Subjective Cognitive Difficulties Research Articles

Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model

Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1–5 years of follow-up. Classes were defined using ‘peak-age’ global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.

Investigating the relationships between race, cardiovascular disease, mild cognitive impairment, Alzheimer’s disease, and functional outcomes among older former National Football League players

AbstractBackgroundHigher prevalence rates of Alzheimer’s disease and Related Dementias (ADRD) and cardiovascular disease (CVD) have been reported among former National Football League (NFL) players. Ethnoracial minorities comprise a large proportion of NFL players; among the general population, they experience higher rates of CVD. Ethnoracial minority group membership and CVD are independent risk factors for ADRD. We investigated the associations of race and CVD on risk of AD, mild cognitive impairment (MCI), and functional difficulties in older former NFL players.MethodFormer NFL players (N=944; 656 self‐identified as White [69.5%]), aged 50‐92 years (M=64.8+8.9)completed a general health survey involving comprehensive health history and current function. CVD included the presence of at least one of the following: coronary artery disease or/myocardial infarction, peripheral vascular disease, and/or stroke. Logistic models assessed individual and interaction effects of CVD and race on odds of MCI and AD; covariates included age, education, and concussion history. A multivariate regression (additional covariate of current psychosocial stressors [Life Events Scale]) examined associations between race and CVD on current function (Patient Reported Outcome Measurement Information System [PROMIS] Depression, Cognitive Function, and Ability to Participate in Social Roles and Activities).ResultsCVD (AdjOR=1.73[1.17‐2.55]) and Race (non‐White participants; AdjOR=2.16[1.52‐3.07]) were significantly associated with higher odds of MCI diagnosis. Race (AdjOR=2.90[1.44‐5.83]), not CVD, significantly predicted AD diagnosis. Significant race by CVD interactions were not observed for either MCI or AD. Race (non‐White) was significantly associated with greater depression symptoms (ηp2=.022), subjective cognitive difficulties (ηp2=.017), and social roles/activity disruptions (ηp2=.019). The presence of CVD was associated with greater depression symptoms (ηp2=.016) and social roles/activity disruptions (ηp2=.011). A significant race by CVD interaction was observed, suggesting that the presence of CVD was disproportionately associated with significantly greater depression symptoms (ηp2=.010), subjective cognitive difficulties (ηp2=.004), social activity/roles disruption (ηp2=.005) among non‐White individuals.ConclusionSimilar to the general population, race and CVD are uniquely and dynamically associated with MCI, AD, and functional difficulties among former NFL players, independent of concussion history. Future work should investigate social determinants of health contributing to racial disparities of long‐term outcomes within this sample.

A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders.

To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12-month course of IPSRT with CR (IPSRT-CR), or without CR (IPSRT). In IPSRT-CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12months). Sixty-eight individuals (BD n=26, MDD n=42; full/partial remission n=39) were randomised to receive IPSRT-CR or IPSRT (both n=34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment-end (12months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT-CR arm over 12months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41-0.60). At 18months, small to moderate, non-significant benefits (0.26-0.47) of IPSRT vs IPSRT-CR were found on functioning and mood outcomes. Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.

Work and everyday life in a digitalized time: Experiences of people with subjective cognitive difficulties related to neurological disorders.

Digitalization has changed working life and increased cognitive demands on employees in general. Nevertheless, the consequences for employees with cognitive impairments and subjective cognitive difficulties are to a large extent unexplored. The aim of this study was to explore and describe how employees with subjective cognitive difficulties who are performing digital work tasks experience their vocational situation and how this situation influences their everyday life. A qualitative, descriptive, multiple-case study was designed. Self-reports, assessments and qualitative interviews were used to collect data from the seven participants with neurological disorders. The data were analysed using pattern matching. The analysed data formed four categories conceptualized as "Working to my full potential", "Working, but it is largely up to me", "Working at the expense of everyday life" and "Working without known difficulties", and these categories included one to four subcategories. Managing subjective cognitive difficulties in vocational situations and everyday life was challenging in a digitalized working life for participants with neurological disorders. To provide equal access to preventive measures and rehabilitation and a sustainable working life, it is important to investigate the influence of subjective cognitive difficulties systematically on work, everyday life and management strategies in people with neurological disorders in digitalized work.

Adult Aging Moderates the Relationship Between Trait Cognitive Anxiety and Subjective Everyday Cognitive Difficulties.

The present aim was to determine, across the adult lifespan, the extent to which different dimensions of trait anxiety might affect subjective cognitive difficulties in everyday life. Following Attentional Control Theory (ACT; Eysenck et al., 2007), we predicted that trait anxiety would have a greater effect on attention and verbal abilities than on visual abilities. We also expected trait cognitive anxiety to exhibit more robust relationships with cognition than trait somatic anxiety. Importantly, we predicted that effects of anxiety would be greater in older adults, in line with the Strength and Vulnerability Integration model (SAVI; Charles, 2010). The sample comprised 286 United Kingdom-based adults aged 18–93 years. Participants completed self-report measures of trait cognitive and somatic anxiety (the State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA, Ree et al., 2008) and everyday cognitive difficulties (the Multiple Abilities Self-Report Questionnaire; MASQ, Seidenberg et al., 1994). Moderated regression models were constructed, including trait cognitive or somatic anxiety as a predictor of cognitive difficulties, and age as the moderator variable. Covariates included depression, stress (the Depression Anxiety Stress Scales—short form; DASS-21, Lovibond and Lovibond, 1995), gender, current mental health treatment status, and physical health status. When cognitive anxiety was the predictor variable, somatic anxiety was also included as a covariate, and vice-versa. Trait cognitive anxiety and age interacted to predict all MASQ subscales other than visual-perceptual ability. Difficulties with attention, verbal memory, and language abilities were significantly greater at higher levels of anxiety for all age groups, with the effect greatest in older adults. Difficulties with visual-spatial memory were significantly greater at higher levels of anxiety in middle-aged and older adults only. Higher trait somatic anxiety predicted difficulties with verbal memory and language ability independently of age, and interacted with age to predict language difficulties. Interestingly, age also significantly predicted less subjective difficulty with attention, independently of anxiety level. The results show that trait cognitive and somatic anxiety are both related to subjective, everyday cognitive difficulties. However, effects of trait cognitive anxiety are more robust across cognitive domains and tend to increase, or first appear, over the course of the adult lifespan.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

IntroductionMild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients’ subjective cognitive and communicative difficulties has not been explored. ObjectiveWe aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints. MethodsWe included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted. ResultsPD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores. ConclusionsHRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

Beyond depression: examining the role of anxiety and anxiety sensitivity on subjective cognition and functioning in older adults

Objectives Subjective cognitive difficulties in the elderly may serve as potential risk-factors for future, objective decline and conversion to neurodegenerative disorders (e.g., mild cognitive impairment [MCI] and dementia). Though these subjective declines have been associated with depression, and to a lesser extent, anxiety, it is unknown if related constructs (e.g. anxiety sensitivity) and specific kinds of worries (e.g. worry about developing dementia, health anxiety) are related to subjective declines. The current study sought to examine if cognitive concerns related to anxiety sensitivity, dementia worry, and health anxiety added incremental validity beyond general symptoms of anxiety and depression in predicting subjective cognition and functioning in a sample of older adults. Methods Participants were 429 older adults who were at least 60 years old. Participants completed questionnaires on subjective cognition, subjective everyday function, anxiety, depression, anxiety sensitivity, dementia worry, and health anxiety via Qualtrics Panels. Hierarchical multiple regressions were conducted. Results Our variables of interest (anxiety sensitivity, dementia worry, and health anxiety) added significant variance in predicting subjective cognition and everyday function. Specifically, anxiety sensitivity was related to subjective cognition and functioning, while dementia worry and health anxiety were variably associated. Conclusion Our results suggest that constructs related to anxiety and worry have a significant relationship with subjective cognition and function in older adults beyond general symptoms of depression and anxiety. Future work should examine if interventions and education may help to decrease anxiety sensitivity and worry about dementia respectively in older adults, which may in tern protect against future subjective declines.

Mental health, pain, and sleep factors associated with subjective cognitive difficulties in individuals with spinal cord injury.

Objective: We examined the relationships between self-reported demographic, mental health, physical health, and health behavior factors and subjective cognitive difficulties in a unique cohort of individuals with spinal cord injury (SCI) who averaged more than 30 years postinjury at assessment. Method: The study involved cross-sectional analyses of self-report assessment data collected during the most recent data-collection period (2018-2019) of a 45-year multicohort longitudinal study. Participants (n = 553) were identified from a specialty hospital in the southeastern United States and two midwestern university hospitals and were initially enrolled in the study in 1973-1974, 1984-1985, 1993-1994, or 2003-2004. The Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function-Short Form 8a v2.0 was the main outcome measure used to assess subjective cognitive difficulties. Results: Bivariate analyses indicated that greater subjective cognitive difficulties were associated with being female, elevated anxiety and depressive symptoms, sleep disturbance, cardiovascular disease, worse pain, polypharmacy, worse self-rated diet, and tobacco use. A hierarchical linear regression analysis including sociodemographic and SCI-related variables (Step 1) and physical, mental health, and health variables (added in Step 2) explained 33% of the variance in subjective cognitive difficulties, F(16, 421) = 13.45, p ≤ .001. Depressive, anxiety, and pain symptoms; sleep disturbance; and injury level remained significant predictors of variance in subjective cognitive symptoms when considering all variables simultaneously. Conclusion: Improving mental health symptoms, pain experiences, and sleep difficulties may be promising to improve subjective cognitive symptoms in individuals with SCI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychiatric and cognitive characteristics of older adults admitted to a Video-EEG monitoring (VEM) unit

ObjectiveTo compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit. MethodThis was a retrospective case–control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and ‘other’ diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales. ResultsFive-hundred and thirty three patients (71 older, 462 younger) aged 16–91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and ‘other’ in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group. ConclusionPsychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.

Neuronal and cognitive predictors of improved executive function following action-based cognitive remediation in patients with bipolar disorder

Cognitive impairments in bipolar disorder (BD) are prevalent but effective treatments with replicated and lasting pro-cognitive effects are lacking. Treatment development is hampered by a lack of neurocircuitry biomarkers to predict treatment efficacy. Action-Based Cognitive Remediation (ABCR) improves executive function in BD and this was accompanied by increased dorsal prefrontal cortex (dPFC) response during working memory (WM) after two weeks of treatment. This study investigated whether pre-treatment WM-related dPFC response, executive dysfunction and/or subjective cognitive difficulties predicted ABCR treatment response on executive functions. Forty-five patients with fully or partially remitted BD (ABCR: n = 25, control treatment: n = 20) in our ABCR trial completed a spatial N-back WM task during functional magnetic resonance imaging (fMRI) at baseline. Patients also completed neuropsychological tests and rated their cognitive functions before and after 10 weeks of ABCR or control treatment. Multiple linear regression analyses were conducted to assess whether pre-treatment dPFC response, objective executive impairment and/or subjective cognitive difficulties predicted greater ABCR-related improvements of executive function. We found that treatment-related improvement in executive function was predicted by more WM-related dPFC hypo-activity at baseline (p = 0.03) in linear regression analyses adjusted for age, gender and education. In contrast, there was only a non-significant trend towards more executive dysfunction at baseline predicting greater ABCR-related executive improvement (p = 0.08). Subjective cognitive difficulties at baseline showed no association with treatment effects (p = 0.16). In conclusion, pre-treatment dPFC hypo-activity during WM performance predicts greater effects of ABCR treatment on executive function and may represent a neurocircuitry biomarker for treatment efficacy in this cognitive domain.

Gender differences in the perception of subjective vs. objective cognitive decline: Baseline data from the SCD‐Well Trial

AbstractBackgroundSubjectively experienced cognitive decline (SCD), particularly associated with worries, in older adults is known to be a risk factor for dementia. So far, only few studies focus on gender‐specific profiles in SCD.MethodGender differences in SCD subjects who were enrolled in the SCD‐Well trial were analyzed with regard to their perception of subjective cognitive difficulties and the corresponding objective cognitive performance. SCD‐Well is a multicenter, observer‐blinded, randomized, and controlled superiority trial (Marchant et al. 2018). Two different types of 8‐week interventions are compared within the study: a mindfulness‐ and compassion‐based intervention with a validated health education program. 147 participants (95 female) were included. Data from the SCD‐Interview (SCD‐I; Miebach et al., 2019), the Cognitive Difficulties Scale (CDS; McNair &amp; Kahn, 1983), and different cognitive scales summarized in a modified Preclinical Alzheimer’s Cognitive Composite (PACC; Donohue et al., 2014) were analyzed for gender differences.ResultStatistical analyses revealed no gender differences concerning variables of the SCD‐I and CDS. Regarding objective cognitive performance, a significant gender effect for the PACC score with men showing lower cognitive performance was detected (U = 1859.00 , p &lt; .05). However, only women showed a negative correlation between the PACC and reported SCD as indicated on the SCD‐I (r=‐.436, p= &lt; .001) and CDS (r = ‐.514, p &lt; .001): more subjective cognitive difficulties and worries were associated with lower cognitive performance. To further explore this relationship, we will analyse differences between sites.ConclusionLiterature reveals gender differences in SCD for objective cognition, neuroimaging and biomarkers (Wang &amp; Tian, 2018). The present study supports the finding of woman performing better in a cognitive assessment than men. Moreover, it adds to this literature by showing an association between self‐perceived cognitive difficulties and actual cognitive performance in women, but not men. Further research is needed to provide a deeper understanding of gender differences in SCD, which are highly relevant for approaches on early detection of cognitive decline, which might in turn impact the choice of pre‐clinical interventions.

Sarcoidosis and Corticosteroid Therapy: Dilemma from a Psychiatric Point of View

Introduction and Methods: A man diagnosed with sarcoidosis developed partial retrograde amnesia followed by three months of depressive symptoms with panic attacks, which remitted with an antidepressant and a benzodiazepine. However, three months later hallucinations and overvalued persecutory ideations subsequently emerged, only to show partial response to antipsychotic treatment. Results: Sarcoidosis was treated with corticosteroids but serial thorax imaging shows minimal response. Corticosteroid was onboard throughout treatment, corresponding with non-remission of psychotic symptoms. There are persistent subjective cognitive difficulties but Mini Mental State Exam score is full. He is currently being treated with escitalopram, alprazolam and quetiapine. Conclusion: This case illustrated the dilemma between prolonging the corticosteroid therapy for sarcoidosis treatment and the psychiatric sequalae. While symptomatic antipsychotic treatment is effective, multi-disciplinary approach is imperative in determining the duration of the corticosteroid therapy.

A-237 Investigating the Reliability and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form

Abstract Objective We present the normative reference values, item level endorsement, and the internal consistency reliability of the PROMIS® v2.0 Cognitive Function-8-Item Short Form. Method The PROMIS® v2.0 Cognitive Function 8-Item Short Form measures subjective cognitive difficulties (raw score range = 8–40). A cohort of 1,009 adults (51.1% women) from the US population completed this measure. The total sample was stratified by gender and health status for analyses. A healthy subgroup (n = 475; 49.5% women) reported no personal history of mental health, neurological, or sleep disorders and rated their overall health, functioning, and quality of life as “good” or better. Results The healthy group reported less cognitive symptoms (i.e., higher raw score) than the total sample (total sample, M = 32.17, SD = 7.57, Md = 34; healthy sample, M = 35.02, SD = 5.94, Md = 38). This pattern was shown in men [all men, M = 31.06, SD = 7.68, Md = 32; healthy men, M = 33.95, SD = 6.34, Md = 36] and women [all women, M = 33.23, SD = 7.32, Md = 36; healthy women, M = 36.12, SD = 5.30, Md = 39]. The base rates for endorsing three or more cognitive symptoms were consistently lower among the healthy samples (total sample = 14.8%, total healthy sample = 4.8%, all men = 19.7%, healthy men = 7.5%, all women = 10.1%, and healthy women = 2.1%). Internal consistency, as measured by Cronbach’s alpha, ranged from 0.89 to 0.95 depending on subgroup. Conclusions The PROMIS® v2.0 Cognitive Function 8-Item Short Form is a reliable self-report measure of cognitive difficulties. Participants who reported their overall health status to be good tended to report less cognitive difficulties. The presented normative reference values can be useful in both research and clinical practice when assessing cognition in the general population.

A-103 Normative Reference Values and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form in Adults with Mental Health Problems

Abstract Objective The purpose of the study is to present normative data and reliability statistics for the PROMIS® v2.0 Cognitive Function-8-Item Short Form for the total normative sample and subgroups with mental health problems. Method The PROMIS® v2.0 Cognitive Function 8-Item Short Form measures subjective cognitive difficulties (raw score range = 8–40). We stratified the normative sample from the US general population (n = 1,009; 51.1% women) by gender, self-reported history of a depression or anxiety diagnosis, and recent mental health symptoms (i.e., endorsed frequent anxiety or depression symptoms in the last week) and examined cognitive symptom reporting. Results Those with past or present mental health difficulties obtained lower raw scores on the measure, reflecting greater cognitive symptom reporting. This was apparent in men (all men, M = 31.06, SD = 7.68; depression group, M = 26.74, SD = 8.09; anxiety group, M = 26.95, SD = 7.54; mental health group M = 24.73, SD = 7.79) and women (all women M = 33.23, SD = 7.32; depression group, M = 29.78, SD = 8.57; anxiety group, M = 30.19, SD = 7.81; mental health group, M = 28.60, SD = 8.61). The base rates for endorsing three or more cognitive symptoms was greater in those with mental health problems (men: full sample = 19.7%; depression group = 37.1%; anxiety group = 32.8%; mental health group = 45.7%; women: full sample = 10.1%; depression group = 22.8%; anxiety group = 19.4%; mental health group = 24.8%). Internal consistency, as measured by Cronbach’s alpha, ranged from 0.92 to 0.95. Conclusions The PROMIS® v2.0 Cognitive Function-8-Item Short Form is a reliable measure of subjective cognitive functioning across genders and mental health status. Those with past or present mental health difficulties report a greater number of cognitive symptoms. It may be important to address these difficulties in clinical practice.

Examining Normative Reference Values and Item-Level Symptom Endorsement for the Quality of Life in Neurological Disorders (Neuro-QoL™) v2.0 Cognitive Function-Short Form.

We examined the normative reference values, item-level symptom endorsement, internal consistency reliability, and the base rates of symptoms endorsed for the quality of life in neurological disorders (Neuro-QoL™) v2.0 Cognitive Function-Short Form. The Neuro-QoL™ v2.0 Cognitive Function-Short Form measures subjective cognitive difficulties. The normative sample from the U.S. general population was stratified by gender, education, health status, self-reported diagnosis of depression or anxiety, and recent mental health symptoms (i.e., endorsed frequent anxiety or depression symptoms in the last week). A cohort of 1,009 adults completed this scale and their mean score was 32.60 (SD=6.89). The base rates of those who reported zero cognitive symptoms were consistently higher among the healthy samples (healthy men=79.2%; all men=63.9%; healthy women=90.2%; all women=80.0%). Endorsing three or more cognitive symptoms was more common in the mental health subgroups for both men (full men's sample [n=493]=17.6%; depression subgroup [n=70]=30.0%; anxiety subgroup [n=61]=29.5%; mental subhealth group [n=70]=38.6%) and women (full women's sample [n=516]=7.4%; depression subgroup [n=123]=13.0%; anxiety subgroup [n=103]=12.6%; mental health subgroup [n=101]=14.9%). Internal consistency was measured using Cronbach's α and ranged from 0.87 to 0.94 across groups. The Neuro-QoL™ v2.0 Cognitive Function-Short Form is a brief, efficient, and reliable measure of perceived cognitive difficulties. As expected, individuals with a favorable overall health and quality of life reported less cognitive symptoms than the total sample, whereas individuals with mental health difficulties reported more. These normative values and base rates stratified by gender, overall health, and mental health status may be useful when interpreting this measure in clinical practice.

Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment.

Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. This was a cohort study of 656 youth aged 12-25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. With a one-point reduction in PHQ9 at follow-up, there was an estimated 11-18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7-14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.

Self-reported cognitive decline in Japanese patients with breast cancer treated with endocrine therapy.

Despite contributing to the control of hormone receptor-positive breast cancer, a highly prevalent cancer type, endocrine therapy affects patients' cognitive function. We aimed to identify cognitive decline following the start of endocrine therapy using patient-reported measures and investigate factors associated with cognitive difficulties. This cross-sectional survey used a self-administered, anonymous questionnaire. The participants were 876 patients with breast cancer who experienced subjective cognitive difficulties after starting endocrine therapy. Our sample was recruited from 11 patient advocacy groups, 5 clinics, and 2 hospitals in Japan. The questionnaire assessed subjective cognitive difficulties (30 items), psychological well-being, demographic and clinical information, and other subjective symptoms. Of 510 (58.2%) responses, we analyzed 405 (46.2%) questionnaires. Exploratory factor analysis identified three factors of cognitive difficulties: Factor 1, "difficulties in manipulating memory and language;" Factor 2, "difficulties in processing multiple pieces of information;" and Factor 3, "difficulties in maintaining attention and concentration." Factor 1 was the most common type, and it was significantly related to the treatment characteristics of endocrine therapy. Multivariate logistic regression analysis revealed that fewer household members, a history of breast surgery, more severe menopausal symptoms, and greater psychological distress were significantly associated with cognitive difficulties. As cognitive difficulties increased, the proportion of participants suspected to have psychological disorders increased significantly. Patients treated with endocrine therapy for breast cancer experience intricately intertwined impairments in several domains of cognitive function. They have an increased risk of psychological disorders corresponding to the degree of subjective cognitive function.

Neuropsychological dysfunction in chronic fatigue syndrome and the relation between objective and subjective findings.

This study aimed to explore the relationship between self-reported cognitive difficulties, objective neuropsychological test performances, and subjective health complaints in chronic fatigue syndrome (CFS) and to examine the degree of impaired cognitive functions. A total of 236 consecutively recruited outpatients, 18-62 years of age, completed the tests. Self-administered questionnaires were used for assessing fatigue, pain, depression, anxiety and subjective cognitive complaints (Everyday Memory Questionnaire [EMQ]). Also, neuropsychological tests, that is, Stroop I-IV, California Verbal Learning Test-Second Edition (CVLT-II) learning and delay, Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Letter Number (L-N) Sequencing, and the Paced Auditory Serial Addition Task were performed to examine whether these objective measures correlated with subjective complaints and were compared with normative data. There was a trend of association (p < .05) between the unadjusted EMQ with Stroop IV (inhibition and shifting attention), the CVLT-II learning and delay (verbal learning and memory), and the WAIS-III L-N Sequencing (working memory), but none were statistically significant at the .001 level. The EMQ was positively associated with fatigue, pain, and depression (p < .001). The PASAT (working memory) was negatively associated with pain (p < .001). Between 21% and 38% of the patients performed below the 1.5-SD cutoff for clinically significant impairment on the Stroop tests. The self-reported cognitive performance was not strongly associated with the objective cognitive performances on any domains in patients with CFS. Patients with higher fatigue, pain, and depression levels reported greater subjective cognitive difficulties, as well as higher pain related to lower objective working memory function. The CFS patients had problems mainly in the domains of psychomotor speed and attention measured by the objective neuropsychological tests. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Longitudinal Associations Among Older Adults' Neurocognitive Performance, Psychological Distress, and Self-Reported Cognitive Function.

Subjective cognitive complaints increase with age. Although subjective cognitive difficulties have been linked to cognitive impairment and psychological distress, some studies have failed to establish a link between subjective cognitive complaints and present or future cognitive impairment. The present study examined the interactive, longitudinal effects of age, psychological distress, and objective cognitive performance on subjective cognitive function. Older adults (N=147, Mage = 74.17) were assessed biannually for up to six years. Subjective cognitive function, psychological distress, and neuropsychological testing were obtained at each assessment. In multilevel models with single predictors, age, poorer average task-switching and poorer memory predicted worse subjective cognitive functioning. Both average levels and within-person deviations in distress predicted worse subjective cognitive function. There were two significant interactions: one between average distress and chronological age, and the other between average memory and within-person distress. Task switching performance and distress had an additive effect on subjective cognitive function. Both individual differences (i.e., between-person differences) and fluctuations over time (i.e., within-person changes) contributed to worse subjective cognitive function. Psychological distress may help explain the relationship between objective cognitive performance and subjective cognitive function and should be assessed when patient concerns about cognitive functioning arise.

Divergence of subjective and performance-based cognitive gains following cognitive training in schizophrenia

BackgroundCognitive training is effective for improving cognitive performance among people with schizophrenia. An individual’s perception of their own cognition is dissociable from performance on objective cognitive tests. Since subjective cognitive benefit may impact engagement, motivation, and satisfaction with time-intensive cognitive interventions, this study aimed to determine whether subjective cognitive difficulties improve in conjunction with cognitive gains following 30 h of cognitive training. MethodsPatients with schizophrenia or schizoaffective disorder (N = 46) were randomized to treatment as usual (TAU) or TAU augmented with auditory-targeted cognitive training (TCT). All participants completed assessment batteries at baseline and follow-up. As previously reported, the TCT group showed significant improvements in verbal learning and memory and reductions in auditory hallucinations relative to the TAU group. ResultsSubjective cognitive difficulties did not significantly improve following TCT, even among TCT participants who showed improvements in cognitive performance (all ps > 0.05). Subjective cognitive difficulties were significantly associated with severity of depressive symptoms and hallucinations (r = 0.48 and r = 0.28, p < 0.001), but not global or specific domains of cognition (all rs < 0.1) at baseline. There were no significant relationships between change in subjective cognitive difficulties and change in cognitive or clinical variables (all ps > 0.05). DiscussionPatients with schizophrenia do not detect change in their cognition following cognitive training, even among those who showed robust gains in cognitive performance. Failure to detect improvement may undermine treatment engagement, motivation, and satisfaction. Translating score improvements on the cognitive exercises into tangible metrics, and providing ongoing, clinician-delivered feedback on performance may facilitate patient ability to detect improvements and improve motivation to engage with cognitive training interventions.