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Objective and subjective memory impairment in elderly adults: A revised version of the Everyday Memory Questionnaire

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Abstract

Growing interest in understanding the relationship between subjective memory complaints (SMCs) and objective measures of memory abilities emphasizes the importance of SMC assessment for diagnostic purposes. The present study investigated the relationship between SMCs and objective memory deficits in elderly adults by analysis of the factor structure of the Everyday Memory Questionnaire (EMQ). Objective and subjective assessment of memory function was carried out in 112 elderly adults. Principal component analysis was then performed to study the factor structure of the EMQ in relation to the assessment. Objective memory impairment was evident in 8.9% of elderly adults. The factor analysis showed that the most interpretable solution to detect objective changes with the EMQ comprised only 20 out of 28 items of the original list, with three factors explaining 48% of total variance. This version was more sensitive for detecting SMCs in elderly adults, since one out of the three factors was able to differentiate subjects with objective memory deficits from those without. Taken together, these results illustrate that this 20-item version of the revised EMQ may serve as an easy-to-use instrument during clinical screening, to evaluate objective memory impairment in individuals who report SMC.
Aging Clin Exp Res, Vol. 23, No. 1 67
Key words: Aging, Everyday Memory Questionnaire, memory deficits, subjective memory complaints.
Correspondence: Maria Cotelli, PhD, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy.
E-mail: mcotelli@fatebenefratelli.it
Received November 20, 2009; accepted in revised form February 18, 2010.
Objective and subjective memory impairment in
elderly adults: a revised version of the Everyday
Memory Questionnaire
Aging Clinical and Experimental Research
Marco Calabria1, Rosa Manenti2, Sandra Rosini2, Orazio Zanetti2, Carlo Miniussi2,3 and Maria Cotelli2
1Department of Technology, Universitat Pompeu Fabra, Barcelona, Spain, 2IRCCS Centro San Giovanni di
Dio Fatebenefratelli, Brescia, Italy, 3Department of Biomedical Sciences and Biotechnologies and National
Institute of Neuroscience, University of Brescia, Brescia, Italy
ABSTRACT. Background and aims: Growing inter-
est in understanding the relationship between subjec-
tive memory complaints (SMCs) and objective measures
of memory abilities emphasizes the importance of
SMC assessment for diagnostic purposes. The pre-
sent study investigated the relationship between SMCs
and objective memory deficits in elderly adults by
analysis of the factor structure of the Everyday Mem-
ory Questionnaire (EMQ). Methods: Objective and
subjective assessment of memory function was car-
ried out in 112 elderly adults. Principal component
analysis was then performed to study the factor struc-
ture of the EMQ in relation to the assessment. Results:
Objective memory impairment was evident in 8.9% of
elderly adults. The factor analysis showed that the
most interpretable solution to detect objective changes
with the EMQ comprised only 20 out of 28 items of
the original list, with three factors explaining 48%
of total variance. This version was more sensitive for
detecting SMCs in elderly adults, since one out of
the three factors was able to differentiate subjects
with objective memory deficits from those without.
Conclusion: Taken together, these results illustrate
that this 20-item version of the revised EMQ may
serve as an easy-to-use instrument during clinical
screening, to evaluate objective memory impairment in
individuals who report SMC.
(Aging Clin Exp Res 2011; 23: 67-73)
©2011, Editrice Kurtis
subjective memory complaints (SMCs) are commonly re-
ported by elderly adults, with a prevalence estimated
from 11% (3) to 60% (4).
Several studies have investigated the relationship be-
tween objective and subjective memory deficits, suggest-
ing the predictive role of SMCs for cognitive decline (3, 5-
7). Geerlings et al. (3) found that SMCs were associated
with later development of Alzheimer’s disease in sub-
jects with normal objective cognition at baseline. Along the
same lines, Glodzik-Sobanska et al. (5) conducted a lon-
gitudinal study with a eight-year follow-up in healthy elderly
individuals, showing that the presence of SMCs con-
tributes to the risk of future decline.
Other studies have reported no such predictive feature
of SMCs for cognitive decline (4, 8) and some have
shown that SMCs are mainly related to personality traits
(7) or depressive symptoms (9), more than to objective
memory loss.
The inconsistent results reported so far in the literature
raise the question about how SMCs are rated. Therefore,
a critical point about SMC assessment is methodology:
how questionnaires are structured and their sensibility and
sensitivity. In general, SMCs are rated through a series of
simple questions or a structured or semi-structured ques-
tionnaire. Thus, sensitivity in detecting the complaints
changes from one study to another (for methodological is-
sues, see [10]).
The Everyday Memory Questionnaire (EMQ) was pro-
posed by Sunderland et al. to rate SMCs (11). In its
original version, the EMQ comprised 35 items describing
memory failures of everyday life; it was later modified to
a 28-item version (12). The factor structure of the EMQ
has been studied in closed head injury patients (12), elderly
adults (13) and multiple sclerosis patients (14). Sunderland
et al. (13) applied the EMQ to a group of elderly adults
INTRODUCTION
Aging-related cognitive changes are characterized by a
long-term memory decline, mainly of the ability to encode
and retrieve events from everyday life (i.e., episodic
memory) (1, 2). As well as this objective memory decline,
aging_11_05_Calabria.qxp:. 4-04-2011 15:34 Pagina 67
©2011, Editrice Kurtis
FOR PERSONAL USE ONLY
and found that it had low test-retest reliability, although
other authors studying the same factor structure reported
its usefulness (15, 16). In particular, Cornish (15) ex-
amined the EMQ factor structure in a large population of
undergraduate students, and proposed a five-factor struc-
ture, suggesting that a 28-item version of the EMQ might
provide a means of studying memory phenomena.
Recent growing interest in studying the relation of
SMCs with objective memory measures is emphasized
by the fact that SMCs may be a crucial clinical feature of
diagnostic criteria in patients with amnesic Mild Cognitive
Impairment (17-19), one of the clinical population with
higher risk of development of dementia. Evaluation of
the usefulness of SMCs in predicting the onset of memo-
ry deficits in the elderly population is an important field of
research, due to its clinical importance (for a review, see
[20]). Indeed, all knowledge about the relation of SMCs and
objective memory measures has an influence in clinical
practice for the diagnosis of cognitive decline (21, 22) and
for prognosis to development of dementia (6).
In the present study, we analysed responses to the
EMQ with the aim of investigating the relationship be-
tween SMCs and objective memory impairment in elderly
adults. We also aimed at determining an improved factor
structure for the EMQ in the elderly population and eval-
uating its psychometric properties. To date, only one
study has used the EMQ in the elderly (13) and failed to
demonstrate its reliability in this population. Evaluation of
the EMQ factor structure in the elderly may help to define
its sensitivity and reliability and therefore its usefulness in
the clinical setting.
METHODS
Participants and Cognitive Evaluation
A total of 112 elderly adults were recruited via a
newspaper advertisement to take part in a weekly four-ses-
sion course about age-related changes in memory at the
IRCCS Centro San Giovanni di Dio Fatebenefratelli of
Brescia, Italy.
The demographic and cognitive data of participants are
listed in Table 1.
All participants underwent a semi-structured interview
recording their medical and psychiatric history, as well as
present medical condition and medication usage. In ad-
dition, a cognitive assessment aimed at identifying par-
ticipants with memory impairment. The brief cognitive as-
sessment included a screening test for dementia (MMSE)
(23), a verbal long-term memory evaluation (Story Recall)
(24) and an executive functions test (Trial Making Test)
(25). The assessment was administered and scored ac-
cording to published procedures (26, 27).
The EMQ was administered a week after the cognitive
assessment by an experimenter blind to the experimental
purpose of the study. The 28-item version of the EMQ
was used for the evaluation of memory complaints (12,
13, 15). Each item is rated on a 9-point scale according
to the frequency with which subjects experienced a spe-
cific event over the past six months. The higher the
score, the higher the frequency of the experience of
that item (1: not at all in the last six months; 2: once in
the last six months; 3: more than once in the last six
months, but fewer than once a month; 4: once a month;
5: more than once a month, but fewer than once a
week; 6: once a week; 7: more than once a week, but
fewer than once a day; 8: once a day; and 9: more than
once a day). A detailed explanation of the response scale
was provided by the experimenter and then each partic-
ipant self-rated each item of the EMQ (see Appendixes 1
and 2 for complete list of items).
Exactly the same assessment was repeated one year af-
ter the initial assessment, in a subset of 35 participants
without memory deficits, in order to evaluate reliability
over time.
RESULTS
Neuropsychological tests and the EMQ
For the Story Recall task, 10 out of 112 participants
(8.9%) scored below the normal range (2 standard devia-
tions below the normal range, compared with an age- and
education-matched population). The cognitive assessment
results were used to identify Low Performers (LP) as par-
ticipants with objective memory impairment, and Nor-
mal Memory participants (NM) as those without objective
memory difficulties. T-tests for independent samples were
employed to check for differences between groups (LP vs
NM). LPs were significantly (p=0.05) older (74.4±5.1) than
NMs (70.4±6.2). They also had lower MMSE scores
compared with NMs (LP: 27.0±1.4; NM: 28.5±1.4;
p=0.01). The two groups did not differ significantly with re-
gard to the Trial Making Test (TMT) A (p=0.690) and B
(p=0.185). Table 2 gives more details.
LPs did not show a significantly different score in the 28-
item EMQ when compared with NMs (LP: 71.7±21.0;
NM: 60.19.1; p=0.130). Therefore, no differences on the
28-item EMQ scores were found with respect to the objec-
tive memory differences revealed between the two groups.
M. Calabria, R. Manenti, S. Rosini et al.
68 Aging Clin Exp Res, Vol. 23, No. 1
Elderly Participants
(n=112) Cut-off
Gender (male/female) 25/87
Age (yrs) 70.8 (6.2)
Education (yrs) 10.1 (4.2)
MMSE 28.3 (1.5) >24
Story Recall 11.6 (4.7) >7.5
Trail Making A 51.4 (25.5) <93
Trail Making B 149.2 (81.4) <282
n
Table 1 - Demographic characteristics and cognitive test scores of
elderly participants (n=112).
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FOR PERSONAL USE ONLY
Factor structure
With the 1986 version of Sunderland et al. (28 items)
of the EMQ, no significant differences were found on the
EMQ between participants scoring within the normal
range and those scoring below it. From this first result, we
moved to a deeper analysis to identify an alternative fac-
tor structure of the EMQ, more sensitive to detect SMCs
in participants with objective memory deficits. For this pur-
pose, we performed principal component analysis to
study the EMQ factor structure in the normal NM group
(n=102), in order to find the best structure to be used in
elderly people.
We first performed principal component analysis with
oblimin rotation. Reliability was verified with Cronbach’s
alpha, which showed good consistency (0.86) within the
questionnaire as a whole. A solution of nine factors was
found, explaining 70.8% of total variance.
We then eliminated items which obtained lower means
or which did not load onto components. Eight items
were excluded (2, 4, 11, 19, 20, 23, 26, 27) to reach a
finer factor structure. A second analysis with the re-
maining items was run and revealed a solution of seven
components, explaining 68.9% of total variance. Princi-
pal component analysis with an oblimin rotation was
then performed on the responses on the remaining 20
items. Oblique rotation was adopted, because no a priori
hypothesis was made, by means of the ‘scree test’ method
(28). Inspection of the eigen values suggested that a
four- or three-factor solution was optimal. According to
previous works on EMQ and factor structure (15), four-
and five-factor solutions are the most frequently reported
structure for this questionnaire. Accordingly, a four-factor
solution that indicated non-coherent structure was first test-
ed, with several items loading on different components.
This solution accounted for 55% of total variance. A
three-factor solution was also run and, in this case, a more
easily interpretable structure was defined. Nine of these 20
items loaded onto a first component, and their loadings
ranged from 0.92 to 0.47. Another six items loaded
onto a second component, loadings being from 0.75 to
0.42. The remaining five items loaded onto a third com-
ponent, ranging from 0.84 to 0.62. In all, the four factors
accounted for 48% of total variance. Reliability was
checked with Cronbach’s alpha, and good consistency
(0.83) was found within this new set of items.
According to the items considered in the analysis, the
following three-factor solution is proposed (see Table 3): i)
Factor 1, Memory and Learning: This factor included
items related to episodic memory (1, 5 to 8, 24 and
28), learning (12) and language (13); ii) Factor 2, Atten-
tion: Items which loaded on this factor were more often
related to concentration during conversations (10, 16, 21),
reading (9, 17) or watching movies (3); iii) Factor 3,
Procedure and Monitoring: The items of this factor
were based on task monitoring of daily living (14, 15, 18,
22) and space (25).
Correlations among the three components were low:
the correlation between components 1 and 2 was 0.21
and with component 3 was 0.21; correlation between
components 2 and 3 was 0.12.
20-item EMQ and memory test performance
We tested this revised EMQ version in our sample. To
investigate the relationship between self-reported memory
complaints and objective memory performance, we com-
pared the EMQ scores obtained by the LP participants
(n=10), excluded from the original sample of 112 par-
ticipants, with those obtained by NM participants. We se-
lected a group of 20 (two controls for each case) NMs
(mean age=71.9±4.3 yrs, mean education=10.4±3.6)
from the dataset of NMs to be compared with the LP
group. These two groups did not differ significantly
as regards age (t(28)=1.45, p=0.15) or education
(t(28)=-0.64, p=0.52).
Scores on the 20-item EMQ were lower in the NM
(M=44.6±16.7) than in the LP group (M=75.1±24.4)
[t(28)=3.71, p<0.001]. The first factor, Memory and
Learning [LP group: M=34.4±10.6; NM group:
M=24.2±10.4; t(28)=2.47, p=0.02] and the third one,
Procedure and Monitoring [LP group: M=26.2±11.5; NM
group: M=8.2±6.1; t(28)=5.37, p<0.001] distinguished
the two groups. Instead, the scores obtained on the sec-
Revised version of the EMQ
Aging Clin Exp Res, Vol. 23, No. 1 69
Normal Memory Low performers Cut-off p-value
Participants (n=102) (n=10)
Gender (male/female) 24/78 1/9
Age (yrs) 70.4 (6.2) 74.4 (5.1) 0.05
Education (yrs) 10.1 (4.3) 9.5 (3.4) 0.65
MMSE 28.5 (1.4) 27.0 (1.4) >24 <0.01
Story Recall 12.3 (4.2) 4.4 (2.8) >7.5 <0.01
Trail Making A 51.1 (20.4) 54.8 (18.5) <93 0.69
Trail Making B 144.6 (76.8) 196.3 (111.7) <282 0.18
n
Table 2 - Demographic characteristics and cognitive test scores of elderly participants as a function of presence (n=10) or absence (n=102)
of an objective memory deficit.
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ond factor (Attention) were not statistically different be-
tween the two groups [LP group: M=14.5±7.2; NM
group: M=11.6±6.5; t(28)=1.30, p=0.21]. This means
that attention is not one of the main factors that con-
tributes toward differentiating the two groups on the to-
tal EMQ score, as factor 1 (Memory and Learning) and
factor 3 (Procedure and Monitoring) do.
We also tested convergent validity by examining Pear-
son correlations between scores obtained on the revised
EMQ and the cognitive performance (general cognitive sta-
tus, Story Recall and executive functions), separately in
NM and LP participants.
With respect to NM participants, a weak negative
correlation between the EMQ total score and the MMSE
score (r=-0.37, p=0.02) was found. No other variable was
correlated to the questionnaire score (p>0.05).
Conversely, objective (Story Recall) and subjective
(EMQ-revised) memory measures were highly correlated
(r=-0.69, p=0.03) in the LP group. Interestingly, the
EMQ score did not correlate with any other cognitive mea-
sure (MMSE and TMT) in LP. Lastly, no changes were
found after one year in the re-tested subgroup of NM par-
ticipants for Story Recall [first assessment=14.4±4.5,
second assessment=14.3±3.8; t(34)=0.15, p=0.89],
MMSE [first assessment=28.8±1.3, second assess-
ment=28.8±1.2; t(34)=0.11, p=0.91], TMT A [first as-
sessment=46.1±17.2, second assessment=44.1±20.3;
t(34)=0.75, p=0.46], TMT B [first assessment=121.83.6,
second assessment=125.4±60.1; t(34)=-0.53, p=0.60]
and EMQ score [first assessment=47.8±16.1, second
assessment=49.9±15.1; t(34)=-1.70, p=0.10]. This re-
sult confirms the reliability of the revised EMQ over time
in NM individuals.
DISCUSSION
In this study of subjective and objective measures of
memory in the elderly population, to evaluate their use-
fulness as assessed by the EMQ and determining the
best factor structure for this purpose, we found that
8.9% of elderly adults had an objective memory deficit,
matching literature data reporting a prevalence between
about 6% (29, 30) and 15% (31). We had recruited our
participants by means of a newspaper advertisement for
attending a course on aging-related changes of memory,
and this method may have induced a bias in sample se-
lection, but as we found the same prevalence of memory
deficits as reported in previous studies, we can assume that
our sample was representative of the elderly population.
In participants without memory deficits, we investigated
the psychometric and factor structure of the EMQ. In our
comparison of elderly participants with or without mem-
ory impairment, we found that a three-factor solution of
M. Calabria, R. Manenti, S. Rosini et al.
70 Aging Clin Exp Res, Vol. 23, No. 1
Item No. Factor structure Loadings Means SD
Factor 1 - Memory and Learning
7 I forget to take things with me 0.92 2.64 1.47
8 I forget I was told something and had to be reminded 0.79 3.11 1.93
6 I forget when something happened 0.75 2.18 1.57
5 I have to go back to check whether I have done something 0.55 3.48 2.16
28 I repeat to someone what I have just told them 0.54 1.92 1.30
12 I have difficulty learning a new skill 0.52 2.56 1.90
13 I find that a word is ‘on the tip of my tongue’ 0.52 4.60 2.35
24 I forget where things are normally kept 0.51 1.96 1.38
1 I forget where I put things 0.47 3.77 2.10
Factor 2 - Attention
16 I forget what I have just said 0.75 2.45 1.63
10 I let myself ramble on about unimportant or irrelevant things 0.74 2.07 1.54
21 I tell someone a story or a joke I have told them already 0.69 1.98 1.57
17 I am unable to follow the thread of a story 0.62 2.40 1.83
3 I find television movies difficult to follow 0.61 1.56 1.16
9 I start to read something without realizing I have read it before 0.42 2.02 1.69
Factor 3 - Procedure and Monitoring
18 I forget to tell somebody something important 0.84 2.08 1.23
14 I forget to do things I said I would do or planned to do 0.73 2.37 1.74
22 I forget details of things I do regularly 0.67 1.77 1.55
25 I get lost in places where I have often been before 0.65 1.87 1.15
15 I forget important details of what I did the day before 0.62 1.70 1.34
n
Table 3 - Final version of questionnaire (20 items) according to factor structure, with component loadings for each item.
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These results match those of the literature, suggesting
that SMCs are correlated with memory impairment (for a
recent review, see [9]), although some such studies give
controversial results (32, 33). There is also increasing ev-
idence that SMCs may be related to the risk of develop-
ing dementia (3).
It is noteworthy that we also analysed the reliability of
EMQ scores over time in a subgroup of healthy partici-
pants. Retesting a subgroup of healthy subjects gave the
same scores on the EMQ one year later, indicating that
the present version is also reliable over time.
Altogether these preliminary data are really interesting
for their scientific and clinical importance, they do need
substantiation from a larger sample.
In conclusion, these results emphasize the importance
and usefulness of this short revised version of the EMQ to
predict objective memory impairment, since it may serve
as an easy-to-use instrument to evaluate SMCs objectively
in elderly adults, both in a clinical setting and in scientif-
ic investigations.
20 items was more sensitive in differentiating the SMCs
in the two groups. One previous study of EMQ and fac-
tor structure (15) reported a five-factor solution, whereas
others (13, 15, 16) have suggested three- or four-factor
solutions. In our study, the final and more easily inter-
pretable solution was a three-factor structure. This solution
explained the 48% of total variance, the same percentage
reported in other works applying a larger number of
factors.
For example, Cornish (15) reported a five-factor solu-
tion, which explained 48.5% of total variance. Although
this author eliminated some items with low means in a fur-
ther analysis, he failed to find a different factor structure.
His final solution considered the following factors: re-
trieval, task monitoring, conversational monitoring, spatial
memory, and memory for activities. A similar structure was
found also by Richardson and Chan (14), who used the
EMQ to study SMCs in multiple sclerosis patients. They
proposed a solution of five factors: receptive communi-
cation, route finding, absent-mindedness, face recognition,
and expressive communication.
The differences between our factor structure and the
ones previously reported may be due to differences in the
sample cohort used. We considered elderly adults with a
mean age of 70 years, whereas in Cornish’s (15) study,
participants had an age ranging from 19 to 45 and
Richardson and Chan (14) studied a clinical population
with a mean age of 48.6 years. Some differences with re-
spect to previous studies may be attributed to age and age-
related changes in memory functioning (1). Our three-fac-
tor solution considered: a first factor including items related
to episodic memory, learning and language; a second one
more related to ‘Attention’ during conversation and read-
ing; and a third considering items related to task moni-
toring of daily living. Cornish (15) reported similar factors
in his solution: ‘retrieval’ for memory functioning, ‘task
monitoring’ and ‘memory for activities’ similar to our
‘procedure and monitoring’. In their revised version of the
EMQ, Royle and Lincoln (16) also found a similar struc-
ture with two main factors, one related to memory re-
trieval and one to attentional tracking.
One crucial aim of the present study was to investigate
the relationship between subjective and objective measures
of memory in the elderly population, evaluating the use-
fulness of SMC assessment in them. With the revised
shorter version of the EMQ, in this study we found that
Low Performers (LP) i.e., those with objective memory
deficits, obtained higher scores than elderly adults cate-
gorized as having Normal Memory (NM). These data sug-
gest that the EMQ can provide reliable indications on
memory ability in the elderly.
In addition, the correlation between the revised EMQ
score and memory performance was obtained only in the
LP group, in which the only significant correlation was
that between the EMQ and Story Recall.
Revised version of the EMQ
Aging Clin Exp Res, Vol. 23, No. 1 71
1. Dimentico dove ho messo qualcosa. Perdo le cose per
casa
2. Provo difficoltà a seguire un film alla TV
3. Devo tornare indietro per controllare se ho fatto
qualcosa che dovevo fare
4. Dimentico quando è successo qualcosa (per esempio,
non ricordo se una cosa è successa ieri o la settimana
scorsa)
5. Dimentico di portare le cose con me
6. Dimentico che mi è stato detto qualcosa ieri o qualche
giorno fa, e devo farmelo ripetere
7. Comincio a leggere qualcosa (un libro, un articolo, o
una rivista) senza rendermi conto di averlo già letto
8. Mi accade di divagare, parlando di cose irrilevanti o
prive di importanza
9. Ho difficoltà ad imparare un’abilità nuova. Per
esempio, stento ad imparare un nuovo gioco o ad
usare un nuovo strumento dopo averci provato una
o due volte
10. Ho una parola "sulla punta della lingua". So che cos'è
ma non riesco a trovarla
11. Dimentico completamente di fare cose che mi è sta-
to detto di fare
12. Dimentico particolari importanti di ciò che ho fatto o
che mi è successo il giorno prima
APPENDIX 1
20-item revised version of Everyday Memory Questionnaire
(Italian version).
Deve rispondere al questionario utilizzando la scala dei punteggi
da 1 a 9 come di seguito indicato.
Scala dei Punteggi
(vedere versione Inglese per la scala dei punteggi)
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©2011, Editrice Kurtis
FOR PERSONAL USE ONLY
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72 Aging Clin Exp Res, Vol. 23, No. 1
APPENDIX 1 (continued)
13. Quando parlo con qualcuno, mi capita di dimenticare
ciò che ho appena detto. A volte dico "di che cosa
stavamo parlando?"
14. Leggendo un giornale o una rivista, mi capita di non
riuscire a seguire il filo di una storia, non ricordo
più l'argomento
15. Dimentico di dire a qualcuno qualcosa di importante:
per esempio, dimentico di trasmettere un messaggio
o di ricordare qualche cosa a qualcuno
16. Racconto a qualcuno una storia o una barzelletta
che gli avevo già raccontato
17. Dimentico particolari importanti di cose che faccio re-
golarmente. Per esempio non ricordo più i partico-
lari di ciò che devo fare o quando devo farlo
18. Dimentico dove si trovano normalmente delle cose, o
le cerco nel posto sbagliato
19. Mi perdo e giro nella direzione sbagliata nel corso di
un viaggio, di una passeggiata, o in un edificio in cui
sono stato spesso in precedenza
20. Ripeto a qualcuno una cosa che ho appena detto, op-
pure faccio due volte la stessa domanda
Punteggio Totale
Not at all in the last six months 1
Once in the last six months 2
More than once in the last six months, but fewer
than once a month 3
Once a month 4
More than once a month, but fewer than once a week 5
Once a week 6
More than once a week, but fewer than once a day 7
Once a day 8
More than once a day 9
APPENDIX 2
20-item revised version of Everyday Memory Questionnaire
(English version)
Please rate the frequency with which you experience each event on
a 9-point scale from 1 to 9, in agreement with the following table.
Response Scale
1. I forget where I put things
2. I find television movies difficult to follow
3. I have to go back to check whether I had done
something
4. I forget when something happened
5. I forget to take things with me
6. I forget I was told something and have to be reminded
7. I start to read something without realizing I have read
it before
8. I let myself ramble on about unimportant or irrelevant
things
9. I have difficulty learning a new skill
10. I find that a word is ‘on the tip of my tongue’
11. I forget to do things I said I would do or planned to do
12. I forget important details of what I did the day before
13. I forget what I have just said
14. I am unable to follow the thread of a story
15. I forget to tell somebody something important
16. I tell someone a story or a joke I have told them
already
17. I forget details of things I do regularly
18. I forget where things are normally kept
19. I get lost where I have often been before
20. I repeat to someone what I have just told them
Total score
aging_11_05_Calabria.qxp:. 4-04-2011 15:34 Pagina 72
©2011, Editrice Kurtis
FOR PERSONAL USE ONLY
Revised version of the EMQ
Aging Clin Exp Res, Vol. 23, No. 1 73
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Chapter
Subjective memory complaints are often reported in the elderly (but also in middle-aged) adults. In some cases, they can be part of neurocognitive disorders such as mild cognitive impairment. Several studies investigated the association between subjective memory abilities and objective memory functioning in older age showing that negative perceptions of one’s own memory abilities would be indicative of actual memory deficit or dysfunction related to psychological factors, such as depression or some personality traits. Growing interest in subjective memory complaints has led to development of different approaches to self-rate frequency and severity of one’s own memory failures by means of a series of simple questions or via structured questionnaires. This chapter describes the construct of subjective memory complaints and reviews the most widely used instruments characterized by well-established psychometric properties. The chapter provides suggestions to clinicians and researchers to identify the most suitable measures according to their specific aims.
Chapter
Subjective memory complaints are defined as concerns about one's own memory (or other cognitive) abilities that may or may not be associated with actual impairment on objective testing. They are often reported in elderly individuals, with a prevalence ranging from approximately 25%–50%. Because of their possible relationships with increased risk for future cognitive decline, subjective memory complaints should be detected in clinical settings. To assess and quantify subjective memory complaints accurately, several standardized questionnaires are available. In this chapter, we provide a practical guide to use three of the most common questionnaires for subjective memory: the Memory Functioning Questionnaire, the Everyday Memory Questionnaire, and the Memory Complaint Questionnaire. We describe the questionnaires and the respective administration, scoring, and interpretation procedures to help clinicians to choose the most appropriate questionnaire as a function of their specific clinical or research aims.
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Aim The aim of this study was to investigate the association between subjective memory complaint (SMC) and executive function in a community sample of South Korean elderly. Method Data for 1442 non‐cognitive impaired elderly individuals aged 65 and over were selected from a nationwide dementia epidemiological study conducted in South Korea. Global cognitive function was assessed by the Korean version of the Mini‐Mental State Examination (MMSE‐KC). The registration and recall subscales of the MMSE were used for evaluating memory function. Executive function was measured by using the Initiation/Perseveration (IP) subscale of the Korean dementia rating scale (K‐DRS). Results Of the 1442 participants, 1088 were in the normal control group and 354 were in the SMC group. In the SMC group, compared to the normal control group, the proportion of depression was significantly higher, total MMSE scores, delayed recall score and total IP scores were significantly lower, and the mean scores of complex/simple verbal IP, alternating movements, and graphomotor design were lower. In the unadjusted linear regression model, the SMC significantly associated with a lower score of total MMSE‐KC, MMSE delayed recall, K‐DRS IP, complex/simple verbal IP, alternating movements and graphomotor design. After adjusting for age, gender, education, marital status, alcohol consumption, smoking behaviour, and depression, the SMC were significantly associated with lower total MMSE score, MMSE delayed recall, K‐DRS IP, and K‐DRS complex/simple verbal IP. Conclusion In this population‐based sample, individuals with SMC had evidence of lower performance on global cognition, memory function, and executive function, especially verbal fluency, after adjusting for demographic variables and depression.
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Memory for personally past events (episodic memory) is critical for activities of daily living. Decline in this type of declarative long-term memory is a common characteristic of healthy ageing, a process accelerated in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Transcranial electrical stimulation (tES) has been used as a strategy to ameliorate episodic memory. Here, we critically review studies investigating whether tES may improve episodic memory in physiological and pathological ageing. Evidence suggests that tES over the prefrontal or temporoparietal cortices can be beneficial in healthy older adults or individuals at risk of developing AD. The studies in AD patients do not provide sufficient evidence for a recommendation for the use of multiple sessions of tES to improve episodic memory. More work is needed to better understand the mechanisms underlying the effects of tES and optimizing the dosing of stimulation. Future studies should also investigate the optimal timing of stimulation and the combination with medications to induce long-lasting beneficial effects in pathological ageing. More open science efforts to improve rigor and reliability will be essential to answering these questions.
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Background Subjects with a mild cognitive impairment (MCI) have a memory impairment beyond that expected for age and education yet are not demented. These subjects are becoming the focus of many prediction studies and early intervention trials.Objective To characterize clinically subjects with MCI cross-sectionally and longitudinally.Design A prospective, longitudinal inception cohort.Setting General community clinic.Participants A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease (AD), all from a community setting as part of the Mayo Clinic Alzheimer's Disease Center/Alzheimer's Disease Patient Registry, Rochester, Minn.Main Outcome Measures The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the Mini-Mental State Examination, Wechsler Adult Intelligence Scale–Revised, Wechsler Memory Scale–Revised, Dementia Rating Scale, Free and Cued Selective Reminding Test, and Auditory Verbal Learning Test. Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria, respectively.Results The primary distinction between control subjects and subjects with MCI was in the area of memory, while other cognitive functions were comparable. However, when the subjects with MCI were compared with the patients with very mild AD, memory performance was similar, but patients with AD were more impaired in other cognitive domains as well. Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD.Conclusions Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD. They appear to constitute a clinical entity that can be characterized for treatment interventions.
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The relationship between memory performance in everyday life and performance on laboratory tests was investigated in a group of subjects with normal memory and two groups of severely head-injured subjects differing in time since injury (several months vs several years). Everyday memory was assessed using questionnaires and checklists completed by each subject and independently by a relative who was in daily contact with him. Overall, a high degree of consistency was found among these measures, though the lower consistency of the subjects' questionnaire illustrated the problems of validity with self-assessment. The relatives' questionnaire correlated with test performance for normal subjects and for the long-term head-injured group but not for the recently head-injured subjects who had not yet reached a stable state. The highest correlations were with prose recall and paired-associate learning. The absence of correlations with visual memory tests may have been due to low salience of visual errors in everyday life.
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Subjective memory complaint (SMC) is central to the diagnosis of mild cognitive impairment (MCI). People with MCI are at a higher risk of progressing to dementia, and research on SMC is contradictory in terms of the accuracy of SMC and its predictive role for future dementia. One possible reason for these contradictory findings is that the level of awareness of memory function may vary among people with MCI. This review examines whether the level of awareness of memory functioning varies amongst people classified as having MCI and whether there is support for the suggestion that the level of awareness in MCI predicts future progression to dementia. Sixteen studies were identified which evaluate the awareness level in people classified as having MCI in either a clinical or research setting. In addition to the outcome of each study, the conceptualization of awareness, 'object' of awareness and methodology were also considered. There is evidence to show that the level of awareness in MCI does vary, and this may have implications for future progression to dementia. Given the increased risk of progression to dementia for those identified as having MCI, the role of awareness should be explored further with due consideration given to the conceptualization of awareness and the methodology employed. The finding of variability in awareness has implications for the use of SMC in the diagnostic criteria for MCI.