Individual differences in frequency and impact of daily memory lapses: results from a national lifespan sample.

BACKGROUND: Everyday memory problems are believed to increase with age, leading many researchers to focus on older ages when examining reports of memory lapses. However, real world memory lapses are ubiquitous across the adult lifespan, though less is known about the types of problems and their impacts at younger ages. The current study examined occurrence and impacts of memory lapses using daily diaries in a broad age range and whether characteristics of lapses varied across age, gender, or education level. METHODS: Using an 8-day daily diary protocol, 2,018 individuals (ages 25-91) provided reports of their experiences of two types of daily memory lapses (retrospective and prospective) as well as the impact those lapses had on their emotional and functional well-being that day. Using multilevel modeling, we examined the likelihood of reporting memory lapses and their impacts on daily life and whether these depended on age, gender, or education level. RESULTS: Participants reported lapses on approximately 40% of days; retrospective memory lapses were significantly more likely than prospective lapses. Older ages and higher education level were related to greater likelihood of reporting retrospective lapses. Women (compared to men) were more likely to report prospective memory lapses. Women also tended to report greater impacts of their memory lapses. Lower education levels were related to greater impacts of memory lapses compared to higher education levels. Interestingly, age was not related to impacts of lapses. DISCUSSION: Our results indicate that memory lapses are common across the lifespan and that those individuals more likely to report lapses are not necessarily those that experience the greatest impacts of those lapses on daily life. Additional work is needed to understand the daily experience of memory lapses and how they differentially affect individuals regardless of age, gender, and education. CONCLUSIONS: Memory lapses are an important aspect of daily life across the lifespan and require measurement in an individual's real-world environments. Better measurement of these experiences will allow the development of more sensitive measures of changes in cognitive functioning that may impact an individual's ability to live independently.

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.

Age Discrepancies Across Two Decades: Desiring to be Younger Is Associated with Daily Negative Affect Over Three Waves of Assessment.

Negative perceptions of aging and older adulthood, including the idealization of youth, are common in the United States. Past work has found that holding negative perceptions of aging is closely associated with poor mental and physical health consequences, yet few studies have examined how these perceptions impact day-to-day experiences. The current study had two objectives: (1) investigate whether age discrepancy (specifically desiring to be younger than one's chronological age) was related to daily negative affect and (2) examine whether this relationship changed as participants aged over time. We utilized the Midlife in the United States (MIDUS) diary study, a longitudinal measurement burst study with three waves of 8-day daily diaries indexing approximately 20 years. Participants (N = 2398; Mage [baseline] = 46.85, SD = 12.24; 54.7% women; 92.4% White) reported their desired age as well as daily negative affect at each wave. Using multilevel modeling, we examined whether age discrepancy predicted daily negative affect across 3 waves of observation. Results supported a significant relationship between age discrepancy and daily negative affect. However, no interactions among age discrepancy and baseline age or time across study were found. This suggests that the relationship between age discrepancy and daily negative affect was consistent across waves and participants over a 20-year period and provides evidence for the pernicious effect of deidentifying with one's real age on daily life. Daily experiences can act as potential risk or protective factors and shape developmental trajectories. Reducing ageism through societal interventions or increasing personal acceptance of aging through targeted interventions are two potential pathways of promoting health and well-being across the lifespan.

The Role of Cognitive Self-Report Measure Type in Predicting Cognitive Decline Among Older Adults: A Systematic Review.

Many types of items are used to measure self-reported cognition, resulting in heterogeneity across studies. Certain cognitive self-report measure types may be more predictive of future decline. Therefore, the purpose of this systematic review was to compare whether specific types of cognitive self-report measures better predict risk for cognitive decline over time when measures are directly compared within the same study. The PRISMA criteria guided the review. Eligibility criteria included: longitudinal studies, outcome of cognitive decline, at least 2 different cognitive self-report measures, and no cognitive impairment at baseline. Nineteen studies were included in the final review. A narrative synthesis of results was completed, resulting in 3 thematic groups of comparisons across self-reported measure types. Self-reported memory decline with worry and peer perceptions of memory were associated with the highest risk for cognitive decline. Future longitudinal investigations of self-reported cognitive problems should focus on using measures that may be most sensitive to predicting cognitive decline risk.

Age and gender disparities in depression and subjective cognitive decline-related outcomes.

OBJECTIVES: Determine the association between depression and SCD-related outcomes by age and gender. METHODS: Using 2018 Behavioral Risk Factor Surveillance System survey data, crude and multivariable logistic regression models were used to determine the associations between depression and SCD-related outcomes by age and gender. RESULTS: Among respondents 45 to 69, depression was associated with SCD [adjusted OR (aOR): 4.36; 95% CI: 3.24-5.86]; needing assistance with activities due to confusion/memory loss (aOR: 2.38; 95% CI: 1.26 - 4.51); needing help with activities and the help is not available (aOR: 4.46; 95% CI: 1.31 - 15.2); and having discussed confusion/memory loss with a health care professional (aOR: 1.87; 95% CI: 1.09 - 3.23). However, among respondents 70 and older, depression was associated with SCD (aOR): 3.52; 95% CI: 2.06-6.02); needing help with activities and the help is not available (aOR: 0.09; 95% CI: 0.01-0.56); confusion/memory loss interfering with work/social activities (aOR: 2.44; 95% CI: 1.03-5.79); and having discussed confusion/memory loss with a health care professional (aOR): 2.99; 95% CI: 1.20-7.40). Depression was positively associated with SCD among men (aOR): 3.68; 95% CI: 2.52-5.38) and women (aOR): 4.76; 95% CI: 3.29-6.87; and was positively associated with all SCD-related outcomes among men except for confusion/memory loss interfering with work/social activities and given up chores. Depression was positively associated with the latter among women (aOR): 2.10; 95% CI: 1.09-4.06). DISCUSSION: SCD interventions should include assessment of and intervention for depression, and consider age and gender differences.

Parental dementia and subjective memory impairment in the health and retirement study.

OBJECTIVES: To examine relationships between subjective memory impairment (SMI) and parental dementia among in older adults while considering the interactive influence of depressive symptoms, ethnicity, and race. METHOD: The sample was drawn from the Health and Retirement Study, a nationally representative longitudinal study of aging (n = 3,809; Mage = 66.09; SD = 1.88; 84.20% White; 12.23% Black; 7.88% Hispanic). Biennial assessments included two measures of SMI (current memory problems and perceived memory decline), depressive symptoms, and parental dementia, over periods of up to sixteen years. Multilevel modeling analyses examined longitudinal relationships between parental dementia and SMI and whether depressive symptoms, ethnicity, and race interactively influenced this association. RESULTS: Results showed that when older adults reported parental dementia, they were more likely to report a decline in memory in the past two years. They also reported poorer current memory problems, especially when they experienced increased depressive symptoms. Associations of parental dementia were consistent across ethnicity and race. CONCLUSIONS: Results demonstrate the importance of considering parental dementia as a factor that may contribute to SMI in older adults.

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.

Longitudinal relationships among depressive symptoms and three types of memory self-report in cognitively intact older adults.

OBJECTIVES: The current study examined whether self-reported memory problems among cognitively intact older adults changed concurrently with, preceded, or followed depressive symptoms over time. DESIGN: Data were collected annually via in-person comprehensive medical and neuropsychological examinations as part of the Einstein Aging Study. SETTING: Community-dwelling older adults in an urban, multi-ethnic area of New York City were interviewed. PARTICIPANTS: The current study included a total of 1,162 older adults (Mage = 77.65, SD = 5.03, 63.39% female; 74.12% White). Data were utilized from up to 11 annual waves per participant. MEASUREMENTS: Multilevel modeling tested concurrent and lagged associations between three types of memory self-report (frequency of memory problems, perceived one-year decline, and perceived ten-year decline) and depressive symptoms. RESULTS: Results showed that self-reported frequency of memory problems covaried with depressive symptoms only in participants who were older at baseline. Changes in perceived one-year and ten-year memory decline were related to changes in depressive symptoms across all ages. Depressive symptoms increased the likelihood of perceived ten-year memory decline the next year; however, perceived ten-year memory decline did not predict future depressive symptoms. Additionally, no significant temporal relationship was observed between depressive symptoms and self-reported frequency of memory problems or perceived one-year memory decline. CONCLUSION: Our findings highlight the importance of testing the unique associations of different types of self-reported memory problems with depressive symptoms.

Memory complaints and depressive symptoms over time: a construct-level replication analysis.

BACKGROUND: Memory complaints and depressive symptoms are frequently associated in older adults and both serve as potential indicators of future cognitive decline. However, the temporal ordering of the development of these two symptoms remains unclear. The goal of the current study was to examine concurrent and temporal relationships between memory complaints and depressive symptoms in older adults. METHODS: Data were drawn from two longitudinal, nationally representative datasets and included cognitively intact older adults aged 65 and over. The datasets in the current study were from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Using an integrative analytic framework, we tested bidirectional temporal relationships between memory complaints (memory ratings and perceived memory decline) and depressive symptoms over 6 to 9 years of data in over 5000 older adults across these two samples. RESULTS: Across both datasets, perceived memory decline predicted future depressive symptoms whereas memory ratings did not. Additionally, results showed that at times when depressive symptoms tended to be higher, memory complaints were also higher, but depressive symptoms did not predict future memory complaints. One finding that was inconsistent across datasets was memory ratings predicting depressive symptoms. After accounting for covariates, this relationship was only significant in one dataset. CONCLUSIONS: Cognitively intact older adults who report memory decline may be at risk for developing depressive symptoms in the future. Furthermore, our findings highlight the importance of using immediate replication of results across datasets to determine the generalizability of conclusions.

The Relationship between Subjective Cognitive Impairment and Activity Participation: A Systematic Review.

This systematic review synthesizes current evidence to determine how subjective cognitive impairment (SCI) relates to physical, cognitive, and social activity participation in older adults. Nine peer-reviewed articles were reviewed and appraised for evidence quality. Most were cross-sectional and had high methodological quality. Higher levels of SCI were almost universally associated with lower levels of physical and social activity participation. These findings suggest that older adults who report higher SCI engage in fewer activities. Examining these relationships longitudinally is an important next step to determine whether SCI precedes withdrawing from activities in older adults.

Predicting current and future anxiety symptoms in cognitively intact older adults with memory complaints.

OBJECTIVES: Memory complaints are a common concern for older adults and may co-occur with anxiety symptoms. Although both memory complaints and anxiety are associated with heightened cognitive decline risk, little is known about how these symptoms develop over time. The purpose of this study was to examine the differential concurrent and longitudinal relationships among anxiety symptoms and two types of memory complaints in cognitively intact older adults. METHODS/DESIGN: The current study sample was drawn from two longitudinal, nationally representative datasets, the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Cognitively intact older adults aged 65 and over were included, representing six (n = 5069; NHATS) and two (n = 5284; HRS) waves of data, respectively. Using multilevel linear modeling, we tested bidirectional relationships between anxiety and two types of memory complaints: current rating of memory performance and perceived memory decline. RESULTS: Concurrent associations between anxiety symptoms and memory complaints were found in both datasets: At times when current memory performance was rated more poorly or perceived memory decline was reported, anxiety symptoms tended to be higher, and vice versa. A longitudinal relationship was identified in NHATS such that perceived memory decline, and not current memory rating, predicted future anxiety symptoms. CONCLUSION: This study provides a better understanding of the relationships between memory complaints and anxiety symptoms over time. Cognitively intact older adults with perceived memory decline are at greater risk for current as well as future anxiety symptoms.

Relationships Between Subjective Cognitive Impairment and Personality Traits: A Systematic Review.

This systematic review examined the relationships between personality traits and subjective cognitive impairment (SCI) in older adults without dementia. A comprehensive literature search conducted according to PRISMA guidelines identified empirical investigations of SCI and at least one of the big five personality traits among adults age 60 or older. All articles were critically appraised using the weight of evidence framework and findings were compared, contrasted, and synthesized across studies. Sixteen of the 797 studies initially identified met eligibility criteria. A higher level of SCI was associated with higher neuroticism in 88% of the studies reviewed. In addition, a consistent negative association was identified between conscientiousness and SCI (57% of studies). No consistent relationships between openness, extraversion, or agreeableness and SCI were identified. Overall, this review supports the oft-cited association between higher neuroticism and greater self-reports of cognitive problems; however, the complexity of the relationship between SCI and personality is not yet fully understood. Future research should examine the extent to which different personality traits predispose individuals to report symptoms versus those traits that are associated with increased sensitivity to early indicators of pathological change. [Journal of Gerontological Nursing, 45(2), 27-34.].

Alzheimer's disease risk factors as mediators of subjective memory impairment and objective memory decline: protocol for a construct-level replication analysis.

BACKGROUND: Subjective memory impairment (SMI), or the perception of memory problems in the absence of objective memory deficits, is associated with negative outcomes of individual and societal significance, including a substantially increased risk of Alzheimer's disease (AD). However, little is known regarding the mediators that link SMI and memory decline in some individuals, or which older adults with SMI are at greatest risk for memory decline. In this study, we will examine modifiable AD risk factors (specifically affective symptoms and activity participation) as mediators underlying linkages among SMI and memory decline over time; furthermore, we will characterize SMI subgroups at highest risk for memory decline via this pathway. METHODS: This study utilizes a series of construct-level replication analyses across four large longitudinal datasets to maximize the unique aspects of each dataset as well as test the reproducibility of findings across multiple populations to establish generalizability. The current study's sample (n > 40,000) is drawn from the Einstein Aging Study, Health and Retirement Study, Minority Aging Research Study, and National Health and Aging Trends Study. Participants must meet the following basic criteria for inclusion: age 55 or older and no evidence of cognitive impairment at baseline. We will use multilevel modeling to determine whether higher levels of SMI are related to increased affective symptoms and decreased activity participation, as well as whether this relationship is moderated by neuroticism, family history of AD, and race/ethnicity. Finally, we will test our full conceptual model that examines whether changes in affective symptoms and activity participation mediate the relationship between SMI and objective memory decline. Specifically, we will test moderated mediation as we hypothesize these relationships to hold among subgroups of older adults. DISCUSSION: Discovery of modifiable AD risk factors that mediate the association between SMI and memory decline (the earliest and most central deficit in AD) will provide explicit, and potentially novel, targets for intervention. Additionally, identifying individuals at highest risk for negative reactions to SMI will serve to enrich samples for future research as well as to help guide the development of SMI assessment tools to identify older adults at greatest risk for debilitating outcomes.

Subjective cognitive impairment and quality of life: a systematic review.

BACKGROUND: Older adults with subjective cognitive impairment (SCI) experience increased affective symptoms, reduced engagement in a range of activities, as well as more functional problems when compared to those without SCI. These associations suggest that SCI may be detrimental to older adults' quality of life (QoL). The purpose of this paper is to advance understanding of the SCI-QoL relationship through a comprehensive review of the empirical literature relating SCI and QoL. METHODS: A systematic literature review was conducted in CINAHL, PsycINFO, and PubMed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Eligible articles were appraised using the weight of evidence (WoE) framework to evaluate methodological quality, methodological relevance, and topic relevance. A narrative synthesis of results was conducted, based on conceptual definitions of QoL. RESULTS: Eleven articles were identified that met eligibility criteria. WoE ratings ranged from low to high scores. Studies reviewed reported that the presence, greater frequency, or greater severity of SCI is associated with lower QoL regardless of methodological quality rating, sample characteristics (e.g. geographic location, clinical vs. community settings), study design (e.g. cross-sectional vs. longitudinal), and operationalization of SCI or QoL. CONCLUSION: Across studies, QoL was negatively associated with SCI. However, a frequent limitation of the reviewed literature was the mismatch between the conceptual and operational definitions of SCI and QoL. Similarly, SCI measures varied in quality across the reviewed literature. This suggests future empirical work should focus on the appropriate strategies for conceptually and operationally defining these constructs.

When study participants are vulnerable: getting and keeping the right team.

BACKGROUND: Research assistants (RAs) are critical members of all research teams. When a study involves vulnerable populations, it is particularly important to have the right team members. AIM: To describe the motivations, personal characteristics and team characteristics that promoted the job satisfaction of RAs who worked on two multi-year, randomised clinical trials involving older adults with dementia. DISCUSSION: A survey was conducted with 41 community members who worked as RAs for up to five years. Measures included demographics, work engagement, personality and characteristics of effective teams, as well as open-ended questions about respondents' experiences of the study. Quantitative analyses and coding of open-ended responses were used to summarise results. Almost all the RAs surveyed joined the team because of previous experiences of interacting with cognitively impaired older people. The RA respondents scored higher in 'dedication to work', 'extraversion', 'agreeableness' and 'conscientiousness' than average. An important aspect of their job satisfaction was team culture, including positive interpersonal interaction and the development of supportive team relationships. CONCLUSION: A positive work culture provides RAs with an opportunity to work with a study population that they are personally driven to help, and promotes motivation and satisfaction in team members. IMPLICATIONS FOR PRACTICE: Results from this study can guide the recruitment, screening and retention of team members for studies that include vulnerable populations.

Assessment of subjective cognitive impairment among older adults.

Subjective cognitive impairment (SCI) refers to an individual's everyday concerns related to cognitive functioning, which can exist even in the absence of objectively assessed impairment. SCI is common among older adults, and although symptoms may be mild, SCI is associated with subsequent cognitive decline as well as significant negative effects on everyday functional ability, mood, and social engagement. Despite the potential consequences, SCI is often underreported and undetected. Thus, it is critical to consider assessing for SCI among older adults to determine cognitive impairment risk and support early intervention to promote functional well-being and health management. The current article reviews factors related to SCI, evaluates existing methods for the assessment of SCI, and proposes a person-centered framework for enhancing assessment. Application of the framework is further illustrated through the use of clinical examples.

Licensed Nurse and Nursing Assistant Recognition of Delirium in Nursing Home Residents With Dementia.

Many nursing home residents experience delirium. Nursing home personnel, especially nursing assistants, have the opportunity to become familiar with residents' normal cognitive function and to recognize changes in a resident's cognitive function over time. The purpose of this study was to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Participants were asked to complete five case vignette assessments at three different time points (in 6-month intervals) to test their ability to identify different subtypes of delirium and delirium superimposed on dementia (DSD). A total of 760 case vignettes were completed across the different time points. Findings reveal that staff recognition of delirium was poor. The case vignette describing hyperactive DSD was correctly identified by the greatest number participants, and the case vignette describing hypoactive DSD was correctly identified by the least number of participants. Recognition of the case vignette describing hypoactive delirium improved over time. Nursing assistants performed similarly to the licensed nurses, indicating that all licensed nursing home staff require further education to correctly recognize delirium in older adults.