Cognitive Complaints in a Diverse Cohort of Elders: Novel Assessment Approaches

描述（由申请人提供）：记忆丧失的主观感知在老年人中非常常见，尽管使用传统神经心理学仪器评估的认知主诉和表现之间没有直接的关系。我们已经确定了一组非抑郁症，健康的老年人显着的认知投诉（特别是涉及记忆），尽管完整的功能，广泛的神经心理测试（称为认知投诉，CC组）。这些个体显示出介于遗忘型轻度认知障碍（MCI）和正常老年人之间的结构性脑变化，可能代表了“MCI前”人群。因此，在其他健康，非抑郁的老年人的认知投诉可能表明潜在的神经退行性变化，可以提供一个更早的治疗机会比MCI。然而，要实现这种潜力，就需要更好地理解自我评价记忆与实际表现之间的关系，以及影响这种关系的因素。我们的主要目标是使用新的范例来测试假设的性质和临床意义的认知投诉在人口统计学上的不同群体约250名老年人不同程度的认知投诉和损害。我们建议，认知投诉反映了微妙的异常，不容易检测到的传统工具，和任务开发使用的范式比传统的情景记忆可能提供更敏感的标准，以测试主观和客观的记忆之间的关系。我们将招募符合入选标准的非抑郁、非痴呆老年人，并使用提案中描述的程序将其分类为健康对照、CC或MCI。我们预测，神经心理学上完整的老年人，有明显的认知抱怨，但不是那些没有抱怨，将显示：（1）轻度的性能缺陷的前瞻性和程序性元记忆任务，尽管在传统工具上的完整性能;（2）较低的记忆自我效能和减少使用记忆策略和补偿行为;（3）随着时间的推移转换为MCI的风险增加。我们的长期目标是评估认知主诉的诊断和预测效用，并确定最能预测从MCI前期进展到MCI并最终痴呆的变量。我们还希望在未来扩大队列，并对MCI前实施认知干预，目标是在拟议的研究中发现的相关行为和信念，并且可能是可修改的，例如增强记忆策略的使用和自我效能。该研究将具有以社区为基础的样本，纵向设计和心理测量方法来评估认知投诉的优势。NIH对该提案的支持将为申请人提供过渡到独立研究者所需的经验。重要的是，这些发现将促进对记忆自我评价和痴呆症发作前认知变化的科学理解，对早期诊断和临床护理具有重要意义。 公共卫生相关性：阿尔茨海默病（AD）是一个严重影响患者，他们的家庭和社会的主要全球性公共卫生问题;在AD的早期表现的正常和异常的记忆过程的理解是一个关键的研究重点，这将有助于检测痴呆前的条件。这项研究将推进对记忆自我评价和AD发病前认知变化的基本科学理解，对早期诊断，临床护理和干预具有重要意义。此外，这项研究将满足重要的公共卫生需求，增加少数民族获得研究和提高区分个体的能力，在高风险的渐进性认知能力下降从“担心好，”谁可以放心，并遵循。

DESCRIPTION (provided by applicant): Subjective perception of memory loss is very common in older adults, though there is no straightforward relationship between cognitive complaints and performance as assessed with conventional neuropsychological instruments. We have identified a group of nondepressed, healthy older adults with significant cognitive complaints (particularly involving memory) despite intact functioning on extensive neuropsychological testing (referred to as the Cognitive Complaint, CC, group). These individuals show structural brain changes intermediate between those seen in amnestic mild cognitive impairment (MCI) and normal elders and may represent a "pre-MCI" population. Thus, cognitive complaints in otherwise healthy, nondepressed older adults may indicate underlying neurodegenerative changes that could provide an earlier therapeutic opportunity than MCI. The realization of this potential, however, will require an improved understanding of the relationship between self-appraised memory and actual performance, as well as the factors that influence this relationship. Our main goal is to use novel paradigms to test hypotheses regarding the nature and clinical significance of cognitive complaints in a demographically diverse group of approximately 250 older adults with varying degrees of cognitive complaints and impairment. We propose that cognitive complaints reflect subtle abnormalities not readily detected by conventional tools, and that tasks developed using paradigms other than traditional episodic memory may provide more sensitive criteria by which to test the relationship between subjective and objective memory. We will enroll nondepressed, nondemented older adults meeting inclusion criteria and classify them as healthy control, CC, or MCI using the procedures described in the proposal. We predict that neuropsychologically intact older adults with marked cognitive complaints, but not those without complaints, will show: (1) mild performance deficits on prospective and procedural metamemory tasks despite intact performance on conventional tools; (2) lower memory self-efficacy and reduced use of mnemonic strategies and compensatory behaviors; and (3) increased risk of conversion to MCI over time. Our long-term goals are to evaluate the diagnostic and predictive utility of cognitive complaints and identify variables that best predict progression from pre-MCI to MCI and eventually dementia. We also hope to expand the cohort in the future and implement a cognitive intervention for pre-MCI that targets behaviors and beliefs that were found to be relevant in the proposed study and that are potentially modifiable, such as enhancing the use of memory strategies and self-efficacy. The proposed study will have the advantages of a community-based sample, longitudinal design, and psychometric approach to the assessment of cognitive complaints. NIH support of this proposal will provide the applicant with the experience necessary to transition to an independent investigator. Importantly, findings will advance scientific understanding of memory self-appraisals and the cognitive changes that precede the onset of dementia, with important implications for early diagnosis and clinical care. PUBLIC HEALTH RELEVANCE: Alzheimer's disease (AD) is a major global public health problem that seriously impacts patients, their families, and society; an understanding of normal and abnormal memory processes in the early presentation of AD is a critical research priority that will facilitate detection of predementia conditions. The proposed study will advance basic scientific understanding of memory self-appraisals and the cognitive changes that precede the onset of AD, with significant implications for early diagnosis, clinical care, and intervention. Additionally, this study will meet important public health needs by increasing minority access to research and improving the ability to differentiate individuals at high risk for progressive cognitive decline from the "worried well," who can be reassured and followed.