug use category ranged from a low of 4.8% for insulin/oral hypoglycemics to a high of 43.7% for narcotic analgesics. Various reasons for these discrepancies are discussed. A series of logistic regression models relating the discrepancies to respondent characteristics shows that there is no clear pattern of variables associated with the discrepancies. These results show that surveys should be carefully planned to reflect the type of information needed.     

Verbal and Nonverbal Memory in Adults Prenatally Exposed to Alcohol

Background: Neurocognitive effects of prenatal alcohol exposure in adulthood are not well documented. Questions persist regarding the extent to which there are specific, measurable effects beyond those associated with global ability deficits, whether individuals without the full fetal alcohol syndrome (FAS) demonstrate alcohol‐related cognitive impairments, and whether observed memory effects are specific to a particular modality, i.e., verbal vs. visual/spatial domains. Methods: In this study, verbal and nonverbal selective reminding paradigms were used to assess memory function in 234 young adults (M age: 22.78, SD: 1.79). Alcohol exposure was quantified prenatally. Alcohol groups included: Individuals with physical effects of alcohol exposure (Dysmorphic group, n = 47); Exposed individuals without such effects (n = 74). Contrast groups included: Controls (n = 59) matched for ethnicity, socioeconomic status, and hospital of birth; Special Education contrast group (n = 54) included to control for disability status. Memory outcomes entailed total recall, delayed recall, and measures of encoding and retrieval, and learning over trials as indexed by slope. Results: Results indicated that Dysmorphic individuals were significantly less efficient in memory performance than Controls on all of the outcomes measured, but they did not differ from those in the Special Education contrast group. The nondysmorphic, alcohol‐exposed group was intermediate in their performance, suggesting a continuum of effects of prenatal exposure. Evaluation of the encoding and retrieval aspects of memory performance indicated that learning rather than forgetting accounted for the deficits associated with prenatal alcohol exposure. Finally, no interaction was found between modality of presentation (verbal and nonverbal) and effects of alcohol exposure on memory performance. Conclusion: These findings indicate that prenatal alcohol exposure is associated with persistent and specific effects on memory performance, and these problems result from less efficient encoding of information across both verbal and nonverbal modalities. Education and training efforts with this clinical group should take these characteristics into account.     

Cognitive and neurobiologic markers of early Alzheimer disease

Recent studies indicate that impairments in two cognitive domains characterize the cognitive abnormalities that appear earliest in the course of Alzheimer disease (AD). These cognitive domains pertain to memory and executive function ability; in particular, memory test scores reflecting the difference between immediate and delayed recall and tasks that assess cognitive flexibility (e.g., set-shifting). Preliminary data indicate that tasks of this nature, along with specific genetic information (i.e., APOE-4 status), are important in identifying which individuals with recent cognitive changes (considered to have “questionable” disease) will progress to the point where they meet criteria for AD over time. When this cognitive and genetic information is combined with neuroimaging measures targeted at the brain regions demonstrating pathology early in AD, it may serve as specific and accurate prognostic markers of AD.     

Attitudes towards menopause in a group of women followed in a public service for menopause counseling.

This preliminary study addressed some specific attitudes towards menopause, and behavioral styles in menopausal women. The study was conducted during the period January-May 1998 at the Menopausal Service of the Magenta Hospital (Milano) in 88 women, representing almost one half of the patients followed during that period; 43 women were treated with HRT. Some traits characterizing women's life during menopause were examined, such as presence of disturbing physical symptoms, changes in interests and discovery of new interests, and feelings of loss and uselessness. We used different psychological tests in order to evaluate anxiety and depression, in particular, the STAI (State-Trait Anxiety Inventory), the SDS (Self-rating Depression Scale), and 16 cartoon-like images representing stereotypes of menopause. The answers of our subjects showed high individual variation, with negative symptoms (e.g., hot flashes, memory loss) frequently associated with positive experiences (e.g., new hobbies, new life-styles). However, even the most frequent negative symptom (memory loss) was reported only by 70%. The experience of a change represented by menopause was described both in terms of objective change (e.g., weight increase, hot flashes, memory loss), and of subjective change (e.g., character, feeling of not being attractive, new life-styles). Treatment with HRT seems to reduce the onset of hot flashes considerably. The occurrence of anxious-depressive states was comparable to that observed in other studies; it was not associated with HRT, but rather to losses (loss of desire, memory loss, insomnia). In conclusion, menopause represents a transitional moment in which physical and psychological changes are generally integrated by the persons experiencing them. In order to preserve a good quality of life in menopause, it seems relevant to check memory loss and stabilize the mood in persons who are most "at risk" of psychological disease.     

Problematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom Severity

Problematic alcohol use has been shown to negatively impact cognitive functions germane to achieving optimal HIV health outcomes. The present study, a secondary data analysis, examined the impact of problematic alcohol use on aspects of everyday memory functioning in a sample of 172 HIV-infected individuals (22 % female; M _age = 48.37 years, SD = 8.64; 39 % Black/non-Hispanic). Additionally, we tested whether self-reported memory functioning explained the relation between problematic alcohol use and HIV symptom severity. Results indicated that problematic patterns of alcohol use were associated with lower total memory functioning, retrieval (e.g., recall-difficulty) and memory for activity (e.g., what you did yesterday) and greater HIV symptom severity. Memory functioning mediated the relation between problematic alcohol use and HIV symptom severity. However, the direction of this relation was unclear as HIV symptom severity also mediated the relation between problematic alcohol use and memory functioning. Findings highlight the importance of integrated care for HIV and alcohol use disorders and suggest that routine alcohol and cognitive screenings may bolster health outcomes among this vulnerable population.     

Long-term effects of memory training in the elderly: a longitudinal study

The effects of different types of memory training in young and older adults reported in a previous study [Cavallini, E., Pagnin, A., Vecchi, T., 2003. Aging and everyday memory: the beneficial effect of memory training. Arch. Gerontol. Geriatr. 37, 241-257] were again investigated from a longitudinal perspective 2 years after the original memory training sessions. The authors retested the original participants to measure the long-term effectiveness of two mnemonic strategies: the loci technique and strategic training. Three groups of participants (13 adults, M=24.1, 13 younger elderly, M=64.2 and 13 older elderly, M=74.4) were tested using a battery of seven tasks and four questionnaires, to evaluate memory performance and metamemory variables. The three age groups and the two trainings showed similar results on memory performance. Long-term effects were found only on two memory tasks, both were highly related to everyday life showing that, without additional practice, memory performance tended to go back to the original level. Moreover, the beneficial effects of the previous training sessions were particularly evident for older adults in metamemory knowledge and for strategic training in memory complaints. Results partially support the durability of memory training in improving memory performance.     

Doctor-patient communication in rheumatology: studies of visual and verbal perception using educational booklets and other graphic material.

Patients (n = 404) with osteoarthrosis and control subjects (n = 233) were studied to examine the communicational value of five styles of illustration (cartoon (C), matchstick (M), representational (R), symbolic (S), photographic (P) and two levels of text ('easy', 'hard'), presented as educational booklets about osteoarthrosis. Booklet comprehension was tested with a multiple choice questionnaire (MCQ) scored by two raw score and two, more sensitive, weight-of-evidence methods. Further studies assessed perception of image detail, tone, and colour by ranking, rating, latency, and questionnaire methods. A subgroup was tested psychometrically. The main findings were: pictures in booklets enhance communication; perception of pictorial style depends on its vehicle of presentation, cartoons being most effective in booklets, photographs overall; simplifying text does not significantly enhance communication; certain picture-text 'interactions' appear to increase comprehension (e.g. 'hard' text with 'easy' pictures); several 'endogenous' factors are associated with increased comprehension: 'psychological' (e.g., intelligence, memory, reading skill); 'demographic' (e.g., the young, males, higher social grades, higher educational levels); 'disease' (e.g., longer disease duration, previous information about the disease).     

Relationship of Medication Management Test-Revised (MMT-R) Performance to Neuropsychological Functioning and Antiretroviral Adherence in Adults with HIV

While performance-based tests of everyday functioning offer promise in facilitating diagnosis and classification of HIV-associated neurocognitive disorders (HAND), there remains a dearth of well-validated instruments. In the present study, clinical correlates of performance on one such measure (i.e., Medication Management Test—Revised; MMT-R) were examined in 448 HIV+ adults who were prescribed antiretroviral therapy. Significant bivariate relationships were found between MMT-R scores and demographics (e.g., education), hepatitis C co-infection, estimated premorbid IQ, neuropsychological functioning, and practical work abilities. MMT-R scores were not related to HIV disease severity, psychiatric factors, or self-reported adherence among participants with a broad range of current health status. However, lower MMT-R scores were strongly and uniquely associated with poorer adherence among participants with CD4 T cell counts <200. In multivariate analyses, MMT-R scores were predicted by practical work abilities, estimated premorbid functioning, attention/working memory, learning, and education. Findings provide overall mixed support for the construct validity of the MMT-R and are discussed in the context of their clinical and research implications for evaluation of HAND.     

Age excuses: conversational management of memory failures in older adults

The social consequences of appealing to age to excuse memory failure were examined in 2 vignette-based studies. In Study 1, 75 older (M = 72 years) and 78 young (M = 22 years) adults evaluated forgetful older targets in their 70s who used their age, lack of ability, lack of effort, or the situation to explain forgetting. In Study 2, 105 older (M = 72 years) and 105 young participants (M = 19 years) evaluated forgetful targets with no specific age given in 4 excuse conditions (age, ability, situation, and no excuse). In support of the prediction of positive consequences, age excuses were rated as more believable than situation in both studies and more believable and socially fluent than effort in Study 1. In support of predictions of negative consequences, both groups in Study 2 rated target persons who used an age excuse to be much older than their peers and, along with ability excuse users, as eliciting more worry and frustration than the others. Moreover, young adults showed additional sensitivity to the negative aspects of age excuses in terms of worry and frustration in Study 1 and anticipated repeat forgetting in Study 2. These results suggest that although age excuses may relieve socially awkward situations, this strategy reinforces negative age stereotyping of the older forgetter.     

Ethnicity,self-care,and use of medical care among the elderly with joint symptoms

Elderly individuals with self-reported joint symp-toms representing three ethnic groups (i.e., blacks [n = 105], Hispanics[n = 100], and whites of Eastern European origin [n = 112] answered questions about their use of self-care and medical care for these symptoms. Ethnic groups differed in both self-care practices and their use of medical care for joint symptoms. Multiple regression analyses demonstrated that arthritis-specific and general health status were better predictors than ethnicity of the tendency to rely on self-care and medical care. There was no evidence that self-care served as a substitute for medical care.     

Colorectal cancer: Parametric evaluation of morphological,functional and molecular tomographic imaging

Colorectal cancer(CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians' disposal for the diagnostic management of the disease, tomographic imaging(e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques,such as diffusion-weighted MRI and perfusion imaging, were designed for the"in vivo" evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone(e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes(e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition frompurely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.     

Perceptions of quality-of-life effects of treatments for diabetes mellitus in vulnerable and nonvulnerable older patients

OBJECTIVES: To assess whether patient perceptions of treatments for diabetes mellitus differ according to clinical criteria such as limited life expectancy and functional decline (i.e., vulnerability).
DESIGN: Cross-sectional survey.
SETTING: Clinics affiliated with two Chicago-area hospitals.
PARTICIPANTS: Patients aged 65 and older living with type 2 diabetes mellitus (N=332).
MEASUREMENTS: Utilities (quantitative measures of preference on a scale from 0 to 1, with 0 representing a state equivalent to death and 1 representing life in perfect health) were assessed for nine hypothetical treatment states using time trade-off questions, and patients were queried about specific concerns regarding medications. Vulnerability was defined according to the Vulnerable Elders Scale.
RESULTS: Thirty-six percent of patients were vulnerable. Vulnerable patients were older (77 vs 73) and had diabetes mellitus longer (13 vs 10 years; P <.05). Vulnerable patients reported lower utilities than nonvulnerable patients for most individual treatment states (e.g., intensive glucose control, mean 0.61 vs 0.72, P <.01), but within group variation was large for both groups (e.g., standard deviations >0.25). Although mean individual state utilities differed across groups, no significant differences were found in how vulnerable and nonvulnerable patients compared intensive and conventional treatment states (e.g., intensive vs conventional glucose control). In multivariable analyses, the association between vulnerability and individual treatment state utilities became nonsignificant except for the cholesterol pill.
CONCLUSION: Older patients' preferences for intensity of treatment for diabetes mellitus vary widely and are not closely associated with vulnerability. This observation underscores the importance of involving older patients in decisions about treatment for diabetes mellitus, irrespective of clinical status.     

How do verbal distractors influence age-related operation span performance? A manipulation of inhibitory control demands

This study examined how different verbal distractors influence (age-related) performance in the operation span working memory task. Forty-six older (M = 68 years, SD = 3.82) and 49 younger adults (M = 27 years, SD = 3.02) performed a conventional operation span task version and three versions with non-related, conceptually related, or phonologically related distracting words. Thus, the amount of inhibitory control demands varied across the task versions. Age effects were found for all versions. Furthermore, age effects in the versions with distracting words were even larger than in the conventional version, indicating that a decline in the ability to inhibit irrelevant verbal information can partly explain age effects in working memory performance.     

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.     

The CASE adherence index: A novel method for measuring adherence to antiretroviral therapy

The Center for Adherence Support Evaluation (CASE) Adherence Index, a simple composite measure of self-reported antiretroviral therapy (ART) adherence, was compared to a standard three-day self-reported adherence measure among participants in a longitudinal, prospective cross-site evaluation of 12 adherence programs throughout the United States. The CASE Adherence Index, consisting of three unique adherence questions developed for the cross-site study, along with a three-day adherence self-report were administered by interviews every three months over a one-year period. Data from the three cross-site adherence questions (individually and in combination) were compared to three -day self-report data and HIV RNA and CD4 outcomes in cross-sectional analyses. The CASE Adherence Index correlated strongly with the three-day self-reported adherence data (p < 0.001) and was more strongly associated with HIV outcomes, including a 1-log decline in HIV RNA level (maximum OR = 2.34; p < 0.05), HIV RNA < 400 copies/ml (maximum OR = 2.33; p < 0.05) and performed as well as the three-day self-report when predicting CD4 count status. Participants with a CASE Index score >10 achieved a 98 cell mean increase in CD4 count over 12 months, compared to a 41 cell increase for those with scores < or =10 (p < 0.05). The CASE Adherence Index is an easy to administer instrument that provides an alternative method for assessing ART adherence in clinical settings.     

Effects of age on physiological and psychological functioning among COPD patients in an exercise program

Older adults with chronic illness may be at greater risk of psychological distress than healthy older adults. This study examined the effect of age on physiological and psychological functioning of exercising older adults with chronic obstructive pulmonary disease (COPD). Sixty-four older adults (mean age = 67.4 plus or minus 7.0; 35 male, 29 female) with COPD were included in the study. All subjects participated in a 30-day rehabilitation program consisting of exercise (walking, stationary bicycle, pool exercises), education, and stress management. Subjects underwent assessments of physiological functioning (e.g., bicycle ergometry,12-minute walk), cognitive status (e.g., memory, psychomotor speed, concentration), and psychological well-being (e.g., anxiety, depression, psychiatric symptoms) before and after the exercise program. Results were analyzed by repeated measures multivariate analysis of variance, with age (median split = 67.5 years) as a between-subject factor. Although the exercise program appeared to have a greater effect on physiological functioning and on concentration and short-term memory of younger-old subjects, both groups of subjects achieved gains in physiological functioning, and psychological well-being.     

Memory for topics of conversation: adult age differences and intentionality

Young adults and elderly adults received a series of topics for discussion, followed by a recall test of the topics per se and a recognition memory test of the questions asked during the conversations. Half of the participants in each age group were forewarned of the subsequent recall test (intentional memory); the remaining participants were not forewarned (incidental memory). Null effects for instructional variation were found at both age levels for all memory scores. For recall, an age difference, favoring young adults, was found. However, no age difference was found for either the recognition of old questions as old or the recognition of new questions as new. The results were interpreted in terms of an age deficit for the retrieval of memory traces established by the comprehension of conversational content.