Predictors of migraine interictal burden: The hidden role of subjective memory complaints.

BACKGROUND: The "interictal burden of migraine" (MIB) is a new concept that encompasses the overall impact of the disease between migraine episodes. However, the factors that contribute to this interictal burden are still unclear. OBJECTIVE: This study aimed to identify explanatory factors of interictal burden in patients with migraine. METHODS: This prospective cross-sectional observational including 200 patients with migraine (92% [n = 184] female, with a mean [standard deviation] age of 44.8 [12] years, 53% [n = 106] with chronic migraine) completed a clinical and questionnaire assessment targeting MIB, migraine impact, and depressive and cognitive complaints. RESULTS: More than three-fourths (76% [n = 152]) of patients had moderate-to-severe interictal burden. Higher interictal burden (MIB Scale ≥2) was associated with higher headache frequency (eight vs. 14, p = 0.001) and intensity (headache index score 17.0 vs. 30.0, p = 0.002), higher headache impact (six-item Headache Impact Test score 59.2 vs. 63.9, p = 0.001), and more subjective memory complaints (Subjective Memory Complaints Questionnaire [SMC] score 9.0 vs. 4.5, p = 0.001), as well as anxiety (Hospital Anxiety and Depression Scale (HADS)-Anxiety score 5 vs. 10, p < 0.001) and depression symptoms (HADS-Depression score 5 vs. 8, p < 0.001). Once accounted for these potential explanatory variables, subjective memory complaints and impact of headache during ictal phase remained as individual determinants of the interictal burden, with SMC explaining 15% (odds ratio 1.15, 95% confidence interval 1.03-1.28; p = 0.010) of the interictal burden. CONCLUSION: This finding highlights the need to consider cognitive complaints as part of the construct of interictal burden of these patients to refine the focus of their management.

Subjective memory complaints and medication adherence among hypertensive Korean older adults with multimorbidity: mediating effect of depression and social support.

BACKGROUND & AIM(S): Medication adherence (MA) is a key factor in maintaining adequate blood pressure and preventing complications. However, some older adults experience difficulties in taking medicine properly due to declines in cognitive function. Although subjective memory complaints (SMC) are recognized as early markers of cognitive impairment, previous studies concerning the relationship between MA and cognitive function have focused only on objective cognitive function. Furthermore, while depression has a high correlation with SMC, low MA, and social support, there is limited evidence on their relationship. This study aims to understand the effect of SMC on MA and the mediating effect of depression and social support. METHOD(S): This study is a descriptive cross-sectional investigation. A sample of 195 community-dwelling hypertensive older adults with multimorbidity from 3 community senior centers in Gwangju, South Korea were recruited through convenience sampling. Data was collected through face-to-face survey from January to March 2018. The PROCESS macro v4.2 program [Model 6] was used to analyze the mediating effect of depression and social support in the relationship between SMC and MA. Data analysis was performed using SPSS/WIN 26.0 and STATA MP 17.0. RESULTS: The average MA was 6.74. There were significant differences in MA according to awareness of prescribed drugs, awareness of side effects, insomnia, and healthcare accessibility. SMC was positively correlated with depression, while social support and MA were negatively correlated. While depression was a significant mediator of the effect of SMC on MA, the mediating effect of social support was not significant. The multiple mediation effect of depression and social support was not significant. CONCLUSION: The results suggest that medication management of older adults in community settings should be accompanied by a comprehensive health assessment of associated factors. Health professionals should explore strategies to improve memory as well as prevent and alleviate depression to increase MA among hypertensive older adults with multimorbidity.

Association of mobile device proficiency and subjective cognitive complaints with financial management ability among community-dwelling older adults: a population-based cross-sectional study.

BACKGROUND: Mobile devices have been used by many older adults and have the potential to assist individuals with subjective cognitive complaints (SCCs) in daily living tasks. Financial management is one of the most complex daily activity for older adults, as it is easily impaired in the prodromal stage of dementia and cognitive impairment. AIM: To investigate financial management ability among older adults from SCCs and mobile device proficiency. METHODS: A self-administered questionnaire was sent to 529 participants who were ≥ 65 years and regularly use mobile devices. Participants were divided into four groups based on SCC prevalence and scores of the Mobile Device Proficiency Questionnaire (MDPQ-16). Financial management abilities were compared between groups using the Process Analysis of Daily Activities for Dementia subscale. Regression model and crosstabulation table were used to investigate associations in detail. RESULTS: A significant difference in financial management ability was observed among the four groups (p < 0.001), with the dual impairment group showed significantly lower than the robust and SCC groups (p < 0.001). Educational history, sex, and MDPQ-16 score were significantly associated with participants' financial management ability (p ≤ 0.01). The proportion of participants who could use ATMs and electronic money independently was significantly lower among those with low proficiency in mobile devices (LPM), regardless of SCC (p < 0.05). CONCLUSION: The LPM group showed an impaired ability to manage their finances, particularly in situations where they would use information devices. Therefore, healthcare professionals should assess not only the SCC but also their proficiency with mobile devices to predict their impairment in activities of daily living.

Clusters of cognitive performance predict long-term cognitive impairment in elderly patients with subjective memory complaints and healthy controls.

INTRODUCTION: Patients with subjective memory complaints (SMC) may include subgroups with different neuropsychological profiles and risks of cognitive impairment. METHODS: Cluster analysis was performed on two datasets (n: 630 and 734) comprising demographic and neuropsychological data from SMC and healthy controls (HC). Survival analyses were conducted on clusters. Bayesian model averaging assessed the predictive utility of clusters and other biomarkers. RESULTS: Two clusters with higher and lower than average cognitive performance were detected in SMC and HC. Assignment to the lower performance cluster increased the risk of cognitive impairment in both datasets (hazard ratios: 1.78 and 2.96; Plog-rank: 0.04 and <0.001) and was associated with lower hippocampal volumes and higher tau/amyloid beta 42 ratios in cerebrospinal fluid. The effect of SMC was small and confounded by mood. DISCUSSION: This study provides evidence of the presence of cognitive clusters that hold biological significance and predictive value for cognitive decline in SMC and HC. HIGHLIGHTS: Patients with subjective memory complaints include two cognitive clusters. Assignment to the lower performance cluster increases risk of cognitive impairment. This cluster shows a pattern of biomarkers consistent with incipient Alzheimer's disease pathology. The same cognitive cluster structure is found in healthy controls. The effect of memory complaints on risk of cognitive decline is small and confounded.

Improved Mood Boosts Memory Training Gains in Older Adults With Subjective Memory Complaints via Enhanced Amygdala-hippocampal Connectivity.

OBJECTIVE: Older adults with subjective memory complaints (SMC) have a higher risk of dementia and commonly demonstrate symptoms of anxiety. This study examined the neural correlates of group counseling (GC)-boosted memory training (MT) gains. DESIGN: This study was an active, controlled, randomized trial. SETTING: Neighborhoods near the Institute of Psychology of the Chinese Academy of Sciences (CAS). PARTICIPANTS: Community-dwelling older adults, aged 60 or above with a minimum of 6 years of education, were recruited through advertisements and flyers posted at community service stations. MEASUREMENTS: The amplitude of low-frequency fluctuations and resting-state functional connectivity (rs-FC) analyses were used to examine the neural correlates associated with MT gains enhanced by improved mood in older adults with SMC. Participants were randomly assigned to the combined intervention (CI) or GC group. The CI group received 3 weeks of GC followed by 4 weeks of MT, and the GC group received GC and health lectures. Cognitive function and emotions were assessed before GC (T1), after GC (T2), and after MT (T3). Both groups underwent resting-state functional magnetic resonance imaging scanning at T2 and T3. RESULTS: Alleviated anxiety was positively correlated with rs-FC between the amygdala and left hippocampus and negatively correlated with rs-FC between the amygdala and right hippocampus. MT improvement was negatively correlated with rs-FC between the amygdala and right hippocampus in the CI group; the correlation was not significant after controlling for emotional changes. CONCLUSIONS: Amygdala-hippocampal connectivity may be associated with improved mood-enhanced MT gains in individuals with SMC.

Subjective memory complaints: Prevalence, associated factors and sex differences in the ELSI-Brazil study.

BACKGROUND: Subjective memory complaints (SMCs) are a possible prodrome of cognitive decline but are understudied in low- and middle-income countries (LMIC). We aimed to estimate the prevalence of SMCs in a large, nationally representative sample of older adults from Brazil and to identify sociodemographic and health-related factors that are associated with SMCs independently of objective memory. METHODS: Baseline data (n = 7831) from the ELSI-Brazil study, a national representative sample of adults aged 50 and over. They were asked to rate their memory and then divided into two groups - having or not having SMCs. Logistic regression models were used to estimate the association of demographic characteristics, health related factors, objective memory performance and disability in basic (b-ADL), instrumental (i-ADL), and advanced (a-ADL) activities of daily living associated with SMCs. Whether sex was an effect modifier of the association between age and objective memory performance and SMCs was also tested. RESULTS: Of the sample, 42% (95% CI; 39.9-43.9) had SMCs, and it was higher among women (46.9%) than men (35.9%). SMC prevalence decreased with age among women and increased among men, and for both it decreased with better cognitive performance. Fully adjusted logistic regression model showed that older age, higher education, higher b-ADL scores, and better cognitive performance were associated with decreased SMCs, while being female, with higher number of chronic conditions, higher i-ADL scores, worst self-rated health, and an increased number of depressive symptoms were associated with increased SMCs. However, the interaction test (p < 0.001) confirmed that increased age was associated with decreased SMCs only among women, and that better objective memory performance was associated with decreased SMCs only among men. CONCLUSIONS: SMCs are common in the Brazilian older population and are associated with health and sociodemographic factors, with different patterns between men and women. There is a need for future studies looking at the cognitive trajectory and dementia risk in older adults with subjective cognitive complaints.

Longitudinal relationships between grip strength, subjective memory complaints and cognitive function among middle-aged and older adults in China.

BACKGROUND: Subjective memory complaints are considered an early sign of cognitive decline. Recent evidence shows that grip strength is an important predictor of cognitive function. However, few studies have compared whether one condition is uniquely associated with cognitive function when another condition is controlled for. AIMS: To explore the longitudinal associations of cognitive function with subjective memory complaints and grip strength in middle-aged and older adults, with a particular focus on whether one condition is uniquely associated with cognitive function when another condition is considered. METHODS: A total of 3,877 middle-aged and older adults (aged 45-92 years) from the China Health and Retirement Longitudinal Study reported on their demographic and health status and completed measures of grip strength and subjective memory complaints, as well as a series of cognitive tests, every two years between 2011 and 2015. Generalized estimating equation models were used to assess the relationships between grip strength, subjective memory complaints, and cognitive function. RESULTS: Grip strength was longitudinally associated with cognitive function (ß = 0.021, 95% confidence interval [CI]: 0.011, 0.030, P < 0.001) independent of subjective memory complaints. In contrast, changes in the subjective memory complaints were not related to cognitive function over time (ß = 0.107, 95% CI: - 0.025, 0.238, P = 0.112). Only at baseline subjective memory complaints were associated with poorer cognitive function (ß = - 1.142, 95% CI: - 1.309, - 0.975, P < 0.001). CONCLUSIONS: Grip strength might be a more important clinical correlate of cognitive function decline over time than subjective memory complaints. DISCUSSION: Regular assessment and close monitoring of grip strength might help identify individuals who might be at high risk for cognitive impairment.

Development and testing of an intervention to increase staff knowledge and confidence in responding to health anxiety in the context of cognitive decline: a pilot study.

BACKGROUND: Memory complaint in the absence of organic pathology is a common phenomenon accounting for up to one third of patients presenting to memory clinics. Health anxiety has been specifically linked to dementia worry and repeated presentations to the National Health Service (NHS). Providing reassurance that an individual does not have dementia appears ineffective in reducing presentations to primary and secondary care services. AIMS: This study sought to evaluate and establish the effectiveness of a 1-hour pilot training workshop to enhance healthcare professionals' knowledge and confidence to those with health anxiety around cognitive decline. METHOD: The one-session pilot training workshop was developed and informed by previous work and consultation with the 2Gether NHS Foundation Trust Memory Assessment Service staff. The training workshop was then evaluated by employing an idiosyncratic self-report questionnaire. Participants completed the questionnaire prior to and after the training workshop. RESULTS: Pre- and post-training questionnaires revealed that the pilot training workshop was effective in increasing perceived knowledge and confidence in staff responding to patients presenting with health anxiety and co-occurring subjective memory complaints. CONCLUSIONS: The findings suggest that healthcare professionals may benefit from training in identifying and addressing health-anxious individuals with subjective memory complaints. This may have implications in the provision of psychologically informed care offered in a memory assessment service. Recommendations are made for further enhancing the effectiveness of staff training and promoting alternative service treatment pathways.

Implications of refrigerator management on subjective memory complaints among Japanese community-dwelling older adults.

AIM: Older adults with subjective memory complaints (SMC) may experience very minor difficulties in daily activities. Although caregivers and occupational therapists who support community-dwelling older adults are aware of the existence of characteristic behaviours related to refrigerator management, no specific studies have been conducted. This study aimed to examine the implications of refrigerator management for older adults with SMC. METHODS: A self-administered questionnaire was sent to 3000 randomly selected members of Consumer's Co-operative Kagoshima. Of the returned responses, a total of 282 older adults were analyzed. Analyzed subjects were divided into two groups: SMC (+) group (n = 74) and SMC (-) group (n = 192). A questionnaire was created by four occupational therapists and used to assess the characteristics of analyzed subjects and their abilities to manage the refrigerator. The observation list for early signs of dementia was also utilised. A multiple logistic analysis was performed to examine the association between SMC and refrigerator management. RESULTS: The SMC (+) group had a significantly higher number of refrigerator management errors than the SMC (-) group (P = 0.008). The SMC (+) group had more errors than the SMC (-) group in the following four items regarding refrigerator management; the refrigerator has a lot of the same foods / expired food, the person does not know what's in the refrigerator, the person cannot find what he/she needs in the refrigerator. Moreover, SMC was associated with the item 'the person does not know what is in the refrigerator' (odds ratio 7.44, 95% CI 1.51-43.8, P = 0.02). CONCLUSIONS: Our results showed that older adults with SMC had several problems regarding refrigerator management. Evaluating refrigerator management among older adults with SMC may help consider multifaceted support.

The MN RIDE pilot: feasibility of a synchronous, remotely delivered, aerobic exercise training program for rural-dwelling adults with subjective cognitive decline.

INTRODUCTION: Out of all the modifiable risk factors for Alzheimer's disease and related dementias (ADRD), physical inactivity is the strongest. Rural residents have an increased risk for dementia and face significant barriers to accessing ADRD information, caregiving support, and memory-related services, which contributes to substandard care. Rural communities have greater barriers to participating in physical activity, and in particular exercise, due to lack of social support, travel/weather problems, and lack of facilities/equipment. The purpose of this pilot study was to implement and evaluate the feasibility and safety of a synchronous, remotely delivered, aerobic exercise (AEx) telerehabilitation program in persons with subjective cognitive decline (SCD) living in rural areas. METHODS: The Minnesota Rehabilitation Intervention for Dementia Evasion for rural residents (MN RIDE) pilot study was one of five pilot studies conducted through the Center for Community Engaged Rural Dementia and Alzheimer's Research, conducted in collaboration with the Memory Keepers Medical Discovery Team. The Memory Keepers Medical Discovery Team employs a community-based participatory research model and uses a community advisory group, community-based researchers and a rural community engagement specialist to ensure research studies are aligned with rural community needs and to facilitate the recruitment of participants living in rural northern Minnesota. The MN RIDE study employed a single group, pretest-post-test design to test the feasibility and safety of an AEx-focused synchronous telerehabilitation program in rural-living middle-aged or older adults (>45 years) with SCD (indicated by answering yes to both, 'Do you perceive memory or cognitive difficulties?' and 'In the last two years, has your cognition or memory declined?'). All 36 AEx sessions (conducted over 12 weeks) were supervised remotely via smart devices and Zoom. The AEx program was classified as moderate intensity stationary cycling starting at a rating of perceived exertion (RPE) 11-12 or for 30-35 minutes in session 1, and was alternatively increased by 1-point RPE or 5-minute increments as tolerated up to RPE 12-14 for 50 minutes a session over time (by session 18). Secondarily, moderate intensity was defined as achieving an exercise heart rate of 64-76% of age-predicted maximum heart rate (HRmax). Feasibility and safety outcomes were assessed by session attendance, intensity adherence, presence of adverse events, and participant satisfaction. RESULTS: The average age of the study sample (n=9) was 57.44±7.16 years (average age of SCD onset 53.44±7.47 years) with 14.00±5.57 years of education and 88.9% female. All patients completed the study, resulting in a dropout rate of 0%. Out of the possible 324 sessions scheduled, 276 were attended (85% session adherence). Average intensity metrics achieved over the AEx sessions were RPE 13.2±0.5 and HRmax 72.0±7.9%, which both represent of moderate intensity AEx metrics. No adverse events were reported. CONCLUSION: This pilot study further provides the first evidence of preliminary feasibility of synchronous audiovisual, telerehabilitation programs delivered to rural residents at risk for ADRD. Thus, exercise telerehabilitation programs that focus on AEx could be viable and useful tools to overcome situations with limited access to healthcare services such as in rural communities. Further controlled studies with greater sample size could help further expand our results.

Alleviated Anxiety Boosts Memory Training Gain in Older Adults with Subjective Memory Complaints: A Randomized Controlled Trial.

OBJECTIVE: Older adults with subjective memory complaints (SMC) have a higher risk of dementia and commonly demonstrate symptoms of depression and anxiety. The study aimed to examine the effect of a memory training program for individuals with SMC, and whether additional group counseling aimed at alleviating depression and anxiety would boost memory training gains. DESIGN: A three-armed, double-blind, randomized controlled trial. SETTING AND PARTICIPANTS: Community-dwelling older adults with SMC, age ≥60. METHODS: Participants (n = 124) were randomly assigned to memory training (MT), group counseling (GC), or GC + MT intervention. The GT + MT group received 3 sessions of group counseling followed by a 4-week memory training, while the MT group attended reading and memory training, and the GC group received group counseling and health lectures. Cognitive function and symptoms of depression and anxiety were assessed at baseline, mid-, and post-intervention. RESULTS: After group counseling, the GC + MT and GC groups showed reduced symptoms of anxiety compared to the MT group. Memory training enhanced associative learning in both MT and GC + MT groups compare with the GC group, but the GC + MT group demonstrated a larger memory improvement (Cohen's d = 0.57) than the MT group (Cohen's d = 0.44). CONCLUSION AND IMPLICATIONS: Group counseling decreased symptoms of anxiety, memory training increased associative learning, and the combination of two intervention induced larger memory gain than memory training alone. The results suggest that it may need to integrate treatment for anxiety into memory training for older adults with SMC to achieve better intervention effect. TRIAL REGISTRATION: ChiCTR-IOR-15006165 in the Chinese Clinical Trial Registry.

Subjective Memory Complaints and Their Relationship with the Objective Cognitive Performance of Stroke Patients.

INTRODUCTION: Subjective memory complaints (SMCs) are common among patients with stroke, significantly affect long-term disability, and contribute to poor functional outcomes. We explored changes in the subjective memory complaints questionnaire (SMCQ) score of stroke patients, correlations among SMCs, objective cognitive performance (OCP), and functional status. We also explored whether participants could be divided into groups based on the presence or absence of SMCs and OCP impairment, which could be related to rehabilitation outcomes. METHODS: A total of 102 stroke patients were recruited from a single rehabilitation center. Their OCP was determined on admission. The Mini-Mental State Evaluation (MMSE), SMCQ, and modified Barthel Index (MBI) scores were obtained at admission and at discharge. These variables were compared and time and group interactions were explored. RESULTS: The SMCQ score did not show consistent patterns of change among individuals. The objective cognitive function and activities of daily living consistently improved after rehabilitation. The proposed cognitive impairment classification after stroke based on SMCs and objective cognitive decline was able to predict improvement attributable to rehabilitation. CONCLUSION: Changes in SMCQ scores of stroke patients were inconsistent and varied when compared to changes in MMSE and MBI scores, indicating that it is not a reliable metric on its own. SMCs have a clinical relationship with OCP and significant emotional and motivational effects. In clinical practice, it is important to understand and consider SMCs after stroke.

Subjective, neuropsychological, and neural markers of memory in older adults.

OBJECTIVES: To investigate the relationship between the P300 event-related potential, neuropsychological measures of memory, subjective memory complaints (SMCs), and indicators of psychosocial functioning. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of 79 community-based older adults, aged 60-75 years, participants completed online surveys and in-person neuropsychological and electroencephalogram (EEG) assessments. MEASUREMENTS: Measures included: the Change subscale of the Metamemory in Adulthood Questionnaire, NIH Toolbox Emotions battery (Perceived Stress and Psychological Well-Being), Geriatric Depression Scale, Geriatric Anxiety Scale, electrocortical measures (EEG), California Verbal Learning Test, 3rd Edition, and diagnostic ratings for mild and major neurocognitive disorders based on full neuropsychological battery, clinical interview, and two-clinician consensus. RESULTS: P300 amplitude was associated with long-delay verbal memory recall and diagnostic rating. SMCs were not associated with objective memory or diagnostic rating. SMCs were associated with higher perceived stress, anxiety, and depression symptoms and lower psychological well-being. CONCLUSIONS: Neural indicators such as the P300 may be useful for early detection of cognitive impairment. SMCs were not a reliable indicator of early memory impairment in relation to neuropsychological or neural indicators, but may be a useful indicator of unreported stress and mood symptoms in clinical settings.

Subjective cognitive decline, APOE e4 allele, and the risk of neurocognitive disorders: Age- and sex-stratified cohort study.

OBJECTIVE: Subjective cognitive decline and APOE e4 allele (APOE4) are known predictors of mild cognitive impairment and dementia (mild cognitive impairment/dementia), with recent evidence showing interaction between subjective cognitive decline and APOE4 in amplifying the risk of mild cognitive impairment/dementia. However, the literature is unclear whether the interaction effect is seen across various age and sex strata. This study examined the interaction between subjective cognitive decline and APOE4-across different age and sex strata-on the risk of mild cognitive impairment/dementia. METHODS: This cohort study included 16,221 participants aged ⩾50 years and had normal cognition at baseline. Participants were evaluated for subjective cognitive decline and APOE4 at baseline, and followed-up almost annually for mild cognitive impairment/dementia (median follow-up = 4.5 years). Interaction effects were examined in Cox regression using Relative Excess Risk due to Interaction, stratified by age (⩽70 vs >70 years) and sex. RESULTS: Subjective cognitive decline and APOE4 were independently associated with mild cognitive impairment/dementia (hazard ratio: 1.4-1.8), with the highest risk when subjective cognitive decline and APOE4 co-occurred (hazard ratio: 2.6). APOE4 amplified the association between subjective cognitive decline and mild cognitive impairment/dementia in older women (Relative Excess Risk due to Interaction 1.0; 95% confidence interval = [0.3, 1.6]), but not in other age or sex strata. Among older women, half of them developed mild cognitive impairment/dementia by 12.1 years in the absence of subjective cognitive decline or APOE4. This duration shortened to 8.1-10.3 years in the presence of either subjective cognitive decline or APOE4, and to 4.4 years in the presence of both subjective cognitive decline and APOE4. Interaction effect among older women remained consistent when alternate outcomes were used (i.e. mild cognitive impairment and dementia due to Alzheimer's disease; dementia; and Alzheimer's dementia) (Relative Excess Risk due to Interaction 1.2-2.5). CONCLUSIONS: APOE4 amplifies the association between subjective cognitive decline and neurocognitive disorders in older women, with the findings suggesting the need for further research to delineate underlying neurobiology. APOE4 may potentially have a role in facilitating further risk stratification of older women with subjective cognitive decline in clinical practice.

Subjective memory complaints and social participation among older adults: results from the health and retirement study.

Objectives:This study aims to examine whether subjective memory complaints (SMC) contribute to social participation among older adults.Method:The study sample was 4,713 community-dwelling older adults aged 65 years and older from four waves (2010, 2012, 2014, 2016) of the Health and Retirement Study. Hierarchical linear modeling analysis was used to examine the association of SMC with social participation after controlling for factors influencing social participation. Demographic factors (i.e. age, gender, and perceived socioeconomic status) were entered in block 1, health-related factors (i.e. health conditions, perceived health, instrumental activities of daily living, memory-immediate and delayed, and depressive symptoms) were entered in block 2, environmental factors (i.e. perceived social support and strain from spouse, child, family, and friend) were entered in block 3, and SMC was entered in block 4.Results:The result showed that factors significantly contributing to social participation are age (standardized ß = -0.08, p < 0.01), perceived socioeconomic status (ß = 0.16, p < 0.001), perceived health (ß = 0.15, p < 0.001), instrumental activities of daily living (ß = 0.12, p < 0.001), memory-immediate and delayed (ß = 0.09, p < 0.001; ß = 0.08, p < 0.001, respectively), social support from spouse and friend (ß = 0.04, p < 0.05; ß = 0.13, p < 0.001, respectively), social strain from friend (ß = 0.07, p < 0.001), and SMC (ß = -0.05, p < 0.001). The demographic factors explained 9.5%, health-related factors explained 8.5%, environmental factors explained 2.4%, and SMC explained 0.1% of the variance in social participation.Conclusion: This finding suggests that SMC may contribute to social participation in older adults.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1961123 .

Life during COVID-19 lockdown in Italy: the influence of cognitive state on psychosocial, behavioral and lifestyle profiles of older adults.

OBJECTIVE: Few studies have examined lockdown effects on the way of living and well-being of older adults stratified by cognitive state. Since cognitive deficits are common in this population, we investigated how cognition influenced their understanding of the pandemic, socio-behavioral responses and lifestyle adaptations during lockdown, and how these factors affected their mood or memory. METHOD: Telephone-based survey involving 204 older adults ≥65 y/o (median: 82) with previous assessments of cognitive state: 164 normal-old (NOLD), 24 mild-neurocognitive disorder (mild-NCD), 18 mild-moderate dementia. A structured questionnaire was developed to assess psychological and socio-behavioral variables. Logistic regression was used to ascertain their effects on mood and memory. RESULTS: With increasing cognitive deficits, understanding of the pandemic and the ability to follow lockdown policies, adapt to lifestyle changes, and maintain remote interactions decreased. Participants with dementia were more depressed; NOLDs remained physically and mentally active but were more bored and anxious. Sleeping and health problems independently increased the likelihood of depression (OR: 2.29; CI: 1.06-4.93; p = 0.034 and OR: 2.45; CI: 1.16-5.16; p = 0.018, respectively); Regular exercise was protective (OR: 0.30; CI: 0.12-0.72; p = 0.007). Worsening subjective memory complaints were associated with dementia (p = 0.006) and depression (p = 0.004); New-onset sleeping problems raised their odds (OR: 10.26; CI: 1.13-93.41; p = 0.039). Finally, >40% with health problems avoided healthcare mainly due to fear of contagion. DISCUSSION: NOLD and mild-NCD groups showed similar mood-behavioral profiles suggesting better tolerance of lockdown. Those with dementia were unable to adapt and suffered from depression and cognitive complaints. To counteract lockdown effects, physical and mental activities and digital literacy should be encouraged.

Are subjective cognitive complaints associated with executive functions and mental health of older adults?

Subjective cognitive complaints are used to detect detrimental age-related variations in cognitive efficiency before cognitive decline occurs in late adulthood. Despite this, there is controversial evidence on the relationship between the aforementioned metacognitive measure and the actual cognitive efficiency of older individuals. Instead, subjective cognitive complaints seem to be related to perceived mental health. This study aimed to investigate the nature of the relationships between subjective cognitive failures, mental health, and executive functioning. An additional goal was to examine whether there were significant differences in perceived mental health and executive functions efficiency by comparing older people who exhibited fewer subjective cognitive complaints with a group who reported more cognitive complaints. Eighty-nine community-dwellers (Mage = 78.6 years, SD = 6.5 years; age range = 66-95 years), 42 males and 47 females, were recruited and completed a battery of tools assessing cognitive failures, depressive symptoms, psychological well-being, optimism, global cognitive functioning, vocabulary, and several executive functions. Significant relationships were only found between self-reported cognitive failures, depressive symptoms, optimism, and psychological well-being. Moreover, participants who reported more cognitive failures also exhibited less optimism and psychological well-being and showed more depressive symptoms than older respondents who exhibited fewer cognitive complaints. Finally, no differences in the measures of executive functioning were found between groups exhibiting low vs. high levels of subjective cognitive complaints. In conclusion, the concurrent objective assessment of cognitive functioning and self-reported evaluation of cognitive processes and mental health of older people should be encouraged, to detect possible threats to their well-being.

Event-related brain potential indexes provide evidence for some decline in healthy people with subjective memory complaints during target evaluation and response inhibition processing.

In the preclinical stage of the Alzheimer's disease (AD) continuum, subjects report subjective memory complaints (SMCs), although with the absence of any objective decline, and have a higher risk of progressing to dementia than the general population. Early identification of this stage therefore constitutes a major focus of current AD research, to enable early intervention. In this study, healthy adult participants with high and low SMCs (HSMCs and LSMCs) performed a Go/NoGo task during electroencephalogram (EEG) recording. Relative to LSMC participants, HSMC participants performed the task slower (longer reaction times) and showed changes in the event-related potential (ERP) components associated with response preparation (lower readiness potential -RP- amplitude in the Go condition), and also related to response inhibition processes (lower N2-P3 amplitude in the NoGo condition). In addition, HSMC participants showed lower Go-N2 and NoGo-N2 peak-to-baseline amplitudes, however these results seem to be influenced by a negative tendency overlapping stimulus-related waveforms. The declines observed in this study are mostly consistent with those observed in aMCI participants, supporting the notion of the AD continuum regarding SMC state.

Learning to play golf for elderly people with subjective memory complaints: feasibility of a single-blinded randomized pilot trial.

BACKGROUND: Subjective Memory Complaints (SMC) in elderly people due to preclinical Alzheimer's Disease may be associated with dysregulation of the Kynurenine Pathway (KP), with an increase in neurotoxic metabolites that affect cognition. Golf is a challenging sport with high demands on motor, sensory, and cognitive abilities, which might bear the potential to attenuate the pathological changes of preclinical AD. This trial investigated the feasibility of learning to play golf for elderly with cognitive problems and its effects on cognitive functions and the KP. METHODS: In a 22-week single-blinded randomized controlled trial, elderly people with SMC were allocated to the golf (n = 25, 180 min training/week) or control group (n = 21). Primary outcomes were feasibility (golf exam, adherence, adverse events) and general cognitive function (Alzheimer's Disease Assessment Scale). Secondary outcomes include specific cognitive functions (Response Inhibition, Corsi Block Tapping Test, Trail Making Test), KP metabolites and physical performance (6-Minute-Walk-Test). Baseline-adjusted Analysis-of-Covariance was conducted for each outcome. RESULTS: 42 participants were analyzed. All participants that underwent the golf exam after the intervention passed it (20/23). Attendance rate of the golf intervention was 75 %. No adverse events or drop-outs related to the intervention occurred. A significant time*group interaction (p = 0.012, F = 7.050, Cohen's d = 0.89) was found for correct responses on the Response Inhibition task, but not for ADAS-Cog. Moreover, a significant time*group interaction for Quinolinic acid to Tryptophan ratios (p = 0.022, F = 5.769, Cohen's d = 0.84) in favor of the golf group was observed. An uncorrected negative correlation between attendance rate and delta Quinolinic acid to Kynurenic acid ratios in the golf group (p = 0.039, r=-0.443) was found as well. CONCLUSIONS: The findings indicate that learning golf is feasible and safe for elderly people with cognitive problems. Preliminary results suggest positive effects on attention and the KP. To explore the whole potential of golfing and its effect on cognitive decline, a larger cohort should be studied over a longer period with higher cardiovascular demands. TRIAL REGISTRATION: The trial was retrospectively registered (2nd July 2018) at the German Clinical Trials Register ( DRKS00014921 ).

Pilot feasibility study of cognitive training exercises for Egyptian adults: Proof of concept.

OBJECTIVES: Cognitive training exercises (CTE) are promising and effective interventions to enhance cognitive reserve and slowdown cognitive deterioration in people with subjective memory impairment (SCI) and mild cognitive impairment (MCI). In this pilot study, we aimed to assess the feasibility of CTE among Egyptian adults. METHODS: Eighteen participants above 40 years old were recruited. They underwent baseline neuropsychological assessment and functional assessment. However, after receiving a 6 weeks' cognitive training, eight participants (seven with MCI and one was cognitively intact) dropped out from the study. Finally, 10 participants (8 participants with MCI, 1 with SCI and 1 was cognitively intact) completed 12 weeks of CTE and undergone the post-assessment afterward. CTE included visual, verbal, memory, executive function, visuospatial, attention, and psychokinetic exercises through onsite and home-based sessions. RESULTS: For the 10 participants who completed 12 weeks of CTE, the Wilcoxon signed-rank test showed a statistically significant change in the scores of mini-mental state examination (Z = -2.546, p = 0.011), semantic fluency test (Z = -2.913, p = 0.004), subjective memory complaint questionnaire (Z = -2.913, p = 0.004), Consortium to Establish a Registry for Alzheimer's Disease Word List (first trial: Z = -2.641, p = 0.008; Word list recall: Z = -2.825, p = 0.005), construction abilities (immediate: Z = -2.121, p = 0.034; delayed recall: Z = -2.414, p = 0.016), and Digit span test (forward: Z = -2.724, p = 0.006; backward: Z = -2.724, p = 0.006). CONCLUSIONS: The results of this study suggested that CTE are feasible among Egyptian adults, especially those with MCI, and potentially effective in enhancing global cognition and after 12 weeks of training. Future research should shed light on the efficacy of longitudinal CTE implementation in Arab adults' populations.