Abstract
Background
Concerns of memory decline in older adults are the bridge connecting the patient to appropriate clinical services, and are therefore worthy of study. Current approaches to the measure of subjective memory complaints involves thematically unstructured questionnaires. These measures do not tap the complexity of memory complaints in a clinical presentation. Our aim was to study memory complaints through a qualitative thematic analysis.
Methods
A semi-structured interview, probing scenarios derived from clinical protocols, was administered to 80 healthy elderly controls (M age =75.6, SD =6.9) and 43 individuals with MCI (M age =79.6, SD =6.9). Responses were transcribed and coded, and were grouped according to their thematic content.
Results
Eleven themes were extracted: frequency, sense of predomination, situational or general lapses, contextual recall, coping strategies, dismissive attitude, vagueness, impact on affect, sense of progression of memory decline, dependency on a significant other, and quality of the account. MCI participants complained significantly more about frequency, a sense of predomination, progression, dependency and impact on affect. They were also more dismissive of their memory symptoms (dismissive attitude), and displayed a poorer overall quality of their account. Individuals with MCI expressed more maladaptive coping strategies, with poorer contextualisation of their recent memory lapses. MCI participants were approximately four times more likely to exhibit maladaptive coping strategies, and twice as likely to express a sense of progression. Healthy controls were 1.6 times more likely, on the other hand, to complain of poorer attentional focus (vagueness).
Conclusions
This is the first thematic analysis of memory complaints in the elderly. While most themes were elevated in individuals with MCI, we found certain complaints more effectively differentiated between the diagnostic categories. Complaints of vagueness were more likely to be expressed in healthy elderly individuals, perhaps driven by affective or stress-related factors. MCI individuals were more likely to express maladaptive coping strategies and a sense of progressive memory decline, suggesting a complaint more aligned with an organic condition. Thematic analysis of subjective memory complaints in affected individuals on clinical presentation has the potential to provide a clearer window into the earliest manifestations of Alzheimer's disease than conventional memory complaint questionnaires.