Abstract
ObjectiveSubjective cognitive decline (SCD) has emerged as one of the first manifestations of Alzheimer’s disease (AD). However, discrepancies in its relationship with tests of memory and other cognitive abilities have hindered SCD’s diagnostic utility. Inter-individual heterogeneity in metamemory, or memory awareness, and the use of clinical measures of cognition lacking sensitivity to early cognitive dysfunction, may contribute to these discrepancies. We aimed to assess if the relationship between SCD and markers of early cognitive dysfunction is moderated by metamemory abilities.MethodsThe sample included 79 cognitively healthy older adults (77% female, 68% White, and 32% Black participants) with a mean age of 74.4 (SD = 6.1) and 15.9 (SD = 2.7) years of education. Metamemory was assessed using an episodic Feeling of Knowing test with four 5-item trials. Outcome measures included a resolution metric defined as a gamma correlation reflecting the accuracy of item-level predictions (“Will you know the correct answer?”). Early cognitive dysfunction was measured through the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) and the Short-Term Memory Binding Test (STMB), measures sensitive to preclinical AD. SCD was assessed with a 20-item questionnaire that asked participants to compare themselves to others their age on a 7-point Likert scale. Regression analyses examined whether a potential relation between SCD and early cognitive dysfunction was moderated by metamemory.ResultsSubjective cognitive decline was associated with susceptibility to semantic proactive interference such that greater complaints were associated with increased susceptibility to semantic proactive interference (b = −0.30, p = 0.003) only. Metamemory moderated the association between SCD and susceptibility to and recovery of semantic proactive interference such that those with more accurate metamemory showed a stronger association between increased complaints and susceptibility to semantic proactive interference (b = −0.71, p = 0.005; b = −0.62, p = 0.034). Metamemory, however, did not moderate the association of SCD with retroactive semantic interference nor short term memory binding.DiscussionThe accuracy of an individual’s metamemory, specifically their ability to adjust moment to moment predictions in line with their performance, can influence the extent to which SCD maps onto objective cognition. Such self-referential assessment should be considered when interpreting SCD.
Highlights
Researchers are mapping the earliest end of the Alzheimer’s disease (AD) continuum to identify patients in a critical window for therapeutic intervention (Dubois et al, 2016)
The Loewenstein-Acevedo Scales of Semantic Interference and Learning (LASSI-L) was available for 98 participants, as it was added to the study battery later
Age was negatively associated with gamma, susceptibility and ability to recover from proactive interference and retroactive interference (r range = −0.20, −0.29, p range = 0.004, 0.042)
Summary
Researchers are mapping the earliest end of the Alzheimer’s disease (AD) continuum to identify patients in a critical window for therapeutic intervention (Dubois et al, 2016). At least a third of cognitively normal older adults have evidence of pathological AD on autopsy (Negash et al, 2013) or amyloid imaging (Chételat et al, 2013), and the pathological definition of AD continues to be debated (de la Torre, 2004; Castellani and Smith, 2011; Castellani and Perry, 2014). The ongoing questions and controversies surrounding clinical-pathological correlations in AD (Castellani and Smith, 2011; Castellani and Perry, 2014) emphasize the importance of identifying the earliest clinical manifestations of disease. Research in AD as well as in aging generally supports an association between SCD and objective memory both crosssectionally and longitudinally, and there is emerging evidence of the association between SCD and AD biomarkers (Gilewski et al, 1990; Hertzog et al, 1990; Pearman and Storandt, 2004; Beaudoin and Desrichard, 2011; Amariglio et al, 2012; Perrotin et al, 2012; Hülür et al, 2014; Snitz et al, 2015; Chen et al, 2019, 2021). With regard to person factors, there is recognition that personality and mood are likely important in the conceptualization of SCD; other factors remained to be explored (Pearman and Storandt, 2004; Slavin et al, 2010; Merema et al, 2013; Steinberg et al, 2013)
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