Development and Psychometric Validation of a Questionnaire Assessing the Impact of Memory Changes in Older Adults

Development and Psychometric Validation of a Questionnaire Assessing the Impact of Memory Changes... Abstract Background and Objectives Many healthy older adults experience age-related memory changes that can impact their day-to-day functioning. Qualitative interviews have been useful in gaining insight into the experience of older adults who are facing memory difficulties. To enhance this insight, there is a need for a reliable and valid measure that quantifies the impact of normal memory changes on daily living. The primary objective of this study was to develop and validate a new instrument, the Memory Impact Questionnaire (MIQ). Research Design and Methods We examined the underlying component structure and psychometric properties of the MIQ in a sample of 205 community-dwelling older adults. Results Principal component analysis revealed three clusters: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. Comparisons of the corresponding subscale scores with scores on other instruments revealed good convergent and discriminant validity. In addition, the MIQ subscales and the total score showed good test–retest reliability (rs = 0.65–0.91) and internal consistency (αs = 0.87–0.93). Discussion and Implications This novel questionnaire can be used in both clinical and research settings to better understand the impact of memory changes on the day-to-day functioning of older adults and to monitor outcomes of support programs for this population. Social Support, Stress and Coping, Well-being Subjective memory complaints are common even among healthy older adults, with prevalence rates ranging from 27 to 43% (Reid & MacLullich, 2006). Indeed, community-dwelling older adults rate memory decline as the most problematic cognitive change they experience due to aging (Newson & Kemps, 2006). Common memory errors reported by healthy older adults include tip-of-the-tongue errors, failure to take one’s medication at the appropriate time, and forgetting assorted items and events, such as recently learned names, the location of items (e.g., keys, eyeglasses), or why one walked into a room (Farias et al., 2006; Ossher, Flegal, & Lustig, 2013; Smith, Della Sala, Logie, & Maylor, 2000). These everyday memory errors can have important consequences for older adults. Several studies have reported an association between subjective memory complaints and poorer quality of life, lower life satisfaction, and reduced feelings of well-being (Maki et al., 2014, Mol et al., 2007, Montejo et al., 2011, Montejo et al., 2012). Memory changes can disrupt daily living in older adults and cause psychological distress, which has been shown to further exacerbate memory problems (Zuniga, Mackenzie, Kramer, & McAuley, 2016). In addition, memory changes can have a negative impact on positive health behaviors. Hutchens et al. (2013) reported a reciprocal relationship between control beliefs and memory performance; specifically, memory difficulties were associated with a reduced sense of control, which in turn decreased the likelihood of strategy use that could improve performance on memory tasks. Memory decline may also affect how old one feels, or one’s subjective age, which is an important predictor of psychological well-being and positive health characteristics. Hughes, Geraci, and De Forrest (2013), for example, found that older adults who held negative perceptions of their memory ability were more likely to report a higher subjective age. There is also an extensive body of research that points toward a connection between memory complaints and symptoms of depression and anxiety (Comijs, Deeg, Dik, Twisk, & Jonker, 2002; Jorm et al., 2004). Finally, recent research suggests that subjective memory complaints may predict the development of dementia years later in healthy adults and those with a mild cognitive impairment (MCI; Dardenne et al., 2017; Luck et al., 2010), thus underscoring the need for a valid and reliable instrument for measuring the impact of subjective memory complaints. Although studies have explored the impact of memory change on quality of life, health outcomes, and other psychological factors, there is a dearth of research investigating the impact of memory changes on day-to-day living. Early work with clinical populations revealed emotional responses to memory failures, including diminished self-confidence, fear of embarrassment, frustration with self, and feelings of irritation or anger towards others (Frank et al., 2006; Joosten-Weyn Banningh, Vernooij-Dassen, Rikkert, & Teunisse, 2008). More recently, our own research (Parikh, Troyer, Maione, & Murphy, 2016) examined the impact of memory changes on older adults with normal memory changes and those with amnestic MCI, and showed that even mild memory changes can have a meaningful impact on several aspects of their day-to-day functioning, which speaks to the importance of memory in maintaining personal identity. Qualitative analysis revealed four major themes related to the impact of age-associated memory changes in the two groups: (a) changes in feelings and views about the self, (b) changes in social interactions and relationships, (c) changes in work and leisure activities, and (d) deliberate increases in compensatory behaviors. The Current Study Although qualitative data offer a rich source of insight into the experience of older adults living with mild memory changes, a quantitative tool for measuring the impact that age-related memory changes can have on life domains (such as relationships and self-identity) would be of great utility for both clinicians and researchers alike. In clinical settings, it could provide complementary information to extant measures that tap objective memory ability. Researchers could use this to measure the efficacy of memory interventions and to maximize the functional impact of such interventions. To address this gap, the current study uses findings from earlier qualitative work as a basis for developing a psychological measure, the Memory Impact Questionnaire (MIQ). Specifically, we assess the psychometric properties of this measure by examining its component structure, convergent validity, discriminant validity, test–retest reliability, and internal consistency. In addition, we provide preliminary normative data for this measure. Design and Methods Participants Participants were community-dwelling older adults recruited through flyers, e-mails, online postings, research databases, and memory intervention programs in the community. Inclusion criteria were the following: (a) 55–90 years of age, (b) a total score >24 on the modified version (Welsh, Breitner, & Magruder-Habib, 1993) of the Telephone Interview for Cognitive Status (TICS-m; Brandt, Spencer, & Folstein, 1988), and (c) fluency in written and spoken English. In total, 301 participants expressed interest in participation and met the inclusion criteria. Of these, only 211 participants completed the study. Inspection of the data revealed 6 of the 211 participants with low response rates (i.e., greater than 10% missing values on the MIQ), and these participants were eliminated from subsequent analyses. The final sample consisted of 205 older adults, ranging from 56 to 90 years of age (M = 71.8, SD = 8.7). As shown in Table 1, the sample was well educated; most participants were female, retired, and living with a spouse or life partner. Table 1. Demographic Characteristics of Sample (N = 205) Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Note:aTelephone Interview for Cognitive Status-modified. View Large Table 1. Demographic Characteristics of Sample (N = 205) Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Note:aTelephone Interview for Cognitive Status-modified. View Large Memory Impact Questionnaire Memory Impact Questionnaire items were generated by reviewing transcripts from our previous qualitative interviews with older adults about the impact of memory change (Parikh et al., 2016). Whenever possible, we used the same words and phrases as the interviewees, editing as necessary to create scale items that were self-contained and clear. A review of the 84 items generated by this process revealed that some reflected positive impacts (e.g., an increased interest in memory research), some reflected negative impacts (e.g., increased self-criticism), and others were less clear regarding affective valence (e.g., changes with respect to responsibilities at work). To obtain consensus on the affective valence of each item, eight psychology students and eight psychologists or social workers who work with older adults rated each item on a five-point scale, anchored by Quite Negative and Quite Positive. For most items, there was strong agreement among raters regarding item valence. However, nine items were identified for which valence was unclear. Where possible, these items were reworded to provide a more obvious valence. Four items were deleted because they could not be clarified without significantly altering the item’s underlying meaning. This resulted in 80 items, of which 27 were positive and 51 were negative. To create a more balanced complement of items, four negative items were reworded to be positive. At this stage, two additional items were deemed to be redundant and were deleted. The remaining 78 items were randomly ordered and presented as a single scale with instructions for respondents to rate their level of agreement with each statement on a five-point scale (Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, and Strongly Agree). We then administered these items to 10 healthy older adults and solicited their feedback about the instrument. Pilot participants indicated that they could not discriminate between agreement and strong agreement (or disagreement and strong disagreement) with an item. We therefore revised the rating scale to Disagree, Somewhat Disagree, Neither Agree nor Disagree, Somewhat Agree, and Agree. After these revisions, the MIQ consisted of 78 items with a 60:40 distribution of negative (n = 47) and positive (n = 31) items. All items were assigned a score from 0 (Disagree) to 4 (Agree). For further details on scoring the MIQ, see Component Scoring section below. Other Measures Other validated self-report measures of memory and mood were administered to determine convergent and discriminant validity of the MIQ. Based on the four domains identified by Parikh and colleagues (2016), we expected the MIQ subscales to be associated with measures of feelings and views about one’s self, relationships, work and leisure activities, and compensatory behaviors. The following scales were used as measures of convergent validity: (a) The Contentment subscale of the Multifactorial Memory Questionnaire (MMQ; Troyer & Rich, 2002) consists of 18 items that assess how respondents feel about their memory; higher scores indicate greater satisfaction with one’s memory function. (b) The Levels of Self-Criticism Scale (Thompson & Zuroff, 2004) consists of 22 items, and higher scores indicate greater self-criticism. (c) The Toronto Empathy Questionnaire (Spreng, McKinnon, Mar, & Levine, 2009) is a 16-item measure, and higher scores indicate greater empathy towards others. (d) The UCLA Loneliness scale (Russell, 1996) is a 20-item measure, with higher scores indicating greater self-rated loneliness. (e) The Ability subscale of the MMQ measures subjective memory ability. It has 20 items that assess the frequency of memory mistakes, with higher scores indicating better self-appraised memory ability. (f) The Victoria Longitudinal Study (VLS) Activity Questionnaire (Jopp & Hertzog, 2010) is a 61-item questionnaire that assesses frequency of participation in leisure activities, with higher scores indicating greater levels of participation. (g) The Strategy subscale of the MMQ is a 19-item questionnaire that assesses the frequency of strategy use, with higher scores indicating greater strategy use. (h) The Strategy subscale of the Metamemory in Adulthood Questionnaire (Dixon & Hultsch, 1983) assesses frequency of strategy use with 17 items. Higher scores on this measure suggest greater strategy use. The MIQ should not be associated with unrelated psychological constructs. Our measures of discriminant validity included: (a) The Morningness-Eveningness Questionnaire (Horne & Östberg, 1976) assesses circadian rhythm type using 19 items, with high scores indicating a morning type and low scores indicating an evening type. (b) The Internal Cognitive Experiencing Scale (Kohn & Annis, 1975) consists of 20 items, with higher scores indicating greater novelty seeking. Procedure All participants who expressed an interest in this study were contacted for a telephone interview and provided with a detailed description of the study. In addition, a demographic questionnaire and the TICS-m were administered. Participants were provided with two options for completing the study: 87 participants preferred to complete the study on paper and were mailed a copy of the remaining study materials; 118 participants preferred to complete the study online and were emailed a link to the study materials. Questionnaires were presented in a fixed order as follows: MIQ, Levels of Self-Criticism Scale, Morningness-Eveningness Questionnaire, VLS Activity Questionnaire, Metamemory in Adulthood-Strategy subscale, Toronto Empathy Questionnaire, UCLA Loneliness Scale, Internal Cognitive Experiencing Scale, and MMQ. A small subset of participants (n = 24) completed the MIQ on a second occasion, 4–6 weeks later, for assessment of test–retest reliability. It took participants approximately 60 min to complete the assessment. Participants were encouraged to take breaks as needed during the completion of questionnaires. Participants were instructed to complete questionnaires independently (no proxy completions and no consultation with others). All study procedures were approved by the Research Ethics Boards at York University (Approval Number: e2016-073) and Baycrest Health Sciences (Approval Number: 16-07). Results Component Structure Two items on the MIQ had very low response rates, with more than 50% of respondents indicating that these items did not apply to them; thus, these items were eliminated from subsequent analyses. We performed a principal component analysis (PCA) with direct oblimin rotation on the remaining 76 items from all 205 participants. Cattell’s (1966) scree test revealed three components instead of the four components we had expected based on the original qualitative research. As a result, we forced the solution to three components. The PCA revealed one item that did not load highly onto any component and 22 items that had high cross loadings on more than one component. High cross loadings were defined as loadings that were (a) ≥0.25 and (b) the difference between the highest and second highest loading was less than 0.15. These items were eliminated from subsequent analyses, for a total of 53 retained items. In all, the three components accounted for 40% of total score variance. The first component had 21 items with high item loadings, ranging from 0.36 to 0.78, and a mean loading of 0.57. This component had an eigenvalue of 18.4 and accounted for the most variance (24.2%) in the observed scores. Examination of the individual items indicated that, overall, they reflected negative impacts of memory changes on social relationships, work, and leisure activities. We therefore interpreted this as a Lifestyle Restrictions component. Two items that were not conceptually related to the interpretation of this component were eliminated from subsequent analyses, creating a final component with 19 items. The second component had 19 items with item loadings ranging from 0.27 to 0.78, a mean loading of 0.53, and a total eigenvalue of 8.3. This component accounted for 10.9% of the variance in total scores. Overall, these items reflected acceptance of memory changes, proactive lifestyle changes to enhance memory, and the use of specific memory strategies to compensate for memory changes; thus, we interpreted this component as a Positive Coping component. The third component had 13 items with item loadings ranging from 0.44 to 0.83, with a mean loading of 0.68 and a total eigenvalue of 3.7. This component account for 4.9% of the variance in total scores. Taken together, these items reflect negative self-perceptions and perceived judgment by others; therefore, this component was interpreted as a Negative Emotion component. The individual items and their loadings on the three components are provided in Supplementary Table 1. Component Scoring A subscale score was calculated for each of the components described above by summing the scores obtained on the respective items. Possible scores on the Lifestyle Restrictions subscale range from 0 to 76, with higher scores indicating greater restriction on lifestyle due to age-related memory changes. This subscale contains two items on which the respondents may indicate that the item does not apply to them. Possible scores on the Positive Coping subscale range from 0 to 76, with higher scores indicating more positive coping with age-related memory changes. Possible scores on the Negative Emotion subscale range from 0 to 52, with higher scores indicating a more negative emotional response to memory changes. When two or fewer items on a subscale were left unanswered, a prorated score was calculated based on the number of items completed on that subscale. This included items considered not applicable on the Lifestyle Restrictions subscale, as described previously, as well as items that were left unanswered for any other reason. Subscales with more than two unanswered questions were considered invalid and were excluded from analyses. Total scores for the MIQ were calculated using the following formula:   Total Score =(∑​Lifestyle Restrictions Items)+(76 −∑​Positive Coping Items)+  (∑​Negative Emotion items) Possible total scores range from 0 to 204, with higher scores reflecting a greater negative impact of memory changes on one’s day-to-day functioning. Intercorrelations between subscales and the total score are reported in Table 2. We observed strong positive correlations between the Lifestyle Restrictions subscale, the Negative Emotion subscale, and the total score. Small to moderate negative correlations were observed between the Positive Coping subscale and the other two subscales, as well as with the total score. Due to the large number of comparisons being conducted, we used an alpha level of 0.01 for all statistical tests (including those presented in subsequent sections) to reduce the risk of Type I errors. Table 2. Intercorrelations Between Scales of the Memory Impact Questionnaire   Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —    Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —  Note: *p< .01. View Large Table 2. Intercorrelations Between Scales of the Memory Impact Questionnaire   Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —    Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —  Note: *p< .01. View Large Construct Validity Measures Based on our definitions of the three components emerging from the PCA, we assigned each of the convergent validity measures to a specific MIQ subscale, as shown in Table 3. Although we originally included the Toronto Empathy Questionnaire as a measure of convergent validity, our revisions of scale items (detailed above) resulted in the deletion of questions relating to empathizing with the experience of others; as such, we did not expect it to correlate with any of the empirically derived MIQ subscales. Table 3. Intercorrelations Between Subscales of the Memory Impact Questionnaire and Convergent and Discriminant Validity Measures   Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09    Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09  Note: Shaded squares indicate that a relationship between those measures and subscale of the MIQ was predicted a priori. aVictoria Longitudinal Study Activity Questionnaire. bUniversity of California, Los Angeles Loneliness Scale. cMultifactorial Memory Questionnaire. *p < .01. View Large Table 3. Intercorrelations Between Subscales of the Memory Impact Questionnaire and Convergent and Discriminant Validity Measures   Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09    Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09  Note: Shaded squares indicate that a relationship between those measures and subscale of the MIQ was predicted a priori. aVictoria Longitudinal Study Activity Questionnaire. bUniversity of California, Los Angeles Loneliness Scale. cMultifactorial Memory Questionnaire. *p < .01. View Large The Lifestyle Restrictions scale assesses the impact of memory changes on social relationships and work and leisure activities. As such, it was expected to correlate with the UCLA Loneliness Scale and the VLS Activity Questionnaire. As expected, a small but significant correlation was observed between this subscale and the UCLA Loneliness Scale. However, no significant correlation was observed between this subscale and the VLS Activity Questionnaire. Correlations were noted between the Lifestyle Restrictions subscale and nontarget measures. There were significant, small to moderate correlations between this subscale and the MMQ-Contentment and MMQ-Ability subscales. Also, there was a significant, moderate correlation between the Lifestyle Restrictions subscale and the Levels of Self-Criticism Scale. The Positive Coping subscale explores an individual’s ability to adapt to age-related memory changes. As such, it was expected to correlate significantly with measures of memory strategy use, which was indeed the case for both the Metamemory in Adulthood-Strategy subscale and the MMQ-Strategy subscale. The Negative Emotion subscale includes items that assess negative self-perceptions due to memory changes and was therefore expected to correlate with other measures of memory-related affect as well as subjective memory ability. Indeed, there was a significant, moderate correlation between this subscale and the Levels of Self-Criticism scale. Responses on this subscale of the MIQ were also inversely correlated with the MMQ-Contentment scale and the MMQ-Ability scale, as expected. A small but significant correlation was observed between this scale and the UCLA Loneliness Scale. To test the discriminant validity of the MIQ, we examined correlations between observed scores on this measure and scores on self-report questionnaires that were selected a priori to be unrelated to the effect of memory changes on everyday life. As expected, all subscales of the MIQ as well as the total score were unrelated to both the Morningness-Eveningness Questionnaire and the Internal Cognitive Experiencing Scale (Table 3). Reliability We examined test–retest reliability using data from 24 participants who were tested on two occasions, 4–6 weeks apart. Correlations indicated reliable scores on the Lifestyle Restrictions, r = 0.73, p < .01, Positive Coping, r = 0.65, p < .01, and Negative Emotion subscales, r = 0.91, p < .01, as well as the MIQ total score, r = 0.74, p < .01. This indicates that 43–83% of the test–retest score variance was due to true variance rather than to the effects of random changes between the two testing occasions. We examined internal consistency using Cronbach’s alpha on data from all participants. These analyses indicated reliable scores on the Lifestyle Restrictions, α = 0.91, Positive Coping, α = 0.87, and Negative Emotion, α = 0.93, subscales. In addition, our analyses demonstrated reliable scores on the measure as a whole, α = 0.86. This indicates that 86–93% of the squared within-test score variance was due to true score variance rather than item content heterogeneity. Relation of MIQ to Demographic Variables and Mental Status Neither the total MIQ score nor any of the three subscales were significantly correlated with age, rs = −0.04 to 0.06, or education, rs = −0.01 to 0.11. In addition, the total and subscale scores were not significantly related to mental status, as measured by the TICS-m, rs = −0.02 to 0.08. There was no significant effect of gender on the Lifestyle Restrictions, t(203) = 1.06, p = .29, η2 = 0.005, Positive Coping, t(203) = 1.17, p = .24, η2 = 0.007, or Negative Emotion subscales, t(203) = 1.26, p = .21, η2 = 0.008, as well as the total score, t(203) = 2.01, p = .05, η2 = 0.019. Similarly, there was no significant effect of format (online vs. paper) on the Lifestyle Restrictions, t(203) = 2.21, p = .028, η2 = 0.023, Positive Coping, t(203) = 1.94, p = .054, η2 = 0.018, or Negative Emotion subscales, t(203) = 2.04, p = .042, η2 = 0.02. However, there was a significant effect of format on the total score, t(203) = 3.57, p < .001, η2 = 0.059, with higher scores obtained by participants completing the questionnaire on paper. Normative Data Scores on the TICS-m demonstrated that 188 participants were in the normal range (scores above 30) and 17 participants were in the mildly impaired range (scores between 25 and 29) with respect to cognitive status (Welsh et al., 1993). Because no participants scored in the range indicative of dementia, we developed preliminary normative data for the MIQ based on performance of all 205 participants. We observed a significant effect of format (i.e., paper vs. online) on the total score, but not on the subscale scores; thus, norms were calculated separately for each format type for the total score only. Means, standard deviations, and scaled scores for the observed MIQ scores, by subscale, are reported in Table 4. Normative data for the total score are reported in Table 5. Table 4. Observed Scores on the Memory Impact Questionnaire Subscales   Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76        Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76      View Large Table 4. Observed Scores on the Memory Impact Questionnaire Subscales   Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76        Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76      View Large Table 5. Observed Total Scores on the Memory Impact Questionnaire   Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+    Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+  View Large Table 5. Observed Total Scores on the Memory Impact Questionnaire   Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+    Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+  View Large Discussion and Implications This study describes the development and validation of the MIQ, a novel questionnaire assessing the impact of age-related memory changes in day-to-day life. We provide evidence for the component structure of this questionnaire. In addition, we demonstrate good convergent validity, discriminant validity, test–retest reliability, and internal consistency of this scale. Subscales of the MIQ Quantitative analyses conducted on responses from this sample revealed three components: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. These three empirically derived subscales assess distinct impacts of age-related memory changes that have significant overlap with themes derived from our previous qualitative research (Parikh et al., 2016). Items from the Lifestyle Restrictions component came from two themes reflecting changes in relationships and social interactions, and changes in work and leisure activities. As such, we conceptualized the Lifestyle Restrictions component as a general omnibus lifestyle factor encompassing social relationships, work, and volunteer and leisure activities. It is perhaps not surprising that these items clustered onto a single factor, as there is a social component to many work and leisure activities, and many relationships are formed through participation in common activities. Items from the Positive Coping scale came from previously identified qualitative themes related to changes in views of the self and deliberate increases in compensatory activities. This component includes items involving participation in cognitively engaging tasks that may help maintain memory, such as reading and crossword puzzles, as well as other positive responses to memory changes, such as seeking support from others and practicing self-acceptance. Taken together, these items seem to reflect an ability to manage one’s age-related memory changes in a constructive manner. In addition, the grouping of these items may suggest that older adults who experience age-related memory changes are motivated to use both problem-focused (e.g., choosing to improve memory performance by participating in activities) and emotion-focused (e.g., changing one’s expectations with respect to memory performance) coping strategies. This is consistent with previous research showing that older adults typically consider both types of coping responses when confronted with an interpersonal problem instead of relying on one approach alone (Schoenmakers, van Tilburg, & Fokkema, 2015). Lastly, the Negative Emotion component consists of items from qualitative themes related to changes in self-perception and changes in relationships and social interactions. This component encompassed items involving negative perceptions of the self as well as perceived negative judgments from others. Therefore, we conceptualized this component as negative affect due to unfavourable self-assessments and perceived criticisms from others, which an individual may experience in association with age-related memory changes. This is supported by previous work that suggests that negative self-views about aging are associated with perceived negative behaviors of others (Voss, Wolff, & Rothermund, 2017). In addition to the identification of three subscales, our results support the use of the total score on the MIQ as an indicator of the overall impact of memory changes. The 51 items on our measure show high internal consistency, and the total score has moderate to strong correlations with each subscale, which suggests that it may be an effective measure of the global impact of age-related memory changes. Overall, the three subscales account for 40% of the total score variance. This is comparable (25–40%) to similar extant memory measures, including the MMQ, Memory Functioning Questionnaire, the Memory Experiences and Dreams Questionnaire, Prospective Retrospective Memory Questionnaire, used in research and clinical practice (Gilewski, Zelinksi, & Schaie, 1992; Horton & Conway, 2009; Troyer & Rich, 2002; Zimprich, Kliegel, & Bast, 2011). Construct Validity of the MIQ Subscales Overall, the subscales of the MIQ were related to other similar psychological constructs. The relationship between the Lifestyle Restrictions subscale and a measure of loneliness reflects the fact that an individual experiencing social isolation would report greater loneliness. Unexpectedly, the Lifestyle Restrictions subscale did not correlate with a scale that measures participation in leisure activities. This may be because the Lifestyle Restrictions subscale includes several items relating to social relationships as well as participating in activities. As such, the final subscale consisted of only six items that specifically focus on participating in leisure activities. Furthermore, we observed small to moderate correlations between scores on this subscale and measures of memory-related affect, as well as memory ability. Although this relationship was not originally hypothesized, it makes sense that individuals who report greater negative impact of memory changes to their lifestyle would report greater self-criticism and less contentment with their memory ability. We observed small but significant correlations between the Positive Coping subscale and measures of strategy use. Improving memory performance using compensatory strategies can be thought of as a problem-focused coping approach; thus, it holds that these measures would be correlated with our more general measure of Positive Coping. The relatively small size of the correlation is also understandable, as our scale includes other types of coping as well (e.g., emotion-focused coping). Associations between the Negative Emotion subscale and measures of memory-related affect and subjective memory ability reflects the fact that individuals who are experiencing negative self-views and perceived judgments by others following age-related memory changes express less confidence in and less contentment with their memory ability, as well as increased self-criticism. Although we did not predict a relationship between Negative Emotion and loneliness, it is not surprising that individuals who feel isolated and less supported by others report greater negative emotions. Clinical and Research Applications of the MIQ The MIQ was designed to be applicable and convenient for use in clinical settings. Its relatively short length (51 items) and multiple subscales mean that multifaceted information can be collected with minimal administration time. Further, this measure allows clinicians to assess the extent to which age-related memory changes are disrupting an individual’s day-to-day functioning. This may be valuable information when determining whether additional cognitive or psychological assessment is required, and whether a client might benefit from intervention. The MIQ may provide complementary information for clinical diagnosis. For example, individuals with MCI may report greater impact of memory changes than healthy older adults. In addition, the MIQ may be useful for evaluating the effectiveness of memory intervention programs when administered as a pre- and post-intervention outcome measure. Several validated memory interventions focus on normalizing memory changes and teaching memory strategies (Chan et al., 2017; Hyer, Scott, Lyles, Dhabliwala, & McKenzie, 2014; Kinsella et al., 2009; Troyer, 2001; Wiegand, Troyer, Gojmerac, & Murphy, 2013; Willis, Chan, Murray, Matthews, & Banerjee, 2009), which may be associated with improved scores on the MIQ (particularly the Positive Coping subscale) following intervention. In this way, the MIQ could help clinicians and researchers better understand outcomes for their participants following an intervention, which in turn could help facilitate development of more targeted interventions for this population. Limitations and Future Directions The participants in our sample were highly educated, which may not be representative of the general population. It is possible that education moderates the negative impact of memory changes. For example, individuals with access to greater education may be more likely to seek out health resources, such as memory interventions, and therefore may not be as impacted by memory changes. However, education was not strongly related to MIQ scores in our sample suggesting that this effect is likely to be small, if present. Most participants in this study were retired. Thus, further work would be needed to address questions of interest involving working older adults. Finally, it will be interesting to learn whether the impact of memory changes is related to important outcomes, such as mental health, cognitive abilities, and functional independence. Memory is a crucial aspect of identity, and even normal age-related memory changes can have important consequences for day-to-day functioning in older adults. The MIQ is the first measure that allows researchers and clinicians to quantify the impact of memory changes on older adults’ emotions, relationships, activities, and coping behaviours, thus allowing for broader investigations of health and aging. Supplementary Material Supplementary data are available at The Gerontologist online. Funding This work was supported by the Ontario Women’s Health Scholars Award, awarded to K.T. Shaikh. The Ontario Women’s Health Scholars Award is funded by the Ontario Ministry of Health and Long-Term Care. Conflict of Interest Statement None reported. Acknowledgements We thank Daniel Chiacchia and Rebecca Hudes for their assistance with data entry. References Brandt, J., Spencer, M., & Folstein, M. ( 1988). The telephone interview for cognitive status. Neuropsychiatry, Neuropsychology, & Behavioral Neurology , 1, 111– 117. Cattell, R. B. ( 1966). The scree test for the number of factors. 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Development and Psychometric Validation of a Questionnaire Assessing the Impact of Memory Changes in Older Adults

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Abstract

Abstract Background and Objectives Many healthy older adults experience age-related memory changes that can impact their day-to-day functioning. Qualitative interviews have been useful in gaining insight into the experience of older adults who are facing memory difficulties. To enhance this insight, there is a need for a reliable and valid measure that quantifies the impact of normal memory changes on daily living. The primary objective of this study was to develop and validate a new instrument, the Memory Impact Questionnaire (MIQ). Research Design and Methods We examined the underlying component structure and psychometric properties of the MIQ in a sample of 205 community-dwelling older adults. Results Principal component analysis revealed three clusters: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. Comparisons of the corresponding subscale scores with scores on other instruments revealed good convergent and discriminant validity. In addition, the MIQ subscales and the total score showed good test–retest reliability (rs = 0.65–0.91) and internal consistency (αs = 0.87–0.93). Discussion and Implications This novel questionnaire can be used in both clinical and research settings to better understand the impact of memory changes on the day-to-day functioning of older adults and to monitor outcomes of support programs for this population. Social Support, Stress and Coping, Well-being Subjective memory complaints are common even among healthy older adults, with prevalence rates ranging from 27 to 43% (Reid & MacLullich, 2006). Indeed, community-dwelling older adults rate memory decline as the most problematic cognitive change they experience due to aging (Newson & Kemps, 2006). Common memory errors reported by healthy older adults include tip-of-the-tongue errors, failure to take one’s medication at the appropriate time, and forgetting assorted items and events, such as recently learned names, the location of items (e.g., keys, eyeglasses), or why one walked into a room (Farias et al., 2006; Ossher, Flegal, & Lustig, 2013; Smith, Della Sala, Logie, & Maylor, 2000). These everyday memory errors can have important consequences for older adults. Several studies have reported an association between subjective memory complaints and poorer quality of life, lower life satisfaction, and reduced feelings of well-being (Maki et al., 2014, Mol et al., 2007, Montejo et al., 2011, Montejo et al., 2012). Memory changes can disrupt daily living in older adults and cause psychological distress, which has been shown to further exacerbate memory problems (Zuniga, Mackenzie, Kramer, & McAuley, 2016). In addition, memory changes can have a negative impact on positive health behaviors. Hutchens et al. (2013) reported a reciprocal relationship between control beliefs and memory performance; specifically, memory difficulties were associated with a reduced sense of control, which in turn decreased the likelihood of strategy use that could improve performance on memory tasks. Memory decline may also affect how old one feels, or one’s subjective age, which is an important predictor of psychological well-being and positive health characteristics. Hughes, Geraci, and De Forrest (2013), for example, found that older adults who held negative perceptions of their memory ability were more likely to report a higher subjective age. There is also an extensive body of research that points toward a connection between memory complaints and symptoms of depression and anxiety (Comijs, Deeg, Dik, Twisk, & Jonker, 2002; Jorm et al., 2004). Finally, recent research suggests that subjective memory complaints may predict the development of dementia years later in healthy adults and those with a mild cognitive impairment (MCI; Dardenne et al., 2017; Luck et al., 2010), thus underscoring the need for a valid and reliable instrument for measuring the impact of subjective memory complaints. Although studies have explored the impact of memory change on quality of life, health outcomes, and other psychological factors, there is a dearth of research investigating the impact of memory changes on day-to-day living. Early work with clinical populations revealed emotional responses to memory failures, including diminished self-confidence, fear of embarrassment, frustration with self, and feelings of irritation or anger towards others (Frank et al., 2006; Joosten-Weyn Banningh, Vernooij-Dassen, Rikkert, & Teunisse, 2008). More recently, our own research (Parikh, Troyer, Maione, & Murphy, 2016) examined the impact of memory changes on older adults with normal memory changes and those with amnestic MCI, and showed that even mild memory changes can have a meaningful impact on several aspects of their day-to-day functioning, which speaks to the importance of memory in maintaining personal identity. Qualitative analysis revealed four major themes related to the impact of age-associated memory changes in the two groups: (a) changes in feelings and views about the self, (b) changes in social interactions and relationships, (c) changes in work and leisure activities, and (d) deliberate increases in compensatory behaviors. The Current Study Although qualitative data offer a rich source of insight into the experience of older adults living with mild memory changes, a quantitative tool for measuring the impact that age-related memory changes can have on life domains (such as relationships and self-identity) would be of great utility for both clinicians and researchers alike. In clinical settings, it could provide complementary information to extant measures that tap objective memory ability. Researchers could use this to measure the efficacy of memory interventions and to maximize the functional impact of such interventions. To address this gap, the current study uses findings from earlier qualitative work as a basis for developing a psychological measure, the Memory Impact Questionnaire (MIQ). Specifically, we assess the psychometric properties of this measure by examining its component structure, convergent validity, discriminant validity, test–retest reliability, and internal consistency. In addition, we provide preliminary normative data for this measure. Design and Methods Participants Participants were community-dwelling older adults recruited through flyers, e-mails, online postings, research databases, and memory intervention programs in the community. Inclusion criteria were the following: (a) 55–90 years of age, (b) a total score >24 on the modified version (Welsh, Breitner, & Magruder-Habib, 1993) of the Telephone Interview for Cognitive Status (TICS-m; Brandt, Spencer, & Folstein, 1988), and (c) fluency in written and spoken English. In total, 301 participants expressed interest in participation and met the inclusion criteria. Of these, only 211 participants completed the study. Inspection of the data revealed 6 of the 211 participants with low response rates (i.e., greater than 10% missing values on the MIQ), and these participants were eliminated from subsequent analyses. The final sample consisted of 205 older adults, ranging from 56 to 90 years of age (M = 71.8, SD = 8.7). As shown in Table 1, the sample was well educated; most participants were female, retired, and living with a spouse or life partner. Table 1. Demographic Characteristics of Sample (N = 205) Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Note:aTelephone Interview for Cognitive Status-modified. View Large Table 1. Demographic Characteristics of Sample (N = 205) Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Age (in years)   Mean (SD)  71.8 (8.7)   Range  56–90  Education (in years)   Mean (SD)  15.2 (2.6)   Range  8–20  TICS-m score (max = 50)   Mean (SD)  37.9 (4.5)   Range  25–48  Gender (F%:M%)  68:32  Employment (%)   Full time  16%   Part time  9%   Retired  75%  Marital status (%)   Married/life partner  65%   Divorced/separated  11%   Single/never married  9%   Widowed  15%  Note:aTelephone Interview for Cognitive Status-modified. View Large Memory Impact Questionnaire Memory Impact Questionnaire items were generated by reviewing transcripts from our previous qualitative interviews with older adults about the impact of memory change (Parikh et al., 2016). Whenever possible, we used the same words and phrases as the interviewees, editing as necessary to create scale items that were self-contained and clear. A review of the 84 items generated by this process revealed that some reflected positive impacts (e.g., an increased interest in memory research), some reflected negative impacts (e.g., increased self-criticism), and others were less clear regarding affective valence (e.g., changes with respect to responsibilities at work). To obtain consensus on the affective valence of each item, eight psychology students and eight psychologists or social workers who work with older adults rated each item on a five-point scale, anchored by Quite Negative and Quite Positive. For most items, there was strong agreement among raters regarding item valence. However, nine items were identified for which valence was unclear. Where possible, these items were reworded to provide a more obvious valence. Four items were deleted because they could not be clarified without significantly altering the item’s underlying meaning. This resulted in 80 items, of which 27 were positive and 51 were negative. To create a more balanced complement of items, four negative items were reworded to be positive. At this stage, two additional items were deemed to be redundant and were deleted. The remaining 78 items were randomly ordered and presented as a single scale with instructions for respondents to rate their level of agreement with each statement on a five-point scale (Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, and Strongly Agree). We then administered these items to 10 healthy older adults and solicited their feedback about the instrument. Pilot participants indicated that they could not discriminate between agreement and strong agreement (or disagreement and strong disagreement) with an item. We therefore revised the rating scale to Disagree, Somewhat Disagree, Neither Agree nor Disagree, Somewhat Agree, and Agree. After these revisions, the MIQ consisted of 78 items with a 60:40 distribution of negative (n = 47) and positive (n = 31) items. All items were assigned a score from 0 (Disagree) to 4 (Agree). For further details on scoring the MIQ, see Component Scoring section below. Other Measures Other validated self-report measures of memory and mood were administered to determine convergent and discriminant validity of the MIQ. Based on the four domains identified by Parikh and colleagues (2016), we expected the MIQ subscales to be associated with measures of feelings and views about one’s self, relationships, work and leisure activities, and compensatory behaviors. The following scales were used as measures of convergent validity: (a) The Contentment subscale of the Multifactorial Memory Questionnaire (MMQ; Troyer & Rich, 2002) consists of 18 items that assess how respondents feel about their memory; higher scores indicate greater satisfaction with one’s memory function. (b) The Levels of Self-Criticism Scale (Thompson & Zuroff, 2004) consists of 22 items, and higher scores indicate greater self-criticism. (c) The Toronto Empathy Questionnaire (Spreng, McKinnon, Mar, & Levine, 2009) is a 16-item measure, and higher scores indicate greater empathy towards others. (d) The UCLA Loneliness scale (Russell, 1996) is a 20-item measure, with higher scores indicating greater self-rated loneliness. (e) The Ability subscale of the MMQ measures subjective memory ability. It has 20 items that assess the frequency of memory mistakes, with higher scores indicating better self-appraised memory ability. (f) The Victoria Longitudinal Study (VLS) Activity Questionnaire (Jopp & Hertzog, 2010) is a 61-item questionnaire that assesses frequency of participation in leisure activities, with higher scores indicating greater levels of participation. (g) The Strategy subscale of the MMQ is a 19-item questionnaire that assesses the frequency of strategy use, with higher scores indicating greater strategy use. (h) The Strategy subscale of the Metamemory in Adulthood Questionnaire (Dixon & Hultsch, 1983) assesses frequency of strategy use with 17 items. Higher scores on this measure suggest greater strategy use. The MIQ should not be associated with unrelated psychological constructs. Our measures of discriminant validity included: (a) The Morningness-Eveningness Questionnaire (Horne & Östberg, 1976) assesses circadian rhythm type using 19 items, with high scores indicating a morning type and low scores indicating an evening type. (b) The Internal Cognitive Experiencing Scale (Kohn & Annis, 1975) consists of 20 items, with higher scores indicating greater novelty seeking. Procedure All participants who expressed an interest in this study were contacted for a telephone interview and provided with a detailed description of the study. In addition, a demographic questionnaire and the TICS-m were administered. Participants were provided with two options for completing the study: 87 participants preferred to complete the study on paper and were mailed a copy of the remaining study materials; 118 participants preferred to complete the study online and were emailed a link to the study materials. Questionnaires were presented in a fixed order as follows: MIQ, Levels of Self-Criticism Scale, Morningness-Eveningness Questionnaire, VLS Activity Questionnaire, Metamemory in Adulthood-Strategy subscale, Toronto Empathy Questionnaire, UCLA Loneliness Scale, Internal Cognitive Experiencing Scale, and MMQ. A small subset of participants (n = 24) completed the MIQ on a second occasion, 4–6 weeks later, for assessment of test–retest reliability. It took participants approximately 60 min to complete the assessment. Participants were encouraged to take breaks as needed during the completion of questionnaires. Participants were instructed to complete questionnaires independently (no proxy completions and no consultation with others). All study procedures were approved by the Research Ethics Boards at York University (Approval Number: e2016-073) and Baycrest Health Sciences (Approval Number: 16-07). Results Component Structure Two items on the MIQ had very low response rates, with more than 50% of respondents indicating that these items did not apply to them; thus, these items were eliminated from subsequent analyses. We performed a principal component analysis (PCA) with direct oblimin rotation on the remaining 76 items from all 205 participants. Cattell’s (1966) scree test revealed three components instead of the four components we had expected based on the original qualitative research. As a result, we forced the solution to three components. The PCA revealed one item that did not load highly onto any component and 22 items that had high cross loadings on more than one component. High cross loadings were defined as loadings that were (a) ≥0.25 and (b) the difference between the highest and second highest loading was less than 0.15. These items were eliminated from subsequent analyses, for a total of 53 retained items. In all, the three components accounted for 40% of total score variance. The first component had 21 items with high item loadings, ranging from 0.36 to 0.78, and a mean loading of 0.57. This component had an eigenvalue of 18.4 and accounted for the most variance (24.2%) in the observed scores. Examination of the individual items indicated that, overall, they reflected negative impacts of memory changes on social relationships, work, and leisure activities. We therefore interpreted this as a Lifestyle Restrictions component. Two items that were not conceptually related to the interpretation of this component were eliminated from subsequent analyses, creating a final component with 19 items. The second component had 19 items with item loadings ranging from 0.27 to 0.78, a mean loading of 0.53, and a total eigenvalue of 8.3. This component accounted for 10.9% of the variance in total scores. Overall, these items reflected acceptance of memory changes, proactive lifestyle changes to enhance memory, and the use of specific memory strategies to compensate for memory changes; thus, we interpreted this component as a Positive Coping component. The third component had 13 items with item loadings ranging from 0.44 to 0.83, with a mean loading of 0.68 and a total eigenvalue of 3.7. This component account for 4.9% of the variance in total scores. Taken together, these items reflect negative self-perceptions and perceived judgment by others; therefore, this component was interpreted as a Negative Emotion component. The individual items and their loadings on the three components are provided in Supplementary Table 1. Component Scoring A subscale score was calculated for each of the components described above by summing the scores obtained on the respective items. Possible scores on the Lifestyle Restrictions subscale range from 0 to 76, with higher scores indicating greater restriction on lifestyle due to age-related memory changes. This subscale contains two items on which the respondents may indicate that the item does not apply to them. Possible scores on the Positive Coping subscale range from 0 to 76, with higher scores indicating more positive coping with age-related memory changes. Possible scores on the Negative Emotion subscale range from 0 to 52, with higher scores indicating a more negative emotional response to memory changes. When two or fewer items on a subscale were left unanswered, a prorated score was calculated based on the number of items completed on that subscale. This included items considered not applicable on the Lifestyle Restrictions subscale, as described previously, as well as items that were left unanswered for any other reason. Subscales with more than two unanswered questions were considered invalid and were excluded from analyses. Total scores for the MIQ were calculated using the following formula:   Total Score =(∑​Lifestyle Restrictions Items)+(76 −∑​Positive Coping Items)+  (∑​Negative Emotion items) Possible total scores range from 0 to 204, with higher scores reflecting a greater negative impact of memory changes on one’s day-to-day functioning. Intercorrelations between subscales and the total score are reported in Table 2. We observed strong positive correlations between the Lifestyle Restrictions subscale, the Negative Emotion subscale, and the total score. Small to moderate negative correlations were observed between the Positive Coping subscale and the other two subscales, as well as with the total score. Due to the large number of comparisons being conducted, we used an alpha level of 0.01 for all statistical tests (including those presented in subsequent sections) to reduce the risk of Type I errors. Table 2. Intercorrelations Between Scales of the Memory Impact Questionnaire   Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —    Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —  Note: *p< .01. View Large Table 2. Intercorrelations Between Scales of the Memory Impact Questionnaire   Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —    Lifestyle restrictions  Positive coping  Negative emotion  Total score  Lifestyle restrictions  —        Positive coping  −0.21*  —      Negative emotion  0.63*  −0.29*  —    Total score  0.73*  −0.36*  0.71*  —  Note: *p< .01. View Large Construct Validity Measures Based on our definitions of the three components emerging from the PCA, we assigned each of the convergent validity measures to a specific MIQ subscale, as shown in Table 3. Although we originally included the Toronto Empathy Questionnaire as a measure of convergent validity, our revisions of scale items (detailed above) resulted in the deletion of questions relating to empathizing with the experience of others; as such, we did not expect it to correlate with any of the empirically derived MIQ subscales. Table 3. Intercorrelations Between Subscales of the Memory Impact Questionnaire and Convergent and Discriminant Validity Measures   Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09    Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09  Note: Shaded squares indicate that a relationship between those measures and subscale of the MIQ was predicted a priori. aVictoria Longitudinal Study Activity Questionnaire. bUniversity of California, Los Angeles Loneliness Scale. cMultifactorial Memory Questionnaire. *p < .01. View Large Table 3. Intercorrelations Between Subscales of the Memory Impact Questionnaire and Convergent and Discriminant Validity Measures   Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09    Lifestyle restrictions  Positive coping  Negative emotion  Total  VLS Activity Questionnairea  −0.12  0.12  0.01  −0.13  UCLA Loneliness Scaleb  0.26*  −0.12  0.22*  0.33*  Toronto Empathy Questionnaire  0.08  −0.02  −0.02  0.04  Metamemory in Adulthood Strategy  0.06  0.25*  0.12  −0.03  MMQ Strategyc  0.17  0.22*  0.15  0.03  Levels of Self-Criticism  0.37*  0.06  0.33*  0.42*  MMQ Contentmentc  −0.35*  −0.07  −0.42*  −0.37*  MMQ Abilityc  −0.29*  −0.12  −0.31*  −0.25*  Morningness-Eveningness Questionnaire  0.04  0.01  0.11  0.08  Internal Cognitive Experiencing scale  −0.03  0.11  −0.01  −0.09  Note: Shaded squares indicate that a relationship between those measures and subscale of the MIQ was predicted a priori. aVictoria Longitudinal Study Activity Questionnaire. bUniversity of California, Los Angeles Loneliness Scale. cMultifactorial Memory Questionnaire. *p < .01. View Large The Lifestyle Restrictions scale assesses the impact of memory changes on social relationships and work and leisure activities. As such, it was expected to correlate with the UCLA Loneliness Scale and the VLS Activity Questionnaire. As expected, a small but significant correlation was observed between this subscale and the UCLA Loneliness Scale. However, no significant correlation was observed between this subscale and the VLS Activity Questionnaire. Correlations were noted between the Lifestyle Restrictions subscale and nontarget measures. There were significant, small to moderate correlations between this subscale and the MMQ-Contentment and MMQ-Ability subscales. Also, there was a significant, moderate correlation between the Lifestyle Restrictions subscale and the Levels of Self-Criticism Scale. The Positive Coping subscale explores an individual’s ability to adapt to age-related memory changes. As such, it was expected to correlate significantly with measures of memory strategy use, which was indeed the case for both the Metamemory in Adulthood-Strategy subscale and the MMQ-Strategy subscale. The Negative Emotion subscale includes items that assess negative self-perceptions due to memory changes and was therefore expected to correlate with other measures of memory-related affect as well as subjective memory ability. Indeed, there was a significant, moderate correlation between this subscale and the Levels of Self-Criticism scale. Responses on this subscale of the MIQ were also inversely correlated with the MMQ-Contentment scale and the MMQ-Ability scale, as expected. A small but significant correlation was observed between this scale and the UCLA Loneliness Scale. To test the discriminant validity of the MIQ, we examined correlations between observed scores on this measure and scores on self-report questionnaires that were selected a priori to be unrelated to the effect of memory changes on everyday life. As expected, all subscales of the MIQ as well as the total score were unrelated to both the Morningness-Eveningness Questionnaire and the Internal Cognitive Experiencing Scale (Table 3). Reliability We examined test–retest reliability using data from 24 participants who were tested on two occasions, 4–6 weeks apart. Correlations indicated reliable scores on the Lifestyle Restrictions, r = 0.73, p < .01, Positive Coping, r = 0.65, p < .01, and Negative Emotion subscales, r = 0.91, p < .01, as well as the MIQ total score, r = 0.74, p < .01. This indicates that 43–83% of the test–retest score variance was due to true variance rather than to the effects of random changes between the two testing occasions. We examined internal consistency using Cronbach’s alpha on data from all participants. These analyses indicated reliable scores on the Lifestyle Restrictions, α = 0.91, Positive Coping, α = 0.87, and Negative Emotion, α = 0.93, subscales. In addition, our analyses demonstrated reliable scores on the measure as a whole, α = 0.86. This indicates that 86–93% of the squared within-test score variance was due to true score variance rather than item content heterogeneity. Relation of MIQ to Demographic Variables and Mental Status Neither the total MIQ score nor any of the three subscales were significantly correlated with age, rs = −0.04 to 0.06, or education, rs = −0.01 to 0.11. In addition, the total and subscale scores were not significantly related to mental status, as measured by the TICS-m, rs = −0.02 to 0.08. There was no significant effect of gender on the Lifestyle Restrictions, t(203) = 1.06, p = .29, η2 = 0.005, Positive Coping, t(203) = 1.17, p = .24, η2 = 0.007, or Negative Emotion subscales, t(203) = 1.26, p = .21, η2 = 0.008, as well as the total score, t(203) = 2.01, p = .05, η2 = 0.019. Similarly, there was no significant effect of format (online vs. paper) on the Lifestyle Restrictions, t(203) = 2.21, p = .028, η2 = 0.023, Positive Coping, t(203) = 1.94, p = .054, η2 = 0.018, or Negative Emotion subscales, t(203) = 2.04, p = .042, η2 = 0.02. However, there was a significant effect of format on the total score, t(203) = 3.57, p < .001, η2 = 0.059, with higher scores obtained by participants completing the questionnaire on paper. Normative Data Scores on the TICS-m demonstrated that 188 participants were in the normal range (scores above 30) and 17 participants were in the mildly impaired range (scores between 25 and 29) with respect to cognitive status (Welsh et al., 1993). Because no participants scored in the range indicative of dementia, we developed preliminary normative data for the MIQ based on performance of all 205 participants. We observed a significant effect of format (i.e., paper vs. online) on the total score, but not on the subscale scores; thus, norms were calculated separately for each format type for the total score only. Means, standard deviations, and scaled scores for the observed MIQ scores, by subscale, are reported in Table 4. Normative data for the total score are reported in Table 5. Table 4. Observed Scores on the Memory Impact Questionnaire Subscales   Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76        Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76      View Large Table 4. Observed Scores on the Memory Impact Questionnaire Subscales   Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76        Lifestyle restrictions (19 items)  Positive coping (19 items)  Negative emotion (13 items)  Mean  9.1  42.8  16.9  SD  10.8  13.9  13.0  Observed range  0–52  0–72  0–48  Possible range  0–76  0–76  0–52  Scaled score   1    0–3     2    4–7     3    8–12     4    13–17     5    18–21     6    22–26  0–1   7  0  27–31  2–5   8  1-3  32–35  6–10   9  4–7  36–40  11–14   10  8–10  41–45  15–19   11  11–14  46–49  20–23   12  15–18  50–55  24–28   13  19–21  56–58  29–31   14  22–25  59–63  32–36   15  26–29  64–68  37–40   16  30–32  69–72  41–44   17  33–35  73–76  45–49   18  36–39    50–52   19  40–76      View Large Table 5. Observed Total Scores on the Memory Impact Questionnaire   Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+    Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+  View Large Table 5. Observed Total Scores on the Memory Impact Questionnaire   Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+    Total MIQ Score    Online (n = 118)  Paper (n = 87)  Mean  54.6  65.4  SD  20.9  22.3  Observed range  9–120  12–139  Possible range  0–204  0–204  Scaled score   1       2  0  0–2   3  1–9  3–8   4  10–16  9–24   5  17–22  25–31   6  23–30  32–39   7  31–36  40–46   8  37–44  47–54   9  45–50  55–61   10  51–58  62–69   11  59–64  70–76   12  65–73  77–85   13  74–78  86–91   14  79–86  92–99   15  87–93  100–106   16  94–99  107–113   17  100–106  114–120   18  107–113  121–128   19  114+  129+  View Large Discussion and Implications This study describes the development and validation of the MIQ, a novel questionnaire assessing the impact of age-related memory changes in day-to-day life. We provide evidence for the component structure of this questionnaire. In addition, we demonstrate good convergent validity, discriminant validity, test–retest reliability, and internal consistency of this scale. Subscales of the MIQ Quantitative analyses conducted on responses from this sample revealed three components: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. These three empirically derived subscales assess distinct impacts of age-related memory changes that have significant overlap with themes derived from our previous qualitative research (Parikh et al., 2016). Items from the Lifestyle Restrictions component came from two themes reflecting changes in relationships and social interactions, and changes in work and leisure activities. As such, we conceptualized the Lifestyle Restrictions component as a general omnibus lifestyle factor encompassing social relationships, work, and volunteer and leisure activities. It is perhaps not surprising that these items clustered onto a single factor, as there is a social component to many work and leisure activities, and many relationships are formed through participation in common activities. Items from the Positive Coping scale came from previously identified qualitative themes related to changes in views of the self and deliberate increases in compensatory activities. This component includes items involving participation in cognitively engaging tasks that may help maintain memory, such as reading and crossword puzzles, as well as other positive responses to memory changes, such as seeking support from others and practicing self-acceptance. Taken together, these items seem to reflect an ability to manage one’s age-related memory changes in a constructive manner. In addition, the grouping of these items may suggest that older adults who experience age-related memory changes are motivated to use both problem-focused (e.g., choosing to improve memory performance by participating in activities) and emotion-focused (e.g., changing one’s expectations with respect to memory performance) coping strategies. This is consistent with previous research showing that older adults typically consider both types of coping responses when confronted with an interpersonal problem instead of relying on one approach alone (Schoenmakers, van Tilburg, & Fokkema, 2015). Lastly, the Negative Emotion component consists of items from qualitative themes related to changes in self-perception and changes in relationships and social interactions. This component encompassed items involving negative perceptions of the self as well as perceived negative judgments from others. Therefore, we conceptualized this component as negative affect due to unfavourable self-assessments and perceived criticisms from others, which an individual may experience in association with age-related memory changes. This is supported by previous work that suggests that negative self-views about aging are associated with perceived negative behaviors of others (Voss, Wolff, & Rothermund, 2017). In addition to the identification of three subscales, our results support the use of the total score on the MIQ as an indicator of the overall impact of memory changes. The 51 items on our measure show high internal consistency, and the total score has moderate to strong correlations with each subscale, which suggests that it may be an effective measure of the global impact of age-related memory changes. Overall, the three subscales account for 40% of the total score variance. This is comparable (25–40%) to similar extant memory measures, including the MMQ, Memory Functioning Questionnaire, the Memory Experiences and Dreams Questionnaire, Prospective Retrospective Memory Questionnaire, used in research and clinical practice (Gilewski, Zelinksi, & Schaie, 1992; Horton & Conway, 2009; Troyer & Rich, 2002; Zimprich, Kliegel, & Bast, 2011). Construct Validity of the MIQ Subscales Overall, the subscales of the MIQ were related to other similar psychological constructs. The relationship between the Lifestyle Restrictions subscale and a measure of loneliness reflects the fact that an individual experiencing social isolation would report greater loneliness. Unexpectedly, the Lifestyle Restrictions subscale did not correlate with a scale that measures participation in leisure activities. This may be because the Lifestyle Restrictions subscale includes several items relating to social relationships as well as participating in activities. As such, the final subscale consisted of only six items that specifically focus on participating in leisure activities. Furthermore, we observed small to moderate correlations between scores on this subscale and measures of memory-related affect, as well as memory ability. Although this relationship was not originally hypothesized, it makes sense that individuals who report greater negative impact of memory changes to their lifestyle would report greater self-criticism and less contentment with their memory ability. We observed small but significant correlations between the Positive Coping subscale and measures of strategy use. Improving memory performance using compensatory strategies can be thought of as a problem-focused coping approach; thus, it holds that these measures would be correlated with our more general measure of Positive Coping. The relatively small size of the correlation is also understandable, as our scale includes other types of coping as well (e.g., emotion-focused coping). Associations between the Negative Emotion subscale and measures of memory-related affect and subjective memory ability reflects the fact that individuals who are experiencing negative self-views and perceived judgments by others following age-related memory changes express less confidence in and less contentment with their memory ability, as well as increased self-criticism. Although we did not predict a relationship between Negative Emotion and loneliness, it is not surprising that individuals who feel isolated and less supported by others report greater negative emotions. Clinical and Research Applications of the MIQ The MIQ was designed to be applicable and convenient for use in clinical settings. Its relatively short length (51 items) and multiple subscales mean that multifaceted information can be collected with minimal administration time. Further, this measure allows clinicians to assess the extent to which age-related memory changes are disrupting an individual’s day-to-day functioning. This may be valuable information when determining whether additional cognitive or psychological assessment is required, and whether a client might benefit from intervention. The MIQ may provide complementary information for clinical diagnosis. For example, individuals with MCI may report greater impact of memory changes than healthy older adults. In addition, the MIQ may be useful for evaluating the effectiveness of memory intervention programs when administered as a pre- and post-intervention outcome measure. Several validated memory interventions focus on normalizing memory changes and teaching memory strategies (Chan et al., 2017; Hyer, Scott, Lyles, Dhabliwala, & McKenzie, 2014; Kinsella et al., 2009; Troyer, 2001; Wiegand, Troyer, Gojmerac, & Murphy, 2013; Willis, Chan, Murray, Matthews, & Banerjee, 2009), which may be associated with improved scores on the MIQ (particularly the Positive Coping subscale) following intervention. In this way, the MIQ could help clinicians and researchers better understand outcomes for their participants following an intervention, which in turn could help facilitate development of more targeted interventions for this population. Limitations and Future Directions The participants in our sample were highly educated, which may not be representative of the general population. It is possible that education moderates the negative impact of memory changes. For example, individuals with access to greater education may be more likely to seek out health resources, such as memory interventions, and therefore may not be as impacted by memory changes. However, education was not strongly related to MIQ scores in our sample suggesting that this effect is likely to be small, if present. Most participants in this study were retired. Thus, further work would be needed to address questions of interest involving working older adults. Finally, it will be interesting to learn whether the impact of memory changes is related to important outcomes, such as mental health, cognitive abilities, and functional independence. Memory is a crucial aspect of identity, and even normal age-related memory changes can have important consequences for day-to-day functioning in older adults. The MIQ is the first measure that allows researchers and clinicians to quantify the impact of memory changes on older adults’ emotions, relationships, activities, and coping behaviours, thus allowing for broader investigations of health and aging. Supplementary Material Supplementary data are available at The Gerontologist online. Funding This work was supported by the Ontario Women’s Health Scholars Award, awarded to K.T. Shaikh. The Ontario Women’s Health Scholars Award is funded by the Ontario Ministry of Health and Long-Term Care. Conflict of Interest Statement None reported. Acknowledgements We thank Daniel Chiacchia and Rebecca Hudes for their assistance with data entry. References Brandt, J., Spencer, M., & Folstein, M. ( 1988). The telephone interview for cognitive status. Neuropsychiatry, Neuropsychology, & Behavioral Neurology , 1, 111– 117. Cattell, R. B. ( 1966). The scree test for the number of factors. 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The GerontologistOxford University Press

Published: Mar 7, 2018

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