Applying Generalizability Theory to Examine Assessments of Subjective Cognitive Complaints: Whose Reports Should We Rely on – Participant Versus Informant?

Abstract

Objectives: This study aimed to apply the generalizability theory (G-theory) to investigate dynamic and enduring patterns of subjective cognitive complaints (SCC), and reliability of two widely used SCC assessment tools.

Design: G-theory was applied to assessment scales using longitudinal measurement design with five assessments spanning 10 years of follow-up.

Setting: Community-dwelling older adults aged 70–90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study.

Participants: The sample included 232 participants aged 70 years and older, and 232 associated informants. Participants were predominantly White Europeans (97.8%). The sample of informants included 76 males (32.8%), 153 females (65.9%), and their age ranged from 27 to 86 years, with a mean age of 61.3 years (SD = 14.38).

Measurements: The Memory Complaint Questionnaire (MAC-Q) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

Results: The IQCODE demonstrated strong reliability in measuring enduring patterns of SCC with G = 0.86. Marginally acceptable reliability of the 6-item MAC-Q (G = 0.77–0.80) was optimized by removing one item resulting in G = 0.80–0.81. Most items of both assessments were measuring enduring SCC with exception of one dynamic MAC-Q item. The IQCODE significantly predicted global cognition scores and risk of dementia incident across all occasions, while MAC-Q scores were only significant predictors on some occasions.

Conclusions: While both informants’ (IQCODE) and self-reported (MAC-Q) SCC scores were generalizable across sample population and occasions, self-reported (MAC-Q) scores may be less accurate in predicting cognitive ability and diagnosis of each individual.