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RESEARCH ARTICLE |
Department of Psychology, Washington University in St. Louis, Missouri.
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Abstract |
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Complaints about memory tend to increase with age (e.g., Bolla, Lindgren, Bonaccorsy, & Bleecker, 1991
). Part of the reason for this increase may be a self-awareness of the earliest symptoms of dementia (e.g., Schmand, Jonker, Hooijer, & Lindeboom, 1996), but healthy nondemented older people also complain about their memory (e.g., O'Connor, Pollitt, Roth, Brook, & Reiss, 1990). Subjective evaluations of memory by healthy older adults, however, tend to be unrelated to actual memory performance. For example, Poitrenaud, Malbezin, and Guez (1989) examined 125 men in their 60s in a 7-year longitudinal study. Half the sample reported subjective memory decline over the 7 years; these reports were unrelated to actual changes in memory over the same time period. In studies that do find a correlation between subjective and objective memory assessments, the effect size is usually quite small. Levy-Cushman and Abeles (1998) reported a R2 of.04 between subjective and objective memory in their study of 132 people ranging in age from 47 to 90 years. This lack of a strong relation between subjective and objective memory limits the usefulness of memory complaints in the diagnosis of dementia.
If memory complaints in some older people are not driven by actual memory problems, what is the cause of these complaints? Niederehe (1998) suggested a theoretical model that considers a number of potential contributors to subjective memory complaint, including physiological disorders, state variables, trait variables, and contextual variables as well as objective memory impairment. Indeed, variables such as depression, anxiety, health, personality, and self-efficacy seem to be related to memory complaint (e.g., Comijs, Deeg, Dik, Twisk, & Jonker, 2002; Kahn, Zarit, Hilbert, & Niederehe, 1975; Levy-Cushman & Abeles, 1998). Much of this research, however, has examined only one or a few of the candidate predictors at a time without considering their combined utility. We used aspects of Niederehe's model as well as prior research on correlates of subjective memory evaluation to guide our selection of candidate predictors. We focused primarily on measures of personality and emotional stress but also included measures of objective memory and current health status. Although context may also play a role in memory complaints, it was considered beyond the scope of this initial effort because there was no prior research about contextual variables as related to memory complaints. Our immediate goal was to identify psychological characteristics associated with memory complaints by nondemented older adults in order to achieve our long-term goal: improved treatment of these complaints.
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Methods |
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), which is commonly used to screen for cognitive dysfunction. Sixteen people had scores greater than 6 and were excluded from the study. Eligible participants were mailed a packet of questionnaires, a written informed consent to sign and return, a small stipend ($5), and a self-addressed stamped return envelope. Ten people did not return their surveys, leaving a total of 283 participants (209 women, 74 men). Their mean age was 70.6 (SD = 11.0), ranging from 45 to 89 years. Their mean education was 14.7 (SD = 2.8) years.
Measures and Procedure
The Ability and Frequency scales from the Memory Assessment Clinics Self-Rating Scale (MAC-S, Revised; Winterling, Crook, Salama, & Gobert, 1986) were used to measure subjective memory. Each item is rated on a 5-point scale. The 21 items of the Ability factor indicate people's subjective ratings of their memory ability in various situations. The 24 items of the Frequency factor provide a subjective rating of the frequency of occurrence of certain memory problems. The MAC-S has high test–retest reliability and concurrent validity, and the Ability and Frequency factors remain stable across the life span (Crook & Larrabee, 1992). Because the scores on the two factors were highly correlated (.80) in this study, the scales were standardized and averaged to form a composite that served as the dependent variable. A negative composite indicates poorer subjective memory.
The Logical Memory subtest from the Wechsler Memory Scale III (Wechsler, 1997) was used to measure objective memory. The test includes two different short stories with the second story presented twice. Scores are based on the accuracy of the participant's story recall and can range from 0 to 75, with a high score indicating good memory. Because the test was administered by telephone after the cognitive screening assessment, only immediate recall was assessed. The participant listened while the examiner read a short story. Immediately after hearing the story, the participant retold it from memory. Participants' responses were recorded, with their permission, for subsequent scoring by the first author.
The 15-item Geriatric Depression Scale (GDS; Sheikh & Yesavage, 1986) is a self-report measure specifically designed to avoid classification errors that are due to somatic complaints common in older adults. This shortened version of the original 30-item GDS has been shown to be a valid and reliable instrument for screening depression (Sheikh & Yesavage, 1986). Scores can range from 0 to 15, with higher scores indicating more depression.
We did not expect high rates of depression in this volunteer sample but thought there might be more variability in self-esteem, a related construct. Scores on the Single-Item Self-Esteem Scale (Robins, Hendin, & Trzesniewski, 2001) range from 1 to 5, with higher scores indicating positive evaluations of the self. This scale has been shown to have good convergent validity with the Rosenberg Self-Esteem Scale (Robins et al., 2001) and is a more practical alternative to the longer Rosenberg Scale. The trait measure of the State–Trait Anxiety Inventory (Spielberger, 1983) was used to evaluate trait anxiety. Individuals rank their anxiety levels on 4-point Likert scales. Total scores can range from 20 to 80, with higher scores indicating higher levels of trait anxiety.
The Anxiety about Aging Scale (Lasher & Faulkender, 1993) was used to identify the role that specific fears about aging play in subjective memory. This scale includes four general areas of aging anxiety, including the fear of old people, psychological concerns, physical appearance concerns, and the fear of losses. This 20-item scale uses 5-point Likert ratings; scores can range from 20 to 100, with higher scores indicating more anxiety about aging.
A simple 11-point rating scale ranging from 0 (poor) to 10 (excellent) was used to evaluate participants' present health (Botwinick & Storandt, 1974, p. 57).
The self-rated NEO-Five Factor Inventory (NEO-FFI; Costa & McCrae, 1992) was used as a measure of personality. The five personality domains include Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Scores on each dimension can range from 0 to 48, with higher scores indicating higher levels of the particular trait.
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Results and Discussion |
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). We chose Logical Memory as our measure of objective memory because people are more likely to experience the need to recall prose in everyday life than they are to perform serial or paired-associates recall. For example, one of the items from the measure of complaint asks for a rating of the ability to recall specific facts from a story one has just read. This item, however, was not significantly correlated with Logical Memory scores (r = -.11). Future studies might include other objective measures of memory that closely parallel other common memory failures (e.g., word-finding difficulties, prospective memory) to determine if other objective memory measures are more strongly related to subjective memory evaluations.
A novel finding in this study was the association of the personality characteristic of conscientiousness with subjective memory evaluation. Individuals low in conscientiousness had more memory complaints. Although this result was from a stepwise regression analysis, which can capitalize on chance sampling fluctuations, similar results were obtained in another sample of 97 people from the same volunteer pool and in a sample of 95 college students (Pearman, 2003). In contrast, Lane and Zelinski (2003) reported that neuroticism, not conscientiousness, was related to their measures of memory complaint, which differed from the one used here. Their sample involved people who were in a longitudinal study for at least 16 years; perhaps less conscientious people dropped out.
Our results regarding the correlation of self-esteem and memory complaints agree with those Giovagnoli, Mascheroni, and Avanzini (1997) observed in people with epilepsy. Older adults' perceptions of their memory appear to depend on their view of the self. Alternatively, it could be that their self-esteem depends on their perceived memory ability. Because of the correlational nature of this study, the direction of causality is unclear. Previous studies concluded that depression is a major contributor to memory complaints by older adults (Antikainen et al., 2001), but none included a measure of self-esteem. Although depression certainly may lead to complaints about memory, in those who are not depressed low self-esteem may be a more useful predictor. The mean GDS score in the present sample was 1.79 (SD = 2.19).
As shown in Table 1, Neuroticism was correlated with both Conscientiousness (-.37) and self-esteem (-.52), but it still contributed to the prediction of memory complaint after these two related variables were included in the analysis. This additional component of explained variance (4%) probably contains elements of anxiety, which has been reported in previous studies (e.g., Poitrenaud et al., 1989). Neuroticism and trait anxiety were strongly correlated in our sample (r =.80). An examination of the facets of both conscientiousness and neuroticism is needed to determine which aspects of these personality traits are related to memory complaint.
In summary, several personality variables—conscientiousness, self-esteem, neuroticism—were associated with memory complaints. Considered together, they explained approximately a third of the variance in subjective memory evaluation. These findings suggest directions for future interventions. In the past, the focus has been on teaching memory skills. We need interventions that address the other variables that are related to memory complaint. Although personality change is a complex task, low self-esteem and anxiety are problems commonly addressed in therapeutic settings. Treatments for these conditions should be considered for treatment of memory complaints as well. In addition, interventions may be tailored to the individual. For example, different approaches to learning may be needed for people low in conscientiousness compared with those high in conscientiousness.
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Acknowledgments |
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Address correspondence to Martha Storandt, Department of Psychology, Box 1125, Washington University, 1 Brookings Drive, St. Louis, MO 63130. E-mail: mstorand{at}wustl.edu
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Footnotes |
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Received for publication November 19, 2002. Accepted for publication August 12, 2003.
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This article has been cited by other articles:
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  J. M. Duchek, D. A. Balota, M. Storandt, and R. Larsen The Power of Personality in Discriminating Between Healthy Aging and Early-Stage Alzheimer's Disease J. Gerontol. B. Psychol. Sci. Soc. Sci., November 1, 2007; 62(6): P353 - P361. [Abstract] [Full Text] [PDF]
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 L. Imhof, M. I. Wallhagen, R. Mahrer-Imhof, and A. U. Monsch Becoming forgetful: how elderly people deal with forgetfulness in everyday life. American Journal of Alzheimer's Disease and Other Dementias, October 1, 2006; 21(5): 347 - 353. [Abstract] [PDF]
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