Patient-provider communication about cognition and the role of memory concerns: a descriptive study.

BACKGROUND: Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns. METHODS: We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory concerns. Questionnaires included measures of subjective memory decline (SMD), memory concerns, past healthcare experiences, as well as open-ended questions regarding patient-provider communication about cognition. Content analysis was used to code open-ended responses. Logistic regression was used to examine differences in facilitators and barriers to communication among three groups: no SMD (n = 130), SMD without memory concerns (n = 143), and SMD with memory concerns (n = 136). RESULTS: Only 16.6% of participants reported discussing cognition with a healthcare provider. Of the remaining 83.4%, approximately two-thirds would be open to such discussions in certain circumstances, most frequently if they had worsening memory problems. Over half of participants reported that their provider had never offered cognitive testing. Compared to the no SMD and SMD without memory concerns groups, participants reporting SMD with memory concerns were more likely to: (1) discuss cognition if their healthcare provider initiated the conversation, and (2) avoid discussions of cognitive problems due to fears of losing independence. CONCLUSIONS: We found that most participants, including those reporting SMD with memory concerns, had never discussed cognition with their healthcare providers. Patient-reported barriers and facilitators to communication about cognition differed in several areas based on SMD status and the presence or absence of memory concerns. Consideration of these differences can guide future efforts to improve early identification of subtle cognitive changes that would benefit from further monitoring or intervention.

The Factor Structure of Items Assessing Subjective Memory: Between-Persons and Within-Persons across Time.

INTRODUCTION: Current understanding of the psychometric properties of items intended to assess the multidimensional construct of subjective memory (SM) is limited, as longitudinal studies of aging commonly use single items or brief sets of items to assess SM. Investigating how SM items cluster within individuals over time would increase the understanding of how combining these items impacts their utility as an early indicator of cognitive change in the aging trajectory. To address this need, the current study examined the factor structure of a brief set of SM items in an existing longitudinal study focused on cognitive aging at both the within-person and between-person levels. METHODS: Data were drawn from the Einstein Aging Study, a longitudinal cohort study of aging (N = 1,239, Mage = 77.51, SD = 5.03; 69.50% white; 24.27% black; 6.23% other). Community-dwelling older adults from an urban area of New York City were interviewed annually. At each wave, participants responded to 6 items intended to assess SM. Items assessed participants' perceived memory decline as well as current memory ability. Multilevel exploratory factor analyses examined which factor solution best fit the data at between-person and within-person levels. RESULTS: Factor structure of the SM items varied at the two levels. At the within-person level, two factors emerged, whereas at the between-person level, a single factor best represented the SM items. Items assessing perceived declines in memory functioning tended to have similar trajectories, while items assessing current memory ability were less related to change over time. CONCLUSION: Items appeared to assess two different dimensions of SM when examining within-person changes in SM across time; however, the item structure suggested no other items covaried systematically within persons over time. In contrast to the conceptualization of SM as a multidimensional construct, our findings suggest that when measuring SM between individuals, SM items tend to capture a single dimension underlying SM. This may be due to the long retrospection period of items assessing perceived memory ability. A single item assessing perceived memory decline in older adults without evidence of objective cognitive impairment may be sufficient to monitor memory change in clinical or research settings.

Neuroticism biases memory self-report in women.

Reports of memory problems are associated with cognitive decline risk and other adverse health outcomes, and the personality trait of neuroticism is known to influence these reports. Since women tend to have higher neuroticism as well as a unique risk profile for cognitive decline, we examined the relationship between neuroticism and responses to two memory self-report items (self- and age-anchored comparisons) among women (n = 1,132; Mage = 52.71; SD = 13.99) in the Midlife in the United States Refresher Study. Multivariate regression demonstrated that women lower in neuroticism may be more likely to make a distinction between self-comparisons vs. age-anchored comparisons of memory.

Poor-Quality Daily Social Encounters, Daily Stress, and Subjective Cognitive Decline Among Older Adults.

Background and Objectives: Although prior research has shown that social relationships and daily stress are strongly associated with cognitive function, few studies have explored the link between the quality of daily social encounters and subjective cognitive decline (SCD). The present study explores whether the quality of older adults' daily social encounters is associated with SCD through daily stress. Research Design and Methods: This study used data from 254 adults aged 70 or older (M age  = 76.5 years, SD = 4.4; 67.7% women) who completed the Einstein Aging Study, a 2-week experience sampling study. Multilevel mediation analyses were conducted to account for daily measurements nested within individuals. We tested the indirect effect of the quality of daily social encounters on SCD through daily stress levels. Results: There was a significant positive association between ambivalent and neutral social encounters and daily stress levels at both the within- and between-person levels. Between-person daily stress was, in turn, associated with greater SCD. Specifically, there was a significant indirect path from ambivalent social encounters to SCD through daily stress. Discussion and Implications: This study contributes to a more detailed understanding of how the quality of daily social encounters can influence cognition via increased exposure to daily stress. The findings suggest that emotional support may be crucial to preserving perceptions of older adults' cognitive functioning.

Within-Person Associations of Self-Reports of Memory Impairment and Depressive Symptoms in Older Adults: Moderation of Relationships Over Time by Personality.

OBJECTIVES: The current study examined within-person associations of self-reports of impaired current memory functioning and perceived decline with depressive symptoms in older adults without cognitive impairment, and whether these associations were moderated by individuals' levels of neuroticism, conscientiousness, and extraversion. METHODS: Samples were drawn from the Einstein Aging Study, Rush Memory and Aging Project (MAP), Minority Aging Research Study (MARS), Health and Retirement Study (HRS), and National Health and Aging Trends Study (NHATS), with over 8,000 participants (65+ years) included across data sets. In a series of coordinated analyses, multilevel linear models tested within-person relationships over periods of up to 22 years. RESULTS: Across HRS and NHATS samples, self-reports of impaired current memory functioning covaried with depressive symptoms over time. This association was moderated by neuroticism, such that the association was stronger for individuals with higher levels of neuroticism. Across all samples, perceived memory decline covaried with depressive symptoms over time. This association was moderated by neuroticism in MAP/MARS, HRS, and NHATS, such that the association was stronger for individuals with higher levels of neuroticism. DISCUSSION: Self-reports of impaired current memory functioning and perceived memory decline are important determinants of older adults' psychological well-being. In our results, at times when older adults perceive poorer memory functioning or decline, they also tend to report more depressive symptoms. Further, results from two larger data sets suggest that individuals' level of neuroticism may determine the extent to which self-reports of memory impairment and depressive symptoms covary over time.

Factors that influence the emotional impact of memory problems in older adults: A qualitative descriptive study.

BACKGROUND: Associations among psychological health and memory concerns in older adults are well-established, but much of this research is quantitative. OBJECTIVES: This study examined how memory problems influence emotional well-being in older adults without dementia, and whether this differs by cognitive status and current depressive or anxiety symptoms. METHODS: A qualitative descriptive design was used to examine our research questions. Community-dwelling older adults without dementia (n = 49, Mage  = 74.5[10.1], 63% women) completed a cognitive assessment, questionnaires and two semi-structured interviews. Content analysis was used to code and categorise the transcribed interview data, then identify themes within and across participant groups. RESULTS: Five themes described the influence of memory problems on emotional well-being: Evoking Emotions, Fearing Future, Undermining Self, Normalising Problems and Adjusting Thinking. Memory problems' impact on emotional well-being varied by current anxiety symptoms, characteristics of the problem and personal experience with dementia. CONCLUSION: The emotional impact of memory problems tended to differ by affective symptoms, not cognitive status. Older adults who report memory concerns without objective evidence of impairment may be at risk for negative impacts to mental health and well-being. IMPLICATIONS FOR PRACTICE: Cognitive screening guidelines should consider best practices for responding to memory concerns when cognitive testing results are normal.

Help-seeking for cognitive problems in older adults without dementia: A systematic review.

Introduction: Understanding the help-seeking decision-making process in older adults experiencing cognitive problems is needed to improve early identification of cognitive impairment. The purpose of this systematic review was to determine what factors influence whether community-dwelling older adults without dementia seek help for cognitive problems. Methods: We conducted a mixed-methods systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted in PubMed, CINAHL, PsycINFO, Web of Science, and ProQuest Dissertations and Theses Global in June 2020. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was used to integrate findings across studies. Results: Eighteen articles met eligibility criteria. All were cross-sectional studies, including nine quantitative, eight qualitative, and one containing quantitative and qualitative components. Factors that facilitated help-seeking were problem intensity, social support, valuing early detection, having a family history of dementia, and positive views of the healthcare system. Factors that detracted from help-seeking were normalizing cognitive problems, attributing problems to psychosocial causes, and not perceiving a benefit to disclosing cognitive problems. Discussion: The decision to seek help for cognitive problems is influenced by a variety of factors. Our review suggests these differ in older adults without dementia compared to previous reviews of help-seeking for a dementia diagnosis. Given the importance of early detection of cognitive impairment to improve long-term outcomes, intervention development based on the factors we identified has important implications for older adults' cognitive health.

Within-Person Associations Among Self-Perceptions of Memory, Depressive Symptoms, and Activity Participation in Older Adults.

BACKGROUND AND OBJECTIVES: Self-perceptions of memory problems may impact older adults' mood as well as their activity participation, thereby negatively affecting health and well-being. We examined within-person associations among self-reported memory, depressive symptoms, as well as physical, social, and cognitive activity participation in older adults without cognitive impairment. RESEARCH DESIGN AND METHODS: Samples were drawn from the Einstein Aging Study (EAS), National Health and Aging Trends Study (NHATS), Rush Memory and Aging Project (MAP), and Minority Aging Research Study (MARS), with over 8,000 participants (65+ years) included across data sets. In a series of coordinated analyses, multilevel structural equation modeling was used to examine within-person relationships over periods of up to 20 years. RESULTS: Across EAS, NHATS, and MAP/MARS samples, we found that older adults' self-perceptions of memory did not directly covary with activity participation over time. However, we did find an indirect association in NHATS such that within-person changes in depressive symptoms were associated with changes in self-reported memory, and these contributed to lower physical as well as social activity participation. DISCUSSION AND IMPLICATIONS: Older adults' activity participation is important for health, but maximizing engagement requires understanding potentially impeding factors. We found some evidence that as self-perceptions of memory change over time, associated depressive symptoms may contribute to lower activity participation. Inconsistent findings across data sets, however, suggest future research is needed to understand individual characteristics that may influence these relationships.

Longitudinal Relationships Between Subjective Cognitive Decline and Objective Memory: Depressive Symptoms Mediate Between-Person Associations.

BACKGROUND: Subjective cognitive decline (SCD) may be an early indicator of cognitive impairment, but depressive symptoms can confound this relationship. Associations may be influenced by differences between individuals (i.e., between-persons) or how each individual changes in their experiences over time (i.e., within-persons). OBJECTIVE: We examined depressive symptoms as a mediator of the between- and within-person associations of SCD and objective memory in older adults. METHODS: Coordinated analyses were conducted across four datasets drawn from large longitudinal studies. Samples (range: n = 1,889 to n = 15,841) included participants 65 years of age or older with no dementia at baseline. We used multilevel structural equation modeling to examine the mediation of SCD and objective memory through depressive symptoms, as well as direct relationships among SCD, objective memory, and depressive symptoms. RESULTS: Older adults who were more likely to report SCD had lower objective memory on average (between-person associations), and depressive symptoms partially mediated this relationship in three of four datasets. However, changes in depressive symptoms did not mediate the relationship between reports of SCD and declines in objective memory in three of four datasets (within-person associations). CONCLUSION: Individual differences in depressive symptoms, and not changes in an individual's depressive symptoms over time, partially explain the link between SCD and objective memory. Older adults with SCD and depressive symptoms may be at greater risk for poor cognitive outcomes. Future research should explore how perceived changes in memory affect other aspects of psychological well-being, and how these relationships influence cognitive decline and Alzheimer's disease risk.

Combined Influences of Dementia Exposure and Personality on Self-Reported Memory Problems.

The current study investigated whether having a first-degree relative with dementia influenced older adults' self-reported memory, if personality traits moderated these associations, and whether these associations differed by the type of item asked (ie, frequency of memory problems vs perceived memory decline). Data drawn from the Einstein Aging study included 454 older adults (Mage = 76.64, standard deviation = 4.77, 66.96% white, and 63% female). Multilevel modeling analyses showed participants who had a first-degree relative with dementia reported more frequent memory problems and were more likely to report memory decline over the past year. Among participants with a first-degree relative with dementia, higher levels of neuroticism were related to reports of more frequent memory problems at baseline, whereas higher levels of conscientiousness and lower levels of extraversion were related to reports of more frequent memory problems over time. Future research should consider personality traits and family history of dementia as potential contributors to self-reported memory problems.