Subjective Cognitive Decline Is More Accurate When Metamemory Is Better

Abstract

ObjectiveSubjective cognitive decline (SCD) has emerged as one of the first manifestations of Alzheimer’s disease (AD). However, discrepancies in its relationship with tests of memory and other cognitive abilities have hindered SCD’s diagnostic utility. Inter-individual heterogeneity in metamemory, or memory awareness, and the use of clinical measures of cognition lacking sensitivity to early cognitive dysfunction, may contribute to these discrepancies. We aimed to assess if the relationship between SCD and markers of early cognitive dysfunction is moderated by metamemory abilities.MethodsThe sample included 79 cognitively healthy older adults (77% female, 68% White, and 32% Black participants) with a mean age of 74.4 (SD = 6.1) and 15.9 (SD = 2.7) years of education. Metamemory was assessed using an episodic Feeling of Knowing test with four 5-item trials. Outcome measures included a resolution metric defined as a gamma correlation reflecting the accuracy of item-level predictions (“Will you know the correct answer?”). Early cognitive dysfunction was measured through the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) and the Short-Term Memory Binding Test (STMB), measures sensitive to preclinical AD. SCD was assessed with a 20-item questionnaire that asked participants to compare themselves to others their age on a 7-point Likert scale. Regression analyses examined whether a potential relation between SCD and early cognitive dysfunction was moderated by metamemory.ResultsSubjective cognitive decline was associated with susceptibility to semantic proactive interference such that greater complaints were associated with increased susceptibility to semantic proactive interference (b = −0.30, p = 0.003) only. Metamemory moderated the association between SCD and susceptibility to and recovery of semantic proactive interference such that those with more accurate metamemory showed a stronger association between increased complaints and susceptibility to semantic proactive interference (b = −0.71, p = 0.005; b = −0.62, p = 0.034). Metamemory, however, did not moderate the association of SCD with retroactive semantic interference nor short term memory binding.DiscussionThe accuracy of an individual’s metamemory, specifically their ability to adjust moment to moment predictions in line with their performance, can influence the extent to which SCD maps onto objective cognition. Such self-referential assessment should be considered when interpreting SCD.

Subjective Complaints are Similar in Subjective Cognitive Decline and Early-Stage Alzheimer’s Disease when Assessed in a Memory Clinic Setting

“…In a very recently published study, it was also found that the accuracy of an individual's metamemory can influence to which degree SCD is associated with measures of semantic proactive interference. 31 The frequency of patients with impaired awareness was equivalent in the aMCI and the mild dementia groups and only approximately 25% of the patients had impaired awareness. This is a low number compared to the findings of a previous study in which more than 60% of MCI and mild dementia patients had impaired insight.…”

Examining the Role of Aging Perceptions in Subjective Cognitive Decline

“…Increasingly, studies are revealing the utility of SCD for detecting important imaging and cognitive markers of preclinical AD 3–8,13. However, subjective perceptions of cognitive decline are not always indicative of pathologic cognitive aging,36 and it is important to identify the factors that may contribute to SCD more broadly 37. This is important because it informs the circumstances under which SCD is most likely to be a marker of emerging AD, and because it allows for the identification of potentially modifiable factors that can improve perceptions of cognitive decline.…”

“…[3][4][5][6][7][8]13 However, subjective perceptions of cognitive decline are not always indicative of pathologic cognitive aging, 36 and it is important to identify the factors that may contribute to SCD more broadly. 37 This is important because it informs the circumstances under which SCD is most likely to be a marker of emerging AD, and because it allows for the identification of potentially modifiable factors that can improve perceptions of cognitive decline. Historically, while much emphasis has been placed on mood as a primary contributor to SCD, [38][39][40][41] it is increasingly appreciated that both SCD and mood may together herald emerging AD.…”

Ageing 2023: Proceedings of 6th Gerontological Interdisciplinary Conference

“…Zvýšené seba-monitorovanie typické pre ľudí s PP podporuje patologickú interpretáciu benígnych omylov (Teodoro, Edwards & Isaacs, 2018;Larner, 2021), nemožno však ani vylúčiť fakt, že podporuje aj schopnosť hypervigilantného človeka všimnúť si aj mierne zmeny skôr, než ich je možné objektívne zachytiť. V tejto súvislosti môže určitá úroveň PP byť v súlade s lepšou metapamäťou, ktorá zlepšuje presnosť, s akou je pociťovaný SCD prediktabilný vo vzťahu k vývinu objektívneho poklesu kognície (Chapman et al, 2022). Ďalší výskum by sa mal zamerať na to, ako odlíšiť, do akej miery môže PP prispieť k skorej identifikácii kognitívnych zlyhaní, a do akej miery ide o patologizáciu stavu.…”