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THESIS

(RRb)

 

 

 

 

 

 

 

lull“ill:lllllmlllllum

LIBRARY
Michigan State
University

 

 

 

 

 

This is to certify that the

dissertation entitled

MEMORY COMPLAINTS, MEMORY RECALL,

AND DEPRESSION
presented by

Timothy Leo Gannon

has been accepted towards fulﬁllment
of the requirements for

 

 

Ph . D . degree in Philosophy

Department of Psychology

Mme

Major professor

Date 12/1/94

 

MS U i: an Afﬁrmative Action/Equal Opportunity Institution 0-12771

PLACE IN RETURN BOX to remove thie checkout from your record.
TO AVOID FINES return on or before date due.

DATE DUE DATE DUE DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSU Is An Afﬁrmative Mon/Equal Oppommky InetItutIon
Wane-9.1

 

MEMORY COMPLAINTS, MEMORY RECALL,
AND DEPRESSION

By

Timothy Leo Gannon

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1 994

ABSTRACT

MEMORY COMPLAINTS, MEMORY RECALL,
AND DEPRESSION

By

Timothy Leo Gannon

This study investigated the relationship between depressive symptoms, memory
complaints, and memory recall. Participants (N = 208) for this study were community
dwelling elderly (Mean age = 70) who were oﬁ‘ered a ﬁ'ee assessment of their mood and
memory. Level of depressive symptoms was assessed with the Hamilton Depression
Rating Scale, the Beck Depression Inventory, and the Geriatric Depression Scale. Due to
the differences in score ranges among the depression measures, the participant's test scores
were converted to g-scores and summed to produce a composite depression index. In
addition, three advanced-level clinicians identiﬁed test items on the three depression
inventories that assessed the nine DSM-IV symptoms of depression. These groupings
(i.e., factors) of test items were then assessed for validity and reliability with a
conﬁrmatory factor analysis. Only test items exhibiting factor loadings above .40 were
retained. The score for memory complaints was based on the occurrence of perceived
memory diﬁculties across eight general situations. Verbal recall was assessed with the
Selective Reminding Test while cognitive status was assessed with the Mini Mental State

Examination. Results indicated that a factor composed of test items that assessed

concentration diﬁiculties/indecisiveness had a correlation of .70 (p<.0002) with memory
complaints. Also, the number of words encoded into and retrieved from long-term
memory were signiﬁcantly related (r = -.20, p<.0019) to the composite depression index.
Furthermore, a signiﬁcant relationship was observed between memory complaints and
random recall from long-term memory (r = .16, p<.05) in a subset of our sample who were
identiﬁed as nondepressed. In addition, a correlation of .37 (p<.0002) was exhibited
between memory complaints and syndromal depression in replication of earlier studies.

Implications, as well as, limitations of these ﬁndings were discussed.

ACKNOWLEDGMENTS

I would like to take a moment to express my appreciation to the members of my
dissertation committee. Dr. Hurley, Dr. Caldwell, and Dr. Thornton provided invaluable
assistance in creating this ﬁnal draft. In addition, Dr. Hurley’s knowledge of statistical
theory contributed greatly to my understanding and interpretation of the statistical
analyses that were conducted within this paper. Most of all, I would like to thank Dr.
Norman Abeles, my mentor and committee chairperson. Throughout my graduate
education, no other professor has so consistently demonstrated the qualities that are
essential for those who teach at the graduate level. Dr. Abeles always provided me with
ﬁmding due to his awareness of my ﬁnancial burdens associated with supporting a family.
He was readily accessible for consultations regarding clients, research, and coursework
issues. It is due to his eﬁ‘orts that I have obtained valuable research, coursework,
assessment, and psychotherapy experience in the area of clinical neuropsychology. In
addition, Dr. Abeles has continually exhibited the highest standards of ethical,
compassionate, and professional conduct during the course of my training at Michigan
State University and has endeavored to instill these qualities in each of his graduate

students. Thank you gentlemen.

iv

TABLE OF CONTENTS

LIST OF TABLES .................................................................................................... vii

INTRODUCTION ..................................................................................................... l
Dementia and Explicit Memory Recall ................................................................... 3
Depression and Explicit Memory Recall ................................................................ 10
Memory Complaints ............................................................................................. 14
Memory Complaint Questionnaires ...................................................................... 15
Memory Complaints and Depression .................................................................... 16
Memory Complaints and Dementia ....................................................................... 18
Memory Complaints and Actual Memory Recall ................................................... 20
Summary ............................................................................................................. 24
Hypotheses .......................................................................................................... 28

METHOD ................................................................................................................. 30
Participants .......................................................................................................... 30
Test Instruments for Severity of Depression ......................................................... 30
Hamilton Rating Scale for Depression .................................................................. 31
Beck Depression Inventory .................................................................................. 33
Geriatric Depression Scale ................................................................................... 34
Test Instrument for Explicit Memory ................................................................... 35

Table of Contents (Cont’d)

Test Instrument for Memory Complaints .............................................................. 36

Test Instrument for Mental Status ........................................................................ 36

Procedure ............................................................................................................ 37
RESULTS ................................................................................................................. 37
DISCUSSION ........................................................................................................... 43
Suggestions for Future Research ................................................................................ 50
APPENDD( A Characteristics of the Meta-Analyses .................................................. 53
APPENDD( B List of Tables ..................................................................................... 54
APPENDD( C Rule of Combinations ........................................................................ 79
APPENDD( D SRT Word List ................................................................................. 83
LIST OF REFERENCES ............................................................................................ 84

LIST OF TABLES

Table 1 Depression Factors: Consistency/Correlations with Memory Complaints ..... 40
Table 2 Recall in Depressed versus Nondepressed Elderly ........................................ 42
Table 3 Long-Term Memory and Dementia .............................................................. 54
Table 4 Consistent Long-Term Memory and Dementia ............................................ 58
Table 5 Long-Term Memory and Dementia/Depression ........................................... 59
Table 6 Long-Tenn Memory and Depression ........................................................... 60
Table 7 Long-Term Memory and Depression/Pseudodementia ................................. 64
Table 8 Memory Complaints and Depression ........................................................... 65
Table 9 Memory Complaints and Dementia .............................................................. 68
Table 10 Memory Complaints and Depression/Pseudodementia ............................... 70
Table 11 Complaints versus Performance: Demented Samples .................................. 71
Table 12 Complaints versus Performance: Depressed Samples ................................. 72
Table 13 Complaints versus Performance: Healthy Elderly Samples ......................... 73

Table 14 Complaints versus Performance: Depressed and Healthy Elderly Samples .. 75

Table 15 Complaints versus Performance: Demented, Depressed, and Healthy Elderly

Samples ..................................................................................................... 76
Table 16 Diﬁ‘erentiation of Short- and Long—Term Memory ...................................... 77
Table 17 Hypotheses 95% Conﬁdence Intervals ....................................................... 78

INTRODUCTION

Our memories are the result of a linear series of events. Initially, information ﬁom
the external environment stimulates our sensory organs which encodes this information
and transfers it to the cerebral cortex. Here the information is ﬁrrther encoded into short-
term memory which is a type of time-limited processing store. Next, this information can
be ﬂirther encoded based on certain characteristics (e. g., importance, personal relevance)
and consolidated into a permanent memory store (i.e., long-term memory). This
information can then be retrieved spontaneously or under the aid of cues where it is
experienced consciously once again (Petersen & Weingarter, 1991). This series of events,
however, is often interrupted with advancing age and can lead to the development of
various memory deﬁcits. These deﬁcits can be diﬁ‘erentiated into input and output
problems. Input problems deal with diﬂ'rculties in the processing and storing of
information while output problems deal with diﬁ'rculties associated with the retrieval of
information from long-term memory.

Investigations into the nuances of memory deﬁcits that are associated with various
pathological conditions such as dementia, head injuries, and amnesia have led to the
discovery of different types of long-term memory. Of these types, explicit memory,
working memory, episodic memory, semantic memory, and prospective memory have

been associated with age-related declines (Craik, 1991). Explicit memory refers to the

2
conscious recollection of recent events. An example would be when an individual recalls a

list of words from a laboratory exercise that was just completed. Working memory
describes tasks in which subjects must hold information in mind and also carry out some
calculation or decision making process based on that information. Episodic memory refers
to the "where" and "when" of events and episodes in a person's life. For example, episodic
memory would be used by someone to recall what they had for breakfast this moming.
Semantic memory deals with general knowledge about the world. It would likely be used
to recall who ﬂew the ﬁrst airplane. Prospective memory refers to situations in which the
person must remember to carry out some task in the future.

Long-term memory has also been differentiated by the type of sensory process that
led to the initial encoding. Based on this categorization, a different type of memory can
result ﬁ'om each of our sensory modalities (i.e., visual memory, tactile memory, olfactory
memory, auditory memory, and memory for diﬁ‘erent tastes). Memory has also been
classiﬁed into verbal and visual components. In this case, the two should be viewed as the
poles of a continuum since many spatial diagrams can be encoded both verbally and
spatially by an observer. However, regardless of the type of long-term memory or the
sensory apparatus that led to its encoding, memory impairment can have a devastating
impact on the individual, family, and society (e. g., health care system) due to the essential
role that it plays in learning and functioning in day-to-day life. Presently, memory
problems are considered to be one of the primary reasons for family referrals of the
elderly. Furthermore, they appear to primarily result ﬁ'orn an underlying dementia and/or

depression (Heath, Grant, Kamps, & Margolin, 1991). In order to ascertain the size of the

3
relationship between memory recall difﬁculties, memory complaints, dementia, and

depression, while avoiding the inherent biases in summarizing the results in a narrative
format (Smith, Glass, & Miller, 1980), a series of meta-analyses were conducted (Hunter
& Schmidt, 1990). These analyses were limited to studies involving the elderly (i.e., >55
years of age) to allow direct comparisons with the sample found in the present study and
due to the possibility that the relationship between memory impairment and depressive
symptomatology is moderated by age (Lichtenberg, Manning, & Turkheimer, 1992).
These analyses were also limited to those studies assessing explicit memory recall using
tasks such as word lists and prose recall since they are analogous to many everyday
situations (e.g., shopping list, to-do list, newspaper and magazine articles) that the elderly
encounter.
D ' E 1i it M m R all

Presently, upwards of four million people are thought to suffer from Alzheimer‘s
disease in our country with projections suggesting that this ﬁgure will double or triple
within the next century if a cure is not discovered (National Institute on Aging, 1990). As
staggering as these numbers are, they only represent about one-half of all dementias that
exist within our borders (Lezak, 1983). One of the most commonly used set of criteria for
the diagnosis of dementia is the Diagnostic and Statistical Manual of Mental Disorders-IV
(DSM-IV,‘ American Psychiatric Association, 1994). The DSM-IV considers impaired
learning and memory to be essential features of this condition. Furthermore, at least one
of the following disturbances must also be present: (a) impaired executive functioning

(i.e., disturbances in planning, organization, sequencing, or abstract thinking), (b) agnosia

4
(i.e., inability to recognize or identify items despite normal sensory function), (e) apraxia

(i.e., impaired ability to carry out motor activities despite normal motor ﬁinction), or (d)
aphasia (i.e., a language disturbance). In addition, the associated memory impairments
and cortical disturbances must signiﬁcantly interfere with the individual's work or social
activities and there should be evidence of a speciﬁc organic factor that is related to these
impairments and disturbances. However, in the absence of such evidence, an organic
factor may still be hypothesized if the problems cannot be explained by nonorganic
disorders. If these criteria are met, the dementia is ﬁrrther classiﬁed by the presence of (a)
delirium, (b) delusions, (c) depressed mood, or (d) uncomplicated (i.e., if a - c are not
present). In previous DSM versions that were used across some of the following studies
for diagnoses, dementia was also rated as mild (e.g., presence of work and social
impairment but the individual can still live independently), moderate (e.g., some
supervision in living is necessary), or severe (e. g., continual supervision is required;
individual is mostly incoherent or mute). For the diagnosis of Alzheimer's disease (i.e.,
primary degenerative dementia of the Alzheimer type), the criteria for dementia must be
met in addition to (a) an insidious onset characterized by a general deteriorating course
and (b) the exclusion of all other causes of dementia by history, physical exam, and
laboratory analysis.

A literature search identiﬁed 17 studies that assessed demented individuals on an
explicit memory task (Breen, Larson, Reiﬂer, Vitaliano, & Lawrence, 1984; Feehan,
Knight, & Partridge, 1991; Flicker, Ferris, & Reisberg, 1993; Gibson, 1981; Hart,

Kwentus, Taylor, & Hamer, 1987; Hart, Kwentus, Taylor, & Harkins, 1987; King, Caine,

5
Conwell, & Cox, 1991; Larrabee, Largen, & Levin, 1985; Lines et al., 1991; Masur, Fuld,

Blau, Crystal, & Aronson, 1990; Niederehe & Yoder, 1989; Poitrenaud, Moy, Girousse,
Wolrnark, & Piette, 1989; Robinson-Wheelen & Storandt, 1992; Rubin, Kinscherf, Grant,
& Storandt, 1991; Speedie, Rabins, Pearlson, & Moberg, 1990; Storandt, Botwinick, &
Danziger, 1987; Weingartner, Grafrnan, Boutelle, Kaye, & Martin, 1983;). The criteria
used for ascertaining the existence of dementia among these studies varied widely. Two
of the studies did not mention the diagnostic criteria that their samples were based on,
while the remaining studies based their diagnoses on one or more of the following
measures: the Diagnostic and Statistical Manual of Mental Disorders-Third Edition
(DSM-III; American Psychiatric Association, 1980), its revision (DSM-III-R; American
Psychiatric Association, 1987), the Research and Diagnostic Criteria (LDC; Spitzer,
Endicott, & Robins, 1978), combined ratings from a neurologist, psychiatrist, and
neuropsychologist, the Diagnostic Interview Schedule (Robins, Helzer, Croughin, &
Ratcliﬁ‘e, 1981), a structured interview, the Dementia Scale (Blessed, Tomlinson, & Roth,
1968), the Short Portable Mental Status Questionnaire (Pfeiﬁ‘er, 1975), the Face-Hand
Test (Fink, Green, & Bender, 1952), the Mini-Mental State Examination (MMSE;
Folstein, Folstein, & McHugh, 1975), the National Institute of Neurological and
Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders
Association (NINCDS-ADRDA; McKhann et al., 1984), the Clinical Dementia Rating
Scale (Hughes, Berg, Danzinger, Cohen, & Martin, 1982), or Reisberg's Global
Deterioration Scale (Reisberg, Ferris, de Leon, & Creole 1982). The severity of the

dementia among these studies also varied ﬁom "very mild” cases to ”advanced.” Twelve

6
of the 17 studies only assessed patients with Alzheimer's disease, while the remainder

included patients suffering from other forms of dementia. Age and education, and, in
some cases, gender and socioeconomic status were controlled for. In each of the studies,
the mean diﬁ‘erence in total recall scores was determined by comparing the demented
group against a healthy control group. The memory measures that these recall scores
were based on consisted of a number of different word list tasks (e. g., Selective
Reminding Test) and prose recall tasks (e.g., Logical Memory).

For each of these studies, "r," the point-biserial correlation was computed (Hunter
& Schmidt, 1990; pp. 272-273). The point biserial correlation describes the amount of
relationship that exists between the group (i.e., demented versus control) and the level of
explicit memory. From the 17 studies obtained through the literature search, 24 effect
sizes were calculated. The larger number of eﬁ‘ect sizes were the result of some studies
including multiple memory measures or multiple groups of subjects that varied in the
severity of dementia (See Appendix B, Table 3). These point biserial correlations ranged
from g = -.11 to r = -1.00 and had a weighted average of r = -.75. The weighted average
point biserial correlation gives the average effect size obtained across the studies while
taking into account the diﬁ‘erences in sample size. This negative correlation implies that
the demented subjects had poorer total recall scores on the measures of explicit memory
than normal.

Two studies also examined the consistency of memory recall among demented
samples (Larrabee et al., 1985; Masur et al., 1990). Consistency of recall was measured

with the Buschke Selective Reminding Test (SRT; Buschke, 1973). The SRT has been

7
used extensively to assess the effects of marijuana, anesthesia, benzodiazepines, nerve

growth factor, and Physostigrnine on memory (Miller, Comett, & McFarland, 1978;
Morgan, Funnan, & Dikrnen, 1981; Thal & Fuld, 1983; Thal, Fuld, Masur, & Sharpless,
1983; Block & Berchou, 1984; Pomara et al., 1985; Stem, Sano, & Mayeux, 1987;
Pomara, Deptula, Medel, Block, & Greenblatt, 1989; Thal, Masur, Blau, Fuld, & Klauber,
1989; Olson et al., 1992). It has also been used to examine developmental diﬁ‘erences in
memory, as well as, memory deﬁcits in Age-Associated Memory Impairment,
Huntington's disease, Alzheimer's disease, alcoholism, depression, and dementia (Buschke,
1974; Fuld, 1976; Caine, Ebert, & Weingarter, 1977; Hart, Kwentus, Taylor, & Hamer,
1987; Larrabee & Crook, 1989). Although the SRT is one of several, multiple trial, ﬁ'ee
recall tasks, it is diﬁ‘erent from other word list tasks (e.g., Rey Auditory-Verbal Learning
Task) in that it discriminates between retrieval from short-term memory and long-term
memory. In addition, it quantiﬁes several subcomponents associated with long-term
memory. This discrimination is possible due to the unique way in which the memory test
is conducted. During the ﬁrst trial, all 12 words are presented to the subject while in
subsequent trials, only those words not recalled on the previous trial are mentioned. Once
a word is recalled on two consecutive trials, it is assumed to have entered long-term
memory (i.e., m. Prior to this, it is assumed to have been retrieved from short-term
memory (i.e., 51—14). Here lies the SRT’s uniqueness. Other word list tasks repeat the
entire list of words during each trial. Unfortunately, this does not allow the researcher to
diﬁ‘erentiate words that are being recalled from short-term memory from those that are

being retrieved from long-term memory.

8
Another feature of the SRT is that it differentiates between random and consistent

retrieval from long-term memory. Consistent long term retrieval (i.e., w) refers to
words retrieved from long-term memory on that trial and all following trials while all other
word retrievals from long-term memory are considered random long term retrieval (i.e.,
RL_TR_). Through an analysis of word retrieval from long—term memory in both children
and adults (Buschke, 1974; Fuld & Buschke, 1976), Buschke demonstrated that random
and consistent retrieval represent two qualitatively different stages of verbal learning. The
ability to diﬁ‘erentiate word recall into these subcomponents can lead to the recognition of
differences between subjects that may have initially appeared similar based on a total recall
score. For example, suppose two subjects took a six-trial, 12-word SRT and each
obtained a total recall score of 30 (i.e., SIM). This means that both subjects recalled a
total of 30 words across the six trials. This total, however, is a combination of words that
were recalled from short-term memory and those retrieved both randomly and consistently
ﬁom long-term memory. With this gross measure of recall, it appears that both subjects
remembered the word list to the same extent. However, despite the same total recall
score, dramatic diﬂ‘erences may still exist in how the words are recalled (See Appendix B,
Table 17).

As table 17 demonstrates, an evaluation of subject #l‘s trials reveals that the
subject recalled 18 of the 30 words ﬁom short-term memory and 12 words randomly ﬁ'om
long-term memory. This subject did not recall any words on a consistent basis ﬁ'orn long-
term memory and appears to primarily rely on short-term memory. An evaluation of

subject #2, however, reveals that the subject recalled 7 of the 30 words ﬁom short-term

9
memory, 10 words randomly from long-term memory, and 13 words consistently ﬁ'om

long-term memory. Although recalling 13 words consistently sounds incorrect since there
were only 12 words on the SRT, this is because the words that are consistently recalled
during each trial are summed over the six trials. This method of summing across trials
also holds for SUM, LTM, and RLTR. Based on these scores, one of the main differences
that is evident between these two subjects is that subject #2 has learned a greater portion
of the word list. Learning here is deﬁned as facts that can be consistently recalled ﬁ'om
long term memory.

From the three studies that tested consistent recall among those with dementia,
four eﬁ‘ect sizes were calculated. These ranged ﬁom r = -.54 to r = -.78 and had a
weighted average of r = -.56 (See Appendix B, Table 4). This negative correlation
signiﬁes that as dementia increased in severity, the consistency of recall decreased. This
value is substantially smaller than the correlation of -.75 obtained based on total recall
scores. However, since a total recall score is only partially a result of continuous recall
from long-term memory, the most likely explanation is that the diﬁ‘erence between these
two correlations is due to the role that deﬁcits in short-term memory and random retrieval
from long-term memory play in dementia.

Two studies were also found that examined subjects who were diagnosed with
both depression and dementia (Breen et al., 1984; Rubin et al., 1991). In each of these,
assessment was limited to total recall scores based on Logical Memory, a prose recall task
(See Appendix B, Table 5). The eﬁ'ect sizes that were calculated ﬁ'om the authors'

analyses ranged ﬁ'om r = -.74 to r = -.95 with a weighted average of r = -.92 that takes

l 0
into account the diﬂ‘erences in sample size between the studies. This correlation means

that as dementia and depression increase in severity, there is a corresponding decrease in
total recall scores. Apparently, the relationship between poorer memory performance and
coexisting dementia and depression is stronger than what is observed when the
participants are only amicted with one of these diagnoses. However, without an analysis
of which components of memory were associated with these deﬁcits, it cannot be
determined if this larger correlation is because dementia and depression cause diﬁ‘erent
memory deﬁcits that are additive in nature or if they merely amplify memory diﬁculties
that are common to both. Also, since the weighted correlation is only based on two
studies (N = 21), it may be higher than the actual population value due to chance. In
summary, there appears to be a strong negative relationship between explicit memory
performance and dementia (R = 56%) that appears to be largely due to deﬁcits in
consistent long-term memory retrieval (R = 31%) In addition, when subjects are
diagnosed with both dementia and depression, the relationship with poorer recall becomes
even stronger. Furthermore, since the amount or proportion of words that are entered
into long-term memory and those words randomly recalled from long-term memory
appear to have not been assessed in other dementia-related studies, we still lack an
understanding of what contributions they play to dementia's overall memory deﬁcits.
Depressign and Explicit Margery Recall

The rate of major depression in the United States and Europe appears to range
from 10% to 25% among females and 5% to 12% among males depending on the study

and the speciﬁc criteria that are used (American Psychiatric Association, 1994). The

l l
DSM-IV criteria for this nosological category requires the presence of a major depressive

episode in the absence of a manic or hypomanic episode. A major depressive episode, in
turn, is characterized by the presence of at least ﬁve of the following symptoms (i.e., a - i)
during the same two-week period which occur over most of the day and nearly every day:
(a) depressed mood, (b) signiﬁcantly attenuated interest or pleasure in all, or most of one's
activities, (0) signiﬁcant weight loss/gain or ﬂuctuations in appetite, (d) insomnia!
hypersomnia, (e) observable psychomotor agitation/retardation, (t) fatigue/loss of energy,
(g) perceived worthlessness or inappropriate guilt, (h) decreased concentration, thinking
ability, or indecisiveness, and/or (i) a suicide attempt or plan, recurrent suicidal ideation or
thoughts of death. In addition, (j) there should not be an indication of an organic factor
associated with the depressive disturbance, (k) bereavement and schizoaﬁ‘ective disorder
should be ruled out, (1) delusions and hallucinations should not have been present for two
weeks or longer without the presence of prominent depressive symptoms, (m) the
depressive disturbance should not be superimposed on Schizophrenia, Schizophreniforrn
Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Speciﬁed, and (n)
there is no history of a manic, mixed, or hypomanic episode. Ifthe above conditions are
met, the depressive episode is then rated as (a) mild (e.g., minimal symptoms required for
diagnosis), (b) moderate (e.g., symptoms or level of impairment between mild and severe),
(c) severe without psychotic features (e.g., several symptoms in excess of those required
for diagnosis and marked impairment with the individual's occupational and social realms),
(d) severe with psychotic features (e.g., delusions or hallucinations), (e) in partial

remission, (t) in full remission, or (g) unspeciﬁed.

12
In addition to the nosological category described above, depression can also be

categorized as a syndrome. Syndromal depression indicates a group of symptoms (e. g.,
depressed mood, diminished interest in activities, signiﬁcant weight loss or gain) that may
be primary to a diagnosis of Major Depression (i.e., a nosological category) or be
secondary to another psychopathological disorder (e.g., Schizophrenia). A search of the
literature for studies that examined the relationship between explicit memory and
depression (i.e., either as a nosological category or syndrome) among the elderly resulted
in 18 studies (Danion, Willard-Schroeder, Zimmerman, Grange, Schlienger, & Singer,
1991; Feehan, Knight, & Partridge, 1991; Gannon, 1994; Gibson, 1981; Hart, Kwentus,
Taylor, & Hamer, 1987; Hart, Kwentus, Taylor, & Harkins, 1987; King, Caine, Conwell,
& Cox, 1991; Lachman, Steinberg, & Trotter, 1987; Lichtenberg, Manning, &
Turkheimer, 1992; Mormont, 1984; Niederehe & Yoder, 1989; O'Hara, Hinrichs, Wallace,
Lemke, & Kohout, 1986; Poitrenaud, Moy, Girousse, Wolrnark, & Piette, 1989; Popkin,
Gallagher, Thompson, & Moore, 1982; Rubin, Kinscherf, Grant, & Storandt, 1991;
Speedie, Rabins, Pearlson, & Moberg, 1990; West, Boatwright, & Schleser, 1984; Zarit,
1982). Studies were not limited to those that assessed individuals with a nosological
categorization of depression since there are indications that explicit memory deﬁcits are
associated with the severity of syndromal depression irrespective of the presence of major
depression (Johnson & Magaro, 1987). From these studies, 25 eﬂ‘ect sizes were
calculated. The additional eﬁ‘ect sizes were due to the inclusion of multiple groups or
multiples measures of depression and memory recall within some of the studies. These

studies were of two main types. The ﬁrst type consisted of 12 studies that assessed

l3
depressed elderly inpatients and/or outpatients. Diagnosis was based on a psychiatrist's

rating, the DSM-III, DSM-III-R, or the RDC. Each of these studies determined the mean
difference in explicit memory total recall scores when compared with healthy controls. In
most cases, age and education were controlled for. The second type was composed of
seven studies that examined the relationship between total recall scores and the scores
obtained ﬁ'om depression inventories (e. g., Geriatric Depression Scale). In this second
group, however, the elderly participants were not formally assessed for the presence or
absence of depression. Memory measures across both groups of studies were total recall
scores based on either word lists (e.g., Miller's word list) or paragraph recall (e. g., Logical
Memory). The resulting eﬁ‘ect sizes of the relationship between depression and memory
recall ranged from r = .13 to r = -.90 with a weighted average of r = -.30 (See Appendix
B, Table 6). This negative correlation signiﬁes that as depression increased, total recall
scores on the explicit memory task decreased. These depressed total recall scores, in turn,
are the result of a decrease in word retrieval from short- and/or long-term memory.
However, since there did not appear to be any studies that examined the relationship
between long-term memory or its subcomponents (i.e., random and consistent retrieval)
and depression, the question of what leads to the lower total recall scores in depression is
presently unknown. One possibility for this relationship may be that poorer concentration
among those depressed leads to poorer encoding which, in turn, allows less words to enter
long-term memory. Also, motivational deﬁcits that can be associated with depression may

lead to depressed consistency of recall.

14
In a slightly different vein, Speedie, Rabins, Pearlson, and Moberg's (1990)

assessed depressed subjects who were also suffering from pseudodementia. Here
pseudodementia was deﬁned as depression-induced dementia. In other words, the patients
experienced the symptoms of dementia while being severely depressed but as their
depression lessened, the dementia was also relieved. The participants in this study were
assessed on the Rey Auditory-Verbal Learning Test (Rey, 1964) and compared to a group
of healthy controls (See Appendix B, Table 7). From their results, an eﬂ‘ect size of r =
-.47 was calculated. This indicates that depression and pseudodementia were associated
with poorer recall scores. The authors also reported that their patients with
pseudodementia obtained better recall scores than those with irreversible dementia. This
could suggest that the memory deﬁcits are due to a diﬁ‘erent mechanism and/or are not
impaired to the same extent.
Memgg ngplg'nts

Overall, it appears that a substantial portion of the elderly perceive that their
memory becomes problematic with age. Lowenthal (1967) observed that self-reports of
declining memory among individuals residing in the San Francisco Bay area increased
from 31% for those 60 to 64 years of age to 65% for those over 75 years of age (N =
984). Data based on the Eastern Baltimore Mental Health Survey, which was part of the
National Institute of Health's 1981 Epidemiologic Catchment Area Program, indicated that
the prevalence of memory complaints reached 43% for those 65 to 70 years of age. For
individuals that were 75 to 84 years of age, this ﬁgure increased to 51% while 88% of

those above the age of 84 had memory complaints (N = 810; Bassett & Folstein, 1993).

1 5
In a more recent and larger study (N = 10,611) by Cutler and Grams (1988) that utilized

data from the 1984 National Health Interview Survey, complaints of frequent forgetting
were assessed. However, while this only represents one type of memory complaint, the
rates were still at 15% for those 55 years of age or older and 23% for those 65 or older.
Memory Complaint Questionnaires

This self-awareness of memory ability or disability is considered one of the
components of metamemory (Flavell, 1977). Initial research in this area involved
assessing individuals for the presence of memory complaints through brief interviews or
questionnaires that either asked if the subject had memory problems or that gauged the
extent of any memory diﬁiculties (e. g., ﬁ'equency of problems). Hermann (1982) pointed
out that the beneﬁts of such an approach include not having to assess an individual over a
long period of time and detecting memory problems that observation would not pick up
(e.g., if memory strategies were used). Since these initial measures, numerous memory
complaint questionnaires have been developed that diﬁ‘er in both content and format.
Differences in content include inquiring about the (a) ﬁequency of forgetting, (b) clarity of
memories, (c) quality of memories, (d) degree of change in memory over time, (e)
methods of using their memory, and (t) aﬂ‘ective stance towards their memories. Even
within these content areas, ﬁrrther subdivisions are common. For instance, the ﬁ'equency
of memory dimculties has been estimated based on (a) a certain unit of time, (b) relative to
the number of opportunities to use their memory in speciﬁc situations, and (c) relative to

other individuals (Hermann, 1982).

16
Memory complaint questionnaires can also diﬁ'er in the level of detail that is

obtained. "How often do you forget to take your medicine?" is an example of low detail
while "How often when you are on vacation do you forget to take your medicine?" is an
example of high detail. Some questionnaires may even assess only speciﬁc memory
situations. For example, the Inventory of Learning Processes (Schmeck, Ribich, &
Ramanaiah, 1977), only focuses on situations in a college setting. Format differences
within these questionnaires can range from open-ended questions typical of interviews to
multiple choice answers.

One of the more recent examples of self-appraisal, is the Memory Functioning
Questionnaire (Gilewski, Zelinski, & Schaie, 1990). This measure is composed of 64
items that are weighted on a seven-point Likert scale. They result in scores for (a) the
ﬁ'equency of forgetting, (b) the seriousness of forgetting, (c) retrospective functioning,
and (d) mnemonics usage. The score for frequency of forgetting is based on the subject's
perception of their forgetfulness in 28 situations, as well as, ﬁve ratings of their general
memory performance. Seriousness of forgetting rates the "seriousness" of their forgetting
in 18 diﬁ‘erent situations. Retrospective functioning is based on comparisons of one's
current memory with ﬁve earlier time periods in the subject's life while mnemonics usage
rates how frequently the subject uses eight diﬁ‘erent mnemonics.

Mempry Cpmplaints and Depression

Within the elderly population, a variety of these memory complaint questionnaires

have been used to detail how various parameters of memory complaints (e. g., frequency,

severity) are aﬁ‘ected by emotional and organic conditions such as depression and

l 7
dementia. Fourteen studies were found that examined the relationship between memory

complaints and depression among the elderly (Chandler & Gemdt, 1988; Derouesne et al.,
1989; Feehan, Knight, & Partridge, 1991; Grut et al. 1993; Kahn, Zarit, Hilbert, &
Niederehe, 1975; Niederehe & Yoder, 1989; O'Boyle, Amadeo, & Self, 1990; O'Connor,
Pollitt, Roth, Brook, & Reiss, 1990; O'Hara, Hinrichs, Wallace, Lemke, & Kohout, 1986;
Popkin, Gallagher, Thompson, & Moore, 1982; Tun, Perlrnutter, Russo, & Nathan, 1987;
West, Boatwright, & Schleser, 1984; Zarit, 1982; Zelinski, Anthony-Bergstone, &
Gilewski, 1990;). These could be further subdivided into two categories. The ﬁrst
category assessed elderly who were depressed inpatients or outpatients. Diagnosis was
based on the DSM-HI, DSM-III-R, or the RDC. These studies either assessed the
relationship between memory complaints and scores on a depression inventory (e.g., Beck
Depression Inventory) or determined the mean difference in memory complaints when
compared with healthy controls. The second group of studies examined the relationship
between memory complaints and scores on a depression inventory among elderly
participants who were not formally assessed for the presence or absence of depression.
Again, both types of studies were included due to the possibility that memory complaints
are associated with syndromal depression rather than the nosological category of
depression. From these studies, 19 eﬁ‘ect sizes of the relationship between depression and
memory complaints were calculated. These correlations ranged ﬁ'om ; = .18 to r = .70
with a weighted average of g = .34 (See Appendix B, Table 8). This positive correlation
indicates that depression is associated with a higher prevalence of memory complaints.

Furthermore, since a heightened level of memory complaints has been associated with

1 8
greater levels of somatic complaints (Hanninen et al., 1994), it may be that the relationship

between depression and memory complaints is primarily due to the somatic components of
depression (e. g., insomnia, psychomotor agitation). Alternatively, it may be that a
diminished ability to concentrate, another DSM-IV symptom of depression, leads to a
decreased number of words entering long-term memory (i.e., ES).
Memory Complaints and Dementia

The relationship between memory complaints and dementia was examined by
Kahn, Zarit, Hilbert, and Niederehe (1975), Niederehe and Yoder (1989), McGlone et al.
(1990), O'Connor, Pollitt, Roth, Brook, and Reiss (1990), Feehan, Knight, and Partridge
(1991), and Grut et a1. (1993). All participants within these studies were diagnosed with
dementia based on the criteria of the DSM-III, DSM-III-K Cambridge Mental Disorders
of the Elderly Examination (CAMDEX; Roth et a1. 1986), or from the combined test
results of the Mental Status Questionnaire (Pfeiﬁ‘er, 197 5) and the Face-Hand Test (Kahn,
Goldfarb, Pollack, & Peck, 1960). These samples of elderly were inpatients and
outpatients, as well as, community-dwelling elderly who responded to local newspaper
and radio announcements. While Grut et a1. (1993) calculated the correlation between the
subjects scores on the Mini Mental State Examination (i.e., a test of cognitive impairment)
with the presence of memory complaints, the remainder of the studies examined group
diﬁ‘erences in memory complaints between samples of impaired and healthy controls.
From these 6 studies, 14 eﬁ‘ect sizes were calculated. This sizable diﬁ‘erence between
study number and eﬂ‘ect size number was mainly due to Kahn et al. (1975) in which eight

eﬁ‘ect sizes were calculated. The eﬁ‘ect sizes across these studies ranged from _r_ = -.44 to

19
_r_ = .49 and had a weighted average of r = .23 (See Appendix B, Table 9). The weighted

average indicates that demented individuals had a greater number of memory complaints.
However, the wide range of correlations, which encompasses equally strong negative and
positive values, suggests that other factors are aﬁ‘ecting this relationship. One such factor
appears to be the severity of dementia. Grut et al. (1993) reported that the ﬁequency of
memory complaints were the least among those subjects with Mini Mental State
Examination scores of 26 to 30 (i.e., non-demented) and 0 to 5 (i.e., severe dementia). It
appears that once an individual has severe dementia, they are no longer aware of their
memory deﬁcits. Grut et a1. (1993) also found that between these two extremes, memory
complaints were found to increase as MMSE scores decreased (i.e., participants became
more demented). This observation seems to also be in line with the ﬁndings of O'Connor
et al. (1990). Here, the correlation between memory complaints and dementia increased
from r = .32 for those with mild dementia to r = .46 for those with moderate dementia.
Only one study (O'Boyle, Amadeo, & Self, 1990) was found that examined the
relationship between depression, pseudodementia, and memory complaints (See Appendix
B, Table 10). The patients for this study were selected from an analysis of 83 admissions
to a geropsychiatric unit who had received a DSM-III diagnosis of depression. Of these
patients, 11 had initial Mini-Mental State Examination scores of 23 or below indicating the
presence of dementia. However, following treatment, their scores on the Mini-Mental
State Examination were 24 or better indicating a lack of cognitive impairment. In these 11
pseudodemented subjects, scores on a cognitive complaints inventory completed at

admission were compared with their scores on the Beck Depression Inventory also taken

20
during admission to the unit. A strong relationship (r = .81) was found that was more

than twice the size of average weighted correlation found in studies comparing memory
complaints and depression.
Memory Complaints aLd Actual Memory Recgll

Overall, studies examining the relationship between memory complaints and
depression, dementia, and pseudodementia have described relationships of varying
strength. However, this does not imply that actual memory problems exist. A number of
studies have reported discrepancies between memory complaints and actual memory
performance involving subjects who were depressed, demented, or healthy. Within these
studies, objective memory performance was based on total recall scores ﬁ'om tests of
paragraph recall (e. g., Babcock Story Recall), word recall (e. g., Buschke Selective
Reminding Test), or memory test batteries (e.g., Cambridge Mental Disorders of the
Elderly Examination). Two of these studies investigated the relationship between memory
complaints and objective memory performance among demented samples (Kahn et al.
197 5; O'Connor et al. 1990). The effect sizes that were calculated from their ﬁndings
ranged from r = .06 to r = .29, with a weighted average of r = .22 (See Appendix B, Table
11). This positive correlation indicates only a small association of greater complaints and
greater objective memory impairment. Since the correlations are markedly higher in
O'Connor et al. (1990), in which participants had mild to moderate dementia, it may be
that Kahn et al. (1975) assessed subjects with more severe levels of dementia. It would
seem plausible that persons with advanced dementia would be unable to perceive the

extent of their actual memory deﬁcits and hence would have a lower correlation between

21
complaints and actual performance. These two studies also examined the relationship

between memory complaints and objective memory performance in participants who were
diagnosed depressed (See Appendix B, Table 12). Here the range of eﬁ‘ect sizes was r = -
.01 to r = .01 with a weighted average of r_' = .00. This suggests that no relationship was
found between memory ability and complaints among depressed individuals. Based on
Beck's cognitive theory of depression (Beck, 1967), one potential explanation is that
views of the self were so negatively distorted among those with depression that they did
not reﬂect accurate representations of reality. Based on the DSM-IV criteria for
depression, this explanation would suggest that feelings of worthlessness and
inappropriate guilt may be more related to heightened memory complaints than the other
depressive criteria (e. g., signiﬁcant weight loss or gain).

The relationship between memory complaints and performance has also been
examined using healthy elderly samples (Zarit, 1982; Sunderland, Watts, Baddeley, &
Harris, 1986; O'Connor, Pollitt, Roth, Brook, & Reiss, 1990; Zelinski, Anthony-
Bergstone, & Gilewski, 1990; Taylor, Miller, & Tinklenberg, 1992, Gannon, 1994). In
this population, the 11 eﬁ'ect sizes that were calculated were found to range from g = .05
to I = .40 with a weighted average of r = .20 (See Appendix B, Table 14). This low,
positive correlation signiﬁes that as memory complaints increased, actual memory ability
showed only a slight tendency to become poorer. A few studies also examined mixed
groups of elderly (See Appendix B, Tables 15 & 16). O'Hara, Hinrichs, Wallace, Lemke,
and Kohout (1986) combined depressed and healthy elderly together and reported a

correlation of .10 between memory complaints and performance while in combined groups

22
of demented, depressed, and healthy elderly, similar relationships (gm = .11) have been

observed (Derouesne et al. 1989; Niederehe & Yoder, 1989). These studies that
combined different populations appear to have illustrated the importance of subject
differences. It seems that when elderly who are demented, depressed, or healthy are
combined, any relationship that may exist between memory complaints and objective
performance is no longer evident.

Although the low correlations between memory performance and perception calls
into question the utility of memory questionnaires, numerous reasons have been advanced
to explain these low correlations as well as the sizable interstudy differences. It has been
suggested that (a) the elderly may have a poorer ability to predict their actual memory
performance (Cavanaugh & Perlrnutter, 1982), (b) some subjects may be inaccurate
because of early dementia and/or depression (Wells, 1980; Zarit, 1982; Zelinski et al.,
1990), (c) certain questionnaires may suffer from psychometric limitations, (d) it may be a
ﬁrnction of different types of memory performance that were assessed, (e) it may be due to
diﬁ‘erences in health status of the subjects, (1) depression was not controlled for (Erickson,
Poon, & Walsh-Sweeney, 1980; Hermann, 1982; Zelinski et al., 1990), (g) by including
only healthy subjects, the range of scores is restricted (Hultsch, Hertzog, & Dixon, 1987),
(b) they are due to unassessed diﬂ‘erences in the subjects' attributions and locus of control
(Lachman, Steinberg, & Trotter, 1987), (1) studies using less than a 7—point Likert scale
may not diﬂ‘erentiate memory complaints sufﬁciently enough (Zarit, 1982), (i) it may be a
result of individual diﬁ‘erences in quantifying the degree of memory complaints on a Likert

scale (Taylor, Miller, & Tinklenberg, 1992), (k) studies are not taking into account

23
contributing lifestyle and effort factors (Sunderland, Watts, Baddeley, & Harris, 1986), (l)

the memory questionnaires may not have been extensive enough (N iederehe & Yoder,
1989), (m) grouping all demented patients together may confound the results (Grut et al,
1993), (n) individuals may hold inaccurate beliefs about their memory ability (Hermann,
Grubs, Sigrnundi, & Grueneich, 1986), and (0) memory tests may not be sensitive to
everyday memory problems.

In spite of this wide variety of explanations, it appears that most of the studies in
this area have emphasized only two of the above explanations. The ﬁrst is that memory
questionnaires are not extensive enough. This is based on the increasing number of
studies that are employing questionnaires with additional numbers of test items and
content areas (Hermann, 1982). The other explanation is that individuals may hold
inaccurate beliefs about their memory ability. This is based on the observation that a
number of the newer questionnaires are completed by someone other than the individual
with the memory complaints. In these instances, a spouse or relative who can observe the
participant on a daily basis provides the necessary information (e. g., Sunderland et al.
1986). However, both of these explanations attempt to deal with supposed deﬁcits in the
memory questionnaires. The author is unaware of any study that has addressed the
explanation that the low correlations between memory complaints and memory recall
performance may be the result of the method in which memory is measured (i.e., total
recall scores). For example, it would seem possible that the randomness or consistency of
recall may more directly reﬂect an individual's perception of forgetfulness than a gross

measure of recall such as total recall.

24
Summg !

A number of ﬁndings were gleaned from this series of meta-analyses. First, deﬁcits
in total recall are related to dementia and depression to varying degrees, 1 = -.75 and r = -
.30, respectively. Unfortunately, this measure does not describe to what extent these
deﬁcits are due to problems with short-term memory and long-term memory. Only a
couple of studies limited to demented individuals have attempted to differentiate total
recall deﬁcits into those that are due to impaired entry into long-term memory or the result
of changes in random or consistent retrieval from long-term memory (Larrabee et al.,
1985; Masur et al., 1990). Such information would appear to be essential in order to
successfully critique the direct and side effects of different drug treatments that are being
developed for dementia and depression. Second, the relationship between memory
complaints and memory recall performance (i.e., total recall scores) is dismal irregardless
of the population being examined (estimated mean rs of .22 for dementia, .00 for
depression, and r = -.20 for healthy elderly). Efforts at strengthening this relationship
appear to have been primarily limited to increasing the content and length of memory
questionnaires. The author is unaware of any studies that have attempted to determine if
the relationship would be stronger by comparing memory complaints, as measured by the
initial measures that assessed merely the presence and/or frequency of memory complaints,
with the subcomponents of long-term memory (i.e., LTS, CLTR, RLTR). Since the
presence of subjective memory complaints is required for such conditions as age-

associated memory impairment (AAMI; Crook, Bartus, Ferris, Whitehouse, Cohen, &

25
Gershon, 1986), it would seem vital to examine the extent of all potential relationships

between memory complaints and objective memory performance.

Third, there does appear to be a positive relationship between depression and
memory complaints (i.e., r = .34) and a negative relationship between depression and
poorer explicit memory recall (i.e., r = -.30). However, the author is unaware of attempts
to determine if these relationships are due to some of the speciﬁc criteria of depression
(e.g., feelings of worthlessness, somatic criteria). Fourth, with the exception of Gannon
(1994), the studies in these meta-analyses have not reported correcting for attenuation due
to measurement error in their calculations. This will result in lower correlations than
actually exist in their respective populations. Fifth, the scoring method used in the SRT to
determine consistent recall may lead to an inaccurate representation of the role of
consistent retrieval in diﬁ‘erent conditions (e. g., dementia). Since this has not been
mentioned previously, I will describe this in greater detail.

It may be recalled that through analyses of word retrieval from long-term memory
in both children and adults (Buschke, 1974; Fuld & Buschke, 1976), the SRT was able to
differentiate two qualitatively different stages of verbal learning, random and consistent
retrieval. Buschke (1974) hypothesized that this was the result of retrieval reﬂecting the
adequacy of storage. One beneﬁt of this ﬁnding was that verbal learning could be
investigated through stages of learning (i.e., random versus consistent retrieval) rather
than attempting to make a distinction between storage and retrieval. The diﬁculty with
distinguishing between storage and retrieval is due to their intertwining relationship.

While retrieval is required to demonstrate that the storage of information took place,

26
eﬁ‘ective retrieval requires adequate storage (Fuld & Buschke, 1976). In other words, if a

subject cannot retrieve some piece of information from long-term memory, is it due to
storage dimculties, retrieval diﬁiculties, or both?. With Buschke's approach, it is far
simpler. The better the storage (i.e., encoding), the better the retrieval. The poorer the
storage, the poorer the retrieval.

One difﬁculty with studies that have assessed consistent long term recall (i.e.,
CLTR), is that the criteria for determining which words are consistently recalled often
varies. In Buschke's original paper on the SRT (1973), a word only had to be recalled
across a minimum of the last two trials (i.e., Trial 5 & 6) in order to be considered
consistently recalled. However, other studies have used scoring criteria that required that
the word he recalled across at least the last three trials (Masur et al., 1989) or even a
larger number of trials (Fuld & Buschke, 1976) to be considered consistently recalled.
This can lead to different ﬁndings across studies. A second diﬁculty is that Buschke's
scoring convention appears to assume that if a word was consistently recalled across trials
5 and 6, it would also be recalled on any additional trials (e.g., trial 7). However, the
author is unaware of any study on which this claim can be based. Recalling a word across
two consecutive trials should demonstrate the same degree of consistency in retrieval
irregardless of which two trials the word was recalled on (e. g., trial 1 & 2 or trial 5 & 6).
Using Buschke's scoring criteria misrepresents the role that consistent and, consequently,
random retrieval are playing in the subjects that are being assessed To demonstrate this, I
will use the original deﬁnition of consistent recall which requires that a word from long-

terrn memory be retrieved during at least the last two trials (See Appendix C). This

27
Appendix shows all possible combinations of how a word could be recalled across six

trials and whether it is considered retrieved from: short-term memory (i.e., STM) and/or
long-term memory (i.e, LTS) and retrieved randomly (i.e., RLTR), and/or consistently
(i.e., CLTR) ﬁ'om long-term memory. The problem with the deﬁnition of consistent recall
becomes evident when one examines the different possible events that can occur during
word recall. Some words may be recalled much more consistently across the six trials but
are considered derived ﬁom random retrieval (i.e., RLTR) since they were not recalled
during the 5th and 6th trials.

For example, in the subsection describing all possible events for words that are
recalled four times, it seems that event 1 and event 2 are much more indicative of
consistent retrieval than event 15, however, event 1 and 2 are scored 4 for random
retrieval and 0 for consistent retrieval. Event 15 on the other hand, gets a score of 2 for
consistent retrieval. This results in an inaccurate measure of the consistency of retrieval
from long-term memory. A potential solution could be to use another measure of retrieval
consistency, referred to as consistent retrieval (i.e., QR; Masur et al., 1989). This
represents the total number of events across a word list task in which words are recalled
on two consecutive trials from long-term memory. The higher the number, the greater the
consistency of recall. To calculate random retrieval (i.e., m, words that have been
recalled ﬁ'om long-term memory that are not recalled on two consecutive trials could be
summed. This would also solve the problem of the dichotomous separation of random

and consistent retrieval that results ﬁ'om Buschke's scoring convention. If, as Buschke

28
(1973) states, retrieval reﬂects the adequacy of storage, then retrieval would be better

viewed along a continuum.
Hypotheses

Based on the ﬁndings described in this summary, the following six hypotheses
were examined.
#1. It was hypothesized that the somatic components of syndromal depression were
related to memory complaints. Based on this hypothesis, a factor composed of test-items
ﬁ'om the depression inventories that assessed the DSM-IV somatic criteria of depression
(i.e., signiﬁcant weight loss/ gain, insomnia/ hypersomnia, psychomotor agitation!
retardation, fatigue) should exhibit a stronger positive relationship with the ﬁ'equency of
memory complaints then a "cognitive" factor based on test-items that assessed the
remaining DSM-IV depression criteria (i.e., depressed mood, diminished interest, feelings
of worthlessness, diminished ability to concentrate, recurrent thoughts of death).
#2. It is hypothesized that feelings of worthlessness and inappropriate guilt, one of the
DSM-IV symptoms of depression, is what relates depression scores to the number of
memory complaints. Based on this hypothesis, a factor composed of test-items from the
depression inventories that assessed this characteristic of depression should manifest a
stronger relationship with memory complaints then factors based on the test-items that
assessed the other DSM-IV characteristics of depression.
#3. It is hypothesized that a diminished ability to concentrate or heightened
indecisiveness, another of the DSM-IV symptoms of depression, is what relates depression

scores to the ﬁequency of memory complaints. Consequently, a factor based on test items

29
from the depression inventories that assessed this characteristic of depression should

display a stronger relationship with memory complaints then factors based on test-items
that assessed the other DSM-IV characteristics of depression.

#4. It is hypothesized that the depressed elderly will have a lower mean number of
words that enter long-term memory (i.e., LTS) and a lower mean number of words that
are consistently recalled from long-term memory (i.e., CR) then will be found in the non-
depressed elderly. In addition, it is expected that a negative relationship will exist between
the presence of depressive symptoms (i.e., Dﬂ factor) and these two measures of
memory. This means that as the depression score ﬁ'om the three depression measures
increases in severity, there will be a corresponding decrease in words entered into long-
term memory (i.e., LTS) and words consistently recalled from long-term memory (i.e.,
CR).

#5. It is also hypothesized that as memory complaints increase, there will be a
corresponding decrease in the words consistently recalled on the SRT (i.e., CR) and an
increase in the words randomly recalled (i.e., R). It is also hypothesized that these
correlations will be greater than the correlation between memory complaints and total
recall scores (i.e., SUM).

#6. It is hypothesized that a positive relationship exists between memory complaints
and syndromal depression. Consequently, it is expected that memory complaints will
increase in frequency as depressive symptoms increase (i.e., DEP factor). This hypothesis

serves as a replication of previous studies that have examined this topic.

30
METHOD

Participants

The participants (N = 208) were community-dwelling elderly recnrited through
newspaper and radio ads, circulars, and presentations at local senior citizen centers. Each
participant was oﬁ‘ered a ﬁ'ee assessment of their mood and memory. Nondepressed
elderly were considered those with an absence of syndromal depression and an unimpaired
cognitive status (p = 131). Depressed elderly were considered those with syndromal
depression and an unimpaired cognitive status (3 = 77). The absence of syndromal
depression was considered a score of less than 10 on the Beck Depression Inventory (i.e.,
.321; )and less than 11 on the Geriatric Depression Scale (i.e., QQS; ) and Hamilton
Depression Scale (i.e., HAM; ). The presence of syndromal depression was considered a
score equal to or greater than 10 on the BDI or equal to or greater than 11 on the GDS or
HAM. An unimpaired cognitive status (i.e., >23 on the MMSE; Mini-Mental State
Examination) was required of all participants due to the inﬂuence that dementia and
pseudodementia can have on memory recall and potentially on memory complaints. These
cut-oﬁ‘ scores were based on previously reported scoring guidelines for the BDI (Beck,
Ward, Mendelson, Mock, & Erbaugh, 1961), GDS (Y esavage et al., 1983; Alden, Austin,
& Sturgeon, 1989), HAM (Y esavage et al., 1983; Marks-Cash, 1992), and MMSE
(T ombaugh & McIntyre, 1992).
Tat, Mments for Severity pf Depression

Since multiple measures of depression can more ﬁrlly capture any depressive

symptomatology being experienced by the participants (Kendall, Hollon, Beck, Hammer),

31
& Ingram, 1987), three instruments were chosen. The ﬁrst instrument was an observer-

rating scale, the HAM (Hamilton, 1960). The remaining two, the BDI (Beck et al., 1961)
and the GDS (Yesavage et al., 1983), were self-report measures. Together, these three
measures more fully address the DSM-IV criteria for depression and criteria characteristic
of depression in the elderly population (Weiss, Nagel, & Aronson, 1986).
Hamilton Rating Scale for Depression

The HAM used for this study was a 23-item version of the original 17-item scale.
Since all of the test items in the original 17-item version are contained in the 23-item scale
and no psychometric information was available for the 23 -item version, the following
psychometric information represents the ﬁndings from the original 17-item test. Although
the HAM was originally designed to measure the severity of depression in individuals
already diagnosed depressed, since its inception it has been extensively used to assess
depressive symptoms in other populations as well (Hedlund & Vieweg, 1979). Test-retest
reliability coeﬂicients for the HAM ranged from .61 (Mean interval = 15 days; Lyons,
Strain, Hammer, Ackerman, & Fulop, 1989) to .70 (3 week interval; Maier, 1990) while
Cronbach's (1951) alpha was .76 (Rehm & O'Hara, 1985). Sensitivity to change, which is
a scale's ability to detect changes (e.g., in depressive symptoms) in individuals across time,
was .65 (3 week interval) for the HAM (Maier, 1990). Correlations of the HAM and
psychiatrist's ratings of global severity of depressed patients ranged from a mean of .88

(range = .84 to .90) for three studies reviewed by Hedlund and Vieweg (1979) to .67

(Maier, 1990).

32
Stukenberg, Dura, and Kiecolt-Glaser (1990) observed that the area under the

ROC (i.e., Receiver Operating Characteristics) curve, which represents the probability of a
measure correctly categorizing subjects (e. g., depressed versus nondepressed), was .85.
In a sample of psychiatric inpatients (Lichtenberg, Steiner, Marcopulos, & Tabscott,
1992), the HAM‘s sensitivity and speciﬁcity was 9% and 92%, respectively. These indices
were determined by comparing those subjects who fell above and below a cut-off
criterion. Sensitivity is the proportion of individuals correctly diagnosed depressed (i.e.,
proportion of true positives) while speciﬁcity is the proportion of individuals correctly
diagnosed affectively healthy (i.e., proportion of true negatives; Masur et al. 1989). The
authors mentioned that the low sensitivity of 9% is at odds with the high correlations of
HAM ratings and DSM-III-R diagnoses reported in the literature and suggested that it
may have been due to their study's large number of demented subjects. This may have
been the case since in the only other study that has apparently examined these criteria, a
sensitivity of 86% and a speciﬁcity of 80% was obtained with a cut-oﬁ‘ score of 11 (Brink,
Yesavage, Lum, Heeresema, Adey, & Rose, 1982).

Concurrent validity for the HAM was determined based on its correlation with
other measures of depression. The HAM had an average correlation of .77 (range = .73
to .80) with the BDI across two studies that examined nonpsychiatric samples (Beck,
Steer, & Garbin, 1988). This correlation with the BDI was lower, however, in a sample of
mixed psychiatric and medical inpatients (r = .52; Fitzgibbon, Cella, & Sweeney, 1988)

and across seven studies assessing psychiatric inpatients ([313 = .58; range = .31 to .82;

Hedlund & VreWeg, 1979). The HAM also had a correlation of .60 with the Brief

33
Symptom Inventory Depression scale (Derogatis & Spencer, 1982) in a sample of

community-dwelling elderly. (Stukenberg, Dura, & Kiecolt-Glaser, 1990). In a review of
seven factor analyses, Hedlund and Vieweg (1979) concluded that the ﬁrst of two factors
generally evident across the studies appeared to measure the severity of depressive
symptoms. However, in a more recent study, O'Brien and Glaudin (1988) observed four
factors that they labeled somatic complaints, anorexia, sleep disturbance, and
agitation/retardation. The 23 -item version of the HAM that will be used for the present
study has a scoring range of 0 to 75. Zero denotes a lack of depressive symptoms while
75 suggests severe depression.
Beck Depressipn Invgtpry

The BDI is a 21-item, multiple-choice inventory that rates the intensity of
depressive symptoms, especially those of a somatic nature. Based on a psychometric
review of the BDI (Beck, Steer, and Garbin, 1988), Cronbach's (1951) alpha had a mean
of .81 (range = .73 to .92) based on 15 samples of nonpsychiatric subjects while test-retest
reliability coeﬁcients had a mean of .74 (7 days to 4 month interval; range = .60 to .90)
based on 5 samples of nonpsychiatric subjects. Correlations of the BDI and clinical ratings
of depression for three samples of nonpsychiatric patients, had a mean of .60 (range = .55
to .73). The concurrent validity of the BDI, when correlated with the GDS, was .85 with
medical outpatients (Norris, Gallagher, erson, & Winograd, 1987). The value with the
HAM across two nonpsychiatric samples, however, was slightly lower (5128 = .77, range
= .73 to .80; Beck et al., 1988). In a review by Beck et a1. (1988), the authors concluded

that the more recent factor studies suggest one depressive factor which measures

34
depressive severity. Scores on the BDI can range from 0, which indicates that depressive

statements were not endorsed, to a maximum value of 36 which indicates severe
depression.
(ﬁriatric Depression Scale

The GDS is composed of 30 yes-no questions that primarily examine mood and
psychological symptoms. Test-retest reliability coefﬁcients of .98 (Mean interval = 15
days; Lyons, Strain, Hammer, Ackerman, & Fulop, 1989) and .85 (1 month interval;
Pannalee, Lawton, & Katz, 1989) have been reported. The mean value for Cronbach's
(1951) alpha was .91 based on studies by Yesavage et al. (1; = .94; 1983), Parmalee et al.
([ = .91; 1989), and Salamero and Marcos (r = .87, 1992). A study by Harper, Kotik-
Harper, and Kirby (1990) yielded a sensitivity of 85% for the GDS in a sample of
depressed elderly, while in a study by Koenig, Meador, Cohen, and Blazer (1988), a
sensitivity of 92% and a speciﬁcity of 89% were obtained. Concurrent validities of .62
and .81 were obtained when the GDS was correlated with the HAM at two diﬂ‘erent
assessment periods with medical inpatients (Lyons, Strain, Hammer, Ackerman, & Fulop,
1989). This value was slightly higher (; = .83) when medical outpatients were assessed
(Norris, Gallagher, Wilson, & Winograd, 1987). Correlations were also slightly higher
between the GDS and BDI (r = .85; Norris et al., 1987). Two factor analyses of the GDS
found six (Parmalee et al., 1989) and nine-factor (Salamero & Marcos, 1992) solutions
although both studies mentioned that the GDS was unidimensional (i.e., general

depression factor) based on Cattell's (1966) scree criterion. Scores on the GDS can range

35
from a score of 0, which indicates that no depressive statements were endorsed, to a

maximum value of 30 which indicates severe depression.
Test Instrument for Explicit Memory

The Selective Reminding Test (SRT, Buschke, 1973), served as the word list task
(Appendix D). Words were presented orally at a rate of one word every two seconds.
Test-retest reliability has been found to range from .73 (6 month interval; Ruﬂ',
Quayhagen, & Light, 1988) to .89 (2 hour interval; Masur et al., 1989). In a study by
Masur et al. (1989), the SRT displayed a sensitivity and speciﬁcity in the detection of
patients with mild Alzheimer's disease of 86 and 99%, respectively. However, in a second
study (Masur et al., 1990) with patients diagnosed with dementia based on DSM-III-R
criteria, the SRT obtained a sensitivity of 47% and a speciﬁcity of 86%. Total recall
scores (i.e., SUM) were based on the sum of words recalled across 6 trials and could
range from 0 to a maximum value of 72. The higher the number, the more words were
recalled by the participant across the trials. Retrieval consistency (i.e., CR) represented
the total number of events across a word list task in which words were recalled on two
consecutive trials ﬁom long-term memory. The higher the number, the greater the
consistency of recall. Random retrieval (i.e., R) was based on the number of words
recalled ﬁ'om long-term memory that were not recalled on two consecutive trials. For CR
and RR, the higher the number, the greater the consistency or randomness of recall,

respectively.

36
Test Instrument for Memory Complaints

To provide a measure of subjective memory complaints, participants were asked to
identify the areas in which they were having memory problems. This could be problems
with remembering (a) names, (b) faces, (c) the date, month, or year, (d) appointments, (e)
where objects were placed, (f) what they went into a room to do/get, (g) taking their
medication, or (h) other problem areas not mentioned. The test-retest reliability
coeﬁcient for this questionnaire was .66 (time interval 3 months). These coeﬁcients
were based on 51 control subjects who were assessed on this instrument as part of a larger
study. This measure could range ﬁ'om 0, indicating a lack of memory problems, to a
maximum value of 8 problem areas.

Ta Instrument for Mental Status

The MMSE (Folstein, Folstein, & McHugh, 1975) is a 30-item form that assessed
the presence of cognitive impairment (i.e., mental status). This screening test provided a
brief measure of orientation, registration, attention and calculation, recall, and language.
Based on a review of the MMSE by Tombaugh and McIntyre (1992), the mean coeﬁcient
alpha across ﬁve studies was .72 (range = .54 to .96) while the mean stability coeﬁicient
across 25 samples was .82 (time interval 1 day to 2 months; range = .80 to .97). The
sensitivity of the MMSE across 27 samples that examined demented subjects had a mean
value of .79 (range = .20 to 1.00) while the speciﬁcity across 21 samples had a mean value
of .83 (range = .46 to 1.00). Construct validity, based on 14 studies between the MMSE

and other cognitive status measures, ranged from .70 to .90. Scores could range ﬁ'om a

37
low of 0, indicating severe impairment, to a maximum value of 30, indicating an

unimpaired mental status.
Procedure

Subjects were assessed on the three depression scales, the Selective Reminding
Test, the memory complaints questionnaire, and the MMSE. Testing was done by
clinicians enrolled in a doctoral level clinical psychology program all of whom had prior
training and practice in assessment. Seven to 10 hours of additional training were given to
each of the clinicians in administering and scoring the tests. During their training phase,
each clinician observed an assessment by another clinician with at least 1 year experience
and was then observed by the same clinician during their ﬁrst testing session.
Furthermore, all tests were re-scored by the author to ensure accuracy. Also, in order to
reduce subjectivity in selecting the variables to compose each of the factors examined in
this study (Ford, MacCallum, & Tait, 1986), three advanced-level clinicians individually
provided a summary of test items ﬁom the three depression inventories that assessed each
of the nine DSM-IV criteria for depression. Only test items identiﬁed by all three
clinicians for each factor were retained for subsequent analyses.

RESULTS

The ﬁrst hypothesis examined the relationship between memory complaints and the
somatic and cognitive components of syndromal depression. Three advanced-level
clinicians identiﬁed 16 test items from the HAM, BDI, and GDS that assessed somatic
characteristics of depression and 48 test items that assessed cognitive aspects of

depression. The somatic test items were considered those that focused on weight or

38
appetite ﬂuctuations, sleep problems, psychomotor disturbances, or feelings of fatigue.

The cognitive test items were those that identiﬁed a depressed mood, attenuated interests
or pleasures, feelings of worthlessness/guilt, concentration difﬁculties/indecisiveness, or
thoughts of death/suicide. Construct validity of these two factors was then empirically
tested with a conﬁrmatory factor analysis (C_F_A; Hunter & Cohen, 1969). Initially, the
CFA was examined for the presence of any test items which had negative loadings on their
respective factor. It was assumed that test items exhibiting a negative factor loading were
measuring something diﬁ'erent from either the somatic or cognitive depression construct
being assessed by the other test items. Although none of the test items had negative factor
loadings, several test items exhibited minimal factor loadings. In order to exclude these
peripheral test items and retain those that appeared central in deﬁning the two constructs,
only test items with factor loadings of .40 or greater were retained (Cohen & Cohen,
1983; Ford et al., 1986). This resulted in 10 variables for the somatic factor and 32
variables for the cognitive depression factor. Reliability of these revised factors was then
assessed using Cronbach's (1951) alpha. The resulting internal consistency was .76 for the
somatic factor and .93 for the cognitive factor. In summary, it appears that the two
revised factors had adequate validity and reliability with which to test this hypothesis.
Next, the relationship between these factors and the number of memory complaints
was determined and expressed as Pearson product moment correlations. In addition, these
correlations were corrected for attenuation to take into account the eﬁ‘ects of
measurement error (Hunter, 1990; Hunter, 1993 a). It was hypothesized that the somatic

factor would have a larger positive correlation with memory complaints than the cognitive

39
factor. However, both correlations while signiﬁcant (p<.05), were essentially the same

(somatic r = .36; cognitive ; = .32, _cﬁ‘ = 207) and this hypothesis was rejected. A listing of
the 95% conﬁdence intervals (Hunter, 1993b) for these and subsequent analyses can be
found in Table 18.

The analyses for the second and third hypotheses were combined since both
involved examining the relationship between memory complaints and factors representing
the nine DSM-IV symptoms of depression. The advanced level clinicians identiﬁed test
items in the HAM, BDI, and GDS that assessed depressed mood (17 test items),
attenuated interests or pleasures (11 test items); weight or appetite ﬂuctuations (4 test
items), sleep problems (4 test items), psychomotor disturbances (3 test items), fatigue (5
test items), feelings of worthlessness/ guilt (10 test items), concentration
diﬁcultiesfmdecisiveness (7 test items), and thoughts of death/suicide (3 test items).
Construct validity of these nine depression constructs was then assessed with a CFA The
initial CFA did not indicate any negative factor loadings for each of the factor's respective
test items, however, some test items displayed minimal-sized factor loadings (i.e., <.40)
and were removed. This resulted in 13 test items for depressed mood, 10 test items for
attenuated interests or pleasures, 4 test items for weight/appetite ﬂuctuations, 4 test items
for sleep problems, 5 test items for fatigue, 8 test items for feelings of worthlessness/guilt,
5 test items for concentration diﬁicultiesfmdecisiveness, and 2 test items for thoughts of
death/suicide. The factor assessing psychomotor disturbances was removed entirely due

to factor loadings that ranged from .17 to .35. Reliability of the revised constructs was

40

Table 1

Depression Factors: Consistently/Correlations with Memory Complaints

 

 

N = 208 Coeff. Alpha 1 p
Depressed mood .88 .25 .0002
Interests/pleasure .79 .42 .0002
Weight/appetite .58 .03 ns.
Sleep problems .71 .42 .0002
Fatigue .73 .34 .0002
Worthlessness/guilt .82 .21 .0012
Concentration/mdec. .67 .70 .0002

Death/suicide .82 .18 .0045

 

41
then assessed and can be found in Table 1. In summary, it appears that there is adequate

validity and reliability with which to test these hypotheses.

Next, the relationship between these depression factors and the frequency of
memory complaints was determined and expressed as correlations that had been corrected
for attenuation (Table l). The second hypothesis examined the possibility that the
ﬁequency of memory complaints would exhibit the strongest relationship with the feelings
of worthlessness/guilt factor while the third hypothesis suggested that this relationship
would occur with the concentration diﬁicultiesfmdecisiveness factor. Analyses indicated
that the second hypothesis should be rejected while the third hypothesis should be
accepted. The construct of diminished concentration and indecisiveness displayed the
strongest relationship with memory complaints (r = .70, p<.0002, ﬂ = 207) and was also
signiﬁcantly larger (p<.005) than the other correlations. This correlation means that an
increase in perceived concentration diﬂiculties and indecisiveness was associated with a
greater number of perceived memory problems.

The fourth hypothesis expected that the depressed elderly would have a lower
mean number of words that entered (i.e., LTS) long-term memory and were consistently
recalled (i.e., CR) ﬁ'om long-term memory when compared with the nondepressed group.
Results indicated that the depressed participants exhibited this pattern (Table 2). It was
also hypothesized that a signiﬁcant negative relationship would exist between the amount
of depressive symptoms (i.e., DEP) and these two measures of memory. Since the amount
of depressive symptoms was based on the total score across three diﬁ‘erent depression

measures with diﬁ‘erent scoring ranges, the participant's depression scores were ﬁrst

42
transformed into z-scores and summed to produce a composite depression index (i.e.,

DEP). For this index, a larger score signiﬁed a greater degree of syndromal depression.
Analyses of these relationships also proved to be signiﬁcant (LTS & DEP ; = -.20,
p<.0019, ﬂ= 207; CR & DEP r = -.20, p<.0019, df= 207). Consequently, the fourth

hypothesis was accepted.

Table 2

Recall in Depressed versus andepressed Elderly

 

Depressed Nondepressed
p = 77 p = 131
LTS CR LTS CR
_M 21.6 12.9 25.4 15.6
SD 17.0 12.0 16.8 11.9

 

The ﬁfth hypothesis examined the possibility that as memory complaints increased,
there would be a corresponding decrease in the words consistently recalled (i.e., CR) and
an increase in the words randomly recalled (i.e., RR) ﬁom long term memory. It was also
hypothesized that these relationships would be larger than the one between memory

complaints and total recall scores (i.e., SUM). However since the meta-analyses indicated

43
that the presence of syndromal depression might affect this relationship, these analyses

were carried out separately for the depressed and nondepressed groups. Results indicated
that while the correlations were somewhat different for those with (CR ; = -.02; RR 1 =
.07; SUM r = .06, ﬂ= 76) and without (CR 1 = .04; R r = .16; SUM r = .09, df= 130)
syndromal depression, only R was signiﬁcantly associated with memory complaints
(p<.05) in the nondepressed group. This correlation implies that as memory complaints
increased, there was an increase in random recall ﬁ'om long-term memory. Also,
correlations for R and SUM were not signiﬁcantly diﬁ'erent. Hence, the ﬁfth hypothesis
was only partially accepted. The ﬁnal hypothesis suggested that there would be a positive
relationship between memory complaints and syndromal depression. A correlation
analysis that had been corrected for attenuation yielded a correlation of .37 (p<.0002)
when this relationship was examined. Consequently, this hypothesis was accepted.
DISCUSSION

The observation that the ﬁ'equency of memory complaints was signiﬁcantly related
to the severity of syndromal depression replicated previous studies that have examined this
relationship. However, the examination of the DSM-IV symptoms underlying syndromal
depression has also led to an understanding of the symptom primarily responsible for this
relationship within our sample. By far the strongest relationship was exhibited between
the number of memory complaints and the degree of perceived concentration diﬁculties
and/or indecisiveness. Here, concentration refers to an eﬁ‘ortﬁil and heightened state of
attention in which only relevant stimuli are left in conscious awareness (Russell, 1975).

Consequently, concentration refers to a certain combination of the three subcomponents

44
that encompass the construct of attention (i.e., alertness, capacity, and selection).

Alertness is considered one's level of general preparedness to act upon a stimulus. This
stimulus could be within one’s self (i.e., internal) or within one’s environment (i.e.,
external). Alertness can ﬂuctuate along a continuum over the course of a day. One pole
on the continuum would reﬂect nonresponsiveness (e. g., comatose state) while the
opposite end would describe a maximal degree of awareness and response speed to a
stimulus. Capacity deals with the degree of conscious eﬁ‘ort that is used in attending to a
task. Attentional capacity has been shown to be ﬁnite and susceptible to diurnal variation.
Although, we have a limited attentional capacity, this can be circumvented to a certain
extent by increasing the amount of information that is processed automatically. Many
automatic processes can occur concurrently and only minimally affect the overall supply of
attentional capacity. Automatic processes refer to behaviors that have been practiced
extensively over a period of time, that are performed habitually, and do not require
conscious attention (e. g., tying your shoes). Selection refers to the speciﬁc allocation of
attentional resources for single or multiple stimuli and can be directed internally and/or
externally (Nissan, 1986).

Intuitively, this relationship between memory complaints and disturbances in
concentrationfmdecisiveness makes sense. If one does not possess a certain level of
concentration, information in the environment will not be schiently attended to. This
will result in minimal information being obtained and encoded ﬁom our sensory organs
into memory (Nissen, 1986). For instance, recall of information from the Selective

Reminding Test would be inﬂuenced by the amount of concentration that was allocated or

45
available during the test. If one does not have sufficient levels of attention (i.e.,

concentration), recall of test words will be poor.

Indecisiveness, which is grouped by the DSM-IV along with concentration
disturbances, could be considered an effect of concentration diﬁiculties. Indecisiveness
refers to an inability to make a decision. One reason for indecision may be that there are
insuﬁcient attentional resources to generate the level of concentration required for a
particular problem. \Vrthout sufficient resources, one would be limited in the extent that
viable alternatives could be examined, compared, and selected. This could result in a
person who vacillates between choices or hesitates to choose.

This description of concentration could be used to demonstrate how each of the
DSM-IV symptoms of depression could potentially exhibit a strong, although indirect,
relationship with memory complaints due to their effects on a person's attentional
resources. For example, Hanninen et al. (1994) concluded that memory complaints were
associated with somatic complaints. It may be that those who have somatic ailments
predominately focus their attention/concentration internally on their physical state rather
than externally on their environment. Also, their physical condition may leave them
fatigued. Consequently, lower levels of concentration and attention may be available to
encode external environmental stimuli. Such a hypothesis of attention has also been
proposed by Nideﬁ‘er (1986) within the ﬁeld of sports psychology. Nrdeffer contends that
if one has too broad a focus on internal stimuli (e.g., focusing on your own actions/tactics)
then less resources are available to focus broadly on external stimuli (e.g., the opposing

team). This could result in losing a sports match despite being in better shape or having

46
superior game strategies than the opposing team. IfHanninen et al. (1994) had

participants who had more of a internal focus due to their somatic diﬁiculties, less
attentional capacity would be available to be focused externally. Ifthis results in poor
levels of concentration, then as Nissen (1986) pointed out, poorer encoding and recall of
external information will result. Unfortunately, neither Hanninen et al. (1994) nor the
present study included measures of attention and concentration to test this explanation.

This line of logic could also be used to explain how worthlessness could be
associated with memory complaints. Beck (1967) theorized that depression is
characterized by a negative view of the self, world, and ﬁxture and that these views
become perpetuated and ampliﬁed leading to a "downward spiral of depression." As a
person becomes more depressed, thoughts of worthlessness (i.e., the self) may be focused
on to a greater extent. This would result in greater attentional resources being allocated
for a narrow, internal focus. Consequently, there should be a corresponding decrease in
the ability to concentrate on and recall external stimuli.

Another interesting ﬁnding was that even with a total of 74 test items from the
three depression inventories, only 2 test items loaded adequately on the factor that
assessed thoughts of death/suicide and only 5 test items on the factors that measured sleep
problems and fatigue. In addition, the factor of psychomotor disturbances was removed
due to a lack of variables with a sufficient factor loading. Part of this is undoubtedly a
result of the focus on cognitive aspects of depression in the Geriatric Depression Scale.
Yesavage et al. (1983) points out that this measure was formulated in an attempt to

decrease the rate of false positive in those mildly depressed elderly who are screened for

47
depression. It appears that due to the higher base rates of somatic symptoms among the

elderly, they are often incorrectly considered depressed or considered more depressed then
is actually the case. However, Yesavage et al. (1983) also states that somatic symptoms
are clearly a part of major depression disorders. It would seem advisable then to have a
depression inventory that would adequately assess the presence of all the DSM-IV
symptoms of depression and then take age into account when determining the presence or
severity of syndromal depression. Without such test items to adequately assess these
constructs, false negatives will occur (i.e., depressed individuals who are not considered
depressed).

It was also mentioned that only two test items loaded on the death/suicide factor.
Particularly since these test items did not have perfect reliability, it would seem advisable
for more test items to be donated to assessing this construct. While Yesavage et al.
(1983) contends that thoughts of death and suicide may mean something diﬁ‘erent to the
elderly than for those who are younger, the identiﬁcation of the existence of such thoughts
is important since one of the most serious expressions of depression is suicide. Also,
given the likelihood that most people are only exposed to self-report instruments for
assessing depression (e.g., talk shows, magazines, National Depression Screening Day)
rather than a clinical interview, more comprehensive inventories appear to be needed. For
instance, in October of each year, a National Depression Screening Day is conducted. At
sites all over the country (e.g., schools, shopping malls), mass assessments are performed

with a self-report measure of depression. A useﬁrl purpose of such a screening would be

48
to identify those who are potentially likely to commit suicide. However, with our current

measures many of these people may not be identiﬁed and helped.

Another of the hypotheses examined the notion that depressed elderly would have
a greater difﬁculty encoding and consistently retrieving words from long-term memory.
Although this hypothesis was conﬁrmed, the signiﬁcant correlation was only -.20. One
possibility for this small relationship is that this sample may have had enough automatic
processes at their disposal to attenuate some of the effects of their depression on their
long-term memory abilities. Another possibility is that our sample of elderly were only
mildly depressed (BDI M = 13; GDS M = 13; HAM M = 10). Ifencoding and retrieval
processes are impacted by the severity of syndromal depression, it may be that greater
levels of syndromal depression are required to demonstrate a larger relationship.
Furthermore, if the relationship between depression and memory recall is mediated
through insuﬂicient concentration resources, it may be that concentration levels were only
mildly compromised in our sample. However, it should also be kept in mind that a
correlational relationship does not imply causality.

It was also observed that memory complaints were signiﬁcantly related to random
word recall but not total recall within the nondepressed group. Since other studies that
have examined this relationship have only measured total recall, this may be the reason for
the low correlations that have been previously cited in the literature. Also, since the
relationship was only signiﬁcant in the nondepressed group, it may be that syndromal
depression adversely impacts the metamemory abilities of the elderly. This could then

provide an explanation for the lack of relationship between memory performance and

49
memory complaints observed in those suffering from depression. Another related question

concerns why this relationship was not stronger. One reason may be that only a
laboratory measure of verbal recall (i.e., SRT) was used in the present study. Here a
laboratory measure indicates an assortment of words that are not related to each other and
often have a low frequency of use in the general population. An alternative to a laboratory
measure of verbal recall is an everyday measure. An everyday measure of memory would
be tests that use words that have some commonality between them such as words that
would be found on a shopping list. Recall of a short story would be another example of an
everyday memory measure. It may be that memory complaints are more related to how
participants feel about their everyday memory. This was the concept behind the creation
of the Rivermead Behavioral Memory Test (Wilson, Cockburn, Baddeley, & Hiorns,

1989) which measures an assortment of memory variables couched in everyday situations.
Another reason for this small relationship may be that memory complaints in this study
were based on the occurrence of memory problems in several general areas. It may be
that memory complaints are primarily associated with random recall within speciﬁc
subdivisions of memory. For instance, memory complaints for remembering faces or
where you put things may primarily correlate with random recall scores on spatial memory
tasks. Remembering whether you took your medication may relate more to your level of
attentional ability at the time. A ﬁirther possibility has to due with restriction of range for
the memory complaint variable (M = 2, S_D_ = 2). Possibly there was insuﬁcient breadth

to the memory questionnaire to adequately resolve the relationships that were there.

50
Suggestions for Future Reseaih

Ideally, future research should consider seven components when designing studies
that examine the relationship between memory complaints, depression, and memory recall.
The ﬁrst component is sample composition. In addition to including depressed and
nondepressed elderly, participants should demonstrate a broader range of symptom
severity (i.e., mild to severe). The sample should also include those who meet, and fail to
meet, the DSM-IV criteria for major depression. The inclusion of symptom severity and
depression diagnosis could help elucidate which variables are involved in this
interrelationship. Secondly, although recognizing the limitations of our current
attentional/concentration measures (Schmidt, Trueblood, Merwin, & Durham, 1994),
instruments based on cognitive models of attention should be included in future designs.
Such measures could provide the link that is needed between theory and clinical practice.
It may also be beneﬁcial for these instruments to employ stimuli having verbal
characteristics as opposed to those using numerals or symbols. Using stimuli similar to
those contained in the memory tests may allow a more accurate measure of the attention
and concentration resources available for verbal recall. For instance, if subjects have more
extensive experience in attending to verbal stimuli, more automatic attentional processes
may be able to be employed then would exist for attending to numerical stimuli.

Third, memory tests should assess both verbal and spatial memory. Ifmemory
complaints are speciﬁc to a certain type of memory deﬁcit, limiting memory measures to
verbal recall may mask the existence of potential relationships. Since verbal and spatial

memory represent two major subdivisions of memory, these should provide an adequate

51
assessment of any such relationships. It may be that problems with remembering faces

may only relate to spatial measures of memory while difficulties in remembering names
may be conﬁned to disturbances with verbal memory. The fourth component deals with
the type of memory recall stimuli used. If memory complaints primarily relate to memory
difficulties encountered outside a laboratory, objective memory performances that more
closely mirror everyday memory situations may be required to reveal such a relationship.
The inclusion of memory tests to assess verbal memory with either “laboratory” or
“everyday” characteristics should help determine if this is true. Consequently, the
assessment of verbal memory should include tests that assess recall of words, sentences,
and paragraphs. In addition, these should be separately presented as visual or oral stimuli.
This could help determine if the sensory modalities are diﬁ‘erentially susceptible to certain
memory diﬁiculties. Also, the inclusion of both visual and oral modalities takes into
account the two primary mechanisms by which information is obtained ﬁom the
enviromnent. For example, a visual presentation of stimuli would mirror information
obtained by reading a newspaper or shopping list while an oral presentation would mimic
information that could be obtained through a radio or television program. Spatial memory
should be assessed by a laboratory measure that is primarily free of verbal encoding, such
as the Complex Figure Test (Osterrieth, 1944). This restricts memory processes to those
of a spatial nature rather than allowing the simultaneous encorporation of verbal memory
processes. For everyday measures, spatial memory tests could be used that assess recall of

faces or directions on a map.

52
Fifth, a memory complaints inventory should be used that allows the adequate

discrimination of the type, frequency, quality, and degree of memory diﬁculties. It may
be that if the memory questionnaire is too general or only examines the ﬁequency of
memory problems, potential interrelationships with memory recall and depression may be
masked. Sixth, if this data could be collected over multiple time periods, causal
relationships between the variables could be tested. Seventh, if such a study is formulated
that includes these components, a correlational analysis would probably be advisable. This
would allow a determination of any relationships, as well as, causal processes without
losing signiﬁcant amounts of power through the grouping of individuals by condition as is

required with such statistics as an ANOVA.

APPENDIX A

APPENDIX A

Characteristics of the Meta-Analyses

Medline and Psychlit were searched for relevant articles published between 1979
and 1994 that dealt with depression or memory complaints and between 1983 and 1994
for articles that dealt with dementia. Relevancy was based on the following criteria: (a)
the sample needed to include elderly subjects (i.e., 55 years of age or older), (b) subjects
had to be assessed for dementia, depression, depressive symptomatology, or memory
complaints (c) the article had to be published in English, and (d) explicit memory had to be
assessed by either a word list or prose task. Relevant studies cited in the articles obtained
through Medline and Psychlit were also acquired. For each of the studies obtained, the
point biserial correlation (g) was calculated and used as a measure of treatment eﬁ‘ect
(Hunter & Schmidt, 1990). This correlation describes the degree of relationship that
exists between the group (e. g., demented or control) and the level of explicit memory
ability (e.g., total recall score). The overall results of the 1 statistic was expressed as a
weighted average and weighted standard deviation. These measures were used to take

into account the variation in sample size across the studies.

53

APPENDIX B

APPENDIX B

List of Tables

Table 3
Long-Term Memogz and Dementia

 

Author(s) Demented Control
a M S12

 

I5
I:
(0
le
Iz
I-r

 

1. Gibson (1981)
20 16.20 5.65 20 34.70 6.63 40 -.84

Dementia Measure: Not mentioned
Memory Measure: 10-item Miller‘s word list, total recall score; 7 lists,1 trial

each
Dementia Sample: Inpatient/Outpatient elderly diagnosed with dementia

2. Weingartner, Graﬁnan, Boutelle, Kaye, & Martin (1983)

8 4.00 .20 8 7.30 .60 16 -.97
Dementia Measure: Not mentioned
Memory Measure: 12-item Buschke Selective Reminding Test, total recall score,
5 trials

Dementia Sample: Elderly patients diagnosed with dementia, Alzheimer's type

3. Breen, Larson, Reiﬂer, Vitaliano, & Lawrence (1984)
21 -.1 1
Dementia Measure: DSM-III diagnosis; Mini Mental State Exam; Dementia Rating
Scale
Memory Measure: Logical Memory Form 1
Dementia Sample: Community dwelling elderly diagnosed with dementia,
Alzheimer’s type

54

Table 3 (cont'd)

55

4. Larrabee, Largen, & Levin (1985)

#1 16 2.81
#2 22 45.95
Dementia Measure:

Memory Measure:

Dementia Sample:

2.18 25 7.56 3.14 41 -.67

13.88 25 101441809 47 -.87
Research Diagnostic Criteria diagnosis; Blessed Dementia
Scale

Logical Memory Form I (#1); Selective Reminding Test, total
recall score, number of items and trials not mentioned (#2)
Elderly patients diagnosed with dementia, Alzheimer's type

5. Hart, Kwentus, Taylor, & Hamer (1987)

15 43.7
Dementia Measure:

Memory Measure:

Dementia Sample:

9.3 16 83.6 12.4 31 -.88
Neurologist, Psychiatrist, and Neuropsychologist rating;
Clinical Dementia Rating Scale; Global Deterioration Scale
12-item Selective Reminding Test, total recall score,

10 trials

Outpatient elderly diagnosed with mild dementia, Alzheimer's

type

6. Hart, Kwentus, Taylor, & Harkins (1987)

14 8.10
Dementia Measure:

Memory Measure:
Dementia Sample:

1.10 16 17.70 1.40 30 -.97
Diagnostic Interview Schedule; Clinical Dementia Rating
Scale; Global Deterioration Scale

Logical Memory Form I

Inpatient elderly diagnosed with dementia, Alzheimer's type

7. Storandt, Botwinick, & Danziger (1987)

22 2.30
Dementia Measures:

Memory Measure:
Dementia Sample:

2.10 39 9.10 2.10 61 -.86
Structured Interview; Dementia Scale; Short Portable Mental
Status Questionnaire; Face-Hand Test; Clinical Dementia
Rating Scale

Logical Memory Form I

Community dwelling elderly diagnosed with mild dementia,
Alzheimer's type

8. Niederehe & Yoder (1989)

#1 10 7.15
#2 10 6.75
DementiaMeasure:
Memory Measure:

Dementia Sample:

8.83 22 18.43 6.67 32 -.65

6.79 22 18.55 4.86 32 -.77
Mental Status Questionnaire; Face-Hand Test

40-item word list, total recall score, 1 trial (#1); paragraph
recall (#2)

Outpatient/Community dwelling elderly diagnosed with
dementia

56
Table 3 (cont'd)

9. Poitrenaud, Moy, Girousse, Wolrnark, & Piette (1989)
#1 26 14.42 4.12 33 19.03 4.31 59 -.49
#2 17 9.47 3.97 33 19.03 4.31 50 -.78
Dementia Measure: DSM-III diagnosis; Mini Mental State Examination
Memory Measure: McCarthy's shopping list task, total recall score, 1 trial

Dementia Sample: Inpatient elderly diagnosed with mild (1#) or moderate-severe
(#2) dementia, Alzheimer's type
10. Masur, Fuld, Blau, Crystal, & Aronson (1990)
36 31.10 11.10 386 40.10 10.80 422 -.59
Dementia Measure: DSM-III-R diagnosis; Blessed Mental Status Test
Memory Measure: 12-item Selective Reminding Test, total recall score,
6 trials

Dementia Sample: Community dwelling elderly diagnosed with dementia

11. Speedie, Rabins, Pearlson, & Moberg (1990)
22 3.47 2.13 17 6.23 1.3 39 -.40
Dementia Measure: Mini Mental State Examination
Memory Measure: 10-item Rey Auditory Verbal Learning Test, total recall score,

number of trials varied
Dementia Sample: Inpatient elderly diagnosed with dementia
12. Feehan, Knight, & Partridge (1991)
10 3.00 1.86 10 6.30 2.38 20 -.63
Dementia Measure: DSM-III diagnosis; Hachinski Ischemic Scale, Mini Mental
State Examination

Memory Measure: Logical Memory Form I
Dementia Sample: Inpatient elderly diagnosed with dementia, Alzheimer's type

13. King, Caine, Conwell, & Cox (1991)
20 3.60 2.10 23 7.50 1.40 43 -.75

Dementia Measure: National Institute of Neurological and Communicative
Disorders and Stroke-Alzheimer's Disease and Related
Disorders Association (NINCDS-ADRDA); Mini Mental State
Examination

Memory Measure: Caine's lO-item word list, total recall score, 1 trial

Dementia Sample: Outpatient elderly diagnosed with dementia, Alzheimer’s type

Table 3 (cont'd)

14. Lines, et al. (1991)
8 4.40
Dementia Measure:

Memory Measure:
Dementia Sample:

57

1.30 8 8.10 .70 16 -.98
NINCDS-ADRDA; Clinical Dementia Rating Scale; Mini
Mental State Examination

lO-item Paivio's word list total recall score, 1 trial
Community dwelling elderly diagnosed with mild dementia,
Alzheimer's type

15. Rubin, Kinscherf,-Grant, & Storandt (1991)

#1 41 4.70
#2 66 1 .7 0
Dementia Measure:

Memory Measure:
Dementia Sample:

2.10 83 9.00 2.50 124 -.69

1.80 83 9.00 2.50 149 -.86
Clinical Dementia Rating Scale; Blessed Dementia Rating
Scale; Mental Status Questionnaire

Logical Memory Form 1

Elderly diagnosed with very mild (#1) or moderate (#2)
dementia, Alzheimer's type

16. Robinson-Wheelen, & Storandt (1992)

5 1
Dementia Measure:
Memory Measure:
Dementia Sample:

64 115 -.62
Clinical Dementia Rating Scale

Logical Memory Form 1

Community dwelling elderly diagnosed with very mild

dementia

17. Flicker, Ferris, & Reisberg (1993)

#la 47 3.20
#2a 39 1.20
#lb 47 18.10
#2b 39 6.50
Dementia Measure:
Memory Measure:

Dementia Sample:

Summg y:

.30 50 8.80 .50 97 -.99
.20 50 8.80 .50 89 -1.00
1.20 50 38.30 1.30 97 -.99
1.00 50 38.30 1.30 89 -l.00

Reisberg's Global Deterioration Scale

Guild paragraph recall (a); 10-item McCarthy's shopping

list, total recall score, 5 trials (b)

Elderly patients diagnosed with early (p = 47; #1) or advanced
(r_r = 39; #2) dementia, Alzheimer's type

Weighted M: -.75
Weighted S_D: .03

Table 4

58

Consistent Long-Term Memoryand Dementig

 

 

Author(s) Demented Control
a M SD n M S_D N t
1. Larrabee, Largen, & Levin (1985)
22 2.41 4.56 25 63.00 33.58 47 -.78
Dementia Measure: Research Diagnostic Criteria diagnosis; Blessed Dementia
Scale
Memory Measure: Selective Reminding Test, consistent long term retrieval

Dementia Sample:

score, number of items and trials not mentioned
Elderly patients diagnosed with dementia, Alzheimer‘s type

2. Masur, Fuld, Blau, Crystal, & Aronson (1990)

#1 36 10.70 9.00 386 18.60 10.80 422 -.56
#2 36 7.00 7.70 386 15.30 11.90 422 -.54
Dementia Measure: DSM-III-R diagnosis; Blessed Mental Status Test
Memory Measure: 12-item Selective Reminding Test, consistent retrieval (#1);
consistent long term retrieval (#2) scores, 6 trials
Dementia Sample: Community dwelling elderly diagnosed with dementia
5mm:

Weighted M: -.56
Weighted S_D_: .00

Table 5

59

Long-Term Memogz and Dementia/Depression

 

 

Author(s) Demented/Depressed Control
a M .82 a M SD N r
1. Breen, Larson, Reiﬂer, Vitaliano, & Lawrence (1984)
14 -.74

Dementia Measure:

Depression Measure:
Memory Measure:
Dementia/Dep Sample:

DSM-1H diagnosis; Mini Mental State Exam; Dementia Rating
Scale

DSM-III diagnosis

Logical Memory Form I

Community dwelling elderly diagnosed with dementia,
Alzheimer's type and major depressive disorder

2. Rubin, Kinscherf, Grant, & Storandt (1991)

7 1.40
Dementia Measure:

Depression Measure:
Memory Measure:

Dementia/Dep Sample:

Summary:

1.60 83 9.00 2.50 90 -.95
Clinical Dementia Rating Scale; Blessed Dementia Rating
Scale; Mental Status Questionnaire

DSM-III diagnosis, Beck Depression Scale; Geriatric
Depression Scale

Logical Memory Form I

Community dwelling elderly diagnosed with dementia,
Alzheimer's type and major depressive disorder

Weighted M: -.92
Weighted sp: .or

60
Table 6

Long-Term Memory Ed Depression

 

Author(s) Depressed Control
a M S_D a

I:
I3
I2

 

1. Gibson (1981) .
20 25.65 6.16 20 34.70 6.63 40 -.59
Depression Measure: Psychiatrist rating
Memory Measure: lO-item Miller's word list, total recall score, 7 lists, 1 trial
each
Depressed Sample: Inpatient/Outpatient elderly diagnosed depressed

2. Popkin, Gallagher, Thompson, & Moore (1982)

18 17.56 8.66 23 16.87 8.19 41 .04
Depression Measures: RDC diagnosis; Beck Depression Inventory; Zung Depression
Scale

Memory Measure: Paragraph recall
Depressed Sample: Outpatient elderly diagnosed depressed

3. Zarit (1982)

#la 79 -.33
#2a 79 -.21
#lb 79 -.31
#2b 79 -.23

Depression Measures: Zung Depression Scale (a); Brief Symptom Inventory (b)
Memory Measures: 15-item word list, total recall score, 1 trial (#1); 15-item
shopping list total recall score, 1 trial (#2)
Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

4. Mormont (1984)
101 -.24
Depression Measure: von Zerssen's Beﬁndlichkeit Skala
Memory Measure: 15-item Rey's Auditory-Verbal Learning Test, total recall
score for trial 5
Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

6 1
Table 6 (cont’d)

5. West, Boatwright, & Schleser (1984)

#1 67 .12

#2 67 .13

Depression Measure: Beck Depression Inventory

Memory Measure: l6-item Craik's word list, total recall score, 1 trial (#1); 16-
item shopping list, total recall score, 1 trial (#2)

Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

6. O'Hara, Hinrichs, Wallace, Lemke, & Kohout (1986)

#1 22 5.00 2.09 25 6.08 1.85 47 -.27

#2 23 5.57 2.78 25 6.08 1.85 48 -.11

Depression Measures: RDC diagnosis; Schedule for Aﬁ'ective Disorders and
Schizophrenia diagnosis (SADS-L); Center for Epidemiological
Studies Depression Scale (CBS-D)

Memory Measure: 20-item word list, total recall score, 1 trial

Depressed Sample: Community dwelling elderly; diagnosed depressed (#1),
elevated depressive symptoms, not meeting criteria for
depression (#2)

7. Hart, Kwentus, Taylor, & Harner (1987)
14 70.70 16.50 16 83.60 12.40 30 -.42
Depression Measures: DSM-III diagnosis; Hamilton Depression Rating Scale
Memory Measure: 12-item Selective Reminding Test, total recall score, 10 trials
Depressed Sample: Outpatient elderly diagnosed depressed

8. Hart, Kwentus, Taylor, & Harkins (1987)
10 12.20 1.50 14 17.70 1.40 24 -.90
Depression Measures: DSM-III diagnosis; Hamilton Depression Rating Scale
Memory Measure: Logical Memory Form I
Depressed Sample: Inpatient elderly diagnosed depressed

9. Lachman, Steinberg, & Trotter (1987)
47 -.15
Depression Measure: Zung Depression Scale
Memory Measures: lO-item shopping list and lO-item gift list, averaged total recall
score, 1 trial
Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

62
Table 6 (cont'd)

10. Niederehe & Yoder (1989)

#1 24 16.69 5.08 22 18.43 6.67 46 -.15

#2 24 15.17 4.86 22 18.55 4.86 46 -.34

Depression Measures: RDC diagnosis; SADS-L; Hamilton Depression Rating Scale

Memory Measures: 40-item word list, total recall score, 1 trial (#1); paragraph
recall (#2)

Depressed Sample: Outpatient and community dwelling elderly diagnosed
depressed

11. Poitrenaud, Moy, Girousse, Wolrnark, & Piette (1989)
24 14.29 3.67 33 19.03 4.31 57 -.52
Depression Measures: DSM-III diagnosis; Montgomery and Asberg Depression
Rating Scale; Geriatric Depression Scale
Memory Measure: 20-item McCarthy's shopping list task, total recall score,
1 trial
Depressed Sample: Inpatient elderly diagnosed depressed

12. Speedie, Rabins, Pearlson, & Moberg (1990)
21 6.00 1.30 17 6.23 1.30 38 -.O9
Depression Measure: DSM-III diagnosis; Hamilton Depression Rating Scale
Memory Measure: 10-item Rey Auditory-Verbal Learning Test, total recall score,
number of trials varied
Depressed Sample: Inpatient elderly diagnosed depressed

13. Danion, Willard-Schroeder, Zimmerman, Grange, Schlienger, & Singer (1991)
#1 18 6.40 3.70 18 8.90 2.90 36 -.36
#2 18 1.30 2.00 18 4.50 4.50 36 -.43
Depression Measure: DSM-III diagnosis; Hamilton Depression Rating Scale
Memory Measure: Logical Memory Form 1 (#1); 30-item word list, total recall
score, 1 trial (#2)
Depressed Sample: Inpatient elderly diagnosed depressed

14. Feehan, Knight, & Partridge (1991)
10 5.50 2.43 20 7.20 2.46 30 -.34
Depression Measures: DSM-III diagnosis; Geriatric Depression Scale
Memory Measure: Logical Memory Form I
Depressed Sample: Outpatient elderly diagnosed depressed

63
Table 6 (cont’d)

15. King, Caine, Conwell, & Cox (1991)

23 6.40 1.50 23 7.50 1.40 46 -.36
Depression Measures: DSM-III-R diagnosis; Hamilton Depression Rating Scale
Memory Measure: lO-item Caine's word list, total recall score, 1 trial

Depressed Sample: Inpatient elderly diagnosed depressed

16. Rubin, Kinscherf, Grant, & Storandt (1991)

8 5.90 2.20 83 9.00 2.50 91 -.75
Depression Measures: DSM-III diagnosis, Beck Depression Inventory, Geriatric
Depression Scale

Memory Measure: Logical Memory Form 1
Depressed Sample: Elderly diagnosed depressed

17. Lichtenberg, Manning, & Turkheirner (1992)
16 7.30 3.50 19 11.50 2.20 35 -.71
Depression Measure: Geriatric Depression Scale
Memory Measure: Logical Memory Form 1
Depressed Sample: Community dwelling elderly not assessed for depression
diagnosis

18. Gannon (1994)
45 -.35

Depression Measures: Hamilton Depression Rating Scale; Beck Depression
Inventory; Geriatric Depression Scale

Memory Measures: Summed _z-score of 12-item Selective Reminding Test, total
recall score, 6 trials and Logical Memory Form I averaged
over 3 assessment periods

Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

8mm:
Weighted M: -.30
Weighted S_D: .06

Table 7

64

Long-Term Memriv and Depression/Pseudodementie

 

 

Author(s) Depressed/Pseudodem. Contrpl
a M SD n M 52 N t
1. Speedie, Rabins, Pearlson, & Moberg (1990)
18 4.29 2.28 17 6.23 1.30 35 -.47
Dementia Measure: Mini Mental State Examination
Depression Measure: DSM-III diagnosis; Hamilton Depression Rating Scale
Memory Measure: lO-item Rey Auditory Verbal Learning Test, total recall score,
number of trials varied
Dementia/Dep Sample: Inpatient elderly diagnosed with major depression and

dementia that was alleviated over treatment
(i.e., pseudodementia)

65
Table 8

Memogy Complaints and Depression

 

 

 

Author(s) Depressed Control
1.1 M S_D n M SD E. t
1. Kahn, Zarit, Hilbert, Niederehe (197 5)
105 .33

Complaint Measure: Severity of memory problems

Depression Measure: Hamilton Depression Rating Scale

Depressed Sample: Inpatient/Outpatient elderly with mild to moderate
depression

2. Popkin, Gallagher, Thompson, & Moore (1982)

#1 18 4.28 1.27 23 5.01 1.20 41 .29
#2 18 4.02 .99 23 4.69 1.19 41 .30
#3 18 4.24 1.06 23 4.77 .90 41 .27

Complaint Measure: Metamemory Questionnaire: Severity Subscale (#1), Eﬁ‘ort
Subscale (#2), Frequency Subscale (#3) ‘

Depression Measure: RDC diagnosis; Beck Depression Inventory; Zung Depression
Scale

Depressed Sample: Outpatient elderly diagnosed depressed

3. Zarit (1982)
#1 79 .22
#2 79 .25

Complaint Measure: Total memory problems
Depression Measure: lung Depression Scale (#1); Brief Symptom Inventory (#2)
Depressed Sample: Community dwelling elderly not assessed for

depression diagnosis

4. West, Boatwright, & Schleser (1984)
67 .25
Complaint Measure: Number of memory problems
Depression Measure: Beck Depression Inventory
Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

66
Table 8 (cont'd)

5. O'Hara, Hinrichs, Wallace, Lemke, & Kohout (1986)

#1 77 .34
#2 77 .32
#3 77 .20

Complaint Measure: Memory compared to others their age (#1); Memory compared
to when young adult (#2); Frequency of memory problems (#3)

Depression Measure: RDC diagnosis; SADS-L; CES-D

Depressed Sample: Community dwelling elderly diagnosed depressed (p = 26),
elevated depressive symptoms not meeting criteria for
depression (p = 25), and healthy controls (p = 26).

6. Tun, Perlrnutter, Russo, & Nathan (1987)
144 .49
Complaint Measure: Short Inventory of Memory Experiences
Depression Measure: Zung Depression Scale
Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

7. Chandler & Gemdt (1988)
3 1 .42
Complaint Measure: Severity of memory complaint
Depression Measure: DSM-1H diagnosis
Depressed Sample: Inpatient elderly diagnosed depressed

8. Derouesne, Alperovitch, Arvay, Migeon, Moulin, Vollant, Rapin, & LePoncin (1989)
367 .33
Complaint Measure: Severity of memory complaint
Depression Measure: Zung Depression Scale
Depressed Sample: Community dwelling elderly not assessed for
depression diagnosis

9. Niederehe & Yoder (1989)
24 27.38 8.31 22 24.77 5.73 46 .18
Complaint Measure: Metamemory Questionnaire: Concerns Subscale
Depression Measures: RDC diagnosis; SADS-L; Hamilton Depression Rating Scale
Depressed Sample: Outpatient/Community dwelling elderly diagnosed depressed

10. O'Boyle, Amadeo, & Self (1990)
22 .61
Complaint Measure: Cognitive Complaints Inventory
Depression Measure: DSM-III diagnosis; Beck Depression Inventory
Depressed Sample: Inpatient elderly diagnosed depressed

67
Table 8 (cont'd)

11. O'Connor, Pollitt, Roth, Brook, & Reiss (1990)
36 3.40 2.10 213 1.30 1.40 249 .70
Complaint Measure: Number of memory complaints
Depression Measure: DSM-III-R diagnosis
Depressed Sample: Outpatient elderly diagnosed depressed

12. Zelinski, Gilewski, & Anthony-Bergstone (1990)
198 .28
Complaint Measure: Memory Functioning Questionnaire: Frequency of Forgetting
Depression Measure: Zung Depression Scale
Sample: Community dwelling elderly not assessed for
depression diagnosis

13. Feehan, Knight, & Partridge (1991)
10 47.40 11.39 20 33.30 11.50 30 .56
Complaint Measure: Cognitive Failures Questionnaire
Depression Measure: DSM-HI diagnosis; Geriatric Depression Scale
Depressed Sample: Community dwelling elderly diagnosed depressed

14. Grut, Jorm, Fratiglioni, Forsell, Vritanen, & melad (1993)
436 .22
Complaint Measure: Presence of memory complaints
Depression Measure: Comprehensive Psychopathological Rating Scale
Sample: Community dwelling elderly not assessed for
depression diagnosis

Sm:
Weighted M: .34
Weighted Q: .02

68
Table 9

Memory Complaints and Dementia

 

Author(s) Demented Control
a M S_D n M SD 1:1 r

 

1. Kahn, Zarit, Hilbert, & Niederehe (1975)

#IA 66 .07

#1B 66 -.08

#IC 66 .19

#1D 66 .03

#2A 66 -.20

#2B 66 -.32

#2C 66 .03

#2D 66 -. 15
Complaint Measure: Severity of memory problems: recent personal (A), recent

general (B), remote personal (C), remote general (D)
Dementia Measures: Face-Hand Test (#1); Mental Status Questionnaire (#2)
Dementia Sample: Inpatient/Outpatient elderly diagnosed with altered brain
function based on the Face-Hands (p = 38) and the Mental
Status Questionnaire (p = 28)

2. Niederehe & Yoder (1989)
10 30.09 9.17 22 24.77 5.73 32 .40
Complaint Measure: Metamemory Questionnaire: Concerns Subscale
Dementia Measures: Mental Status Questionnaire; Face-Hand Test
Dementia Sample: Outpatient/Community dwelling elderly diagnosed with
dementia

3. McGlone, Gupta, Humphrey, Oppenheimer, Mirsen, & Evans (1990)
29 7.40 3.60 35 11.80 4.30 64 .49
Complaint Measure: Memory Observation Questionnaire-SA
Dementia Measures: DSM-III diagnosis; NINCDS-ADRDA
Dementia Sample: Elderly patients diagnosed with dementia, Alzheimer‘s type

Table 9 (cont’d)

69

4. O'Connor, Pollitt, Roth, Brook, & Reiss (1990)

#1 80 2.20

1.70 213 1.30 1.40 293 .32

#2 55 2.60 2.10 213 1.30 1.40 268 .46

Complaint Measure:
Dementia Measure:
Dementia Sample:

Number of memory complaints

CAMDEX diagnosis

Outpatient elderly diagnosed with mild (#1) or moderate
dementia (#2).

5. Feehan, Knight, & Partridge (1991)
10 20.00 9.29 10 29.30 10.34 20 -.44

Complaint Measure:
Dementia Measures:

Dementia Sample:

Cognitive Failures Questionnaire

DSM-III diagnosis; Hachinski Ischemic Scale; Mini Mental
State Examination

Inpatient elderly diagnosed with dementia, Alzheimer's type

6. Grut, Jorrn, F ratiglioni, Forsell, Viitanen, & Winblad (1993)

Complaint Measure:
Dementia Measures:

Dementia Sample:

Sum:

178 -.30
Presence of memory complaints
DSM-III-R diagnosis, Clinical Dementia Rating Scale,
Mini Mental State Examination
Community dwelling elderly diagnosed with
dementia

Weighted M: . 17
Weighted &: .09

70
Table 10

Memog Complaints and Depression/Pseudodementig

 

Author(s) Depressed/Pseudodem. Control

 

a M S_D a M S_D N r
1. O'Boyle, Amadeo, & Self (1990)
11 .81
Complaint Measure: Cognitive Complaints Inventory
Dementia Measure: Mini Mental State Examination
Depression Measure: DSM-III diagnosis; Beck Depression Inventory
Sample: Inpatient elderly diagnosed with major depression

and also displaying reversible dementia

Table 11

71

Complaints versus Performance: Demented Samples

 

Author(s)

IZ
r—r

 

1. Kahn, Zarit, Hilbert, & Niederehe (1975)

Complaint Measure:
Memory Measure:
Dementia Measure:
Sample:

48 .06
Severity of memory problems
Babcock Story Recall
Face-Hand Test; Mental Status Questionnaire
Inpatient/Outpatient elderly diagnosed with altered
brain function

2. O'Connor, Pollitt, Roth, Brook, & Reiss (1990)

#1

#2

Complaint Measure:
Memory Measure:

Dementia Measure:
Sample:

SUMﬂ y:

80 .29

55 .27
Number of memory complaints
Cambridge Mental Disorders of the Elderly Examination
(CAMDEX), sum of 7 verbal and visual memory tests
CAMDEX diagnosis
Elderly medical patients diagnosed with mild or
moderate dementia

Weighted M: .22
Weighted _s_1_)_: .or

72
Table 12

Complaints versus Performance: Depressed Samples

 

Author(s)

IZ

 

1. Kahn, Zarit, Hilbert, & Niederehe ( 1975)
105 -.01
Complaint Measure: Severity of memory problems

Memory Measure: Babcock Story Recall
Depression Measure: Adjective Mood Checklist; Hamilton Depression Rating Scale

Sample: Inpatient/Outpatient elderly with mild to moderate
depression

2. O'Connor, Pollitt, Roth, Brook, & Reiss (1990)
36 .01

Complaint Measure: Number of memory complaints
Memory Measure: Cambridge Mental Disorders of the Elderly Examination

(CAMDEX)
Depression Measure: DSM-III-R diagnosis
Sample: Elderly medical patients diagnosed depressed
Summit
Weighted M: .00

Weighted S_D_: .00

Table 13

73

Complaints versus Performance: Heglthy Elderly Samples

 

 

 

Author(s)
N r
1. Zarit (1982)
#1 79 .40
#2 79 .3 1
Complaint Measure: Total memory problems
Memory Measure: 15-item word list, total recall score, 1 trial (#1); 15-item
shopping list, total recall score, 1 trial (#2)
Sample: Community dwelling elderly not assessed for any

diagnoses

2. Sunderland, Watts, Baddeley, & Harris (1986)

#1
#2
Complaint Measure:

Memory Measure:
Sample:

60 .26

60 .37
Frequency of memory problems from Sunderland's Memory
Questionnaire (#1); Sunderland's Memory Questionnaire (#2)
Paragraph recall
Community dwelling elderly not assessed for any
diagnoses

3. O'Connor, Pollitt, Roth, Brook, & Reiss (1990)

Complaint Measure:
Memory Measure:

Dementia Measure:
Depression Measure:
Sample:

213 .05
Number of memory complaints
Cambridge Mental Disorders of the Elderly Examination
(CAMDEX)
CAMDEX
DSM-III-R
Elderly medical patients not meeting dementia or
depression diagnosis

74
Table 13 (cont’d)

4. Zelinski, Gilewski, & Anthony-Bergstone (1990)
#1 198 .13
#2 198 .23
Complaint Measure: Memory Functioning Questionnaire: Frequency of Forgetting
Memory Measure: Paragraph recall (#1); 20-item word list, total recall score,

1 trial
Sample: Community dwelling elderly not assessed for any
diagnoses
5. Taylor, Miller, & Tinklenberg (1992)
#1 43 .10
#2 43 .25
#3 43 .17

Complaint Measure: Memory Functioning Questionnaire

Memory Measure: 12-item Selective Reminding Test, total recall score for trial 1
(#1), trial 2 (#2), and trial 3 (#3)

Dementia Measure: Mini Mental State Examination

Depression Measure: Hamilton Depression Rating Scale

Sample: Community dwelling elderly not meeting dementia or
depression diagnosis.
6. Gannon (1994)
45 .21
Complaint Measure: Summed g-score of presence and frequency of memory

complaints

Memory Measure: Summed g-score of 12-item Selective Reminding Test, total
recall score, 6 trials and Logical Memory Form I averaged
over 3 assessment periods

Sample: Community dwelling elderly not assessed for any
diagnoses

51mm:
Weighted M: .20
Weighted S_D: .01

75
Table 14

Complaints versus Performance: Depressed and Healthy Elderly Samples

 

 

Author(s)
N r
1. O'Hara, Hinrichs, Wallace, Lemke, & Kohout (1986)
#1 77 .21
#2 77 .03
#3 77 .07

Complaint Measure: Memory compared to others their age (#1); Memory compared
to when young adult (#2); Frequency of memory problems (#3)

Memory Measure: 20-item word list, total recall score, 1 trial

Depression Measure: RDC diagnosis; SADS-L; CES-D

Sample: Community dwelling elderly diagnosed depressed m = 26),
elevated depressive symptoms not meeting criteria for
depression (r_r = 25), and healthy controls m = 26).

Summgy:
Weighted M: .10
Weighted SQ: .01

Table 15

76

Complaints versus Performance: Demented. Depressed. and Healthy Elderly Samples

 

Author(s)

1H

11

 

1. Derouesne, Alperovitch, Arvay, Migeon, Moulin, Vollant, Rapin, & Le Poncin (1989)

Complaint Measure:
Memory Measure:
Dementia Measure:
Depression Measure:

Sample:

367 .08
Severity of memory complaints
Global Memory Score of 8 verbal and visual tests
Below 2 S_D on Proﬁl de rendement; Visual Retention Test
Zung Depression Scale; Zung Anxiety Scale; Well Being
Questionnaire
Community dwelling elderly diagnosed with organic brain
dysﬁmction (r_r = 23), psychoaﬁ‘ective brain dysfunction
(r_r = 63), healthy controls (p = 269), and organic!
psychoaﬁective brain dysﬁmction (p = 12)

2. Niederehe & Yoder (1989)

#1

#2

Complaint Measure:
Memory Measure:

Dementia Measure:

Depression Measure:
Sample:

Summg y:

54 .22

54 -.20
Metamemory Questionnaire: Concerns Subscale
40-item word list, total recall score, 1 trial (#1); paragraph
recall (#2)
Mental Status Questionnaire; Face-Hand Test
RDC diagnosis; SADS-L; Hamilton Depression Rating Scale
Outpatient/Community dwelling elderly diagnosed demented
(p = 10), depressed (p = 24), or healthy controls (p = 22)

Weighted m: -. 11
Weighted S_D: .oo

Table 16

77

Differentiation of Short- and Long-Term Memory

 

§u_bie_cﬂ

SUM:
S'I'M:
LTM
RLTR:
CLTR:

><><><><

X

Trial

30
18
27
12
00

Subject 2

Trial
234

30
07
34
10
13

 

78
Table 17

Hypotheses 95% Conﬁdence Interyaﬁ

 

 

Worst Best
Case Case
Hypothesis #1:
Memory complaints and somatic depression .22 .50
Memory complaints and cogntive depression .19 .44
Hypothesis #2 & 3:
Memory complaints and depressed mood .11 .39
Memory complaints and diminished interests .29 .56
Memory complaints and weight/appetite changes -. 14 .21
Memory complaints and sleep problems .27 .56
Memory complaints and fatigue .20 .49
Memory complaints and worthlessness/guilt .06 .35
Memory complaints and decreased concen./indec. .58 .82
Memory complaints and death/suicide .04 .33
Hyppthesis 4:
DEP and LTS -.35 -.06
DEP and CR -.33 -.07
Hypothesis 5:
Memory complaints and CR -. 16 .11
Memory complaints and RLTR -.03 .28
Memory complaints and total recall -. 10 .18
H i 6:
Memory complaints and DEP .23 .51

APPENDIX C

APPENDIX C

Rule of Combinations

This rule states that the number of possible choices of "r" objects from a group of
"N" distinct objects is denoted by (N/r). Given that the Selective Reminding Test (i.e.,
SRT) contains six trials, each word can be recalled from zero to six times. The number of
possible choices for zero through 6 successful recall attempts is given immediately below
with their breakdown across trials.

If a word is recalled all six times across six trials, the number'of possible combinations is
given by 6x5x4x3x2x1/6x5x4x3x2x1. This equals one possible combination (i.e., event).

T__rial
1 2 3 4 5 6 SUM STM LTM QLTR RLTR
Event] x x x x x x 6 0 6 6 0

Ifa word is recalled ﬁve times across six trials, the number of possible combinations is
given by 6x5x4x3x2/5x4x3x2x1. This equals six possible events.

Trial
1 2 3 4 5 6 S_UM L L__TM CLTR RLTR
Event 1 x x x x x 5 0 6 0 5
Event 2 x x x x x 5 0 6 0 5
Event 3 x x x x x 5 0 6 2 3
Event 4 x x x x x 5 0 6 3 2
Event 5 x x x x x 5 1 4 4 0
Event 6 x x x x x 5 0 5 5 0

79

80

If a word is recalled four times across six trials, the number of possible combinations is
given by 6x5x4x3/4x3x2x1. This equals 15 possible events.

 

Trial
1 2 3 4 5 6 SUM STM LTM CLTR RLTR
Event 1 x x x x 4 0 6 0 4
Event 2 x x x x 4 0 5 O 4
Event 3 x x x x 4 0 4 4 0
Event 4 x x x x 4 O 6 0 4
Event 5 x x x x 4 0 6 O 4
Event 6 x x x x 4 0 5 0 4
Event 7 x x x x 4 1 4 O 3
Event 8 x x x x 4 1 3 3 0
Event 9 x x x x 4 1 3 3 0
Event 10 x x x x 4 O 6 0 4
Event 11 x x x x 4 0 6 2 2
Event 12 x x x x 4 O 5 2 2
Event 13 x x x x 4 0 6 0 4
Event 14 x x x x 4 1 4 O 3
Event 15 x x x x 4 2 2 2 0

81

If a word is recalled three times across six trials, the number of possible combinations is
given by 6x5x4/3x2x1. This equals 20 possible events.

 

 

 

Trial
1 2 3 4 5 6 SUM STM LTM CLTR RLTR
Event 1 x x x 3 0 6 0 3
Event 2 x x x 3 0 5 0 3
Event 3 x x x 3 0 4 O 3
Event 4 x x x 3 0 3 3 0
Event 5 x x x 3 0 6 0 3
Event 6 x x x 3 0 6 0 3
Event 7 x x x 3 0 6 O 3
Event 8 x x x 3 0 5 0 3
Event 9 x x x 3 0 5 0 3
Event 10 x x x 3 0 4 O 3
Event 11 x x x 3 1 4 0 2
Event 12 x x x 3 3 O 0 0
Event 13 x x x 3 3 0 0 0
Event 14 x x x 3 3 0 0 0
Event 15 x x x 3 1 3 O 2
Event 16 x x x 3 1 3 0 2
Event 17 x x x 3 1 2 2 0
Event 18 x x x 3 l 2 2 0
Event 19 x x x 3 1 2 2 0
Event 20 x x x 3 3 0 0 0

82

If a word is recalled two times across six trials, the number of possible combinations is
given by 6x5/2x1. This equals 15 possible events.

 

Trial
1 2 3 4 5 6 SUM STM LTM CLTR RLTR
Event 1 x x 2 0 6 O 2
Event 2 x x 2 2 O 0 0
Event 3 x x 2 2 0 0 0
Event 4 x x 2 2 O 0 0
Event 5 x x 2 2 0 0 0
Event 6 x x 2 0 5 0 2
Event 7 x x 2 2 0 0 0
Event 8 x x 2 2 0 0 0
Event 9 x x 2 2 0 0 0
Event 10 x x 2 O 4 0 2
Event 11 x x 2 2 0 0 0
Event 12 x x 2 2 0 0 0
Event 13 x x 2 O 3 0 2
Event 14 x x 2 2 O 0 0
Event 15 x x 2 O 2 2 0

Ifa word is recalled one time across six trials, the number of possible combinations is
given by 6/1. This equals six possible events.

Trial
1 2 3 4 5 6 SM 5m _Iﬂ CLTR RLTR
Event 1 x 1 1 O 0 0
Event 2 x 1 1 0 0 0
Event 3 x l 1 0 0 0
Event 4 x 1 1 0 0 0
Event 5 x 1 l 0 0 0
Event 6 x 1 1 0 0 O

Ifa word is recalled zero times across six trials, the number of possible combinations is
given by 0/0. This equals one possible event.

133.1
123456 SUMSTMLTMCLTRRLTR

Event 1 0 0 O O O

APPENDIX D

 

APPENDIX D

W81.

 

Shine Grass
Disagree Moon
Fat Prepare
Wealthy Prize
Drunk Duck
Pin Leaf

 

 

83

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