Exposure to Memory-Relevant versus Memory-Irrelevant Aging Stereotypes Differentially Affects Memory Self-Perceptions and Memory Test Scores of Young, Middle, and Older Age Adults.

This study examined the combined influence of assimilation and contrast effects on the memory self-efficacy and objective memory of young (ages 18-25, n = 114), middle-age (ages 26-59, n = 48), and older (ages 60-98, n = 59) adults. We reminded participants that they matched positive, not negative, memory-relevant or memory-irrelevant stereotypes of aging either before (experimental conditions) or after (control condition) they completed a memory self-efficacy questionnaire and took a memory test. Participants exposed to memory-relevant aging stereotypes prior to other measures reported higher memory self-efficacy than those exposed to memory-irrelevant stereotypes; this effect did not depend on age group. In contrast, the effect of stereotype exposure on memory performance differed with age. Young and older, but not middle-aged, adults showed differences in their memory scores depending on whether they were exposed to memory-relevant, memory-irrelevant or no aging stereotypes. In general, exposure to stereotypes (particularly those relevant to memory) had a negative influence on memory that contrasted with its positive effect on memory self-efficacy. Together, these results indicate that exposure to aging stereotypes can have opposing effects on the memory self-efficacy and objective test performance of adults of various ages and that the relevance of the stereotypes to the cognitive domain being assessed matters.

Same Goals, but Different Outcomes: Present-Focused versus Future-Focused Memory Beliefs Differentially Predict Young and Older Adults' Everyday Use of Memory Strategies.

OBJECTIVE: We investigated whether beliefs about the current versus future effectiveness of memory strategies predict young and older adults' everyday strategy use. METHOD: 103 young and 91 older adults reported their memory goals, beliefs about the current and future effectiveness of various strategies, and frequency of use of each strategy type. RESULTS: The two age groups equally valued current and future memory. Young adults' strategy selection related only to their beliefs about the strategies' current effectiveness; older adults utilized approaches they perceived as effective for improving both future and current memory. IMPLICATIONS: Findings highlight the importance of the temporal nature of memory strategy beliefs.

Mother knows best or does she? Perceptions of the memory abilities of pediatric patients with epilepsy as reported by patients and their parents across time.

PURPOSE: This study compared the self-reported and parent-reported memory of children with epilepsy across time and explored the relationships between these measures of subjective memory and the children's actual performance on objective neuropsychological tests. METHOD: One-hundred and nineteen children with epilepsy who were surgical candidates underwent comprehensive neuropsychological testing that included the Everyday Verbal Memory Questionnaire (EVMQ). Each child's parent and 82 of the children themselves completed the appropriate version of this subjective memory measure. After 9 months, the children returned for a second neuropsychological evaluation with 71 parents and 39 children completing the same questionnaire. Approximately one-third of the children in the study underwent surgery between the two evaluations. Standardized regression-based norms were used to quantify change in cognitive abilities across assessments. RESULTS: Results revealed significant relationships between parent reports and child reports of the children's memory abilities. Parent reports, but not child reports, correlated with the children's objective test scores at baseline. In contrast, children were more attuned to changes in their memory across time. CONCLUSIONS: These findings demonstrate the importance of considering both parent and child perceptions of everyday cognitive functioning when evaluating cognition and cognitive changes over time in pediatric patients with epilepsy.

Cognitive outcomes following frontal lobe resection for treatment of epilepsy in children and adolescents.

OBJECTIVE: To use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy. METHODS: Forty-one pediatric patients (25 male, Mage = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy. Evaluations included tests of intelligence, attention/working memory, processing speed, language, visuospatial skills, executive function, and episodic memory. Practice effect-adjusted RCIs were used to determine clinically significant postoperative cognitive change. Demographic, disease, and surgical variables were examined to identify factors associated with postoperative cognitive decline or improvement. RESULTS: Within each cognitive domain, there was a large proportion of patients (51-84%) who did not exhibit significant cognitive change. In terms of overall cognitive profile, 44% demonstrated improvement in at least one domain and 69% declined in at least one domain. Postoperative cognitive improvement occurred most commonly in the domain of processing speed, whereas postoperative cognitive decline occurred most frequently in the domain of visuospatial skills. Younger age at surgery was associated with cognitive improvement. Older age at seizure onset and higher baseline cognitive performance were associated with cognitive decline. SIGNIFICANCE: Approximately 6.5 months after frontal lobe resection, only 15% of our sample showed stable performance across all cognitive domains. Seventeen percent of patients showed improvements without declines, 42% showed declines without improvements, and 27% showed a mix of improvements and declines across different cognitive domains. Age and baseline abilities were associated with postoperative cognitive change on multiple measures. With 1 in 8 children demonstrating postoperative decline across three or more domains, further research is needed to identify factors associated with cognitive decline in order to inform clinical decision-making and patient/family counseling.

The effect of medication and question wording on self-reported symptoms and their accuracy in young adults with attention-deficit/hyperactivity disorder.

OBJECTIVES: This study examined the effect of whether participants were on or off their medications and the effect of questionnaire wording on self-reported symptoms in young adults with ADHD. Additionally, this research evaluated the relationships between these self-reported symptoms and objective performance on measures of working memory. DESIGN: This experimental study utilized a mixed factorial design with one between-subjects factor (whether participants were unmedicated or medicated at the time they completed their assessment) and one within-subjects factor (whether participants reported their on-medication or off-medication symptoms when describing their ADHD subjective symptomatology). METHODS: Forty-five young adults with ADHD (ages 18-23) completed a brief neuropsychological evaluation and several self-report questionnaires. RESULTS: Although being medicated or unmedicated while completing the questionnaires did not directly affect self-reported symptoms or their accuracy, questionnaire wording exerted a statistically significant effect on subjective symptomatology; participants described themselves as substantially more symptomatic at times when they are off than at times when they are on their medications. More importantly, their general self-perceptions (symptoms when medication state was not specified) of their Inattention/Memory Problems and their Hyperactivity/Restlessness aligned with their descriptions of their off-medication symptoms, whereas their general self-perceptions of their Impulsivity/Emotional Lability and Problems with Self-Concept related to both their self-reported off-medication and on-medication symptoms. CONCLUSIONS: These results highlight the necessity of specifying medication state when asking patients to report their current symptomatology. Failing to do so risks an over-reporting of symptoms from patients who are typically on medications as they may describe the extent of their unmedicated, rather than medicated, symptomatology. PRACTITIONER POINTS: Being medicated or unmedicated while completing questionnaires about subjective symptomatology did not directly affect self-reported symptoms of young adults with ADHD or the accuracy of these self-reports. When medication state was not specified on a questionnaire, young adults with ADHD reported symptoms similar to those they experience when they are not medicated. These results highlight the importance of specifying medication state when asking young adults with ADHD to report their current symptomatology. Failing to do so risks an over-reporting of symptoms from patients who are typically on medications. These findings open the door for further research with larger and more diverse and representative samples of adults with ADHD to evaluate the accuracy of their subjective symptomatology relative to their objective abilities. Future studies should also examine whether gender affects subjective symptoms, their accuracy, or the influence of question wording and medications on self-reported symptomatology of adults with ADHD, as the current study was unable to address this important issue.

Reliable change indices and standardized regression-based change score norms for evaluating neuropsychological change in children with epilepsy.

Reliable change indices (RCIs) and standardized regression-based (SRB) change score norms permit evaluation of meaningful changes in test scores following treatment interventions, like epilepsy surgery, while accounting for test-retest reliability, practice effects, score fluctuations due to error, and relevant clinical and demographic factors. Although these methods are frequently used to assess cognitive change after epilepsy surgery in adults, they have not been widely applied to examine cognitive change in children with epilepsy. The goal of the current study was to develop RCIs and SRB change score norms for use in children with epilepsy. Sixty-three children with epilepsy (age range: 6-16; M=10.19, SD=2.58) underwent comprehensive neuropsychological evaluations at two time points an average of 12 months apart. Practice effect-adjusted RCIs and SRB change score norms were calculated for all cognitive measures in the battery. Practice effects were quite variable across the neuropsychological measures, with the greatest differences observed among older children, particularly on the Children's Memory Scale and Wisconsin Card Sorting Test. There was also notable variability in test-retest reliabilities across measures in the battery, with coefficients ranging from 0.14 to 0.92. Reliable change indices and SRB change score norms for use in assessing meaningful cognitive change in children following epilepsy surgery are provided for measures with reliability coefficients above 0.50. This is the first study to provide RCIs and SRB change score norms for a comprehensive neuropsychological battery based on a large sample of children with epilepsy. Tables to aid in evaluating cognitive changes in children who have undergone epilepsy surgery are provided for clinical use. An Excel sheet to perform all relevant calculations is also available to interested clinicians or researchers.

How you ask matters: an experimental investigation of the influence of mood on memory self-perceptions and their relationship with objective memory.

Stronger relationships often emerge between mood and memory self-efficacy (MSE) than between MSE and memory abilities. We examined how social desirability, mood congruency and framing influence the mood-MSE relationship. Social desirability correlated with all self-report measures, and covarying social desirability diminished the mood-MSE relationship while enhancing the relationship between MSE and objective memory. Participants rated their memory more harshly on positively than neutrally or negatively worded MSE items. Current mood state did not affect MSE overall or when items were worded positively or neutrally. However, on negatively worded items, participants in a negative mood exhibited lower MSE than participants in a positive mood. Thus, both MSE and the mood-MSE relationship depended upon question wording. These results indicate that controlling social desirability and item framing on MSE questionnaires may reduce their confounding influence on memory self-perceptions and the influence of mood on self-reported abilities, allowing subjective memory to more accurately reflect objective memory in healthy and clinical populations.

Computerized assessment of age differences in memory beliefs.

Beliefs about memory play a role in older adults' concerns about aging and can influence their performance on memory tasks. Visual analog scales can capture beliefs about how aging affects memory in general (the General Beliefs About Memory Instrument [GBMI]) and one's own memory (the Personal Beliefs About Memory Instrument [PBMI]). Data were combined across four cross-sectional studies of adults who had completed the two measures, contrasting traditional paper-and-pencil versions of the questionnaires with newer computerized versions that use a computer mouse for visual analog scaling. This scaling method is easy to use and automates scoring of graphic rating scale responses. Adults of all ages produced GBMI responses reflecting their belief that memory declines with advancing age. Older adults' PBMI responses indicated that they perceived their memory ability more negatively than those of young adults and middle-aged adults. Adults of all ages were able to use the computerized questionnaires without difficulty, making these measures suitable for use in adult developmental research.

Older adults' memory beliefs predict perceptions of memory strategy difficulty and effectiveness.

The current study investigated whether memory self-efficacy and beliefs about the controllability of memory abilities relate to older adults' perceptions of the difficulty and effectiveness of various strategies for improving their everyday memory. One hundred and fifteen older adults (ages 65-89) completed the Personal Beliefs about Memory Instrument to evaluate their beliefs about their own memory abilities and the Memory Strategies Questionnaire to assess perceptions of the difficulty and effectiveness of utilizing six different strategic approaches for optimizing memory function. Results showed that memory-self efficacy related to older adults' perceptions of how difficult various memory strategies are to implement, whereas control beliefs related to perceptions of memory strategy effectiveness. These results advance our understanding of how memory beliefs influence older adults' selection of approaches to improve their everyday memory abilities.

Cognitive outcomes following pediatric epilepsy surgery.

OBJECTIVES: To characterize outcomes following pediatric epilepsy surgery across a broad range of cognitive domains using empirical methods (i.e., reliable change indices: RCIs), compare these outcomes with those based on traditional methods (i.e., standard deviation: SD), and identify factors associated with postoperative cognitive declines and/or improvements. METHODS: This retrospective cohort study included 186 children who underwent surgical resection for treatment of pharmacoresistant epilepsy and who completed pre- and postoperative neuropsychological assessments. Postoperative testing occurred approximately 6.5 months after surgery and included measures of intelligence, attention/working memory, processing speed, language, executive functioning, visuospatial skills, memory, and academic achievement. Change scores for each patient were classified as decline, no change, or improvement using epilepsy-specific RCIs. Chi-square goodness of fit tests were used to compare the distribution of outcomes as classified with RCIs to those obtained using a traditional one SD cutoff. Multinomial regression analyses were conducted to identify factors associated with cognitive decline and/or improvement. RESULTS: While 18% of children demonstrated no postoperative declines or improvements in any cognitive domain, the majority demonstrated relatively focal changes (declines and/or improvements in 1-2 cognitive domains). Rates of postoperative decline and improvement across individual cognitive domains were variable and ranged from 4-35% and 2-31%, respectively. Compared to RCIs, SD methodology often overestimated postoperative improvements and varied with respect to declines. Factors associated with RCI decline or improvement included preoperative performance, age at surgery, surgery site, and postoperative seizures. SIGNIFICANCE: Results suggest substantial variability in individual cognitive outcomes approximately 6.5 months following pediatric epilepsy surgery. The differences in change distributions obtained using epilepsy-specific RCIs versus SDs highlight the need for studies using empiric methodology to study postoperative cognitive change. Variables associated with postoperative cognitive change may be used to develop multivariable prediction models in future studies to aid clinical decision-making and patient counseling.

The Effects of Individualized Music Listening on Affective, Behavioral, Cognitive, and Sundowning Symptoms of Dementia in Long-Term Care Residents.

OBJECTIVES: This study aimed to replicate music's positive effects on dementia-related symptoms, determine whether a 6-month intervention would lead to greater positive outcomes than typical 3- to 4-month interventions, and examine changes in sundowning symptoms after music listening. METHODS: 282 nursing home residents with dementia listened to personalized music playlists 1-3 times weekly for 30 minutes across 6 months. Standardized assessments of affect, behavior, and cognition and direct observations of sundowning symptoms comprised the outcomes. RESULTS: Results documented significant improvements in residents' general neuropsychiatric symptoms, agitation, and depression across the first 3 months, but no additional improvements across the subsequent 3 months. Seven sundowning symptoms significantly improved following music listening, with some (e.g., disengagement) being more amenable to music than others (e.g., aggression). DISCUSSION: Results support short-term individualized music listening as an effective non-pharmacological approach for improving dementia-related symptoms in nursing home residents and suggest new applications of music-related interventions.

Nursing Home Residents' Positive Behavioral Responses to Individualized Music Predict Improvements in Sundowning Symptoms After Music Listening.

Objective: The goal of this exploratory study was to predict which long-term care residents with dementia would experience improvements in their sundowning symptoms after listening to personalized music playlists. Methods: We studied 101 residents with moderate to severe dementia from 15 long-term care facilities across 8 months. We observed residents' behavioral responses to individualized music while they listened and recorded sundowning symptoms both before and after each listening session. Results: As hypothesized, residents who exhibited a greater number of positive reactive behaviors while listening to music also evidenced more improvements in their confusion, disengagement, unresponsiveness, and restlessness after their music-listening session. Discussion: Our results reveal that observing behavioral responses during music listening is an effective way to determine when nursing home residents are benefiting from personalized music playlists. These findings inform music programs in long-term care settings by identifying residents whose sundowning symptoms are most amenable to music intervention.

Effect of apolipoprotein ε4 allele on hippocampal and brain volume in intractable temporal lobe epilepsy.

This study investigated the relationship between the apolipoprotein (APOE) ε4 allele and brain volumes in patients with medically intractable temporal lobe epilepsy (TLE). MRI-based volumetric analyses of the hippocampi, cerebral hemispheres, and whole brain were conducted in 59 patients with TLE (31 with left TLE, 28 with right TLE) with hippocampal sclerosis (HS). There were no differences in hippocampal, hemispheric, or whole brain volumes as a function of ε4 status even after correcting for hemispheric and total brain volumes. However, APOE ε4 carriers showed a trend toward having a smaller discrepancy between ipsilateral and contralateral hippocampal volumes than patients without this allele, and post hoc analyses suggest there may be an increased incidence of bilateral HS in ε4 carriers. In summary, APOE ε4 is not associated with significant hippocampal, hemispheric, or whole brain atrophy in patients with medically intractable TLE. However, ε4 carriers may be more likely to have bilateral HS, with an apparent dose-dependent effect.

Easy or effective? Explaining young adults' and older adults' likelihood of using various strategies to improve their memory.

We examined two factors to explain why young and older adults report using different memory strategies in their everyday lives. Participants rated the likelihood of use, difficulty, and effectiveness of six categories of memory strategies that they could implement in order to improve their general memory performance. Consistent with previous literature, older adults were more likely to report utilizing "use it or lose it" approaches than young adults, whereas young adults reported a greater likelihood of using task-focused approaches such as internal strategies and effort than older adults. We found that both perceived strategy difficulty and perceived strategy effectiveness predicted likelihood of strategy use, but young and older adults differentially weighed these factors. Young adults' likelihood of using different strategies was influenced more by strategy effectiveness than difficulty. Older adults differentially weighed difficulty and effectiveness when considering how likely they were to use various strategies.

Expectations about memory change across the life span are impacted by aging stereotypes.

This study examined whether expectations about memory change with age vary for different personality types. Four adjectives from each of M. L. Hummert, T. A. Garstka, J. L. Shaner, and S. Strahm's (1994) age-stereotype trait sets were selected to create 11 adjective clusters varying in both valence (positive vs. negative) and relevance to memory functioning. There were 373 participants in 3 age groups who rated the memory abilities of target adults, defined by the adjective clusters, across the adult life span. Consistent with past studies, participants believed in age-related memory decline. However, participants rated target adults with positive personality traits as having better memory ability and less age-related memory decline than target adults with negative personality traits. This effect was larger when the traits were relevant to memory than when they were not. Finally, older participants were more strongly influenced by both the valence and the relevance of the personality descriptions than younger participants.

APOE epsilon4 is associated with postictal confusion in patients with medically refractory temporal lobe epilepsy.

This study examined the relationship between the APOE epsilon4 allele and postictal confusion in patients with medically intractable temporal lobe epilepsy (TLE). Patients with at least one epsilon4 allele (n=22) were three times more likely to exhibit postictal confusion (68%) than the 63 patients without epsilon4 (43%). These preliminary results demonstrate that APOE epsilon4 is associated with an increased risk of postictal confusion in patients with medically intractable TLE, suggesting possible dysfunction in neuronal recovery mechanisms.

Beliefs about age-related changes in physical functioning across the adult life span and their relationship with physical activity levels of older adults.

Physical activity declines across the adult life span despite the well-established links between physical activity and health-related, psychological, cognitive, and social benefits. We contrasted the beliefs young and older adults hold about how aging affects both physical abilities and physical activity and determined whether older adults' beliefs about physical aging relate to their engagement in physical activity. Using visual rating scales, 56 young and 49 community-dwelling older adults indicated the extent to which a typical woman or typical man aged 20-90 possesses six different physical abilities and engages in three different types of physical activity. Stereotypes of physical aging were ability- and activity-specific, and older adults endorsed more positive views than their younger peers. Stereotypical beliefs predicted older adults' engagement in moderate-intensity activity. This study offers intriguing avenues for future research and suggests that better understanding physical aging stereotypes may contribute toward designing interventions that promote lifelong physical activity.

Age differences in perceptions of memory strategy effectiveness for recent and remote memory.

We examined whether young and older adults hold different beliefs about the effectiveness of memory strategies for specific types of memory tasks and whether memory strategies are perceived to be differentially effective for young, middle-aged, and older targets. Participants rated the effectiveness of five memory strategies for 10 memory tasks at three target ages (20, 50, and 80 years old). Older adults did not strongly differentiate strategy effectiveness, viewing most strategies as similarly effective across memory tasks. Young adults held strategy-specific beliefs, endorsing external aids and physical health as more effective than a positive attitude or internal strategies, without substantial differentiation based on task. We also found differences in anticipated strategy effectiveness for targets of different ages. Older adults described cognitive and physical health strategies as more effective for older than middle-aged targets, whereas young adults expected these strategies to be equally effective for middle-aged and older target adults.

Compared to what? The effects of a frame of reference on older adults' subjective memory.

It is often unclear what comparisons older adults make when evaluating their own memory. If thinking about their memory relative to others, they may assess their own abilities differently than if comparing it to their past capabilities. To test the effect of reference frames on memory assessments and memory performance, we randomly assigned 120 older adults to one of three conditions in which we manipulated frames of reference (control, past-self comparison, or other adults comparison) on a memory self-efficacy questionnaire. Participants also completed general and specific memory predictions and an objective memory test. Participants in the past-self condition reported significantly lower global memory self-efficacy compared with the other adults and control conditions. No condition differences emerged for memory predictions, objective memory, or the likelihood of over- or underpredicting memory performance. These findings suggest that reference frames impact global memory self-efficacy, but do not influence the accuracy of subjective memory judgments.