Subjective Memory Loss Research Articles

The patient perspective of the consent process and side effects of electroconvulsive therapy

Background: Electroconvulsive therapy (ECT) is an effective yet controversial treatment. It is thus important to explore patients' experiences of ECT.Aims: To assess patients' experience of ECT, focusing on the consent process and treatment side effects.Method: Three-hundred-and-eighty-nine patients completed a questionnaire about their experience of ECT as part of a quality assurance programme. Quantitative and qualitative data were obtainedResults: Almost half the patients reported memory loss after ECT. Overall the consent process was reported as having been adequate, with a possible exception in the provision of written information and discussion about alternatives to ECT and the consequences of not having it. Seventy-two percent of those patients who commented on whether ECT worked, said the treatment improved their condition.Conclusions: Psychiatrists need to improve the informed consent process. Subjective memory loss is very common and persistent memory complaints occurred in a minority. Memory should therefore be closely monitored before, during and after a course of ECT.

Cognitive Function in Breast Cancer Survivors Compared to Healthy Age- and Education-Matched Women

The cognitive function of breast cancer survivors (BC, n = 52) and individually matched healthy controls (n = 52) was compared on a battery of sensitive neuropsychological tests. The BC group endorsed significantly higher levels of subjective memory loss and scored significantly worse than controls on learning and delayed recall indices from the Rey Auditory Verbal Learning Test (AVLT). Defining clinically significant impairment as scores at or below the 7th percentile of the control group, the rate of cognitive impairment in the BC sample was 17% for total learning on the AVLT, 17% for delayed recall on the AVLT, and 25% for either measure. Findings indicate that a sizeable percentage of breast cancer survivors have clinically significant cognitive impairment.

Mild cognitive impairment and subjective cognitive impairment

Mild cognitive impairment and subjective cognitive impairment

Importance of Subtle Amnestic and Nonamnestic Deficits in Mild Cognitive Impairment: Prognosis and Conversion to Dementia

Background/Aims: To evaluate baseline characteristics and conversion to dementia in mild cognitive impairment (MCI) subtypes. Methods: We prospectively evaluated conversion to dementia in 106 patients with amnestic MCI (A-MCI) as defined by Petersen’s operationalized criteria on a paragraph recall task, amnestic-subthreshold MCI (AS-MCI) as defined by impairment on the ADAS-cog delayed word list recall with normal paragraph recall, nonamnestic MCI (NA-MCI) defined by a nonmemory domain, and in 27 patients with subjective memory loss who had no deficit on formal neuropsychological testing. Results: For all MCI subtypes, the 4-year conversion to dementia was 56% (14% annually) and to AD was 46% (11% annually). Conversion to AD in the A-MCI (56%) was similar to the rate in AS-MCI (50%). Conversion to AD in the A-MCI and AS-MCI combined was 56% (14% annually). Conversion to dementia in the NA-MCI was 52% (13% annually) and the majority converted to AD (62%). Conclusions: All MCI subtypes are at risk of converting to AD if the groups are carefully defined by an abnormal psychometric domain. All subtypes except subjective memory loss converted to AD at higher than expected rates. Both the A-MCI and AS-MCI subtypes had a similarly high rate of conversion to AD. The deficit on a word list recall task may develop before an abnormality on delayed paragraph recall is evident, at least in some subjects.

Predictors of Conversion to Dementia of Probable Alzheimer Type in Patients with Mild Cognitive Impairment

Mild Cognitive Impairment is a common condition defined as transitional state between normality and dementia of Alzheimer type. Clinically is characterized by subjective and objective memory loss beyond the expected for age and educational level, although a broad range of cognitive inefficiencies may appear, with preservation of daily living activities. Approximately half the patients convert to dementia within 3 years. Since no all patients convert to dementia it is essential to find reliable predictors so as to start the appropriate treatment as soon as possible. Extensive Medline-based search for articles dealing with predictors of conversion to dementia in Mild Cognitive Impairment (MCI). There is a substantial body of literature dealing with predictors of dementia in patients with MCI. These predictors range from a simple delayed recall task on Mini-Mental to sophisticated radiological techniques and CSF biomarkers. Comprehensive neuropsychological tests rarely surpass 70% sensitivity and specificity. The presence of the APOE epsilon 4 allele has been associated with increased risk of conversion but the sensitivity is quite low. CSF biochemical markers are being developed with encouraging results. beta-amyloid 42 protein is usually lower in converters than in people with stable cognitive status and tau protein is higher. The sensitivity is substantial but specificity is so far low. An epitope of tau protein (P231) looks more specific of Alzheimer's disease and therefore a promising biomarker. In the blood, high beta-amyloid protein levels indicate risk of conversion but only a few studies have been published. Hippocampal or entorhinal atrophy on MRI is one of the most used radiological markers of conversion but quantification of atrophy is not simple as it is subject to artifacts and anatomic variations. Proton Magnetic Resonance Spectroscopy (MRS) and Positron Emission Tomography (PET) are emerging as the most promising predictive tools. The highest degree of accuracy (>90%) has been achieved by means of PET plus either memory performance or APOE4 genotype. However, the samples of the published studies are mostly small, and these instruments are not widely available. There is no enough evidence to recommend specific techniques for predictions. Until an accurate marker is developed, a combined use of cognitive tests, APOE genotype, and a neuroradiological technique is probably the best option for prediction purposes depending on availability and experience.

α-Interferon encephalopathy

A 44-year-old woman treated by interferon-alpha (IFN-α) monotherapy for metastatic renal cell cancer presented with progressive apathy and slight subjective memory loss as well as two seizures. EEG showed multifocal epileptiform discharges. …

Relationship between testosterone, sex hormone binding globulin and plasma amyloid beta peptide 40 in older men with subjective memory loss or dementia.

In a group of 28 older men with either subjective memory loss or dementia, serum total testosterone and sex hormone binding globulin (SHBG) correlated inversely with plasma levels of amyloid beta peptide 40 (Abeta40, r=-0.5, P=0.01 and r=-0.4, P=0.04, respectively). Calculated free testosterone was also inversely correlated (r=-0.4, P=0.03), and all three relationships remained statistically significant after allowing for age. A similar but non-significant trend was seen with dehydroepiandrosterone sulphate (DHEAS), and neither luteinising hormone (LH) nor estradiol correlated with Abeta40. These data demonstrate that lower androgen levels are associated with increased plasma Abeta40 in older men with memory loss or dementia, suggesting that subclinical androgen deficiency enhances the expression of Alzheimer's disease-related peptides in vivo. An inverse correlation exists between SHBG and Abeta40, warranting further investigation.

Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline.

The aim of the study was to empirically investigate the hypothesis that anxiety in the elderly, secondary to loss of memory, predicts future cognitive decline. The participants were 137 elderly subjects with no depression or cognitive impairment from a community geriatric assessment unit, 45% with anxiety. In addition to demographic characteristics, cognitive status was assessed using the Mini Mental State Examination; depression was assessed by Tucker's short Interviewer-Assisted Depression Rating Scale; anxiety by Sinoff's Short Anxiety Screening Test and Activities of Daily Living function by Shah's modified Barthel's Index. At follow-up 37 persons had dropped out, leaving 100 participants for final analysis. Mean re-examination time was 3.2 years with no group differences. The mean MMSE and modified Barthel scores decreased significantly more in those with anxiety. A relative risk of 3.96 for developing future cognitive impairment was found. Regression analysis showed that only anxiety was a significant predictor of cognitive decline. By path analysis, a more parsimonious model showed anxiety to have both a direct and an indirect effect on predicting future cognitive decline, and that the effect of loss of memory on cognitive decline was via anxiety. Anxiety is inter-related and inseparable with loss of memory and its presence is a strong predictor for future cognitive decline, directly or indirectly via depression. It appears that loss of memory is the initial problem with consequent development of anxiety. Therefore, anxiety, like depression, is probably an early predictor of future cognitive decline and even possible future cognitive impairment.

Is subjective memory loss correlated with MMSE scores or dementia?

(1) To determine if subjective memory loss (SML) is associated with Mini-Mental State Examination (MMSE) scores, (2) to determine if this association persists after adjustment for other factors, and (3) to determine the sensitivity and specificity of SML for dementia. 1751 seniors sampled from a population registry. Age, sex, education, SML, the MMSE, and the Center for Epidemiologic Studies-Depression (CES-D) scale. Dementia was diagnosed by clinical examination. Linear regression models were constructed. The sensitivity and specificity of SML were determined with a diagnosis of dementia being the gold standard. SML was correlated with MMSE scores, even after adjusting for age, sex, education, and depressive symptoms. The sensitivity of SML was 0.58 (95% confidence interval [CI]: 0.45, 0.71), and the specificity was 0.76 (95% CI: 0.74, 0.78) for dementia. SML is correlated with MMSE score. However, SML is neither sensitive nor specific for dementia.

APOE-epsilon4 and APOE -491A polymorphisms in individuals with subjective memory loss.

The accurate clinical diagnosis of Alzheimer's disease can only be made with a high degree of certainty in specialized centres. The identification of predictive or diagnostic genetic factors may improve accuracy of disease prediction or diagnosis. One major genetic risk factor, the epsilon4 allele of the apolipoprotein E gene, is universally recognised. We have recently shown that the A allele of the apolipoprotein E, -491A/T promoter polymorphism is also an important risk factor for Alzheimer's disease in an Australian population. We designed the present study to investigate the association between apolipoprotein E genotype, -491A/T polymorphism, plasma apoE levels and the subjective experience of memory decline among 98 subjects and 49 age, gender and education-matched normal controls. An increased frequency of the epsilon4 allele of apolipoprotein E was significantly associated with the 'memory complainers' group (OR = 2.35, P = 0.02) as was the A allele of the -491A/T polymorphism (OR = 2, P = 0.02). Among all subjects, only seven individuals were homozygous for both of these alleles, and six of these seven individuals belonged to the 'memory complainers' group. This sub-group also had relatively elevated plasma apolipoprotein E levels (P < 0.01) and tended to score lower on the Mini-Mental State Examination (MMSE) and Cambridge Cognition Test. These data suggest that the epsilon4 allele of apolipoprotein E and the -491A allele are over-represented among individuals who complain of memory difficulties. Follow-up studies should clarify whether these genotypes and phenotypes are useful in the prediction and/or diagnosis of Alzheimer's disease.

Are cognitively intact seniors with subjective memory loss more likely to develop dementia?

Subjective memory loss (SML) is common in elderly persons. It is not clear if SML predicts the development of dementia. (1) to determine if SML in those with normal cognition predicts dementia or cognitive impairment without dementia (CIND); (2) to determine if an association is independent of the effect of age, gender and depressive symptoms. Secondary analysis of the Manitoba Study of Health and Aging (MSHA), a population-based prospective study. Data were collected in 1991, and follow-up was done 5 years later. Community-dwelling seniors sampled randomly from a population-based registry in the Canadian province of Manitoba, stratified on age and region. Only those scoring in the normal range of the Modified mini-mental state examination (3MS) were included. Predictor variables were self-reported memory loss, 3MS, Center for epidemiological studies-depression scale (CES-D), age, gender, and education. Outcomes were mortality and cognitive impairment five years later. In bivariate analyses, SML was associated with both death and dementia. In multivariate models, SML did not predict mortality. After adjusting for age, gender, and depressive symptoms, SML predicted dementia. However, after adjusting for baseline 3MS score, SML did not predict dementia. Memory complaints predict the development of dementia over five years, and clinicians should monitor these persons closely. However, the proportion of persons developing dementia was small, and SML alone is unlikely to be a useful clinical predictor of dementia.

Memory self-appraisal and depressive symptoms in people at genetic risk for Alzheimer's disease.

A previous study found that subjective memory loss in middle-aged and older persons is associated with the major genetic risk for Alzheimer's disease, the apolipoprotein E-4 (APOE-4) allele. No previous study has focused on subjective memory complaints and depressive symptoms in the same subject population at genetic risk for Alzheimer's disease. Sixty-six persons (mean age = 64 years, range = 43 to 82 years) without major depression or dementia but with mild age-related memory complaints were rated for severity of depressive symptoms, using the Hamilton Depression Rating Scale, and assessed for the presence of the APOE-4 allele. Severity of subjective memory loss was assessed using the Memory Functioning Questionnaire, which measures four memory domains: frequency of forgetting, seriousness of forgetting, retrospective functioning, and mnemonics usage. Depressive symptoms were significantly associated with subjective memory loss in subjects without the APOE-4 allele, for retrospective functioning (perceived change in memory) and mnemonics usage, but not in APOE-4 carriers. The same significant associations were found when the analysis was limited to the 44 subjects in the mid-age range (55-74 years), wherein APOE-4 confers its greatest effects on risk for Alzheimer's disease. These results confirm that mild depressive symptoms are related to subjective memory loss, but for some forms of memory complaint, the relationship holds true only for people without the major known genetic risk for Alzheimer's disease.

Persecutory symptoms and perceptual disturbance in a community sample of older people: the Islington study.

While there are extensive studies of paranoid symptoms and perceptual disturbance (PPD) in younger adults, relatively little is known about older adults with similar symptoms. This study took place in Islington, an inner London borough. Enumeration Districts were randomised to provide a sampling frame. Residents aged 65 or over were interviewed at home. The Short-CARE was used to elicit psychiatric symptoms and diagnosis. Sociodemographic particulars were elicited using the Client Sociodemographic and Service Receipt Inventory. Questions were asked regarding sight and hearing. We used subsections of the geriatric mental scale to identify people who had PPD symptoms. Medications taken were recorded. We asked 'Do you have any health problems?' as a screening question for subjective health problems. We interviewed 720 people. Twenty-eight (3.9%) participants scored positively on the PPD sub-scales of the GMS. A forward logistic regression analysis for independent predictors of PPD found the significant independent predictors were dementia (p = 0.0000; odds ratio 6.8), drinking alcohol in last 6 months (p < 0.03; odds ratio 0.3), drinking alcohol to help sleep (p < 0.005; odds ratio 9.6), subjective memory loss (p < 0.007; odds ratio 3.3) and uncorrected visual impairment (p < 0.02; odds ratio 2.8). There is a relatively high prevalence of PPD in older people living in the community. This is not associated with higher use of services despite the increased needs. Further studies should consider interventions to meet this unmet need.

Clinical characteristics of individuals with subjective memory loss in Western Australia: results from a cross-sectional survey.

Subjective memory complaint is common in later life. Its relationship to future risk of dementia is unclear, although many reports have found a positive association. We designed the present cross-sectional survey to investigate the clinical features associated with subjective memory impairment. One hundred and eight volunteers and 38 non-complainers acting as age-matched controls were recruited. Eleven subjects with memory complaints were excluded because of prior stroke or low MMSE score. The CAMCOG was used to measure cognition; complainers had significantly lower scores (p<0.001). Univariate analysis showed that complainers had greater prevalence of depression, anxiety, insomnia, psychotic phenomenon, difficulties with ADL and word-finding difficulties. The frequency distribution of the apolipoprotein E epsilon4 allele was similar for both groups (p=0.469). Logistic regression analysis indicated that CAMCOG scores (p=0.002) and word-finding difficulty (p=0.002) were independently associated with memory complaints. These results show that memory complainers have worse cognitive performance than non-complainers and support the findings of other studies that suggest that subjective memory loss may be a reliable indicator of cognitive decline.

Hereditary form of parkinsonism--dementia.

In four generations of a family, 13 members were afflicted with an autosomal dominant disorder characterized by young age at onset, early weight loss, and rapidly progressive dopa-responsive parkinsonism, followed later by dementia and, in some, by hypotension. Intellectual dysfunction began with subjective memory loss and objective visuospatial dysfunction and was followed later by decline of frontal lobe cognitive and memory functions. Neuropathological examination in 4 autopsied cases showed neuronal loss in the substantia nigra and locus ceruleus and widespread Lewy bodies, many of them in the cerebral cortex; those in the hypothalamus and locus ceruleus were often of bizarre shapes. Other findings were vacuolation of the temporal cortex, unusual neuronal loss and gliosis in the hippocampus (CA 2/3), and neuronal loss in the nucleus basalis. There were no neuritic plaques, neurofibrillary tangles, or amyloid deposits. Positron emission tomography in 3 patients showed decreased striatal uptake of fluorodopa. Neurochemical analysis of an autopsied brain showed a pronounced decrease in choline acetyltransferase activity in the frontal and temporal cortices and hippocampus and a severe depletion of striatal dopamine with a pattern not typical of classic Parkinson's disease.

Comorbidity with depression in older people: The Islington Study

The coexistence of depression with other psychiatric disorders, which has been extensively studied in younger adults, has hardly been reported in older people. This study focuses primarily on comorbidity and other associations of depression in a community sample of older adults. A random sample of 700 older people in the inner London borough of Islington, and any other adults living with them, were interviewed at home using standardized instruments. Older people who were depressed were likely to have other comorbid physical and psychiatric pathology, namely general anxiety, phobic anxiety, physical disability, somatic symptoms, sleep disturbance and subjective memory impairment. The overwhelming majority of older people with depression were not receiving pharmacological treatment. Such lack of treatment may be because patients with physical or psychiatric comorbidity have presenting symptoms that obscure the diagnosis of depression. We conclude that while the majority of elderly people are psychiatrically well and do not require day to day help, those who are depressed have a significant rate of comorbidity. Health workers treating elderly people with depression should look for other physical and psychiatric conditions routinely. Comorbid depression should be considered in elderly people with subjective memory loss, sleep disturbance, somatic complaints, anxiety disorders or activities of daily living (ADL) limitation.

Subjective memory loss in age-associated memory impairment: Family history and neuropsychological correlates

Abstract Self-ratings of everyday memory function and performance on memory tests were examined in 61 first-degree relatives of patients with Alzheimer's disease (AD) and 41 matched controls without a family history of dementia. Subjective memory ratings were significantly related to depression scores, despite the low levels of depressive symptoms in this healthy sample. Relatives of patients with early-onset dementia had higher levels of memory complaints compared to control participants, mediated in part by higher levels of depressive symptoms among these relatives. For the sample as a whole, there was little relationship between subjective memory ratings and performance on memory tests, but among early-onset AD relatives, subjective perceptions of memory decline were associated with poorer memory performance.

Memory training and drug therapy act differently on memory and metamemory functioning: evidence from a pilot study

The aim of this study was to assess the influence of drug therapy (DT) with pramiracetam and memory training (MT), each alone, and in combination (DTMT), on both the objective memory and metamemory performance. Thirty-five non-depressed, non-demented healthy elderly (mean age: 64.8 years) with objective (story recall) and/or subjective (cognitive difficulties scale) memory loss were randomly included in four open-label conditions: an MT condition (n = 10), a DT condition (n = 8), a DTMT condition (n = 10), and a control (CTR) condition (n = 7). MT and DTMT subjects participated in 12 real-life tutor-guided MT sessions, once weekly, each lasting 1.5 hrs. The subjects were tested for objective (Randt memory test) and subjective (Sehulster metamemory scale; memory functioning questionnaire) memory proficiency prior to (t(0)) and shortly after treatment (t(1)). Results showed that objective memory gains of the two groups receiving pramiracetam were significantly larger than that of the MT and CTR groups. The ranking order in terms of decreasing score improvements was DTMT - DT - MT - CTR. Metamemory, on the other hand, displayed only a trend to between-group differences with opposite patterns for the DT and DTMT groups. In the DT group, the level of depression, negatively interfered with metamemory but not with actual memory performance. The present findings stress, once again, the complex relationships between memory, metamemory and affective status, which may be differently modified by DT and MT.

A follow-up study of age-associated memory impairment: neuropsychological predictors of dementia.

To examine the clinical course of age-associated memory impairment (AAMI) and to evaluate the value of neuropsychological tests in predicting cognitive decline in AAMI subjects in a follow-up period of more than 3 years. Prospective cohort study. The outpatient Memory Research Unit of the Department of Neurology at the University of Kuopio in Eastern Finland. A sample of 229 subjects (mean age 71.7 years) identified in two screening studies as having AAMI. A battery of neuropsychological tests and a structured inquiry for health status and subjective memory complaints were performed at baseline and follow-up to diagnose AAMI according to the criteria proposed by a National Institute of Mental Health work group. Of the 229 subjects, 176 (76.9%) participated in the follow-up for, on average, 3.6 years after the baseline. Of the participants, 104 (59.1%) still met the AAMI criteria. Other subjects were classified into five subgroups: (1) subjects showing decline in cognition meeting dementia diagnosis (16, 9.1% (13 of them AD)); (2) subjects with mild cognitive decline meeting neither dementia nor AAMI criteria (13, 7.4%); (3) subjects with memory performance now superior to AAMI criteria (17, 9.7%); (4) subjects having a disease classified as exclusion in the criteria (15, 8.5%); (5) subjects not now reporting subjective memory loss in everyday life (9, 5.1%). Two subjects (1.1%) were not classified because of incomplete data. Neuropsychological tests predicted which subjects would develop dementia during the follow-up period. The best discriminators between these subjects and those who remained AAMI were memory and verbal fluency tests. The study suggests that, in general, AAMI is nonprogressive, but the AAMI population also includes subjects with early dementia and subjects without genuine memory loss. However, these subjects can be differentiated with a more detailed neuropsychological evaluation.

A longitudinal study of cognitive function in elderly persons with subjective memory complaints.

To assess change in cognitive function in elderly individuals with subjective memory loss over a follow-up interval of more than 3 years. Prospective cohort study. An outpatient research clinic in aging and dementia at a university hospital. A convenience sample of 59 healthy, elderly individuals (mean age 68.7 years) with memory complaints but no clinically apparent cognitive dysfunction. Participants were given a full diagnostic evaluation and were administered a neuropsychological test battery at baseline and follow-up. The cognitive assessment battery included 12 tests of recent memory, immediate memory, language function, visuospatial praxis, and psychomotor speed. Most of the tests had been established to be sensitive to cross-sectional age differences. Of 59 subjects, 54 (91.5%) were successfully followed up an average of 3.4 years later. Between baseline and follow-up, two tests exhibited significant improvement, two tests exhibited significant decline, and the other eight were unaffected. Elderly individuals with subjective perceptions of cognitive decrements who fail to provide clear evidence of cognitive impairment upon clinical interview are not at high risk for progressive cognitive deterioration over the subsequent 3- to 4-year interval.