LAUSR

Memory complaints become increasingly common as individuals grow older, which is often thought to reflect the normal aging process rather than a pathological process (Howieson et al., 2015). However, there is also growing evidence that for a subset of these individuals, memory complaints may in fact be an early sign of cognitive changes due to Alzheimer’s disease (AD) (Jessen et al., 2014). Discerning the benign complaint from the more worrisome, particularly among individuals who are otherwise cognitively unimpaired, is a challenge. The context by which memory complaints are captured may be one method to improve our ability to discern the meaningfulness of the complaint. Study setting has been previously shown to increase the likelihood that a complaint is prognostic of future clinical progression (Snitz et al., 2018). Additionally, individual differences of study participants, such as personality, increase the likelihood of reporting memory complaints in the setting of elevated amyloid (Snitz et al., 2015). Demographic factors, such as age and educational level, may modify the relationship between memory complaints and elevated amyloid. Specifically, in a study by Aghjayan et al. (2016), individuals with lower education reported higher memory complaints overall, but it was among individuals with higher education who showed a stronger association between amyloid burden and memory complaints. Mood and anxiety have been strongly correlated with memory complaints cross-sectionally; however, a recent longitudinal study (Hill et al., 2020) reveals the complex relationship between memory complaints and depressive symptoms. While memory complaints and depressive symptoms showed concurrent associations longitudinally, there was less evidence for a temporal influence of memory complaints predicting depressive symptoms or vice versa across the entire sample. Lesser known is the role of response bias or a tendency to overor underreport symptoms as it relates to memory complaints, although a prior study by Consentino and colleagues (2018) found that subjective memory complaints were associated with subjective report of physical function, but not objective physical function, indicating that individuals’ subjective report may reflect a broader perception about health than just cognitive functioning. Goldberg and colleagues (2020) investigate multiple factors that could influence subjective report of memory complaints. Participants in this study (Goldberg et al., 2020) were both from a community-based sample and a memory clinic sample and were administered the same subjective memory questionnaires and personality questionnaires. Associations between study setting, personality, and response bias were investigated. Greater neuroticism, depressive symptoms, and subjective memory complaints were found in the memory clinic sample, compared to the community-based sample, as well as lower extraversion and lower conscientiousness. Individuals in the memory clinic setting did not demonstrate higher overreporting than the community-based participants. By contrast, underreporting was higher in the community-based sample compared to the memory clinic sample. Underreporters were also more likely to have higher agreeableness scores. When examining associations with response bias and personality and memory complaints, overreporting was associated with greater memory complaints, albeit on different questionnaires in the different samples. Underreporting showed a negative correlation with cognitive complaints. Further, neuroticismwas associated with overreporting in the memory clinic sample and inversely associated with underreporting in the community-based sample. Extraversion also showed a divergence by sample, with a positive association with underreporting in the memory clinic sample and a negative relationship with overreporting in the community-based sample. This paper highlights two important considerations when determining the significance of a memory complaint in an older person: (1) individual differences, such as personality and response bias, are associated with memory complaints, and it is possible that these constructs are overlapping and not entirely differentiated, which impacts the significance of a memory complaint. For example, it may be that for those with a longstanding history of concern about physical or mental health, a memory complaint becomes less prognostic of disease in this International Psychogeriatrics (2021), 33:7, 645–646 © International Psychogeriatric Association 2021