Laurien Aben

Memory complaints in chronic stroke patients are predicted by memory self-efficacy rather than memory capacity.

Background: Memory self-efficacy (MSE) is the belief about one’s mastery of memory functioning. In healthy elderly, memory complaints are related to MSE rather than to objectively measured memory capacity. MSE has scarcely been studied in patients that suffered a stroke. The aim of this study was twofold: (1) to examine whether memory capacity and MSE can predict the presence of memory complaints in stroke patients, and (2) to study which variables are the best predictors of MSE. Methods: In a cross-sectional study, 136 stroke patients (>18 months after onset) were recruited from April 2008 to November 2009. MSE was measured using the Metamemory in Adulthood questionnaire. Depression, coping and personality were measured using validated questionnaires, and memory performance was measured using the Rivermead Behavioural Memory Test (RBMT) and the Auditory Verbal Learning Test (AVLT). Patients were divided into a ‘complaints’ and a ‘no complaints’ group. Results: A lower MSE score was an independent predictor of having memory complaints (adjusted odds ratio: 0.422; p = 0.000), adjusted for age and depression. The RBMT and AVLT scores did not predict the presence of memory complaints (p > 0.263). Presence of memory complaints and depression were the strongest predictors of MSE (B = –1.748, p = 0.000; B = –0.054, p = 0.000), followed by word fluency, not having a partner and side of stroke (B = 0.038, p = 0.012; B = –0.517, p = 0.082; B = –0.479, p = 0.088). Conclusions: Memory complaints are predicted by MSE rather than memory capacity. MSE memory training might be an effective training strategy for reducing memory complaints in selected chronic stroke patients.

MEMORY SELF-EFFICACY AND PSYCHOSOCIAL FACTORS IN STROKE

OBJECTIVE To explore whether Memory Self-efficacy is related to depression, neuroticism and coping in patients after stroke, as it is in healthy elderly subjects. DESIGN A cross-sectional design. The relation between Memory Self-efficacy and psychosocial factors was analysed using a Mann-Whitney U test and non-parametric Spearman correlations. PATIENTS Seventeen male and 6 female patients after stroke from an inpatient rehabilitation setting were included. METHODS Memory Self-efficacy, depression, neuroticism and coping were assessed with validated questionnaires. Patients with severe aphasia, subarachnoidal haemorrhage or subdural haematomas were excluded. RESULTS As in healthy elderly subjects, higher depression ratings are significantly related to lower Memory Self-efficacy ratings (Z = -2.13; p = 0.033). Lower Memory Self-efficacy seems related to higher neuroticism ratings and a more passive coping style score (Z = -1.54; p = 0.123; Z = -1.42; p = 0.155, respectively). The Spearman correlations confirm these finding (p < 0.10). CONCLUSION This study replicated the relationships between Memory Self-efficacy and depression and neuroticism found in a healthy population, in an inpatient stroke population. Future research on Memory Self-efficacy in patients after stroke should focus on other potential determinants such as awareness and, ultimately, on the effectiveness and efficacy of interventions aimed at Memory Self-efficacy to improve participation and quality of life.

Training Memory Self-efficacy in the Chronic Stage After Stroke A Randomized Controlled Trial

Background. Stroke patients with a low memory self-efficacy (MSE) report more memory complaints than patients with a high MSE. Objective. The aim of this study was to examine the effect of a memory-training program on MSE in the chronic phase after stroke and to identify which patients benefit most from the MSE training program. Methods. In a randomized controlled trial, the effectiveness of the MSE training program (experimental group) was compared with a peer support program (control group) in chronic stroke patients. The primary outcome was MSE, measured using the Metamemory-In-Adulthood Questionnaire. Secondary outcomes included depression, quality of life, and objective verbal memory capacity. Changes in outcomes over the intervention period were compared between both groups. Demographic and clinical variables were studied as potential predictors of MSE outcome in the experimental group. Results. In total, 153 patients were included: mean age = 58 years (standard deviation [SD] = 9.7), 54.9% male, and mean of 54 months (SD = 37) after stroke. Of these, 77 were assigned to the training and 76 to the control group. Improvement of MSE (B = 0.40; P = .019) was significantly greater in the training than in the control group. No significant differences were found for the secondary outcomes. An increase in MSE after training was predicted by a younger age (B = −0.033; P = .006) and a better memory capacity (B = 0.043; P = .009), adjusted for baseline MSE. Conclusions. MSE can be improved by the MSE training program for stroke patients. Younger patients and patients with a better memory capacity benefit most from the MSE training program (Dutch Trial Register: NTR-TC 1656).

THE RELATivE EffECT Of COPinG sTRATEGy AnD DEPREssiOn On HEALTH-RELATED QuALiTy Of LifE in PATiEnTs in THE CHROniC PHAsE AfTER sTROkE

OBJECTIVE To investigate the relative associations of coping strategy and depression on health-related quality of life in patients in the chronic phase after stroke. DESIGN Cross-sectional study. SUBJECTS A total of 213 patients after stroke (> 18 months post-onset), mean age 59 years (standard deviation (SD) 9.86 years), 56% men, mean time post-stroke 53 months (SD 37.8 months). METHODS Coping strategy was measured using the assimilative-accommodative coping scale, depression using the Center for Epidemiologic Studies Depression Scale, and quality of life using the World Health Organization Quality of Life-BREF. Multivariable regression analyses were performed, adjusted for patient characteristics. RESULTS Depression score was independently related to all domains of quality of life (Psychological Health (B = -0.924; p = 0.000), Physical Health (B = -0.832; p = 0.000), Social Relationships (B = -0.917; p = 0.000), Environment (B = -0.662, p = 0.000)). Accommodative coping (B = 0.305; p = 0.024) and assimilative coping (B = 0.235; p = 0.070) were independently related to the domain Psychological Health, adjusted for depression and education level. CONCLUSION Coping strategies and depression score were independently associated with Psychological Health in patients in the chronic phase after stroke. Patients who prefer an accommodative coping strategy may show less symptoms of depression. Preferable coping strategies may be trained in order to improve both depression score and health-related quality of life in future research.

Long-Lasting Effects of a New Memory Self-efficacy Training for Stroke Patients A Randomized Controlled Trial

Background and purpose. This study aims to determine the long-term effects of a new Memory Self-efficacy (MSE) training program for stroke patients on MSE, depression, and quality of life. Methods. In a randomized controlled trial, patients were allocated to a MSE training or a peer support group. Outcome measures were MSE, depression, and quality of life, measured with the Metamemory-In-Adulthood questionnaire, Center for Epidemiological Studies–Depression Scale (CES-D), and the Who-Qol Bref questionnaire, respectively. We used linear mixed models to compare the outcomes of both groups immediately after training, after 6 months, and after 12 months, adjusted for baseline. Results. In total, 153 former inpatients from 2 rehabilitation centers were randomized—77 to the experimental and 76 to the control group. MSE increased significantly more in the experimental group and remained significantly higher than in the control group after 6 and 12 months (B = 0.42; P = .010). Psychological quality of life also increased more in the experimental group but not significantly (B = 0.09; P = .077). However, in the younger subgroup of patients (<65 years old), psychological quality of life significantly improved in the experimental group compared to the control group and remained significantly higher over time (B = 0.14; P = .030). Other outcome measures were not significantly different between both groups. Conclusions. An MSE training program improved MSE and psychological quality of life in stroke patients aged <65 years. These effects persisted during 12 months of follow-up.

Metamemory and memory test performance in stroke patients

Memory Self-Efficacy (MSE) has been shown to be related to memory performance and social participation in a healthy elderly population. This relation is unclear in stroke. As about 30% of all stroke survivors report memory complaints, there is an urgent need for effective treatment strategies. Before implementing MSE as a potential target in memory training, it should be examined whether the association between MSE and memory performance demonstrated in healthy elderly people also applies in stroke patients. This study therefore explored the predictive value of MSE on two kinds of memory tests in stroke patients; adjusted and unadjusted for age, gender, education and location of stroke. In 57 stroke patients, the Metamemory in Adulthood Questionnaire (MIA), an everyday memory test (RBMT) and a more traditional memory test (AVLT) were completed. The results show that MSE significantly predicts memory test performance on both memory tests (RBMT: β = .34; p = .01 AVLT: β = .28; p = .04). When adjusted for gender, age, education and location of stroke, the predictive value of MSE remained significant for the AVLT (RBMT: β = .23; p = .07; AVLT: β = .23; p = .05). The results support the hypothesis that MSE predicts test performance in stroke patients and, by consequence, enables improving memory performance in post-acute memory rehabilitation after stroke.