A conversation analysis of therapist repeats in open dialogue network meetings.

Writings on Open Dialogue approaches to working with families experiencing mental distress emphasize the importance of the therapist repeating the family's words back to them verbatim. Repeats are theorized to display the therapist's listening and to encourage elaboration without imposing the therapist's own interpretations or conclusions on the family. These recommendations have not been subjected to rigorous interactional investigation. In this study, we used conversation analysis to analyze 160 examples of therapists repeating the prior talk of the family from 14 h of video-recorded Open Dialogue sessions. We found that these repeats had similar functions to those previously described in conversation analysis research such as initiating repair, marking receipt, and requesting elaboration as well as examples of therapist repeats occurring in overlap with the talk of the client. Open Dialogue writings thus present an oversimplified account of how repeats are utilized in clinical Open Dialogue sessions. Consistent with dialogical writings, repeats can elicit elaboration with limited input from the therapist, however repeats reflect selectivity and function to direct and guide the conversation to some extent. So, while therapist authority can be mitigated by repeating clients' words, when a therapist chooses to employ a repeat actively shapes the direction of the interaction.

The relatives of people with depression: A systematic review and methodological critique of qualitative studies.

Being a close relative of a person with depression can take a heavy toll on the former, but these relatives are increasingly made responsible for taking on extensive carer roles. Research on relatives of people with depression is currently dominated by a focus on "carer burden" and although such a focus can explain many relatives' experiences and daily lives, it provides very limited insight into the everyday life of a person living with someone with depression. Therefore, we scoped qualitative research on people who are relatives of people living with depression and identified knowledge gaps caused by explicit or implicit theoretical or methodological assumptions. We conducted an exhaustive literature search in CINAHL, PubMed, PsycINFO, Sociological Abstracts, and Eric. In total, 34 publications were included, their quality evaluated and their findings mapped and summarized. We identified four interrelated and overlapping themes that dominated the findings of the publications: (a) recognition of "depression", (b) emotional responses, (c) interruptions of relationships, and (d) a staged psychosocial process. The vast majority of studies presented de-contextualized and underinterpreted analyses assuming a homogeneity of (illness) experiences and disregarded the important influence of social contributors to social relationships, connectedness, and mental health problems.

Power and dialogue: A review of discursive research.

Collaborative-dialogic approaches to family therapy advise therapists to take a position of client-as-expert and promote an equality of multiple perspectives. This has led to debates about how to conceptualize power in dialogical therapies with scholars theorizing and researching power as social and negotiated through interaction. We aimed to understand power in dialogical therapy through reviewing discursive research on therapeutic conversations. We performed a systematic search of bibliographical databases PsycINFO, PubMed, and CINAHL. We reviewed the findings from 18 studies utilizing discursive analyses of collaborative-dialogical therapy sessions and examined their findings in relation to power within interactions. We found a strong focus on the practices of the therapist rather than on those of the client. The therapist was presented as a catalyst of dialogue using minimal and active responses to promote dialogical conversations. Therapists also utilized power in response to broader institutional and social demands that may not be consistent with some interpretations of dialogical therapy. We consider practice implications where the exercise of power to direct a session facilitates dialogical interactions.

Open dialogue trainees' perspectives on learning processes and psychotherapeutic practice: A prospective focus group study.

Open Dialogue is a collaborative approach to mental health care emphasizing integrated services and a dialogical psychotherapy approach. Open Dialogue training programs eschew traditional didactic teaching of technical therapeutic skills in favor of more experiential learning processes. It is unclear how these training programs affect trainees and shape their perspectives on Open Dialogue. Our aim was to follow up a group of Australian Open Dialogue trainees and explore their perspectives on learning processes and psychotherapeutic practice. We utilized a prospective focus group design with data from audio-recorded focus groups convened before (n = 2) and after (n = 3) participants completing an advanced Open Dialogue training program. Data were subjected to reflective thematic analysis. We identified the theme "Extending possibilities by holding ideas lightly," which represented a universal principle that participants applied to multiple aspects of their practice, for example, favoring multiple perspectives and approaches to therapy, including those other than Open Dialogue. This theme had two sub-themes: (1) "Allowing intimacy by being aware of personal biographies" and (2) "Learning by joining others," which reflected an increased willingness by participants to reflect on and share their inner experiences and an emphasis on joint experiential exercises in the training program. "Extending possibilities by holding ideas lightly" facilitated a means of incorporating a dialogical perspective into existing practices thus avoiding the potential barriers to a wholesale implementation of Open Dialogue. Findings indicated that the participants were not learning how to practice a therapeutic technique or propositional knowledge, but were socialized into a dialogical way of being.

Process modelling and techno economic analysis for optimal design of integrated electrocoagulation-membrane system for dye removal in wastewater.

Textile industry, one of the largest exporting industries in Malaysia, generates azo dyes wastewater which cannot be easily decomposed biologically due to its high stability and xenobiotic nature. Conventional electrocoagulation (EC) system requires high energy consumption, resulting in higher operating cost while membrane system suffers from fouling. To eliminate these drawbacks, an integrated electrocoagulation - membrane (ECM) system has been proposed as one of the emerging methods for treating dye wastewater. However, feasibility analysis of the proposed system is yet to be conducted. This study proposes a statistical technique to evaluate the techno-economic feasibility of the system via John's Macintosh Project (JMP) software. From JMP, an equation represents the whole model had been obtained for each of the system, EC standalone and ECM system. The models have been validated experimentally it is proven all the models can reach dye removal efficiency of 96%. Overall, the total cost for ECM system (1 V and 1.0 g of NaCl) was 40.44% cheaper than the conventional dye treatment method with total cost of 1.079 million MYR. EC standalone system at 1 V and 1.0 g however were found to be more economically feasible with 0.325 million MYR or 82.07% cheaper compared to conventional photocatalytic method. EC standalone system was also more economical than ECM system due to lower capital cost expended for installation of membrane tank and additional membrane purchase.

Implementing Open Dialogue approaches: A scoping review.

Open Dialogue approaches fall broadly into the area of systemic psychotherapeutic practices. They encourage active participation of families and social networks, and emphasize genuine collaboration within highly integrated systems of health-care service delivery. These approaches are currently being implemented in a growing number of services across the globe, and in this review, we summarize and discuss insights from papers concerned with the implementation of Open Dialogue. We used a scoping review method, which included systematic literature searches and summarizing data extraction as well as consultation with eight Open Dialogue implementation stakeholders who were invited to comment on preliminary review findings and a draft paper. We included 18 studies in the review and present their content under four thematic headings: 1. Training, 2. Family and network experiences, 3. Staff members' experiences, and 4. Structural and organizational barriers and resistance to implementation. In general, the studies did not include rich descriptions of the implementation contexts, which made it difficult to draw conclusions across studies about effective implementation practices. The discussion draws on Jamous and Peloille's (Professions and professionalisation, 1970, Cambridge University Press, 109-152) concepts of "indeterminacy" and "technicality," and we argue that the indeterminacy that dominates Open Dialogue is a challenge to implementation efforts that favor specific and standardized practices. We conclude by encouraging the development of implementation initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental spirit of the approach.

Los métodos de diálogo abierto (Open Dialogue) pertenecen ampliamente al área de las prácticas psicoterapéuticas sistémicas. Estos fomentan la participación activa de las familias y los contactos sociales, y enfatizan la colaboración genuina dentro de los sistemas sumamente integrados de prestación de servicios de asistencia sanitaria. Estos métodos se están implementando actualmente en un número cada vez mayor de servicios en todo el mundo y, en esta revisión, resumimos y debatimos los conocimientos obtenidos de artículos relativos a la implementación del diálogo abierto. Utilizamos un método de revisión exploratoria, que incluyó búsquedas sistemáticas de publicaciones y resúmenes de extracción de datos, así como consultas con ocho partes interesadas en la implementación del diálogo abierto, a quienes se las invitó a comentar sobre los resultados preliminares de la revisión y sobre un borrador del artículo. Incluimos 18 estudios en la revisión y presentamos su contenido en cuatro títulos temáticos: 1. Capacitación, 2. La familia y las experiencias de contacto social, 3. Las experiencias de los miembros del personal, y 4. Los obstáculos estructurales y organizativos y la resistencia a la implementación. En general, los estudios no incluyeron descripciones valiosas de los contextos de implementación, lo cual dificultó la posibilidad de sacar conclusiones entre los estudios con respecto a las prácticas eficaces de implementación. En el debate se utilizan los conceptos de "indeterminación" y "tecnicidad" de Jamous y Peloille's (1970), y argumentamos que la indeterminación que domina el diálogo abierto supone un desafío para los esfuerzos de implementación que favorecen prácticas específicas y estandarizadas. Finalizamos fomentando el desarrollo de iniciativas de implementación que teorizan las prácticas de diálogo abierto con niveles más altos de tecnicidad sin alterar el espíritu fundamental del método.

Downgrading Deontic Authority in Open Dialogue Reflection Proposals: A Conversation Analysis.

The Open Dialogue approach promotes collaboration with clients and families in decisions about the direction of therapy. This creates potential problems for Open Dialogue therapists who seek collaboration but also have responsibility for managing the session. Using conversation analysis, we examined 14 hours of video recordings of Open Dialogue sessions, and specifically how therapists proposed the transition to a reflecting conversation. We found that, when making proposals to reflect, therapists routinely downgrade their deontic authority (i.e., adopt a less powerful, more collaborative position). They did this through framing proposals as interrogatives, providing accounts, and by prefacing their proposals with "I'm wondering". More heavily downgraded proposals made acceptance less salient, potentially risking transition to the reflection. These findings provide more detail on how theoretical concepts such as "collaboration" and "power" are actually displayed and negotiated in practice and can contribute to a more nuanced understanding of what constitutes Open Dialogue.

El método de diálogo abierto promueve la colaboración con los pacientes y las familias en las decisiones acerca del rumbo de la terapia. Esto genera posibles problemas para los terapeutas que implementan el diálogo abierto y que buscan colaboración, pero que también tienen la responsabilidad de manejar la sesión. Utilizando el análisis de la conversación, analizamos 14 horas de videograbaciones de sesiones de diálogo abierto y, específicamente, cómo los terapeutas propusieron la transición a una conversación reflexiva. Descubrimos que, cuando los terapeutas hacen una propuesta de reflexionar, habitualmente rebajan su autoridad deóntica (p. ej.: adoptan una postura menos poderosa y más colaborativa). Para esto, los terapeutas plantearon las propuestas como interrogaciones, ofrecieron explicaciones e introdujeron sus propuestas con la frase: "Me pregunto". Las propuestas más rebajadas hicieron que la aceptación se destacara menos, arriesgando potencialmente la transición a la reflexión. Estos hallazgos ofrecen mas detalles sobre cómo los conceptos teóricos, como la "colaboración" y el "poder", en realidad se muestran y se negocian en la práctica, y pueden contribuir a una comprensión más matizada de lo que constituye el diálogo abierto.

Eliciting Stance and Mitigating Therapist Authority in Open Dialogue Meetings.

Open Dialogue is a collaborative systemic approach to working with families in crisis. A core feature is the creation of dialogue through the elicitation of a multiplicity of voices. Using conversation analysis, we studied 14 hr of Open Dialogue sessions. We found that therapists recurrently produced utterances containing "I'm wondering." These utterances topicalized particular issues and invited stance positions from other participants while also allowing the therapist to mitigate their deontic authority and present potentially disaligning stances. Therapists thus exercised authority in eliciting stances, but provided recipients with multiple avenues for responding. These findings illustrate that therapist authority is not necessarily antithetical to dialogue and, in well-crafted forms, may even be necessary for the creation of polyphony through the elicitation of multiple stances.

"Y, what do you think about what X just said?" Conversation analysis of stance-eliciting questions in open dialogue network meetings.

Open dialogue is a resource-oriented approach to mental health, which aims to help those involved in a crisis situation support each other and engage in dialogue. While language use in open dialogue is generally characterized as being open-ended, nondirective, and nonevaluating on the professionals' side, little is known about the specific conversational features. The aim of this study was to analyze the interactional functions of a stance-eliciting question of the form: "Y, what do you think about what X just said?" We used conversation analysis (CA) to examine this in eight video-recorded Danish open dialogue network meetings. In CA, stance involves expressions of attitude, affect, or judgments about people or events. We describe the interactional functions of these stance-eliciting questions and discuss how clinicians used them as a tool for accomplishing neutrality. The findings can be used to gain a more nuanced understanding of open dialogue psychotherapeutic practices.

Physical activity and cognition in young-onset Parkinson's disease.

BACKGROUND: A relationship has been observed between physical activity and cognition in older-onset Parkinson's disease, as well as improvements in cognition after a physical activity intervention. To date, this has not been investigated in young-onset Parkinson's disease (YOPD). OBJECTIVES: To examine the baseline relationship between physical activity and cognition in YOPD; and to examine whether a physical activity intervention can improve cognition in YOPD. METHODS: Two interrelated online studies were conducted. In the first study, 132 participants with YOPD completed self-reported measures of physical activity, and objective and subjective measures of cognition. A subset of 38 participants was then randomly allocated to either a six-week physical activity intervention or control condition. Following the intervention, participants repeated the objective and subjective cognitive measures. RESULTS: No relationship was found between self-reported physical activity and objective cognition; however, there was a relationship between physical activity and subjective cognition. Similarly, following the intervention subjective improvements were found for concentration, attention, and processing speed, but not for memory. Furthermore, medium effect sizes were evident for objective measures of processing speed and small-medium effect sizes for planning and cognitive flexibility, although statistical significance was not reached. CONCLUSIONS: In this first study investigating physical activity and cognition in YOPD, the results suggest that increased physical activity relates to improved processing speed and attention. Replication is recommended with a larger sample size. A longer, more intense physical activity manipulation and utilizing the study's strengths of online recruitment and intervention delivery are also recommended.

Mediators of burden and depression in dementia family caregivers: Kinship differences.

OBJECTIVES: To investigate kinship differences in the caregiver stress process by developing multiple mediation models for two distinct caregiver subgroups (spouses and adult children of older adults living with dementia). The effect of four potential mediating variables (mastery, self-efficacy, satisfaction with social support, positive caregiving appraisals) on the relationship between perceived burden and depression was evaluated. METHOD: Family caregivers of a person living with dementia were recruited through national dementia and carer organisations. Participants completed a paper-based or electronic version of the study survey. A bias-corrected, accelerated bootstrapping method was used to test the effect of the four proposed mediating variables on the relationship between perceived burden and depression in each caregiver subgroup (spouses and adult children). RESULTS: Perceived burden was directly and significantly related to depression for both spouse caregivers and adult child caregivers. The mediation models explained approximately 50% of the variance in the burden-to-depression pathway for both caregiver subgroups. Mastery and social support (but not self-efficacy, nor positive caregiving appraisals) were found to individually significantly influence the impact of perceived burden on depression in spouse caregivers. All four proposed mediators failed to reach statistical significance as individual mediators of the burden-to-depression pathway in adult child caregivers. CONCLUSION: These findings demonstrate differences in the dementia caregiver experience according to kinship, and that certain mediating variables are more relevant for some subgroups of caregivers than others. Implications for the design of psychosocial interventions are discussed.

Conversation Analysis and Family Therapy: A Critical Review of Methodology.

This article critiques the use of conversation analysis (CA) as applied to the study of family therapy. Searches of relevant databases and journals as well as citation searches were conducted in April 2018 for relevant articles. Inclusion criteria included the explicit use of CA either solely or in combination with discourse analysis and discursive psychology. This resulted in the inclusion of 25 articles that were reviewed against a guideline for the evaluation of qualitative research to which five items specific to CA were added to ensure a specific and balanced evaluation of the studies. Articles generally had a good application of quality criteria although there was a variation in detail of transcription, application of sequence analysis, and a limited use of validity testing. CA has the potential to complement existing research on family therapy but requires a rigorous application of process and quality criteria. The article provides recommendations for future CA research into family therapy.

Este artículo analiza el uso del análisis de la conversación (CA) según se aplica al estudio de la terapia familiar. En abril de 2018 se realizaron búsquedas en bases de datos y revistas relevantes así como búsquedas de citas para artículos relevantes. Los criterios de inclusión incluyeron el uso explícito del análisis de la conversación, ya sea exclusivamente o combinado con el análisis del discurso y la psicología discursiva. Esto resultó en la inclusión de 25 artículos que se revisaron según una guía para la evaluación de la investigación cualitativa a la cual se agregaron cinco puntos específicos del análisis de la conversación para garantizar una evaluación específica y equilibrada de los estudios. Los artículos generalmente tuvieron una buena aplicación de los criterios de calidad, aunque hubo una variación en el detalle de la transcripción, la aplicación del análisis de secuencias y un uso limitado de la evaluación de la validez. El análisis de la conversación tiene el potencial de complementar las investigaciones existentes sobre terapia familiar, pero exige una aplicación rigurosa de los criterios de procesamiento y calidad. El artículo ofrece recomendaciones para futuras investigaciones sobre el análisis de la conversación en la terapia familiar.

Naturalistic Measurement of Sleep in Older Adults with Amnestic Mild Cognitive Impairment: Anxiety Symptoms Do Not Explain Sleep Disturbance.

BACKGROUND: Sleep disturbance is prevalent in Alzheimer's disease (AD). In amnestic mild cognitive impairment (aMCI), the preclinical stage of AD, deterioration in sleep quality has also been reported. Consensus is lacking, however, regarding what aspects of sleep are characteristically affected, whether the setting of the sleep recordings impacts these findings, and whether anxiety may account for the differences. OBJECTIVE: The current study aimed to address these knowledge gaps by obtaining comprehensive sleep measurement in aMCI within a naturalistic environment using in-home sleep recordings. METHODS: 17 healthy older adults and twelve participants with aMCI wore an actiwatch for two weeks to objectively record habitual sleeping patterns and completed two nights of in-home polysomnography. RESULTS: In aMCI, habitual sleep disturbances were evident on actigraphy including greater wake after sleep onset (p = .012, d = 0.99), fragmentation (p = .010, d = 1.03), and time in bed (p = .046, d = .76). Although not statistically significant, there was a large group effect on polysomnography with aMCI demonstrating less slow-wave-sleep than controls (p >.05, d = .0.83). Anxiety did not mediate the relationship between the group and sleep in this small study. CONCLUSIONS: The results indicate that people with aMCI have poorer quality sleep than healthy controls, as indicated by greater sleep disruption and less slow-wave sleep, even in naturalistic settings. Additionally, anxiety symptoms do not mediate the relationship. Therefore, this research supports the view that sleep disturbance is likely to be indicative of neuropathological changes in aMCI rather than being attributed to psychological factors.

Face-name memory training in subjective memory decline: how does office-based training translate to everyday situations?

This study aimed to examine whether people with subjective memory decline (SMD) benefit from face-name memory training (single session) as much as older adult controls in an office-based setting. Approximately 2 months later, groups were reassessed for translation to a naturalistic setting. In the office setting, there was a significant interaction between stimulus type (cued name; uncued name) and training condition (spaced retrieval, semantic association, no training), but no group differences nor interactions. Semantic association was only beneficial for cued names, whereas spaced retrieval was beneficial in cued and uncued conditions. In the naturalistic setting, however, there were no training effects. Naturalistic performance was predicted by demographics, cognition, and motivation. All groups reported improved memory control beliefs and contentment. Our study demonstrates the benefit of simple memory strategies for older adults, including those with SMD, in office-based settings. Translation to everyday settings is complex and may require prior intervention to increase motivation.

Prospective memory and subjective memory decline: A neuropsychological indicator of memory difficulties in community-dwelling older people.

INTRODUCTION: Prospective memory difficulties are known to occur in Alzheimer's disease, and may provide an early indicator of cognitive decline. Older people reporting high levels of subjective memory decline (SMD) but without evidence of cognitive decline on standard neuropsychological tests are increasingly considered at increased risk for Alzheimer's disease. Therefore, the objective of this study was to investigate whether prospective memory performance is differentially impaired in older people reporting high levels of SMD as compared to a control group. METHOD: A total of 195 community-dwelling older adults (Mage = 73.48 years) were assessed for self-reported complaints of memory decline and allocated to either a group reporting high levels of SMD (SMD, n = 96) or a healthy control group (HC, n = 99). Groups were assessed on neuropsychological tests, an experimental prospective memory task (focal vs. nonfocal cue conditions), and a naturalistic prospective memory task. RESULTS: The groups did not differ in performance on standard neuropsychological tests of working memory, executive attention, and episodic retrospective memory. Furthermore, on an experimental task of prospective memory (the Supermarket Shopping Trip task), although performance of both groups was better when cues for prospective memory were focal to the ongoing activity (η2 = .35), the SMD group were not impaired relative to the control group. On a naturalistic prospective memory task, however, there was a small but significant effect, with the SMD group performing more poorly than the HC group (η2 = .02). CONCLUSIONS: In older adults with high levels of SMD, naturalistic measures of prospective memory provide an approach to assessing memory performance that can offer a means of investigating the memory complaints of people with SMD. Identifying prospective memory difficulties in SMD also offers a focus for intervention.

Compromised Motor Dexterity Confounds Processing Speed Task Outcomes in Stroke Patients.

Most conventional measures of information processing speed require motor responses to facilitate performance. However, although not often addressed clinically, motor impairment, whether due to age or acquired brain injury, would be expected to confound the outcome measure of such tasks. The current study recruited 29 patients (20 stroke and 9 transient ischemic attack) with documented reduction in dexterity of the dominant hand, and 29 controls, to investigate the extent to which 3 commonly used processing speed measures with varying motor demands (a Visuo-Motor Reaction Time task, and the Wechsler Adult Intelligence Scale-IV Symbol Search and Coding subtests) may be measuring motor-related speed more so than cognitive speed. Analyses include correlations between indices of cognitive and motor speed obtained from two other tasks (Inspection Time and Pegboard task, respectively) with the three speed measures, followed by hierarchical regressions to determine the relative contribution of cognitive and motor speed indices toward task performance. Results revealed that speed outcomes on tasks with relatively high motor demands, such as Coding, were largely reflecting motor speed in individuals with reduced dominant hand dexterity. Thus, findings indicate the importance of employing measures with minimal motor requirements, especially when the assessment of speed is aimed at understanding cognitive rather than physical function.

Naturalistic prospective memory in older adults: Predictors of performance on a habitual task.

Age-related difficulties in episodic prospective memory (PM) are common. However, little is known about habitual PM, which involves remembering to carry out intended actions that are regular and repeated. This is important for many health-related tasks and for maintaining independence in daily living activities. This study investigates, in older people, the predictors of habitual PM performance in a naturalistic setting. A group of 191 community-based, older adults (aged 65-89 years) wore an actigraph over two weeks. The habitual PM task involved pressing a button twice daily (Bed-time, Rise-time) on the actigraph. Accuracy of response was calculated for Bed-time and Rise-time, determined by light, movement, and diary data. The contribution of retrospective memory and executive function to PM performance was assessed. PM was more accurate at Bed-time compared to Rise-time (p < .01), and better in the first compared to the second week (p < .01). Retrospective memory contributed small but significant unique variance (ß = .24) to PM accuracy. For older adults living in the community, both contextual factors (e.g., time of day) and retrospective memory are important for individuals' ability to remember to perform daily tasks. This is relevant when planning interventions for maintaining independent living in ageing.

Making sense of self in Alzheimer's disease: reflective function and memory.

OBJECTIVE: The current investigation examined the relationship between cognitive impairment and sense of self in Alzheimer's disease (AD). METHOD: Forty-nine participants with dementia associated with AD were recruited through memory clinics in Victoria, Australia. The 26 participants of the healthy control sample were recruited from a retirement village. Self was measured via the Reflective Self-Function Scale - a theory of mind indicator that provides personal and social self-reflection scores. Cognitive assessment included measures of new learning, executive function, and speed of information processing. RESULTS: A reduction in sense of self in mild AD was demonstrated in both personal and social domains, as compared to healthy adults of a similar age. With a focus on specific cognitive impairment relationships, new learning was found to predict personal self-reflection, whereas speed of information processing predicted social self-reflection capacity. CONCLUSION: Findings suggest that deficits in new learning ability contribute to a reduced ability of people with early AD to understand their mental world and interpret thoughts, feelings, and beliefs about themselves. This impaired capacity to self-reflect will be intrusive in daily activities that require monitoring of current self-performance. Furthermore, with reduced speed of information processing found to impact on ability to reflect on social relations, individuals with AD are placed at risk of reduced ability to understand their social world, including communicating and interacting with others. Notwithstanding the overall group findings, individual variability was evident which reinforces the need for person-centred care in dementia.

Understanding women's experience of memory over the menopausal transition: subjective and objective memory in pre-, peri-, and postmenopausal women.

OBJECTIVE: Many women complain of forgetfulness during the menopausal transition. This study aimed to examine women's subjective perception of memory and their objective memory performance across the menopausal transition. METHODS: One hundred thirty women, aged 40 to 60 years were recruited from outpatient Menopause and Gynaecological clinics at the Royal Women's Hospital, Melbourne. Women were divided into menopausal stage groups according to the Stages of Reproductive Aging Workshop criteria based on menstrual patterns. All women completed self-report measures of depressive, anxiety, vasomotor, and sleep symptoms; attitude to menopause; and various aspects of memory, including memory contentment, frequency of forgetting, sense of control over memory, and use of memory strategies. Women also completed a comprehensive neuropsychological evaluation assessing memory and executive function. RESULTS: Comprehensive neuropsychological assessment showed no difference between premenopausal (n = 36), perimenopausal (n = 54), and postmenopausal (n = 40) groups in performance on memory and executive tasks. Perimenopausal women, however, reported significantly more frequent forgetting (η = 0.09, P < 0.01) and less contentment with their memory (η = 0.08, P < 0.01) than pre- and postmenopausal women. CONCLUSIONS: Although no impairment was observed in neuropsychological performance, when compared with pre- and postmenopausal women, perimenopausal women were more likely to be dissatisfied with their memory. During the menopausal transition women with a more negative attitude to menopause and more intense depressive, anxiety, vasomotor, and sleep symptoms are more vulnerable to feeling less content with their memory.

Better Objective Sleep Quality in Older Adults with High Subjective Memory Decline.

BACKGROUND: Sleep disturbance is implicated in memory function across normal aging and neurodegenerative disease. Furthermore, there is mounting evidence to suggest that high levels of subjective memory decline (SMD) may signal very early neurodegenerative changes associated with Alzheimer's disease (AD). This view prompts research examining the relationship between SMD and other risk factors for cognitive decline, including sleep disturbance. OBJECTIVE: To determine whether objective and subjective indices of sleep predict SMD in older adults. METHODS: 181 community-based older adults were divided into groups of high and low SMD based on their responses to the Memory Assessment Complaint Questionnaire (MAC-Q). They undertook two weeks of objective sleep monitoring (actigraphy), and completed a subjective sleep quality assessment using the Pittsburgh Sleep Quality Index. RESULTS: Hierarchical logistic regression indicated that after controlling for demographics and mood, objective sleep quality predicted high SMD group status (ΔNagelkerke R2 = 0.07, χ2 = 9.80 (3), p = 0.020), while subjective sleep quality did not. Contrary to expectation, however, less sleep disruption predicted high SMD. CONCLUSION: These unexpected results may suggest a non-linear trajectory between sleep and memory decline in aging. The findings are discussed in relation to previous research, which taken together, may indicate compensatory sleep patterns of reduced sleep disruption in people with high levels of SMD. These preliminary findings suggest the utility of including analysis of sleep behavior in further longitudinal research of this at-risk group of older people.