Memory complaint and impairment in the aged. The effect of depression and altered brain function.

To clarify the role of memory impairment in the aged as a normal or psychopathological phenomenon, 153 persons 50-years-old and over with varying degrees of depression and altered brain function were compared for their complaints about memory and actual performance on a series of memory tests. It was found that while performance varied with altered brain function, complaint was related to level of depression, regardless of performance. Exaggerated memory complaint was considered one manifestation of a general pattern of discrpant reporting of symptoms by depressed persons, and apparently related to an underlying personality factor. The complaint of superiority of remote over recent memory was not substantiated empirically, but was considered part of the pattern of stereotyped language and attitudes characteristic of depressed persons.

Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity.

The existing evidence paints an unclear picture of whether an association exists between depression and memory impairment. The purpose of this investigation was to determine whether depression is associated with memory impairment, whether moderator variables determine the extent of this association, and whether any obtained association is unique to depression. Meta-analytic techniques were used to synthesize data from 99 studies on recall and 48 studies on recognition in clinically depressed and nondepressed samples. Associations between memory impairment and other psychiatric disorders (e.g., schizophrenia, dementia) were also examined. A significant, stable association between depression and memory impairment was revealed. Further analyses indicated, however, that it is likely that depression is linked to particular aspects of memory, the linkage is found in particular subsets of depressed individuals, and memory impairment is not unique to depression.

Dementia management strategies and adjustment of family members of older patients.

Family members caring for dementia patients must often contend with a complex set of behavioral problems evidenced by their demented older relatives. In this study we examined how strategies to manage dementia problems in (N = 152) older people were associated with the adjustment of family members while providing assistance to the patient. Three Dementia Management Strategies were identified (Criticism, Encouragement, and Active Management) and were found to be associated with three indices of family members' emotional adjustment--burden, psychiatric symptoms, and desire to institutionalize the patient. After controlling for the influence of family member and patient background characteristics and family member coping, Dementia Management Strategies accounted for significant and unique variance in family members' burden and desire to institutionalize the patient but not in family members' psychiatric symptoms. The use of Active Management and Criticism was associated with greater burden, whereas use of Encouragement was tied to less family member burden and less desire to institutionalize.

Problem-solving strategies in dementia patient-caregiver dyads.

Examined was the applicability of concepts of the zone of proximal development and scaffolding to the study of dementia. Caregiver-patient dyads were compared to normal elderly dyads in the instructional strategies they used to complete the Block Design subtest of the WAIS-R. Shown by the results was that the use of a detailed behavioral coding scheme was successful in documenting systematic differences between the two groups. Potential use in assessment and intervention is discussed.

Locus of control, depression, and anxiety in young and old adults: a comparison study.

Levenson's Internal, Powerful Others, and Chance scales were administered to 305 college undergraduates and 117 community-living elderly. On the basis of their highest standard score, sixty young and sixty elderly participants were then classified into High Internal, High Powerful Others, and High Chance categories. The young sample was administered the Zung Depression Scale and the debilitating anxiety scale of the Alpert-Haber Achievement Anxiety Test, while the elderly were given the Beck Depression Inventory, the Depression and Anxiety Scales of the Profile of Mood States, and rated on the Hamilton Rating Scale for Depression. Contrary to previous results, the elderly sample was more external (on the Chance dimension) than the young. As predicted, there was a significant relationship linking a pattern of high internality and low belief in powerful others with low depression in the elderly, but not in the young. Applicability of these findings to placement and intervention strategies is discussed.

Metamemory perceptions in depressions of young and older adults.

This research investigated how depression in two age groups related to responses on a metamemory questionnaire (MMQ), and to the correspondence between MMQ self-reports and performance on memory tests. Forty-four younger and 56 older women were clinically assessed and completed both the MMQ and a series of experimental memory procedures. Data on 11 MMQ subscales were analyzed by analysis of variance, chi 2, and canonical correlation techniques. Compared with controls, depressed subjects tended to report more generalized and extensive memory difficulties, particularly in recent as opposed to remote memory, but were not deficient in basic metamemory knowledge and did not manifest different perceptions regarding age changes in memory or regarding its personal significance. There was no evidence for a differential impact of late-life depression on metamemory perceptions, reflected by the general absence of age-by-depression interactions. Cumulatively, self-reports correlated .598 with objective measures, a relationship that did not vary as a function of age or depression. Reports about the retention of "important" information and about the use of recall strategies were identified as the only self-report measures reliably associated with performance.

Signal detection analysis of recognition memory in depressed elderly.

The purpose of this study was to examine the relationship of late-life depression to memory complaint and objective performance in a recognition memory task. Fifty-seven individuals between the ages of 58 and 88 were evaluated for depression using the Beck Depression Inventory (short form). They were then shown two stimulus lists, each consisting of high-imagery and low-imagery words. Recognition for these words was subsequently tested. Error rates and nonparametric signal detection measures were analyzed as indices of performance. Respondents gave global self-assessments of memory and, during the recognition task, also made self-ratings of performance. Depressed individuals showed more conservative response biases than nondepressed respondents, reflected in a higher false-negative error rate but a lower false-positive rate. Neither overall memory sensitivity as assessed by signal detection analysis nor self-ratings of performance were related to depression, though global memory self-ratings were. Elderly depressed individuals thus presented a pattern of greater memory complaint and unwillingness to venture responses in spite of showing small or no information-processing deficits.

Confirmatory factor analysis of the short form Beck Depression Inventory in elderly community samples.

The factor structure of the Beck Depression Inventory short form (BDI-SF) was investigated in two elderly samples, with the method of confirmatory factor analysis. Four models previously reported for the BDI-SF in the general adult population were compared for goodness of fit to the data for elderly respondents, and the best-fitting model was adjusted further for these data. Each step in the analyses of the BDI-SF responses of 199 elderly subjects from Tampa, Florida, was cross-validated with data from a second sample of 113 elderly subjects from Houston, Texas. The results confirmed that the three-factor model reported by Reynolds and Gould (1981) adequately fit the data from both elderly samples. The three identified factors were termed Negative Self-Esteem, Anergy, and Dysphoria and were considered to correspond with the cognitive, behavioral, and affective components that generally are thought to be part of the depressive syndrome. The internal consistency of the overall BDI-SF was .74 and .80 in the Tampa and Houston samples, respectively. These findings provide evidence for the construct validity of the BDI-SF by confirming that it displays a factor structure in the aged similar to that observed in the general adult population.

Measuring locus of control in elderly persons.

Confirmatory factor analysis was used to examine the appropriateness of using with elderly persons Levenson's multidimensional locus of control (LoC) scale that measures beliefs in Internal Control (I), Control by Powerful Others (P), and Chance (C). Data were obtained from elderly individuals in Florida and Texas and reformulated to allow cross-validation at each step in a series of model evaluations. Results indicated that Levenson's three-factor specification of control was not a valid representation of the samples' responses. A model that specified the elimination of eleven unreliable items and the formation of a new external control factor that was based on the remaining C and P items provided an adequate fit to the data for both samples. The failure to confirm Levenson's three-factor structure poses a construct-validity and measurement-equivalence problem when making age-based comparisons of LoC scores.

Diagnosis and treatment of depression in late life. Consensus statement update.

OBJECTIVE: To reexamine the conclusions of the 1991 National Institutes of Health Consensus Panel on Diagnosis and Treatment of Depression in Late Life in light of current scientific evidence. PARTICIPANTS: Participants included National Institutes of Health staff and experts drawn from the Planning Committee and presenters of the 1991 Consensus Development Conference. EVIDENCE: Participants summarized relevant data from the world scientific literature on the original questions posed for the conference. PROCESS: Participants reviewed the original consensus statement and identified areas for update. The list of issues was circulated to all participants and amended to reflect group agreement. Selected participants prepared first drafts of the consensus update for each issue. All drafts were read by all participants and were amended and edited to reflect group consensus. CONCLUSIONS: The review concluded that, although the initial consensus statement still holds, there is important new information in a number of areas. These areas include the onset and course of late-life depression; comorbidity and disability; sex and hormonal issues; newer medications, psychotherapies, and approaches to long-term treatment; impact of depression on health services and health care resource use; late-life depression as a risk factor for suicide; and the importance of the heterogeneous forms of depression. Depression in older people remains a significant public health problem. The burden of unrecognized or inadequately treated depression is substantial. Efficacious treatments are available. Aggressive approaches to recognition, diagnosis, and treatment are warranted to minimize suffering, improve overall functioning and quality of life, and limit inappropriate use of health care resources.