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

描述（由申请人提供）：在老年人中，主观的记忆丧失的感觉是非常常见的，尽管用传统的神经心理学工具评估认知抱怨和表现之间没有直接的关系。我们已经确定了一组无抑郁、健康的老年人，尽管在广泛的神经心理学测试中功能完好，但他们有明显的认知抱怨（特别是涉及记忆）（称为认知抱怨，CC，组）。这些人的大脑结构变化介于遗忘性轻度认知障碍（MCI）和正常老年人之间，可能代表了“轻度认知障碍前”人群。因此，在健康、非抑郁的老年人中，认知疾病可能表明潜在的神经退行性改变可能比轻度认知损伤提供更早的治疗机会。然而，要实现这一潜力，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式来检验关于认知抱怨的性质和临床意义的假设，这些假设是在一个人口统计学上不同的群体中，大约250名老年人有不同程度的认知抱怨和损害。我们认为，认知抱怨反映了传统工具不易检测到的细微异常，而使用传统情景记忆之外的范式开发的任务可能提供更敏感的标准来测试主观和客观记忆之间的关系。我们将招募符合纳入标准的无抑郁、无痴呆的老年人，并按照提案中描述的程序将他们分为健康对照、CC或MCI。我们预测，神经心理完整的老年人有明显的认知抱怨，而不是那些没有抱怨的老年人，将表现出：(1)在前瞻性和程序性元记忆任务上的轻度表现缺陷，尽管在传统工具上表现良好；(2)记忆自我效能降低，助记策略和代偿行为的使用减少；(3)随着时间的推移，转化为轻度认知障碍的风险增加。我们的长期目标是评估认知抱怨的诊断和预测效用，并确定最能预测从早期轻度认知损伤到轻度认知损伤并最终痴呆进展的变量。我们也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相关的行为和信念，并且可能是可修改的，例如增强记忆策略和自我效能的使用。提出的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，研究结果将促进对记忆自我评价和痴呆症发病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。

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.