Subjective Memory Complaints: Practical Recommendations & Tips for Your Toolbox

Transcription

1 Subjective Memory Complaints: Practical Recommendations & Tips for Your Toolbox Dr. Jennifer Fogarty, C. Psych. Specialized Geriatric Services, Parkwood Hospital

2 A Little About Me Psychologist working Aging Brain Clinic and Regional Geriatric Program with individuals with early stage memory loss and complex differential diagnosis cases Interest in cognitive rehabilitation: Grey Matters and Learning the Ropes

3 Overview of Talk Subjective Memory Concerns Why do memory slips occur with age? Are they ever really benign? What is a normal (versus abnormal) score on a memory test? Risk Factors Benefits of Physical, Mental, Social Activity and Diet The Role of Stress

4 Normal versus Abnormal Most people experience some gradual change in thinking skills as they age BUT age-related changes have little impact on performance level Why do these memory slips occur?

5 The Three R s of Memory Registration Must focus attention and ignore distractions for information to get into memory Retention Making information stick in your memory once it is registered Retrieval Pulling information out of your mental library

6 Einstein & McDaniel (2004)

7 Age Associated Brain Changes Brain, like other organs, changes with age and becomes vulnerable to disease Decline in brain volume and brain cells and changes in blood vessels However, neuroplasticity is still possible

8 Situational and Cultural Influences Lupien (2011) Stress, Time of Appointment, Environment, Characteristics of Health Professional, Medical Exam and Diagnosis Levy & Langer (1994) Cultural Biases Memory Deficits Related to Testing Situation?

9 Subjective Memory Complaints When not affecting daily performance, are memory complaints always benign? Cognitive Complainers Saykin et al Pre-MCI (Duara et al., 2011) May be at increased risk of cognitive decline compared to those with no complaints

10 From Sperling et al. (2011) Preclinical AD

11 Pre-Clinical AD Pathophysiological evidence that AD begins years prior to diagnosis Sperling et al., 2011

12 What is a Normal Test Score? Depends on the population studied MoCA has different cut off values for normal depending on how the control population is defined

13 MoCA as Example Original MoCA study Nasreddine et al., Super normals without typical medical comorbidities of aging - No memory or cognitive complaints Research of our own with a similar population (Gagnon et al., 2013) shows that a cut off of 26 is most appropriate -76% specificity and 89% sensitivity BUT - Is this typical aging? i.e., a fair comparison?

14 MoCA Interpretation Rosetti et al. (2011) MoCA administered to a community sample of seniors with vascular risk factors mean total score of 23.4 No dementia screening exclusion criteria: stroke and cognitive complaints Research with ESL populations suggest an even lower cutoff (Mean MoCA of 21.8; Narazaki et al., 2013)

15 MoCA Interpretation Smith et al. (2007) control group was a group of patients presenting to a memory disorder clinic but with normal cognition on testing Poor specificity (50%) at a cutoff of 26 Is this more representative of typical clinic patients? What About Education? (Gagnon et al., 2013)

16 Risk Factors For Cognitive Decline Age Family history Heart disease and Stroke Head injury Mild Cognitive Impairment (MCI) Lifestyle choices

17 Mild Cognitive Impairment Amnestic Mild Cognitive Impairment* Subjective complaint of memory loss Objective impairment of memory on standardized measures Preserved cognitive abilities in other areas Preserved basic day-to-day functioning No other medical, neurologic or psychiatric explanation for the memory problems Individual does not meet criteria for dementia *Petersen et al. (1999).

18 Physical Activity Rising Tide Report (2009) Preventative AND Disease Modifying Role (Ahlskog et al., 2011) Aerobic versus low impact Improved scores on memory and executive function tests May moderate mood and stress with indirect benefit to cognition

19 Physical Activity Better brain connectivity and increased brain volume, benefit to brain vasculature Increase in neurotrophic factors involved in learning, cell health and survival Canadian Physical Activity Guidelines for Older Adults (csep.ca)

20 Initiative to promote healthy and active living Frequency most days of the week, ideally daily Intensity work toward moderate to vigorous activity Time Build up to 150 minutes/week in bouts of 10 minutes or more Type Aerobic and strengthening activities

21 Mental Activity Computer Programs Most studies demonstrate improvement on task at hand - Improvement specific to task How this relates to practical tasks like remembering appointments is understudied How long effect persists also understudied Not always studied in individuals with thinking difficulties Improvement may be related to factors like motivation

22 Mental Activity Group Interventions for Worried Well (Fogarty et al., 2012; Troyer, 2001) and Mild Cognitive Impairment (Belleville et al., 2006; Troyer et al., 2008)

23 Grey Matters Developed in response to a request from local seniors for information about what they could do to improve memory Supported by funding from Ministry of Health Promotion to the City of London Kiwanis Seniors Center (SGS as partner) Five Group Cycles each consisting of Seven 2-hour sessions

24 Grey Matters First hour - Local experts provide education cognitive changes with age, nutrition, medications and supplements, exercise, benefits of music, lifestyle factors impacting memory, hearing loss, relaxation Second hour - Memory education and teaching of memory strategies

25 Grey Matters Memory Strategies Visualization and Verbalization Remembering to do something at a future time or for remembering if you completed a task Association Link new information to what you already know Spaced Rehearsal Repeating names and numbers at gradually longer intervals of time Everything in Its Place

26 Grey Matters Also Included Information About: Role of Stress in Age-Related Memory Slips and Relaxation Strategies Time of Day Effects on Memory and How This Changes with Age Sleep Changes with Age and Effect on Memory Subjective nature of memory and hyperthymesia

27 Grey Matters No pre-screening of participants but were told at point of registration that the group was not for those with diagnosis of MCI or dementia. First session review of what is a normal memory slip and what is not and when to seek an assessment

28 Grey Matters Evaluation Three Questionnaires Given Pre-Post: Knowledge Questionnaire Multifactorial Memory Questionnaire (Troyer and Rich, 2002) Memory Strategy Use Memory Assessment Clinics Scale (Crook & Larrabee, 1990) Self-Ratings of Memory Ability and Frequency of Memory Slips

29 MAC-S Knowledge 120 Pre Post Memory Strategies Pre Post 0 Pre Post

30 Social Activity Individuals that have frequent, satisfying contact with others have lower risk of dementia than individuals that don t (Fratiglioni et al., 2000). Being alone is what is risky, not living alone May influence the effect that Alzheimer s brain pathology has on thinking skills

31 Reduce Stress Stress occurs when we lack a sense of control over a situation or event, positive or negative Direct physiological effect on the brain s memory centers increased cortisol Reduce stress = lower cortisol = improve memory

32 Mediterranean Diet Diet rich in fruits, vegetables, olive oil, legumes, whole grains and fish May slow cognitive decline in older adults, reduce the risk of developing MCI and risk of MCI progressing to dementia More studies are needed (i.e., Daviglus et al., 2011)

33 Take Home Messages Memory changes that don t impact everyday function occur for many people as they age For some individuals, these may reflect a more malignant course preclinical AD Cognitive test interpretation can be challenging Engaging in an overall healthy lifestyle, may reduce risk of decline