The Impact of Memory Change on Everyday Life Among Older Adults: Association with Cognition and Self-Reported Memory.

OBJECTIVES: Many older adults experience memory changes that can have a meaningful impact on their everyday lives, such as restrictions to lifestyle activities and negative emotions. Older adults also report a variety of positive coping responses that help them manage these changes. The purpose of this study was to determine how objective cognitive performance and self-reported memory are related to the everyday impact of memory change. METHODS: We examined these associations in a sample of 94 older adults (age 60-89, 52% female) along a cognitive ability continuum from normal cognition to mild cognitive impairment. RESULTS: Correlational analyses revealed that greater restrictions to lifestyle activities (|rs| = .36-.66), more negative emotion associated with memory change (|rs| = .27-.76), and an overall greater burden of memory change on everyday living (|rs| = .28-.61) were associated with poorer objective memory performance and lower self-reported memory ability and satisfaction. Performance on objective measures of executive attention was unrelated to the impact of memory change. Self-reported strategy use was positively related to positive coping with memory change (|r| = .26), but self-reported strategy use was associated with more negative emotions regarding memory change (|r| = .23). CONCLUSIONS: Given the prevalence of memory complaints among older adults, it is important to understand the experience of memory change and its impact on everyday functioning in order to develop services that target the specific needs of this population.

Examining the factor structure of the Multifactorial Memory Questionnaire.

Many adults report memory changes as they age. The Multifactorial Memory Questionnaire (MMQ) measures different aspects of self-reported memory, including satisfaction with one's memory, self-appraisal of memory ability, and compensatory strategy use. This questionnaire has been extensively used for clinical and research purposes, with studies reporting differences in the factor structure (three or four factors) underlying this measure. The current study evaluates previously reported factor configurations of the MMQ using best measurement practices. Confirmatory factor analyses were conducted on data from 560 cognitively - normal adults, ranging in age from 50 to 90 years old. Our results demonstrate support for both 3-factor model (with Satisfaction, Ability and Strategy scales) and 4-factor model structure (with Satisfaction, Ability, Internal Strategy and External Strategy scales) of this instrument. These results harmonise the existing literature which, in separate studies using exploratory analyses, supports the validity of one model or the other. The confirmation of multiple Strategy scales will provide clinicians and researchers with additional relevant information about how older adults compensate for their memory changes, enabling a broader understanding of the experience of age-related memory change. We contextualise these results within existing research identifying conceptual differences between internal and external strategy implementation.

Assessing one's sense of normalcy: psychometric properties of the subjective normalcy inventory.

OBJECTIVES: Individuals facing a personal challenge, such as age-related memory changes, may feel that their experiences are abnormal or pathological. Previous qualitative research on a group intervention that focuses on memory changes in older adulthood revealed that one of the greatest benefits derived by participants was the realization that their experience with memory changes was normal. In order to quantify this experience, we developed and validated a new measure, the 26-item Subjective Normalcy Inventory (SNI). METHOD: Reliability and validity were assessed with a sample of 167 community-dwelling adults between the ages of 55 and 90. Questionnaire responsiveness was assessed with an additional sample of 29 older adults who completed a 5-session memory intervention program known to cultivate normalization. RESULTS: The SNI exhibited a two-factor structure, excellent test-retest reliability, ICC = .79, excellent internal consistency, Cronbach's α = .91, and good convergent, |rs| = .46-.58, and discriminant, rs = .02-.06, validity. The measure was also responsive to change, as participants who completed the memory intervention program reported a greater sense of normalcy relative to nonintervention controls, η2p = 0.17. CONCLUSION: The SNI has the potential to provide novel and useful outcome information for interventions designed to improve one's sense of normalcy and may be applied in both clinical and research settings. The SNI can also be modified, validated, and used to assess subjective normalcy with respect to other personal challenges outside of memory and attention changes.

Development and Psychometric Validation of a Questionnaire Assessing the Impact of Memory Changes in Older Adults.

BACKGROUND AND OBJECTIVES: Many healthy older adults experience age-related memory changes that can impact their day-to-day functioning. Qualitative interviews have been useful in gaining insight into the experience of older adults who are facing memory difficulties. To enhance this insight, there is a need for a reliable and valid measure that quantifies the impact of normal memory changes on daily living. The primary objective of this study was to develop and validate a new instrument, the Memory Impact Questionnaire (MIQ). RESEARCH DESIGN AND METHODS: We examined the underlying component structure and psychometric properties of the MIQ in a sample of 205 community-dwelling older adults. RESULTS: Principal component analysis revealed three clusters: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. Comparisons of the corresponding subscale scores with scores on other instruments revealed good convergent and discriminant validity. In addition, the MIQ subscales and the total score showed good test-retest reliability (rs = 0.65-0.91) and internal consistency (αs = 0.87-0.93). DISCUSSION AND IMPLICATIONS: This novel questionnaire can be used in both clinical and research settings to better understand the impact of memory changes on the day-to-day functioning of older adults and to monitor outcomes of support programs for this population.

The 5-HTTLPR and BDNF polymorphisms moderate the association between uncinate fasciculus connectivity and antidepressants treatment response in major depression.

Symptom improvement in depression due to antidepressant treatment is highly variable and clinically unpredictable. Linking neuronal connectivity and genetic risk factors in predicting antidepressant response has clinical implications. Our investigation assessed whether indices of white matter integrity, serotonin transporter-linked polymorphism (5-HTTLPR) and brain-derived neurotrophic factor (BDNF) val66met polymorphism predicted magnitude of depression symptom change following antidepressant treatment. Fractional anisotropy (FA) was used as an indicator of white matter integrity and was assessed in the uncinate fasciculus and superior longitudinal fasciculus using tract-based spatial statistics (TBSS) and probabilistic tractography. Forty-six medication-free patients with major depressive disorder participated in a diffusion tensor imaging scan prior to completing an 8-week treatment regime with citalopram or quetiapine XR. Indexed improvements in Hamilton Depression Rating Scale score from baseline to 8-week endpoint were used as an indicator of depression improvement. Carriers of the BDNF met allele exhibited lower FA values in the left uncinate fasciculus relative to val/val individuals [F(1, 40) = 7.314, p = 0.009]. Probabilistic tractography identified that higher FA in the left uncinate fasciculus predicted percent change in depression severity, with BDNF moderating this association [F(3, 30) = 3.923, p = 0.018]. An interaction between FA in the right uncinate fasciculus and 5-HTTLPR also predicted percent change in depression severity [F(5, 25) = 5.315, p = 0.002]. Uncorrected TBSS results revealed significantly higher FA in hippocampal portions of the cingulum bundle in responders compared to non-responders (p = 0.016). The predictive value of prefrontal and amygdala/hippocampal WM connectivity on antidepressant treatment response may be influenced by 5-HTTLPR and BDNF polymorphisms in MDD.

White matter integrity in major depressive disorder: Implications of childhood trauma, 5-HTTLPR and BDNF polymorphisms.

This study examined the impact of childhood neglect, serotonin transporter (5-HTTLPR) and brain derived neurotrophic factor (BDNF) polymorphisms on white matter (WM) integrity in major depressive disorder (MDD) using diffusion tensor imaging (DTI). Fifty-five medication-free MDD patients and 18 controls underwent diffusion tensor imaging scanning, genotyping and completed the Childhood Trauma Questionnaire. Tract based spatial statistics (TBSS) findings revealed reduced fractional anisotropy (FA) in the MDD group in the anterior internal capsule. 5-HTTLPR-S'L' heterozygotes in the MDD group exhibited reduced FA in the internal capsule relative to S'S' and reduced FA in corona radiata compared to L'L'. Probabilistic tractography revealed higher FA in the uncinate fasciculus (UF) for BDNF val/val genotype relative to met-carriers, particularly in individuals with high depression severity. High depression severity and experiences of childhood physical or emotional neglect predicted higher FA in the UF and superior longitudinal fasciculus. Reductions in FA were identified for subgroups of MDD patients who were 5-HTTLPR heterozygotes and BDNF-met carriers. An association between emotional/physical neglect and FA was observed in subjects with high depressive symptoms. Our findings suggest that WM connectivity within frontal and limbic regions are affected by depression and influenced by experiences of neglect and genetic risk factors.

Design and Implementation of an fMRI Study Examining Thought Suppression in Young Women with, and At-risk, for Depression.

Ruminative brooding is associated with increased vulnerability to major depression. Individuals who regularly ruminate will often try to reduce the frequency of their negative thoughts by actively suppressing them. We aim to identify the neural correlates underlying thought suppression in at-risk and depressed individuals. Three groups of women were studied; a major depressive disorder group, an at-risk group (having a first degree relative with depression) and controls. Participants performed a mixed block-event fMRI paradigm involving thought suppression, free thought and motor control periods. Participants identified the re-emergence of "to-be-suppressed" thoughts ("popping" back into conscious awareness) with a button press. During thought suppression the control group showed the greatest activation of the dorsolateral prefrontal cortex, followed by the at-risk, then depressed group. During the re-emergence of intrusive thoughts compared to successful re-suppression of those thoughts, the control group showed the greatest activation of the anterior cingulate cortices, followed by the at-risk, then depressed group. At-risk participants displayed anomalies in the neural regulation of thought suppression resembling the dysregulation found in depressed individuals. The predictive value of these changes in the onset of depression remains to be determined.

Neural systems underlying thought suppression in young women with, and at-risk, for depression.

OBJECTIVE: Ruminative brooding is associated with increased vulnerability to major depression. Individuals who regularly ruminate will often try to reduce the frequency of their negative thoughts by actively suppressing them. We aimed to identify the neural correlates underlying thought suppression in at-risk and depressed individuals. METHODS: Three groups of women were studied; a major depressive disorder group, an at-risk group (having a first degree relative with depression) and controls. Participants performed a mixed block-event fMRI paradigm involving thought suppression, free thought and motor control periods. Participants identified the re-emergence of "to-be-suppressed" thoughts with a button press. RESULTS: During thought suppression the control group showed the greatest activation of the dorsolateral prefrontal cortex, followed by the at-risk, then depressed group. During the re-emergence of intrusive thoughts compared to successful re-suppression of those thoughts, the control group showed the greatest activation of the anterior cingulate cortices, followed by the at-risk, then depressed group. CONCLUSIONS: At-risk participants displayed anomalies in the neural regulation of thought suppression resembling the dysregulation found in depressed individuals. The predictive value of these changes in the onset of depression remains to be determined.

Processing of affective faces varying in valence and intensity in shy adults: an event-related fMRI study

Recent behavioral and electrocortical studies have found that shy and socially anxious adults are hypersensitive to the processing of negative and ambiguous facial emotions. We attempted to extend these findings by examining the neural correlates of affective face processing in shy adults using an event-related fMRI design. We presented pairs of faces that varied in affective valence and intensity. The faces were morphed to alter the degree of intensity of the emotional expressive faces. Twenty-four (12 shy and 12 non-shy) young adult participants then made same/different judgments to these faces while in an MR scanner. We found that shy adults exhibited greater neural activation across a distinct range of brain regions to pairs of faces expressing negative emotions, moderate levels of emotional intensity, and emotional faces that were incongruent with one another. In contrast, non-shy individuals exhibited greater neural activation across a distinct range of brain regions to pairs of faces expressing positive emotions, low levels of emotional intensity, and emotional faces that were congruent with one another. Findings suggest that there are differences in neural responses between shy and non-shy adults when viewing affective faces that vary in valence, intensity, and discrepancy.

Processing of affective faces varying in valence and intensity in shy adults: an event-related fMRI study

Recent behavioral and electrocortical studies have found that shy and socially anxious adults are hypersensitive to the processing of negative and ambiguous facial emotions. We attempted to extend these findings by examining the neural correlates of affective face processing in shy adults using an event-related fMRI design. We presented pairs of faces that varied in affective valence and intensity. The faces were morphed to alter the degree of intensity of the emotional expressive faces. Twenty-four (12 shy and 12 non-shy) young adult participants then made same/different judgments to these faces while in an MR scanner. We found that shy adults exhibited greater neural activation across a distinct range of brain regions to pairs of faces expressing negative emotions, moderate levels of emotional intensity, and emotional faces that were incongruent with one another. In contrast, non-shy individuals exhibited greater neural activation across a distinct range of brain regions to pairs of faces expressing positive emotions, low levels of emotional intensity, and emotional faces that were congruent with one another. Findings suggest that there are differences in neural responses between shy and non-shy adults when viewing affective faces that vary in valence, intensity, and discrepancy.(AU)