Memory Complaints in Healthy Middle-Aged Adults Are Not Associated with Memory or Sustained Attention Performance

Abstract

Objective:

To examine the associations between the number and type of memory complaints with memory and sustained attention performance in healthy middle-aged adults.

Method:

Sixty-six healthy individuals aged 35–64 years (M_age = 47.73 years) were administered the seven Questions, Rey Auditory Verbal Learning Test, Sustained Attention to Response Task, and Depression Anxiety Stress Scales 21.

Results:

The number of memory complaints was not associated with memory or sustained attention performance but was associated with anxiety symptoms. The type of memory complaint was likewise not associated with memory or sustained attention performance. The complaints “recent change in ability to remember things” and “trouble remembering things from one second to the next” were associated with anxiety symptoms.

Conclusion:

Complaints about memory in otherwise healthy middle-aged adults do not reliably indicate memory or sustained attention performance. Rather, these complaints are more likely to be associated with heightened, but nevertheless subclinical, anxiety.

Keywords

cognitive complaints memory sustained attention anxiety adult

Memory complaints are subjective reports of memory loss (Abdulrab & Heun, 2008). Examples of common types of complaints include not being able to remember where an object, such as glasses, keys, or phone, has been placed, not being able to remember whether an intended task, such as locking the door, has been completed, and not being able to remember what has just been read (Burmester et al., 2015). Memory complaints are common among otherwise healthy middle-aged adults (i.e., aged 35–65 years), with prevalence estimates in population-based studies ranging between 10% and 40% (Begum et al., 2014; Cooper et al., 2011; Ponds et al., 1997; Vestergren & Nilsson, 2011). Despite the high prevalence of memory complaints amongst otherwise healthy middle-aged adults, the significance of these complaints remains underexplored.

Memory Complaints and Memory

An important contribution toward understanding the significance of memory complaints is determining the extent to which these subjective complaints relate to objective performance on memory testing. Studies investigating the association between memory complaints and memory performance have largely been conducted in healthy older adults (i.e., aged >65 years). These studies have yielded inconsistent results, with some reporting significant effects (Jonker et al., 1996; Podewils et al., 2003; Zelinski et al., 2001) and others reporting null results (Derouesné et al., 1989; Hänninen et al., 1994; Minett et al., 2008). A meta-analysis on studies evaluating the association between subjective memory reports and objective memory performance in healthy older adults concluded that memory complaints are not consistently associated, or only minimally associated, with memory performance (Crumley et al., 2014). In healthy middle-aged adults, the few existing studies that have investigated the association between memory complaints and performance on memory testing have similarly yielded equivocal results (Bassett & Folstein, 1993; Derouesné et al., 1999; Mäntylä, 2003; Mendes et al., 2008). Moreover, many of these studies in both healthy middle-aged and older adults have observed that memory complaints were more strongly associated with symptoms of depression and anxiety than with memory performance (Bassett & Folstein, 1993; Derouesné et al., 1989, 1999; Mendes et al., 2008; Minett et al., 2008).

A possible explanation for the absence of a consistent correspondence between memory complaints and memory performance is that the conventional methodologies used to measure memory complaints do not acknowledge the qualitative aspects of a memory complaint. In current research practice, the predominant approach to measuring memory complaints is to utilize questionnaire data to derive a global score that quantifies the overall frequency, severity, or quantity of memory complaints reported by an individual (Abdulrab & Heun, 2008). It has been suggested, however, that certain types of memory complaints are more closely aligned with memory performance than others (Amariglio et al., 2011). For example, Amariglio et al. (2011) found that complaints elicited by items such as “trouble following a group conversation or plot in a TV program” and “trouble navigating familiar streets” in healthy older adults were associated with impaired performance on a delayed recall measure, whereas endorsement of the item “trouble remembering things from one second to the next” was not associated with impaired performance on the same memory measure. Bolla et al. (1991) found that the complaint “forgetting while reading a newspaper or magazine article” in healthy older adults was associated with performance on immediate and delayed recall measures. These results, although limited, suggest that some types of memory complaints, possibly those associated with memory use during an extended task, are more indicative of memory performance than others, highlighting the importance of qualitative information in the measurement of memory complaints. To date, no study has investigated the association between the specific nature of memory complaints and memory performance in healthy middle-aged adults.

Memory Complaints and Attention

Studies that have sought to understand the cognitive processes underlying memory complaints have typically investigated the memory domain. It is possible, however, that memory complaints in healthy middle-aged adults are contributed to by underlying cognitive processes in non-memory domains. Subjective experiences of “memory loss” have also been an area of interest in attention research, where such experiences are commonly described as problems of everyday attention (Cheyne et al., 2006; Robertson et al., 1997). For example, the Attention-Related Cognitive Errors Scale (Cheyne et al., 2006) is a questionnaire developed to assess problems of everyday attention and includes items such as “I have misplaced frequently used objects, such as keys, pens, glasses, etc.”, “When reading I find that I have read several paragraphs without being able to recall what I read”, and “I have to go back to check whether I have done something or not (e.g., turning out lights, locking doors)”. These examples of problems of everyday attention resemble some of the experiences of otherwise healthy individuals with memory concerns. Despite the similarity between memory complaints and problems of everyday attention, the role of attentional processes in the experience of memory failure has not been widely investigated in the memory complaint literature.

Whilst various attentional processes may underlie problems of everyday attention, the sustained attention system has been shown to be particularly important, based on studies employing the Sustained Attention to Response Task (SART; Robertson et al., 1997). The SART is a computer-based continuous performance task in which participants are required to respond to frequently presented non-target stimuli and withhold to an infrequently presented target stimulus. Several studies have shown that performance on the SART is associated, albeit modestly, with self-reported problems of everyday attention in healthy individuals (Manly et al., 1999; Robertson et al., 1997; Smilek et al., 2010). Given that problems of everyday attention and memory complaints give rise to similar experiences, these findings also suggest that an inefficient sustained attention system might underpin some forms of memory complaints in healthy middle-aged adults.

Aims and Hypotheses

The current study aimed to examine the associations between (a) memory complaints and memory performance and (b) memory complaints and sustained attention performance in healthy middle-aged adults. Two aspects of memory complaints were examined: the number of complaints and the type of complaint. First, it was hypothesized that the number of memory complaints would not be associated with memory performance. Second, it was hypothesized that the types of memory complaints would be differentially associated with memory performance. Third, it was hypothesized that the number of memory complaints would be associated with sustained attention performance. Fourth, it was hypothesized that the types of memory complaints would be differentially associated with sustained attention performance. As memory complaints have been well established as being strongly associated with age (Jonker et al., 2000) and psychiatric symptomatology (Burmester et al., 2016), the current study additionally explored the association between memory complaints and these variables.

Method

Participants

The study sample comprised 66 participants (68% female) aged 35 to 64 years (M_age = 47.73 years, SD_age = 9.30 years). Participants were generally highly educated, with 51% having completed 13–16 years of education and 47% having completed >16 years of education. Participants were recruited from the community through print and online advertisements, and chain sampling. Participants were screened for eligibility via e-mail or telephone. Participants met the following eligibility criteria: (a) age 35–65 years; (b) no neurological illness; and (c) no psychiatric illness.

Ethical approval for the study was obtained from the University of Melbourne Psychology, Health and Applied Sciences Human Ethics Sub-Committee (Ethics ID: 1851596).

Measures

7 Questions (7Q)

The 7Q (Amariglio et al., 2011) comprises seven yes/no questions on current cognitive abilities and functional status that has been used previously in large epidemiological studies to assess cognitive changes in older adults (Amariglio et al., 2011; Go et al., 1997). The seven questions are listed in Table 1 and are notated using a key name. Responses to these questions (0 = No, 1 = Yes) are considered individually to examine specific associations or summed to derive the overall number of memory complaints.

Table 1.

Frequencies of Memory Complaints.

Variable	%
Number of memory complaints
0	36
1	29
2	15
3	11
4	6
5	3
6	0
7	0
Type of memory complaint
Have you recently experienced any change in your ability to remember things? (Change in Memory)	41
Do you have trouble remembering things from one second to the next? (One Second to the Next)	29
Do you have more trouble than usual remembering a short list of items, such as a shopping list? (Short List)	23
Do you have much more trouble than usual remembering recent events? (Recent Events)	17
Do you have any difficulty in understanding or following spoken instructions? (Understanding Instructions)	17
Do you have more trouble than usual following a group conversation or plot in a TV program due to your memory? (Following a Conversation)	3
Do you have trouble finding your way around familiar streets? (Getting Lost)	2

Rey Auditory Verbal Learning Test (RAVLT)

The RAVLT (Rey, 1964) is a word-list learning test that assesses verbal learning and memory. The RAVLT consists of a list of 15 nouns (List A) that is read aloud to the examinee for five consecutive trials, with each trial followed by a test of free recall (A1–A5). After the fifth trial, an interference list of 15 nouns (List B) is read to the examinee, followed by a free-recall test (B1) of that list. Immediately following the interference trial, recall of List A is tested (A6) without repeated presentation of the word list. After a 20-minute delay interval, the examinee is again asked to recall the words from List A (A7). Following the delayed recall trial, a recognition test is administered, in which the examinee is read a list of 30 words, comprising the 15 target words from List A embedded among 15 semantically and phonetically related distractor words, and is asked to indicate, for each word, whether it had or had not been presented as part of List A. The score of each recall trial is the number of items correctly recalled. The score of the recognition trial is the number of items correctly identified (i.e., True Positives + True Negatives). As several studies in healthy middle-aged adults and healthy older adults have previously observed a significant association between memory complaints and delayed recall measures (Amariglio et al., 2011; Bolla et al., 1991; Derouesné et al., 1999), the current study included only the A7 score (number of words recalled following the 20-minute delay interval).

Sustained Attention to Response Task (SART): Fixed sequence version

The SART (Robertson et al., 1997) is a computer-based go/no-go task designed to measure lapses in sustained attention. In the SART procedure, 225 single digits (25 of each digit 1–9) are presented visually over a 5.5-minute period. Each digit is presented for 313 ms, followed by a mask (a cross in a circle) for 125 ms, then a response cue (a bold cross in a circle) for 63 ms, then a second mask for 375 ms, and a fixation cue (a cross) for 563 ms. The inter-stimulus interval (digit onset to digit onset) is 1439 ms. Participants are instructed to respond, using a single key press, as quickly as possible upon the presentation of the response cue following each digit with the exception of the target no-go digit. The inclusion of a response cue minimizes a speed–accuracy trade-off in participant responding (Manly et al., 2000).

The fixed sequence version of the SART was employed in the current study. In the fixed sequence version, the digits are presented in a fixed, repeating, ascending order (i.e., 1, 2, 3, 4, 5, 6, 7, 8, 9, 1, 2. . .). As the sequence of digits is fixed, the occurrence of the target no-go digit is entirely predictable. By contrast, the sequence of digits in the standard, random sequence version of the task is pseudo-randomized, and the presentation of the target no-go digit is, therefore, unpredictable. The fixed sequence version, due to the predictability of the target no-go digit, minimizes the response inhibition component of the task that is more apparent in the random sequence version (Fassbender et al., 2004; Manly et al., 2003). The current study included commission errors (failure to withhold to the target no-go digit) and omission errors (failure to respond to the non-target go digits). Commission errors in the fixed sequence SART primarily measure lapses in sustained attention and to a lesser degree errors in response inhibition, whilst omission errors in both the fixed and random sequence SART are thought to reflect momentary task disengagement and are thus considered to represent lapses in sustained attention (O’Connell et al., 2009).

Depression Anxiety Stress Scales 21 (DASS21)

The DASS21 (Lovibond & Lovibond, 1995) is a set of three self-report scales designed to measure symptoms of depression, anxiety, and stress. Each scale comprises seven items. Respondents are asked to rate the extent to which each item applied to them over the past week using a 4-point severity/frequency scale (0 = Did not apply to me at all, 3 = Applied to me very much, or most of the time). A total score for each scale is calculated by summing the scores for the relevant items, with a higher score indicating greater severity of symptoms. As depressive symptoms and anxiety symptoms have been well established as being strongly associated with memory complaints (Burmester et al., 2016), the current study included only the Depression scale total score and the Anxiety scale total score.

Procedure

Testing sessions were conducted in a quiet and distraction-reduced environment, such as an interview room. The Attention Network Test (Johnson et al., 2019) was also administered to each participant but was not included in the current study. The task administration order was standardized as such: RAVLT, ANT, SART, 7Q, and DASS21. Each testing session typically ranged between 1–1.5 hours.

Data Analysis

Several hierarchical linear regression analyses and hierarchical binomial logistic regression analyses were conducted to examine the associations between the memory complaint variables with the memory and sustained attention variables. In these analyses, age and the psychiatric variables were entered as the control variables in the first block; the memory or sustained attention variable/s as the independent variable/s in the second block; and the memory complaint variable as the dependent variable. To accommodate deviations from parametric distributional assumptions, standard errors and confidence intervals were estimated using bootstrap sampling analyses based on 1,000 bootstrap samples (Efron, 1979). To evaluate collinearity among the independent and control variables, the pairwise correlations among the variables were evaluated (see Supplemental Table S1); no multicollinearity was evident (i.e., all rs < .90; Tabachnick & Fidell, 2013). As the standard maximum-likelihood logistic regression model may produce extremely large parameter estimates and standard errors when the number of observations is small (e.g., N < 1,000) and the class distribution is imbalanced (e.g., 95:5), the types of memory complaints that were reported by less than 5% of the sample were excluded from the logistic regression analyses (King & Zeng, 2001).

The criterion for statistical significance was set at p < .05 in all statistical evaluations. Measures of effect size were used to guide interpretation about the meaningfulness of results. Specifically, semi-partial correlation coefficients (r_sp) were computed for each independent variable in the hierarchical linear regression analyses and odds ratios (OR) were computed for each independent variable in the hierarchical logistic regression analyses, and those variables that provided a trivial effect size (i.e., r_sp < .1 or 1.5⁻¹ < OR < 1.5; Cohen, 1988; Rosenthal, 1996) were taken to be non-meaningful, irrespective of statistical significance.

Results

Frequencies of Memory Complaints

Overall, 36% of participants reported no memory complaints, 44% reported one or two, and 9% reported four or more (see Table 1). Of the seven types of memory complaints included in the 7Q, Change in Memory was the most common complaint, reported by 41%. One Second to the Next was reported by 29% and Short List was reported by 23%. Getting Lost was the least common complaint, reported by only 2%.

Associations Between Memory Complaints and Age, Neuropsychological Performance, and Psychiatric Symptomatology

As a considerable portion of participants (36%) did not report any memory complaints, group comparisons were conducted between participants who did and did not report memory complaints on age, neuropsychological performance, and psychiatric symptomatology (see Table 2). No significant differences in age, memory performance, sustained attention performance, and depressive symptoms were observed between the groups. Participants who reported memory complaints also reported slightly more anxiety symptoms compared to participants who did not report memory complaints (U = 665.00, p = .026).

Table 2.

Age, Neuropsychological Variables, and Psychiatric Variables in the Overall Sample and by Memory Complaint Status.

Variable	Total (N = 66)		Memory complaints (n = 42)		No memory complaints (n = 24)
Variable	M	SD	M	SD	M	SD	U	p
Age	47.73	9.30	47.24	9.63	48.58	8.84	458.50	.544
RAVLT
Delayed Recall	12.33	2.45	12.29	2.43	12.42	2.52	483.50	.782
SART
Commission	1.15	1.27	1.12	1.21	1.21	1.38	498.00	.933
Omission	0.64	1.20	0.79	1.32	0.37	0.92	596.50	.135
DASS21
Depression	2.11	2.71	2.24	2.69	1.88	2.77	570.00	.365
Anxiety	1.56	2.00	1.95	2.24	0.88	1.15	665.00	.026

Note. DASS21 = Depression Anxiety Stress Scales 21; RAVLT = Rey Auditory Verbal Learning Test; SART = Sustained Attention to Response Task

Associations Between Memory Complaints and Memory Performance

Number of memory complaints

The results of the hierarchical linear regression analysis with memory performance against number of memory complaints are presented in Table 3. Age and the psychiatric variables were entered into the model first as the control variables, which explained 15.7% of the variance in number of memory complaints. The memory variable was entered into the model next as the independent variable but failed to make a significant contribution to the explained variance. The overall model accounted for 17.5% of the variance in number of memory complaints. In the final model, only anxiety symptoms made a significant contribution to number of memory complaints (B = 0.26, p = .003, r_sp = .35).

Table 3.

Hierarchical Linear Regression Model with Memory Performance Against Number of Memory Complaints.

Block, variable	B (SE)	β	r _sp	ΔR²	p
Block 1				0.16	.014
Age	0.0004 (0.02)	.002	.002		.975
DASS21 Depression	0.05 (0.08)	.09	.08		.571
DASS21 Anxiety	0.25 (0.09)	.36	.35		.002
Block 2				0.02	.262
Age	−0.001 (0.017)	−.01	−.01		.932
DASS21 Depression	0.06 (0.08)	.11	.11		.464
DASS21 Anxiety	0.26 (0.09)	.37	.35		.003
RAVLT Delayed Recall	−0.08 (0.06)	−.14	−.13		.227

Note. Bold type indicates statistical significance. DASS21 = Depression Anxiety Stress Scales 21; RAVLT = Rey Auditory Verbal Learning Test.

Type of memory complaint

The results of the hierarchical logistic regression analyses with memory performance against type of memory complaint are presented in Table 4. In these analyses, age and the psychiatric variables were entered into the model first as the control variables and the memory variable was entered into the model next as the independent variable. As the items Following a Conversation and Getting Lost were endorsed by less than 5% of the sample, they were excluded from the logistic regression analyses. In Model 1 (Change in Memory), only anxiety symptoms made a significant contribution to the final model (B = 0.48, p = .022, OR = 1.62). In Model 2 (One Second to the Next), only anxiety symptoms again made a significant contribution to the final model (B = 0.48, p = .024, OR = 1.62). In Model 3 (Short List), both depressive symptoms and memory performance made a significant contribution to the final model (B = 0.21, p = .044, OR = 1.24 and B = −0.30, p = .022, OR = 0.74, respectively). Each of these variables accounted for a trivial effect (i.e., 1.5⁻¹ < OR < 1.5; Cohen, 1988) and were, therefore, taken to be non-meaningful. In Model 4 (Recent Events) and Model 5 (Understanding Instructions), none of the variables made a significant contribution to the final model.

Table 4.

Hierarchical Logistic Regression Models with Memory Performance Against Type of Memory Complaint.

Model, block, variable	B (SE)	OR	Δχ²	p
Model 1: Change in Memory
Block 1			8.18	.042
Age	0.02 (0.03)	1.02		.522
DASS21 Depression	−0.03 (0.16)	0.97		.807
DASS21 Anxiety	0.45 (0.25)	1.56		.020
Block 2			0.64	.425
Age	0.02 (0.04)	1.02		.573
DASS21 Depression	−0.02 (0.17)	0.98		.888
DASS21 Anxiety	0.48 (0.28)	1.62		.022
RAVLT Delayed Recall	−0.09 (0.14)	0.91		.436
Model 2: One Second to the Next
Block 1			10.92	.012
Age	−0.01 (0.04)	0.99		.710
DASS21 Depression	0.07 (0.17)	1.07		.529
DASS21 Anxiety	0.46 (0.30)	1.58		.021
Block 2			0.39	.530
Age	−0.02 (0.04)	0.99		.642
DASS21 Depression	0.08 (0.18)	1.09		.471
DASS21 Anxiety	0.48 (0.34)	1.62		.024
RAVLT Delayed Recall	−0.08 (0.16)	0.92		.518
Model 3: Short List
Block 1			4.13	.248
Age	0.007 (0.05)	1.01		.843
DASS21 Depression	0.14 (0.15)	1.15		.174
DASS21 Anxiety	0.16 (0.24)	1.17		.271
Block 2			5.39	.020
Age	−0.004 (0.05)	1.00		.916
DASS21 Depression	0.21 (0.17)	1.24		.044
DASS21 Anxiety	0.18 (0.25)	1.20		.219
RAVLT Delayed Recall	−0.30 (0.18)	0.74		.022
Model 4: Recent Events
Block 1			2.69	.442
Age	−0.01 (0.08)	1.00		.920
DASS21 Depression	0.13 (0.18)	1.13		.279
DASS21 Anxiety	0.14 (0.24)	1.15		.317
Block 2			0.21	.643
Age	−0.01 (0.09)	0.99		.893
DASS21 Depression	0.14 (0.19)	1.15		.236
DASS21 Anxiety	0.14 (0.27)	1.15		.361
RAVLT Delayed Recall	−0.07 (0.14)	0.94		.528
Model 5: Understanding Instructions
Block 1			1.73	.630
Age	−0.02 (0.07)	0.98		.696
DASS21 Depression	−0.03 (0.40)	0.97		.813
DASS21 Anxiety	0.18 (0.73)	1.20		.256
Block 2			0.77	.382
Age	−0.02 (1.70)	0.99		.742
DASS21 Depression	−0.06 (8.29)	0.95		.718
DASS21 Anxiety	0.20 (3.56)	1.21		.320
RAVLT Delayed Recall	0.14 (2.01)	1.15		.547

Note. Bold type indicates statistical significance. DASS21 = Depression Anxiety Stress Scales 21; RAVLT = Rey Auditory Verbal Learning Test.

Associations Between Memory Complaints and Sustained Attention Performance

Number of memory complaints

The results of the hierarchical linear regression analysis with sustained attention performance against number of memory complaints are presented in Table 5. Age and the psychiatric variables were entered into the model first as the control variables, which explained 15.7% of the variance in number of memory complaints. The sustained attention variables were entered into the model next as the independent variables but failed to make a significant contribution to the explained variance. The overall model accounted for 18.1% of the variance in number of memory complaints. In the final model, only anxiety symptoms made a significant contribution to number of memory complaints (B = 0.26, p = .008, r_sp = .37).

Table 5.

Hierarchical Linear Regression Model with Sustained Attention Performance Against Number of Memory Complaints.

Block, variable	B (SE)	β	r _sp	ΔR²	p
Block 1				0.16	.014
Age	0.0004 (0.02)	.002	.002		.984
DASS21 Depression	0.05 (0.08)	.09	.08		.584
DASS21 Anxiety	0.25 (0.09)	.36	.35		.008
Block 2				0.02	.420
Age	0.007 (0.02)	.05	.05		.720
DASS21 Depression	0.05 (0.08)	.09	.09		.569
DASS21 Anxiety	0.26 (0.10)	.37	.35		.008
SART Commission	0.08 (0.14)	.08	.07		.551
SART Omission	0.14 (0.16)	.12	.12		.295

Note. Bold type indicates statistical significance. DASS21 = Depression Anxiety Stress Scales 21; SART = Sustained Attention to Response Task.

Type of memory complaint

The results of the hierarchical logistic regression analyses with sustained attention performance against type of memory complaint are presented in Table 6. In these analyses, age and the psychiatric variables were entered into the model first as the control variables and the sustained attention variables were entered into the model next as the independent variables. As the items Following a Conversation and Getting Lost were endorsed by less than 5% of the sample, they were excluded from the logistic regression analyses. In Model 1 (Change in Memory), only anxiety symptoms made a significant contribution to the final model (B = 0.45, p = .007, OR = 1.57). In Model 2 (One Second to the Next), only anxiety symptoms again made a significant contribution to the final model (B = 0.48, p = .023, OR = 1.62). In Model 3 (Short List), Model 4 (Recent Events), and Model 5 (Understanding Instructions), none of the variables made a significant contribution to the final model.

Table 6.

Hierarchical Logistic Regression Models with Sustained Attention Against Type of Memory Complaint.

Model, block, variable	B (SE)	OR	Δχ²	p
Model 1: Change in Memory
Block 1			8.18	.042
Age	0.02 (0.03)	1.02		.512
DASS21 Depression	−0.03 (0.14)	0.97		.805
DASS21 Anxiety	0.45 (0.24)	1.56		.014
Block 2			2.42	.298
Age	0.03 (0.04)	1.03		.322
DASS21 Depression	−0.02 (0.15)	0.98		.851
DASS21 Anxiety	0.45 (0.25)	1.57		.007
SART Commission	0.15 (0.27)	1.16		.477
SART Omission	0.28 (0.38)	1.32		.277
Model 2: One Second to the Next
Block 1			10.92	.012
Age	−0.01 (0.04)	0.99		.695
DASS21 Depression	0.07 (0.17)	1.07		.509
DASS21 Anxiety	0.46 (0.29)	1.58		.013
Block 2			0.85	.653
Age	−0.004 (0.05)	1.00		.913
DASS21 Depression	0.07 (0.20)	1.07		.565
DASS21 Anxiety	0.48 (0.35)	1.62		.023
SART Commission	0.19 (0.36)	1.21		.471
SART Omission	0.08 (0.36)	1.09		.730
Model 3: Short List
Block 1			4.13	.248
Age	0.01 (0.05)	1.01		.861
DASS21 Depression	0.14 (0.15)	1.15		.185
DASS21 Anxiety	0.16 (0.25)	1.17		.267
Block 2			0.21	.902
Age	0.003 (0.06)	1.00		.958
DASS21 Depression	0.14 (0.16)	1.15		.207
DASS21 Anxiety	0.15 (0.29)	1.17		.322
SART Commission	−0.09 (0.54)	0.92		.788
SART Omission	−0.07 (1.19)	0.93		.775
Model 4: Recent Events
Block 1			2.69	.442
Age	−0.01 (3.46)	1.00		.887
DASS21 Depression	0.13 (10.35)	1.13		.261
DASS21 Anxiety	0.14 (11.05)	1.15		.354
Block 2			0.25	.884
Age	0.0002 (0.42)	1.00		.997
DASS21 Depression	0.12 (1.03)	1.13		.306
DASS21 Anxiety	0.15 (1.18)	1.16		.311
SART Commission	0.11 (4.73)	1.12		.730
SART Omission	0.06 (0.98)	1.06		.768
Model 5: Understanding Instructions
Block 1			1.73	.630
Age	−0.02 (0.17)	0.98		.722
DASS21 Depression	−0.03 (0.84)	0.97		.856
DASS21 Anxiety	0.18 (0.89)	1.20		.265
Block 2			0.07	.964
Age	−0.02 (0.85)	0.98		.721
DASS21 Depression	−0.03 (4.30)	0.97		.858
DASS21 Anxiety	0.18 (2.64)	1.20		.303
SART Commission	−0.06 (2.44)	0.94		.787
SART Omission	0.06 (2.98)	1.06		.809

Note. Bold type indicates statistical significance. DASS21 = Depression Anxiety Stress Scales 21; SART = Sustained Attention to Response Task.

Discussion

In line with the first hypothesis, the number of memory complaints was not associated with memory performance. This finding is consistent with other studies in healthy middle-aged adults showing that the overall frequency, the severity, and the quantity of memory complaints are not associated with memory performance (Bassett & Folstein, 1993; Mendes et al., 2008). Although some other studies in healthy middle-aged adults have observed a significant association between the frequency, severity, or quantity of memory complaints and memory performance, these studies either recruited only participants with memory complaints (Derouesné et al., 1999) or identified a relationship between memory complaints and prospective memory performance (Mäntylä, 2003), which arguably involves cognitive processes other than memory (McDaniel & Einstein, 2000). Previous work in healthy older adults has also largely observed that the overall frequency, severity, or quantity of memory complaints are not reliably associated, or only marginally associated, with memory performance (Crumley et al., 2014). Taken together, these findings suggest that memory complaints when aggregated into a global outcome do not reliably indicate memory performance.

In contrast to the second hypothesis, the types of memory complaints were not associated with memory performance. More specifically, the complaints Change in Memory, One Second to the Next, Short List, Recent Events, and Understanding Instructions were not associated with memory performance. These findings are inconsistent with previous studies in healthy older adults showing that some types of memory complaints are more strongly associated with memory performance than are other types of complaints (Amariglio et al., 2011; Bolla et al., 1991). The divergence in findings between the current study and these previous studies could well be explained by methodological variations. For example, the previous studies included only depressive symptoms as a control variable (Amariglio et al., 2011; Bolla et al., 1991). In the current study, anxiety symptoms were found to explain a significant amount of the variance in some of the types of memory complaints. Hence, it is possible that anxiety symptoms may also explain a significant amount of the variance in at least some of the types of memory complaints in these other studies. In addition, the samples in these previous studies comprised healthy older adults (Amariglio et al., 2011; Bolla et al., 1991). It is possible that the associations between types of memory complaints and memory performance are somewhat different across healthy middle-aged adults and healthy older adults. Considering these possible explanations, additional investigation into the associations between types of memory complaints and memory performance, particularly across age groups, is warranted in order to more clearly understand the utility of various types of complaints as an indicator of memory performance.

In contrast to the third and fourth hypotheses, the number of memory complaints and the types of memory complaints were not associated with sustained attention performance. The association between memory complaints and sustained attention performance in healthy middle-aged adults has not been previously investigated. In the attention literature, several studies have observed that sustained attention performance is associated with problems of everyday attention in healthy individuals (Manly et al., 1999; Robertson et al., 1997; Smilek et al., 2010). Many of these problems of everyday attention resemble some of the experiences of otherwise healthy middle-aged adults with memory concerns, suggesting that sustained attention performance might also be associated with at least some types of memory complaints. The results of the current study, however, showed that both the number of memory complaints and the types of memory complaints, as measured by the 7Q, were not associated with sustained attention performance.

It is possible that the current study did not observe a significant association between memory complaints and sustained attention performance because the task used to assess sustained attention, the SART, did not have sufficient sensitivity to subtle deficits in sustained attention in the study sample—that is, the fixed sequence SART might not have been sufficiently challenging. Accordingly, improving the sensitivity of the SART to subtle deficits in sustained attention in healthy individuals, such as by increasing the task duration or by using the random sequence version, may assist in clarifying the association between memory complaints and sustained attention. Alternatively, it is also possible that no significant association was observed between memory complaints and sustained attention performance simply because memory complaints in healthy middle-aged adults are not associated with sustained attention performance. Further research might explore the association between memory complaints and other attentional processes, such as selective attention (Tipper & Baylis, 1987).

The current study included depressive and anxiety symptoms as control variables as these symptoms have been well established as being strongly associated with memory complaints (Burmester et al., 2016). In the current study sample, the mean depression and anxiety levels were low and did not reach clinical significance. The results showed that depressive symptoms were not associated with the number of memory complaints or with the types of memory complaints. On the other hand, the results showed that anxiety symptoms were significantly associated with the number of memory complaints and with some types of memory complaints, namely Change in Memory and One Second to the Next.

The finding that memory complaints were associated with anxiety symptoms but not with depressive symptoms is somewhat surprising. It is possible that such a finding is the result of the study sampling design, whereby those individuals who enrolled into the study were more likely to be those who had concerns about their memory arising from a general disposition to worry rather than those who acknowledge memory difficulties as a result of a general tendency to negatively evaluate own abilities. In that respect, memory complaints may reflect worries about one’s own memory (Mol et al., 2008). Such worries may arise when, for example, individuals who are prone to anxiety interpret everyday memory lapses as indicating underlying memory dysfunction. Memory complaints, then, may simply be an expression of underlying anxiety. In the clinical setting, the interpretation of memory complaints in otherwise healthy middle-aged adults might raise the question of an affective etiology.

Limitations

In interpreting the results of the current study, several caveats should be considered. First, the study sample was not an epidemiological sample but a convenience sample and, hence, may not be entirely representative of the healthy middle-aged population. In particular, participants in the current study were highly educated and predominantly Caucasian. Accordingly, it would be important to replicate the current study in a population-based sample to ensure the generalizability of the findings. Second, although participants were asked seven questions about their memory, these questions may not have been sufficiently comprehensive to assess the range of memory complaints that healthy middle-aged adults may report (Burmester et al., 2015). This could have, consequently, resulted in a mis-estimation of the associations between memory complaints with memory performance and sustained attention performance.

Conclusion

These caveats notwithstanding, the results of the current study showed that neither the number of memory complaints nor the type of memory complaint was associated with memory performance or with sustained attention performance. The number of memory complaints and some types of memory complaints were, however, associated with anxiety symptoms. These findings suggest that complaints of memory dysfunction by otherwise healthy middle-aged adults, whether considered in aggregation or by type, are not a reliable indicator of memory performance or of sustained attention performance. Rather, these complaints are more likely to be associated with heightened, but nevertheless subclinical, anxiety.

Supplemental Material

sj-pdf-1-jad-10.1177_10870547211003670 – Supplemental material for Memory Complaints in Healthy Middle-Aged Adults Are Not Associated with Memory or Sustained Attention Performance

Supplemental material, sj-pdf-1-jad-10.1177_10870547211003670 for Memory Complaints in Healthy Middle-Aged Adults Are Not Associated with Memory or Sustained Attention Performance by Yi-En Quek, Kok Hon Leuar, Michael M. Saling and Katherine A. Johnson in Journal of Attention Disorders

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Yi-En Quek

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Yi-En Quek is a PhD candidate with a background in neuropsychology at the University of Melbourne. His research interests include the early detection of neurodegenerative conditions, particularly Alzheimer's disease.

Kok Hon Leuar is is a clinical neuropsychologist at Tan Tock Seng Hospital. His clinical interests include the assessment and management of neurocognitive issues following traumatic brain injuries.

Michael M. Saling is an honorary professorial fellow at the University of Melbourne and the Florey Institute of Neuroscience and Mental Health and a consultant neuropsychologist at Austin Health. His research interests center on neuropsychological and neuroimaging investigations of the breakdown of human memory systems in temporal lobe epilepsy and early detection of Alzheimer's disease dementia.

Katherine A. Johnson is an associate professor at the University of Melbourne. Her research interests relate primarily to attention control in infants, children, and adults. She has a special interest in ADHD and ASD and in how attention in the classroom affects learning. She is also interested in the effects of exposure to nature and greenery on attention.

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