Relationship between Subjective Cognitive Complaints and Executive Functions: History
View Latest Version
Please note this is an old version of this entry, which may differ significantly from the current revision.
Subjects: Health Care Sciences & Services | Allergy
Contributor:
Lydia Giménez-Llort
,
Felipe Webster Cordero

Subjective cognitive complaints correspond to a heterogeneous construct that frequently occurs in the early stages of older adult life. Despite being a common source of worry for middle-aged people, it can be underestimated when clinical and neuropsychological assessments discard any underlying pathological processes. Negative age stereotyping but also self-stereotyping can contribute to doing so. Although its diagnosis is a challenge, its implication as a possible predictor of mild cognitive impairment or dementia increases the interest in its early diagnosis and intervention.

  • subjective cognitive complaints
  • stereotypes
  • aging
  • complaints
  • executive functions
  • memory
  • mild cognitive impairment
  • dementia

1. Introduction

With the aging population, geriatricians highlight the relevance of disease prevention and diagnosis of old-age-specific diseases and the best use of healthcare professionals’ specialties [1]. However, in this context, age stereotypes are known to influence behavioral, physical and cognitive outcomes among healthy older adults [2][3][4]. Moreover, the health care professionals’ beliefs and attitudes toward older people may also exert a significant impact [5]. Thus, stigmatization of older people has been shown to induce the overestimation of their age-related cognitive decline and the common perception that older people have worse cognitive competencies [2]. Growing evidence shows that these negative aging stereotypes impair the performance of healthy older adults on cognitive tests, while positive age stereotyping exerts less intense effects [2]. Thus, the impact of the age-based stereotype threat (the threat of being judged stereotypically) on older adults’ episodic and working memory, false memory susceptibility and subjective age has been recently reported [6][7][8][9][10].
Research on the role of age stereotypes and subjective aging in health across the life span identifies several theoretical approaches for potential mechanisms to explain how personal views of aging might influence health-related outcomes in later life [11]. In fact, self-stereotyping also has long-term negative effects. According to the internalization hypothesis, holding more negative age stereotypes and perceiving more age discrimination are associated with feeling older, lower self-esteem and worse perceptions of one’s own aging [7]. Similarly, internalized negative age stereotypes and subjective cognitive impairment have been related to increased depressive effects despite not being related to age-related dysregulations of cortisol [12]. In contrast, essentialist beliefs about aging seem to moderate the impact of negative age stereotypes on older adults’ performance and physiological reactivity [13].
Despite most research on age stereotypes being focused on the above-mentioned external/internal distortions referred to the older adult, nihilist aptitudes towards the inherent limitations of advanced aging and underestimations during middle adulthood can also occur [5]. Gerontologists warn that negative aging stereotypes can decrease performance on short cognitive tests widely used in primary care to screen for predementia [14]. However, on the other hand, the cognitive decline that occurs after the age of 50 or 60 is accompanied by minimal changes in some cognitive processes that are, in many cases, self-perceived by the individual but yet undetectable by classical neuropsychological assessments primarily focused on declarative memory. Hence, the term subjective cognitive impairment (SCI) associated with a subjective decline in one or more cognitive areas (attention, memory, reasoning, language, etc.) is not objectively measurable after a neurocognitive assessment despite being reported by the subject or a close person [15]. Its possible relationship with dementia points to this challenging SCI diagnosis and understanding as a subject of growing research interest, since it could have a crucial role in applying early and personalized preventive and therapeutic interventions [16][17].
An increasing number of young adults calls at clinical centers for clinical consultation due to problems in their cognitive performance, reporting problems with memory, concentration, or reasoning. In the case of middle-aged adults, this awareness usually becomes a source of worry about a predictive value for a worse clinical condition, a prelude to dementia. People’s subjective perception of their cognitive performance is highly variable and the heterogeneity of these subjective cognitive complaints makes differential diagnosis a challenge [18][19].
In fact, cognitive symptomatology in adults may be directly related to depressive symptoms or personality characteristics that influence their perception of their cognitive performance [20][21]. Moreover, the sum of these factors may be a predictor of a negative perception of quality of life [22]. Therefore, in many cases, neuropsychological assessment discards the existence of an actual cognitive impairment underlying the subjective complaints [23]. In the current pandemic scenario, the number of middle-aged adults with cognitive complaints has increased dramatically, becoming a topic of growing interest [24][25]. This subclinical condition has been usually exclusively associated with loss of memory processes, perhaps due to the lack of specificity when assessing neurocognitive processes. 

2. The Relationship among Dubjective Cognitive Impairment and Executive Functioning

The need for further research and guidelines is enhanced in the current aging population [1] and the global health situation, where the number of middle-aged people with cognitive complaints has dramatically increased [24][25]. The most recent work, a systematic review on the relationship between subjective cognitive complaints and informants’ reports, by Wasef et al. [26] in the context of anesthesiology, provides a general description of the number of cognitive domains affected, with executive functions figuring among them.
Studies assessing executive characteristics in patients with a defined diagnosis, analyzing their impact on a possible prognosis, were more common. For instance, people with amnestic mild cognitive impairment (aMCI) exhibiting frontal executive dysfunction at baseline had overall cortical thinning, including frontal areas, and a higher risk of dementia conversion than those exhibiting visuospatial or language dysfunction [27]. In that clinical scenario, confirming this poor prognosis was essential to determine the higher priority of this subgroup for intervention therapy among aMCI patients. Similarly, proper consideration of the reliability and possible predictive value of subjective cognitive complaints and a better understanding of the early stages of cognitive decline in executive functions would help to define timely interventions in a population that may be at risk. In this sense, comprehensive educational group interventions in community-dwelling older women reporting normal age-related cognitive complaints in the absence of actual cognitive decline were shown to be effective [28]. Complainers receiving psycho-education about cognitive aging and contextual factors, including health, lifestyle, beliefs and negative age stereotypes, reported significatively fewer negative emotional reactions towards cognitive functioning, considered by the authors as a prerequisite for improved subjective cognitive functioning and wellbeing.
Studies analyzing the need to include tools (self-reports) that assess more executive processes such as working memory rather than declarative memory processes also advocated for the relevance of multiple-cognitive-domain screening compared to classical unidimensional cognitive assessments [29]. Thus, one of the limitations in the analyzed studies was the generalization in neurocognitive assessments. Despite the use of more-or-less-specific tests for executive functioning, the study of memory as a unitary process and predictor of dementia continued to be prioritized. However, authors such as Giovanello and Verfaille [30] considered the need to study memory as a multimodal process related to other cognitive functions, making it possible to analyze the relationship of this process with cognitive impairment in-depth. In this sense, the study of specific memory modalities would be associated with executive processes and the activation of frontal regions, which could be associated with preclinical stages of dementia. Types of memory such as prospective memory and metamemory associated with self-awareness of illness are processes that have been investigated in recent years concerning cognitive complaints and executive functioning, as they share a common anato-functional niches, such as the prefrontal cortex [31][32][33][34].
In the same vein, self-reports and reports from external informants can work as sentinels providing valuable information about executive functioning at preclinical stages. Fogarty (2017) [35] stated that people with mild AD had more significant concerns regarding their executive functions associated with their daily lives, an opinion which was corroborated, to a lesser extent, by their informants. However, other studies indicated that only self-reported cognitive complaints predicted future cognitive changes and were associated with executive functioning, unlike informants’ reports being associated with other cognitive processes [36][37].
Highly heterogeneous variables influence subjective cognitive complaints, contributing to underestimating the reliability of this psychological construct. Emotional factors and affective disorders, including depression and anxiety, negatively influence memory but also executive performance. To monitor their contribution, some of the revised studies included neuropsychiatric symptoms in clinical assessments [38][39]. In addition, personality factors can directly influence the self-perception of everyday failures, which could be associated with executive problems [40]. Still, none of the revised works on subjective cognitive complaints and executive functions considered nor assessed the contribution of age stereotypes. In fact, only a few research reports in the literature have specifically studied subjective cognitive complaints and age stereotypes [12][41]. Lubitz et al. [41] recently developed and assessed the psychometric properties of a new questionnaire on subjective cognitive complaints in multiple cognitive domains, its association with psychological variables and the distinction of complainer types. Their study confirmed the strong influence of depressiveness on the overall level of subjective cognitive complaints. Most importantly, it detected that people with complaints about executive functions exhibited the highest levels of affective disorders, were younger and had less social integration.
Depressive symptoms and memory impairments are associated with heightened stress hormone levels during aging; conversely, long-term exposure to high endogenous levels of glucocorticoids is associated with both memory impairment and smaller hippocampal volume. In this context, Sindi et al. [12] studied the role of internalized negative aging perceptions and found them to be associated with increased depressive symptoms and subjective—but not objective—memory complaints. Interestingly, negative age stereotypes did not predict increased cortisol levels, suggesting that the mechanism underlying the association between stereotypes and cognitive impairments may be independent of age-related dysregulations of cortisol secretion [12]. However, although depression and stress contribute to cognitive performance, almost none of the studies used as an obligatory criterion the absence of psychiatric comorbidity.

3. Conclusions

In conclusion, the research of subjective cognitive complaints and their relation to executive functioning draws attention to several dimensions of clinical interest; therefore, it can be foreseen to be a promising emerging field. However, the specific search for information in this regard will find limitations as long as the term “subjective cognitive complaints” remains ambiguous and does not have a precise definition. Psychiatric comorbidity should be considered as a confounding factor, thus an exclusion criterion. Studies including a rather small number of SCI patients, no consistency regarding tools and the general use of MMSE are other limitations of the current literature.
These studies corroborated the relationship between subjective cognitive complaints and some executive processes, which is noteworthy since many people with subjective executive complaints progress to dementia. The relational studies confirmed that impaired executive performance was associated with CSF biomarkers and reduced cortical volume in specific brain regions. However, it is necessary to focus on unifying the screening tools based on processes rather than isolated functions when studying the significant heterogeneity involved in this preclinical construct. Applying an adequate neuropsychological assessment in parallel to the clinical study and a detailed analysis of sociodemographic variables would allow a better definition of the neurocognitive profile of adults who report executive complaints in their daily lives to be obtained. Otherwise, there is a risk of underestimating the reliability and predictive value of self-reporting, which may hamper the chances of providing an adequate diagnosis and early and timely intervention.

This entry is adapted from the peer-reviewed paper 10.3390/geriatrics7020030

References

  1. Arai, H.; Ouchi, Y.; Yokode, M.; Ito, H.; Uematsu, H.; Eto, F.; Oshima, S.; Ota, K.; Saito, Y.; Sasaki, H.; et al. Members of Subcommittee for Aging. Toward the realization of a better aged society: Messages from gerontology and geriatrics. Geriatr. Gerontol. Int. 2012, 12, 16–22.
  2. Marquet, M.; Missotten, P.; Adam, S. Ageism and overestimation of cognitive difficulties in older people: A review. Geriatr. Psychol. Neuropsychiatr. Vieil. 2016, 14, 177–186.
  3. Mazerolle, M.; Régner, I.; Morisset, P.; Rigalleau, F.; Huguet, P. Stereotype threat strengthens automatic recall and undermines controlled processes in older adults. Psychol. Sci. 2012, 23, 723–727.
  4. Barber, S.J.; Lee, S.R. Stereotype Threat Lowers Older Adults’ Self-Reported Hearing Abilities. Gerontology 2015, 62, 81–85.
  5. Masse, M.; Meire, P. Is ageism a relevant concept for health care practice in the elderly? Geriatr. Psychol. Neuropsychiatr. Vieil. 2012, 10, 333–341.
  6. Barber, S.J. An Examination of Age-Based Stereotype Threat about Cognitive Decline. Perspect. Psychol. Sci. 2017, 12, 62–90.
  7. Marquet, M.; Missotten, P.; Dardenne, B.; Adam, S. Interactions between stereotype threat, subjective aging, and memory in older adults. Neuropsychol. Dev. Cogn. B Aging Neuropsychol. Cogn. 2019, 26, 121–143.
  8. Smith, A.M.; Gallo, D.A.; Barber, S.J.; Maddox, K.B.; Thomas, A.K. Stereotypes, Warnings, and Identity-Related Variables Influence Older Adults’ Susceptibility to Associative False Memory Errors. Gerontologist 2017, 57 (Suppl. S2), S206–S215.
  9. Armstrong, B.; Gallant, S.N.; Li, L.; Patel, K.; Wong, B.I. Stereotype Threat Effects on Older Adults’ Episodic and Working Memory: A Meta-Analysis. Gerontologist 2017, 57 (Suppl. S2), S193–S205.
  10. Thomas, A.K.; Smith, A.M.; Mazerolle, M. The Unexpected Relationship between Retrieval Demands and Memory Performance When Older Adults Are Faced with Age-Related Stereotypes. J. Gerontol. B Psychol. Sci. Soc. Sci. 2020, 75, 241–250.
  11. Wurm, S.; Diehl, M.; Kornadt, A.E.; Westerhof, G.J.; Wahl, H.W. How do views on aging affect health outcomes in adulthood and late life? Explanations for an established connection. Dev. Rev. 2017, 46, 27–43.
  12. Sindi, S.; Juster, R.P.; Wan, N.; Nair, N.P.; Ying Kin, N.; Lupien, S.J. Depressive symptoms, cortisol, and cognition during human aging: The role of negative aging perceptions. Stress 2012, 15, 130–137.
  13. Weiss, D. On the Inevitability of Aging: Essentialist Beliefs Moderate the Impact of Negative Age Stereotypes on Older Adults’ Memory Performance and Physiological Reactivity. J. Gerontol. B Psychol. Sci. Soc. Sci. 2018, 73, 925–933.
  14. Mazerolle, M.; Régner, I.; Barber, S.J.; Paccalin, M.; Miazola, A.C.; Huguet, P.; Rigalleau, F. Negative Aging Stereotypes Impair Performance on Brief Cognitive Tests Used to Screen for Predementia. J. Gerontol. B Psychol. Sci. Soc. Sci. 2017, 72, 932–936.
  15. Jessen, F.; Amariglio, R.E.; van Boxtel, M.; Breteler, M.; Ceccaldi, M.; Chételat, G.; Wagner, M. A conceptual frame work for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimer’s Dement. 2014, 10, 844–852.
  16. Gallassi, R.; Oppi, F.; Poda, R.; Scortichini, S.; Stanzani Maserati, M.; Marano, G.; Sambati, L. Are subjective cognitive complaints a risk factor for dementia? Neurol. Sci. 2010, 31, 327–336.
  17. Perrote, M.; Brochero, N.; Concari, I.; García, I.; Assante, M.; Lucero, C. Association between subjective memory loss, mild cognitive impairment and dementia. Neurol. Argent. 2017, 9, 156–162.
  18. Brailean, A.; Steptoe, A.; Batty, G.D.; Zaninotto, P.; Llewellyn, D.J. Are subjective memory complaints indicative of objective cognitive decline or depressive symptoms? Findings from the English Longitudinal Study of Ageing. J. Psychiatr. Res. 2019, 110, 143–151.
  19. Mias, C.; Causse, B. Subjective complaints of memory, objective performance and related neuropsychological functions. A systematic review. Perspect. Metodol. 2021, 21, 376–393.
  20. Ruiz-Sánchez de León, J.M.; Llanero-Luque, M.; Lozoya-Delgado, P.; Fernández-Blázquez, M.A.; Pedrero-Pérez, E.J. Neuropsychological study of young adults with subjective memory complaints: Involvement of executive functions and other associated symptoms. Rev. Neurol. 2010, 51, 650–660.
  21. Carrillo-Mora, P.; García-Juárez, B.; Lugo-Rodríguez, Y.; Moreno-Méndez, E.; Cruz-Alcalá, L. Subjective memory complaints in geriatric population and their associated factors: A pilot study in Mexican population. Rev. Mex. Neurocienc. 2017, 18, 20–31. Available online: https://www.medigraphic.com/pdfs/revmexneu/rmn-2017/rmn176b.pdf (accessed on 7 January 2022).
  22. Montejo-Carrasco, P.; Claver-Martín, M.; Montenegro-Peña, M.; Álvarez-Crespo, B.; Montejo-Rubio, B. Association of quality of life with episodic memory performance. Study in older people without cognitive impairment. Psicogeriatría 2016, 6, 69–80.
  23. Pellicer-Porcar, O.; Mirete-Fructuoso, M.; Molina-Rodríguez, S.; Soto-Amaya, J. Subjective memory complaints in young adults: Influence of emotional state. Rev. Neurol. 2014, 59, 543–550.
  24. Miskowiak, K.W.; Johnsen, S.; Sattler, S.M.; Nielsen, S.; Kunalan, K.; Rungby, J.; Lapperre, T.; Porsberg, C.M. Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. Eur. Neuropsychopharmacol. 2021, 46, 39–48.
  25. Ferrer-Torres, A.; Giménez-Llort, L. Confinement and the Hatred of Sound in Times of COVID-19: A Molotov Cocktail for People With Misophonia. Front. Psychiatry 2021, 12, 627044.
  26. Wasef, S.; Laksono, I.; Kapoor, P.; Tang-Wei, D.; Gold, D.; Saripella, A.; Riazi, S.; Islam, S.; Englesakis, M.; Wong, J.; et al. Screening for subjective cognitive decline in the elderly via subjective cognitive complaints and informant-reported questionnaires: A systematic review. BMC Anesthesiol. 2021, 21, 277.
  27. Jung, Y.H.; Park, S.; Jang, H.; Cho, S.H.; Kim, S.J.; Kim, J.P.; Kim, S.T.; Na, D.L.; Seo, S.W.; Kim, H.J. Frontal-executive dysfunction affects dementia conversion in patients with amnestic mild cognitive impairment. Sci. Rep. 2020, 10, 772.
  28. Hoogenhout, E.M.; de Groot, R.H.; van der Elst, W.; Jolles, J. Effects of a comprehensive educational group intervention in older women with cognitive complaints: A randomized controlled trial. Aging Ment. Health 2012, 16, 135–144.
  29. Almkvist, O.; Bosnes, O.; Bosnes, I.; Stordal, E. Subjective working and declarative memory in dementia and normal aging. Acta Neurol. Scand. 2019, 140, 140–146.
  30. Giovanello, K.S.; Verfaille, M. Memory systems of the brain: A cognitive neuropsychological analysis. Semin. Speech Lang. 2001, 22, 107–116.
  31. Grady, C. The cognitive neuroscience of aging. Nat. Rev. Neurosci. 2012, 13, 491–505.
  32. Rabin, L.A.; Chi, S.Y.; Wang, C.; Fogel, J.; Kann, S.J.; Aronov, A. Prospective memory on a novel clinical task in older adults with mild cognitive impairment and subjective cognitive decline. Neuropsychol. Rehabil. Int. J. 2014, 24, 868–893.
  33. Lee, S.D.; Ong, B.; Pike, K.E.; Kinsella, G.J. Prospective memory and subjective memory decline: A neuropsychological indicator of memory difficulties in community-dwelling older people. J. Clin. Exp. Neuropsychol. 2018, 40, 183–197.
  34. Amanzio, M.; Bartoli, B.; Cipriani, G.E.; Palermo, S. Executive Dysfunction and Reduced Self-Awareness in Patients with Neurological Disorders. A Mini-Review. Front. Psychol. 2020, 11, 1697.
  35. Fogarty, J.; Almklov, E.; Borrie, M.; Wells, J.; Roth, R.M. Subjective rating of executive functions in mild Alzheimer’s disease. Aging Ment. Health 2017, 21, 1184–1191.
  36. Vaskivuo, L.; Hokkanen, L.; Hänninen, T.; Antikainen, R.; Bäckman, L.; Laatikainen, T.; Paajanen, T.; Stigsdotter-Neely, A.; Strandberg, T.; Tuomilehto, J.; et al. Self and Informant Memory Reports in FINGER: Associations with Two-Year Cognitive Change. J. Alzheimer’s Dis. 2019, 71, 785–795.
  37. De Almeida, M.L.; Dalpubel, D.; Ribeiro, E.B.; de Oliveira, E.S.B.; Ansai, J.H.; Vale, F.A.C. Subjective cognitive impairment, cognitive disorders and self-perceived health: The importance of the informant. Dement. Neuropsychol. 2019, 13, 335–342.
  38. Baquero, M.; Martin, N. Depressive symptoms in neurodegenerative diseases. World J. Clin. Cases 2015, 3, 682–693.
  39. Sánchez-Negrete, M.G.; Igol, P.; Mandich, V.C.; Lascar, M. Ansiedad, depresión y quejas cognitivas. In VIII Congreso Internacional de Investigación y Práctica Profesional en Psicología XXIII Jornadas de Investigación XII Encuentro de Investigadores en Psicología del MERCOSUR; Facultad de Psicología—Universidad de Buenos Aires: Buenos Aires, Argentina, 2016.
  40. Pedrero-Pérez, E.J.; Ruiz-Sánchez de León, J.M. Subjective complaints of memory, personality and prefrontal symptoms in young adults. Rev. Neurol. 2013, 57, 289–296.
  41. Lubitz, A.F.; Eid, M.; Niedeggen, M. Complainer Profile Identification (CPI): Properties of a new questionnaire on subjective cognitive complaints. Neuropsychol. Dev. Cogn. B Aging Neuropsychol. Cogn. 2018, 25, 99–121.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
This entry is offline, you can click here to edit this entry!
Video Production Service
Feedback