Queixa subjetiva de memória e a relação com a fluência verbal em idosos ativos

Abstract

Objetivo
Verificar a queixa subjetiva de memória relacionada com a fluência verbal em idosos participantes de grupos de convivência.

Método
Trata-se de um estudo epidemiológico, quantitativo, realizado em grupos de convivência de idosos do município de Florianópolis, Estado de Santa Catarina. Os dados foram coletados por meio de entrevista estruturada utilizando-se o Questionário de Queixas de Memória (MAC-Q) e o Teste de Fluência Verbal (TFV) por categorias semânticas animais/minuto. Para a análise descritiva inferencial, consideraram-se os dados com p < 5%.

Resultados
Foi encontrada a queixa de memória autodeclarada em 35,7% da amostra. Não houve associação e correlação do TFV com a percepção da memória obtida pelo MAC-Q bem como com o seu escore. A análise do TFV com os indivíduos que referiram percepção negativa de memória apresentou significância estatística. Salienta-se que foi encontrada associação significativa entre a percepção (escore do MAC-Q) e a presença da queixa de memória (referida pelos idosos em questão acrescida ao questionário).

Conclusão
Não houve relação entre a queixa subjetiva de memória e a fluência verbal de idosos ativos, sendo as queixas mnemônicas correlacionadas à percepção negativa da memória e ao tempo de queixa apresentada. Porém a queixa subjetiva da memória se mostrou um indicativo para aqueles indivíduos com percepção negativa da memória, sendo um aspecto que deve ser considerado na fala dos idosos ao se investigar um possível declínio cognitivo. Tais dados podem auxiliar no direcionamento das ações de políticas públicas de assistência às pessoas idosas no município, salientando-se a importância em se verificar a queixa subjetiva de memória dos idosos.

Full text

Original Article
Artigo Original
Bernardes et al. CoDAS 2017;29(3):e20160109 DOI: 10.1590/2317-1782/20172016109 1/6
Subjective memory complaints and their
relation with verbal fluency in active older
people
Queixa subjetiva de memória e a relação com
a fluência verbal em idosos ativos
Flavia Rodrigues Bernardes1
Camila Kretzer Machado1
Monique Coan Souza1
Marcos José Machado1
Aline Megumi Arakawa Belaunde1
Keywords
Older People
Memory
Epidemiology
Public Health
Speech, Language and Hearing
Sciences
Descritores
Idoso
Memória
Epidemiologia
Saúde Pública
Fonoaudiologia
Correspondence address:
Aline Megumi Arakawa Belaunde
Universidade Federal de Santa Catarina
– UFSC
Campus Universitário, Trindade-
Florianópolis, Florianópolis (SC),
Brazil, CEP: 88040-900.
E-mail: arakawa.aline@ufsc.br
Received: June 01, 2016
Accepted: September 20, 2016
Study carried out at Coordenadoria Especial de Fonoaudiologia, Universidade Federal de Santa Catarina –
UFSC - Florianópolis (SC), Brazil.
1 Universidade Federal de Santa Catarina – UFSC - Florianópolis (SC), Brazil.
Financial support: nothing to declare.
Conict of interests: nothing to declare.
ABSTRACT
Purpose: To verify subjective memory complaints and their relation to verbal uency in older people participating
in community groups. Methods: An epidemiological quantitative study performed in community groups for
older people in Florianópolis, state of Santa Catarina, Brazil. Data were collected by structured interview using
the Memory Complaint Questionnaire (MAC-Q) and the Verbal Fluency Test (VFT) by semantic categories
“animals/minute”. For an inferential descriptive analysis, data with p < 5% were considered. Results: Self-reported
memory complaints were found in 35.7% of the sample. No association or correlation of VFT with the perception
of memory obtained by MAC-Q, nor with its score was found. The VFT analysis of in individuals who reported
negative perception of memory presented statistical signicance. We found signicant association between the
perception (MAC-Q score) and presence of memory lapses (reported by the older people in question and added
to the questionnaire). Conclusion: We found no relation between subjective memory complaints and verbal
uency of active older people. Mnemonic complaints were correlated to the negative perception of memory and
to the duration of the complaint. However, subjective memory complaints were an indicator for those individuals
with negative perception of memory, being one aspect that must be considered in older people’s speech when
investigating a possible cognitive deterioration. Such data can assist in formulating public health care policies
aimed at older people in the city, which emphasizes the importance of verifying subjective memory complaints
in this population.
RESUMO
Objetivo: Vericar a queixa subjetiva de memória relacionada com a uência verbal em idosos participantes
de grupos de convivência. Método: Trata-se de um estudo epidemiológico, quantitativo, realizado em grupos
de convivência de idosos do município de Florianópolis, Estado de Santa Catarina. Os dados foram coletados
por meio de entrevista estruturada utilizando-se o Questionário de Queixas de Memória (MAC-Q) e o Teste
de Fluência Verbal (TFV) por categorias semânticas animais/minuto. Para a análise descritiva inferencial,
consideraram-se os dados com p < 5%. Resultados: Foi encontrada a queixa de memória autodeclarada em
35,7% da amostra. Não houve associação e correlação do TFV com a percepção da memória obtida pelo
MAC-Q bem como com o seu escore. A análise do TFV com os indivíduos que referiram percepção negativa
de memória apresentou signicância estatística. Salienta-se que foi encontrada associação signicativa entre a
percepção (escore do MAC-Q) e a presença da queixa de memória (referida pelos idosos em questão acrescida
ao questionário). Conclusão: Não houve relação entre a queixa subjetiva de memória e a uência verbal de
idosos ativos, sendo as queixas mnemônicas correlacionadas à percepção negativa da memória e ao tempo de
queixa apresentada. Porém a queixa subjetiva da memória se mostrou um indicativo para aqueles indivíduos
com percepção negativa da memória, sendo um aspecto que deve ser considerado na fala dos idosos ao se
investigar um possível declínio cognitivo. Tais dados podem auxiliar no direcionamento das ações de políticas
públicas de assistência às pessoas idosas no município, salientando-se a importância em se vericar a queixa
subjetiva de memória dos idosos.

Bernardes et al. CoDAS 2017;29(3):e20160109 DOI: 10.1590/2317-1782/20172016109 2/6
INTRODUCTION
The Brazilian population prole has been changing according
to the demographic and epidemiological transition(1), and such
aspects point to a narrowing of the base and an enlargement
of the top of the age pyramid, which is a feature of developed
countries(2). Every year, the Brazilian population gains about
650,000 newly older people. According to projections, by
2020 Brazil will reach the sixth worldwide position in population
number with the contingent of more than 30 million Brazilians
over the age of 60 years(3), and some authors estimate that this
population will add up to 65 million in 2050(2).
Therefore, Brazil is becoming a country with aged population
and, in the context of epidemiological transition, the prole of
population diseases changes, with increase in the prevalence of
chronic noncommunicable diseases. Dementia syndromes, in
particular Alzheimer’s, are among such diseases, with impact
on cognition of the affected individuals(4).
The integrality of the cognitive function in older people
contributes to the autonomy and capacity of self-care, enabling
their independence and safety. The decline in cognitive skills
becomes a factor associated with the increased risk of difculty
in performing instrumental activities of daily living and even
difculties in the social conviviality, which can cause depression
and isolation(5).
During the aging process, it is natural for some cognitive
functions to mitigate, such as attention, executive functions,
and memory(6), with the slowing of information processing(7).
With population aging, it is necessary to try to identify whether
the difculties related to the cognitive processes are within the
standards of normality or characterize dementia processes(8).
One of the consequences of aging that older people most fear
is cognitive decline. Thus, studies are needed to investigate risk
factors associated with this decline. Such aspect is due to knowing
that the decline will affect the performance of daily life activities,
generating great impact on social and occupational activities
of individuals(9). Thus, early identication of cognitive decline
may help to create strategies to promote cognitive activities, in
order to slow the impact on the individuals’ daily life(10).
Some cognitive decits involve memory, which is the most
frequent cognitive complaint in older people
(4)
. It is known that
the decline that occurs in episodic memory is more marked
than that of semantic memory – the latter being used to access
language materials during the aging process
(7)
. Cognitive decline
develops into dementia only in some cases, showing that memory
complaints can be considered part of the concept of metamemory,
i.e., perceptions and self-evaluations of memory(11).
Some authors pointed out that a periodic screening on subjective
memory perception can be an action in the primary health care,
since the need for monitoring the cognitive performance of
individuals who present the complaint is indisputable(12).
Verbal uency can be considered an indicator of executive
functions, storage capacity of the semantic memory system,
capacity to retrieve information stored in memory and, especially,
capacity to organize thoughts and word retrieval. Performance
failure in the verbal uency test may be related to dementia
processes, affecting cognitive aspects(13).
Therefore, this study aims to relate subjective memory
complaints to verbal uency in active older people who take part
in community groups in Florianópolis, Santa Catarina, Brazil.
METHODS
This is an epidemiological quantitative cross-sectional study
carried out in community groups of older people in the city of
Florianópolis. The list of community groups was provided by
Secretaria Municipal de Assistência Social [Municipal Department
of Social Welfare], totaling 3,694 older people from Community
Groups. For the sample calculation held according to Miot(14),
a prevalence of 50% of older people with subjective memory
complaints was considered, with 95% condence, 5% margin
of error, and 10% possible losses, totaling a minimum sample
of 383 individuals. Statistical analysis was performed with
MedCalc, version 16.2.0 (MedCalc Software bvba, Ostend,
Belgium, 2016). The following tests were performed: Chi square,
Kruskal-Wallis, Jonckheere-Terpstra, Spearman’s rank correlation
coefcient (rs), and Odds Ratio (OR), considered signicant
when p-values < 5%.
Our study had as inclusion criteria individuals over 60 years
participating in community groups of the aforementioned city who
accepted to take part in the study by signing an informed consent
form. As exclusion criteria, our study adopted the presence of
cognitive complaints that prevented them from answering the
proposed questionnaires; declaring visual and/or hearing decit
without correction; presence of other conditions that impaired
cognition such as depression (not treated), psychiatric diseases
(both reported by the participants), and/or communication
difculties that made the speech impossible to be understood.
Data were collected by structured interview with two
questionnaires, adding to them the participants’ date of birth
and their years of study. The rst is the Memory Complaint
Questionnaire (MAC-Q) and the second is the Verbal Fluency
Test (FVT) by semantic categories “animals/minute”.
MAC-Q has six questions related to the memory functioning
in everyday activities. The answers are scored on a ve-point
Likert-type scale and range from “much better now” to “much
worse now.” The total score ranges from 7 to 35 points. The higher
the score, the greater the intensity of complaint regarding memory,
and scores ≥ 25 indicate memory impairment associated with
age, allowing to classify the older adult as having “negative”
complaint of memory(15,16). In addition to this criterion, another
one was established for the perception of complaint of older
adults. For this, a question was added to the questionnaire about
the presence or absence of memory complaint and, if so, for
how long this complaint has been constant.
The second instrument applied was the Verbal Fluency Test
(semantic categories “animals/minute”). This test consists of
asking the individual to say the largest possible number of
animals in a minute. It aims at verifying language, semantic
memory, and executive functions, evaluating the word retrieval
ability established in the long-term memory. Cutoff points were
adopted according to education level. Scores of less than nine
animals for individuals with up to eight years of study and less
than 13 for individuals with eight or more years of study indicate
cognitive dysfunction(17).

Bernardes et al. CoDAS 2017;29(3):e20160109 DOI: 10.1590/2317-1782/20172016109 3/6
This research follows the recommendations of Resolution
no. 466/2012 of the National Health Council and is approved
by the Human Subject Research Ethics Committee by CAAE:
34981514.2.0000.0118. All participants signed the informed
consent form.
RESULTS
The sample was composed of 386 older people, with
average age of 72.27 years, most of them (95.9%) being
female. The descriptive analysis with the absolute and relative
frequencies of the scores veried for VFT and MAC-Q can be
observed in Table 1. In the sample, 138 (35.7%) older people
reported memory complaint (according to the answer to the
question added to MAC-Q).
Table 2 shows the statistical tests performed and their ndings
to evaluate the relations between the different studied variables.
We observed a statistically signicant positive correlation between
the duration of memory complaint and MAC-Q scores (r
s
=0.210;
p=0.0192) as well as in the analysis performed only with older
people who presented negative perception (rs=0.206; p=0.0377).
The analysis carried out between VFT and MAC-Q scores
with those individuals who had negative perception presented
statistical signicance (p < 0.05).
We found statistically signicant positive correlation between
VFT scores and the education level of the older people, with a
Spearman’s coefcient (rs) of 0.188 (p=0.0002). However, we
observed no correlation between the age of individuals and
MAC-Q scores, or between MAC-Q scores and VFT scores.
The evaluation of the scores obtained in MAC-Q and in the
education level categories by Kruskal–Wallis and Jonckheere–
Terpstra tests did not indicate signicant association (test for
comparing medians of scores obtained in the questionnaires
according to education level groups). Similarly, we observed,
by the Chi square test, no association between age and
memory perception, or between education level and memory
perception (in this association test, we used negative or positive
categorization for memory impairment based on the scores
obtained in MAC-Q, and groups categorization according to
established education level).
Regarding the association of memory perception (by MAC-Q)
with the individual’s answer to the question added to the
questionnaire (presence of memory complaint), we observed
statistically signicant association, by Chi square test, as
presented in Table 2. In our analysis, 183 older adults had
negative memory perception by in relation to MAC-Q, but, of
these, only 111 complained about memory in the formulated
question. Another measure of statistically signicant association
was the Odds Ratio (OR=9.992, p < 0.0001), allowing to
observe that older people without complaint also present more
chances (almost 10 times more) of having positive perception
in relation to MAC-Q.
Table 1. Characteristics observed for the older people of the community groups in Florianópolis (SC), Brazil, 2015
Characteristics n % x SD Median Min Max
Female 370 95.90
Male 16 4.10
Age (years) 386 100 72.28 7.91 71 60 95
FVT (scores) 12.63 4.45 13 0 28
MAC-Q (scores) 24.45 4.41 24 7 35
Caption: x = mean; SD = standard deviation; Min = minimum; Max = maximum
Table 2. Association measures (associated variables, statistical tests performed, and results obtained) carried out with the frequencies of answers
to memory perception, duration of the complaint, age, and education level of older people from the community groups in Florianópolis (SC),
Brazil, 2015
Associated variables n Statistical Test rs or χ2 or W or z
or OR 95%CI p
Duration of the Complaint ×
MAC-Q Scores 129 Spearman’s Rank Correlation Coefficient (rs) 0.210 0.0343 to 0.366 0.02
Duration of the Complaint ×
MAC-Q Scores (individuals
with negative perception)
102 Spearman’s Rank Correlation Coefficient (rs) 0.206 0.0121 to 0.385 0.04
VFT × MAC-Q Scores
(individuals with negative
perception)
183 Spearman’s Rank Correlation Coefficient (rs) −0.144 −0.284 to 0.001 0.05
Education level × VFT Scores 385 Spearman’s Rank Correlation Coefficient (rs) 0.188 0.0893 to 0.282 0.0002
Age × MAC-Q Scores 384 Spearman’s Rank Correlation Coefficient (rs) −0.010 −0.110 to 0.089 0.84
VFT Scores × MAC-Q Scores 384 Spearman’s Rank Correlation Coefficient (rs) −0.074 −0.173 to 0.026 0.15
Education level × MAC-Q 383 Kruskall–Wallis (W) 3.555 (-) 0.31
Education level × MAC-Q 383 Jonckheere–Terpstra (z) 1.736 (-) 0.08
Age × Perception 386 Chi square (χ2) 46.667 (-) 0.07
Education level × Perception 385 Chi square (χ2) 5.529 (-) 0.13
Perception × Complaint 385 Chi square (χ2) 93.129 (-) < 0.0001
Perception × Complaint 385 Odds Ratio (OR) 9.992 6.047 to 16.511 < 0.0001

Bernardes et al. CoDAS 2017;29(3):e20160109 DOI: 10.1590/2317-1782/20172016109 4/6
DISCUSSION
This study sought to investigate the relationship between
subjective memory complaints, evaluated by the MAC-Q, and
cognitive performance, evaluated by the FVT. Additionally,
we investigated the relation between memory complaint and
cognitive performance with education and age ranges, presence
and time of complaint, and memory perception.
The female gender was prevalent in this study. The literature
on the subject has documented a predominance of women with
memory complaints. Silva et al.(18) concluded that women had
greater perception of memory decline than men. However, in
this study, we were not able to show signicant differences in
the distribution between men and women because the most of
the studied population was female, thus making difcult the
detection of gender-related differences. Guerreiro et al.
(19)
found
a proportion of women (90.2%) higher than that of men (9.8%)
among older people with memory complaint, but they stressed
that the high value was expected by the greater presence of
women in the studied population. This fact reects the tendency
of both greater survival of women and participation in groups
when compared with men.
The results also suggest that the subjective memory complaint
obtained with MAC-Q does not vary according to education
level ranges. Such data is in line with the study by Paulo and
Yassuda(11).
There was no increase in the MAC-Q score correlated to
the participants’ age, according to the studies of Lima-Silva
and Yassuda(20) and Mota et al.(10), in which older participants
did not show worse performance or more memory complaints.
However, in our research we observed the correlation between
the duration of the complaint with MAC-Q and negative memory
perception, since the longer the time of memory complaint, the
worse its perception.
The participants of this study took part in community
groups from various regions of the city. We highlight that the
activities carried out in the community groups visited for our
data collection were related to several actions, such as: singing,
dancing, bingo, handicraft (embroidery and painting), as well
as religious and commemorative activities, in addition to the
organization of tours and excursions. Authors point out that such
groups and activities stimulate leisure activities that provide
satisfactory experiences in old age(21).
We had prevalence of women (95.9%) in the studied sample.
One can relate such factor to the fact that women tend to get
in touch with new people and expand their circle of friends,
attending more social spaces (such as groups), unlike men, who
commonly are the nancial providers of the house and rarely
participate in these activities, sometimes showing resistance or
prejudice in participating in these meetings(22).
We observed a statistically signicant relation between memory
perception and complaint about the issue. According to a study
by Jacinto et al.(23), complaints regarding memory difculties
were present in 59.27% of older people, conrming the study
by Mattos et al.(16) who showed that 53.5% of their research
participants presented subjective memory complaints. Older people
who present mnemonic impairment, even if not pathological,
tend to complain about memory with higher frequency
(11)
.
Authors
(18)
pointed out that memory complaints are part of
subjective memory and are associated with a set of knowledge,
beliefs, perceptions, and feelings that individuals may have about
their cognitive performance, the latter being a larger concept
named metamemory. It is expected that individuals with more
positive perception of memory have higher performance in
memory tasks.
Concerning VFT, we observed that the score increases as
the education level increases. Brucki and Rocha(24) analyzed
257 healthy older people without mnemonic complaint.
They observed that the education level signicantly affected the
total number of animals in the VFT. This inuence persisted after
the division of the group by education level, with statistically
signicant difference between the groups with less and more
than eight years of education.
In our sample, we did not nd a relation between subjective
memory complaint and the VFT, as observed by Paulo and
Yassuda(11) and Silva et al.(18). These authors observed in the
regression analyses that the scores from MAC-Q were not
predictive of cognitive performance in the employed tests.
Also, the VFT score was correlated with the negative memory
perception. This is due to the fact that the negative perception of
older people regarding their own memory is one of the possible
evidence for their inferior performance
(25)
. Thus, it is important
to observe the self-perception that individuals have about their
health such as paying attention to memory complaint.
Considering that the VFT based on categories has great
sensitivity(26) to distinguish individuals with no cognitive changes
from those in the early stages of Alzheimer’s disease
(24)
, its
conduction becomes important and feasible because of the time
spent for its application.
The complaint of the aged population in the mnemonic
performance of activities of daily living is an aspect of
investigative relevance, given that the subjective complaint can
predict the evolution of dementia processes(23,27). In addition,
regardless of the increase or not in cognitive impairment, it is
essential to investigate the factors that may be related to the
perception of memory malfunction, since the complaint already
indicates dissatisfaction and may harm their well-being and
quality of life(27).
The World Health Organization emphasizes that actions
aimed at public policies involving dementia and focusing on
Alzheimer’s disease must be developed, because, in addition to
being considered a public health problem, the lack of knowledge
on it contributes to fears about its appearance and promotes
stigmatizing practices, which may lead to the individuals’
discrimination. The stigma affects the lives of those who have
dementia and their caregivers or family members, leading to
social isolation and delay in the search for help and diagnosis
(28)
.
Since this study was carried out only with active older people
participating in community groups, generalized considerations
should be limited to the active older people of the Florianópolis.
The aged participants still retain their autonomy, being inserted
into an environment in which they perform daily life activities
(such as keeping in touch with friends and family), cultural

Bernardes et al. CoDAS 2017;29(3):e20160109 DOI: 10.1590/2317-1782/20172016109 5/6
and religious activities, and physical activities, which may be
contributing as a protection for their cognitive functions(25).
Although Lima Argimon et al.(29) consider that the aging process
is characterized by bodily changes in physical and cognitive
level, there are also changes in the subjective perceptions. In the
aging process, cognitive changes can be considered normal,
containing gains and losses: while some skills diminish with
age, others tend to remain stable or even improve.
The absence of subjective memory complaints and the
maintenance of cognitive performance have been considered
indicators of successful aging
(27)
. Caramelli and Beato
(30)
reported
that memory complaints can be associated with a specic
situation, and may not be related to a current cognitive decit,
but they are an indicator of high relevance to future cognitive
impairment.
Older people with subjective memory complaints on their
performance in daily life activities, even with normal cognitive
performance, can develop Alzheimer after two years of clinical
follow-up. Stress, symptoms of depression, and low self-esteem
are pointed out as predictors of subjective memory complaint
(27)
.
Therefore, we suggest further research to continue the
investigations on memory complaints, and the inclusion of older
people in several situations, considering the heterogeneity of
this group and contributing to the understanding of the relation
between complaints and cognitive performance in population
level.
CONCLUSION
We found no relation between subjective memory complaints
and verbal uency of active older people, and mnemonic
complaints had statistically signicant correlation with the
negative memory perception and the duration of the complaint.
Our study presented some limitations, since it consisted only
of active older people, which may not represent the population
prole of the Brazilian older people. However, since there was
evidence of cognitive decline, it is necessary to think about the
direction of public policy actions, particularly those directed to
health aspects of the aged population, thinking about the reality
of a growing need for care and treatment for this population,
aiming to promote health throughout life, including the promotion
of a healthy life, healthy environments, and disease prevention,
thus minimizing costs in several sectors of society.
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Author contributions
FRB and AMAB contributed in the preparation, development, and writing of the
manuscript; FRB, CKM, MCS, MJM, and AMAB held the data collection and
analysis and the writing of the manuscript; FRB, MJM, and AMAB contributed
to the development, data analysis, and review of the manuscript.