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Patterns of subjective memory impairment in the elderly: association with memory performance




The association of subjective memory impairment (SMI) with cognitive performance in healthy elderly subjects is poor because of confounds such as depression. However, SMI is also a predictor for future dementia. Thus, there is a need to identify subtypes of SMI that are particularly related to inferior memory performance and may represent at-risk stages for cognitive decline.


A total of 2389 unimpaired subjects were recruited from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe), as part of the German Competence Network on Dementia. Clusters of SMI according to patterns of response to SMI questions were identified. Gender, age, depressive symptoms, apolipoprotein E (apoE) genotype, delayed recall and verbal fluency were included in a Classification and Regression Tree (CART) analysis to identify discriminators between the clusters.


We identified three clusters. Cluster 1 contained subjects without memory complaints. Cluster 2 contained subjects with general memory complaints, but mainly without memory complaints on individual tasks of daily living. Cluster 3 contained subjects with general memory complaints and complaints on individual tasks of daily living. Depressive symptoms, as the first-level discriminator, distinguished between clusters 1 and 2 versus cluster 3. In subjects with only a few depressive symptoms, delayed recall discriminated between cluster 1 versus clusters 2 and 3.


In SMI subjects with only a minor number of depressive symptoms, memory complaints are associated with delayed recall. As delayed recall is a sensitive predictor for future cognitive decline, SMI may be the first manifestation of future dementia in elderly subjects without depression.


Corresponding author

*Address for correspondence: Frank Jessen, M.D., Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. (Email:


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Alvarez, J. A. & Emory, E. (2006). Executive function and the frontal lobes: a meta-analytic review. Neuropsychological Review 16, 1742.
Bäckman, L., Small, B. J. & Fratiglioni, L. (2001). Stability of the preclinical episodic memory deficit in Alzheimer's disease. Brain 124, 96102.
Barnes, L. L., Schneider, J. A., Boyle, P. A., Bienias, J. L. & Bennett, D. A. (2006). Memory complaints are related to Alzheimer disease pathology in older persons. Neurology 67, 15811585.
Bennett, D. A., Schneider, J. A., Arvanitakis, Z., Kelly, J. F., Aggarwal, N. T., Shah, R. C. & Wilson, R. S. (2006). Neuropathology of older persons without cognitive impairment from two community-based studies. Neurology 66, 18371844.
Blair, C. K., Folsom, A. R., Knopman, D. S., Bray, M. S., Mosley, T. H. & Boerwinkle, E.; Atherosclerosis Risk in Communities (ARIC) Study Investigators (2005). APOE genotype and cognitive decline in a middle-aged cohort. Neurology 64, 268276.
Braak, H. & Braak, E. (1991). Neuropathological stageing of Alzheimer-related changes. Acta Neuropathologia (Berlin) 82, 239259.
Breiman, L., Friedman, J. H., Olshen, R. A. & Stone, C. J. (1984). Classification and Regression Trees. Wadsworth: Belmont, CA.
Busse, A., Aurich, C., Zaudig, M., Riedel-Heller, S., Matschinger, H. & Angermayer, M. C. (2002). Age- and education-specific reference values for the cognitive test of the SIDAM (Structured Interview for the Diagnosis of Dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-IV). Zeitschrift für Gerontologie und Geriatrie 35, 565574.
Busse, A., Hensel, A., Guhne, U., Angermeyer, M. C. & Riedel-Heller, S. G. (2006). Mild cognitive impairment: long-term course of four clinical subtypes. Neurology 67, 21762185.
Folstein, M. F., Folstein, M. E. & McHugh, P. R. (1975). ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research 12, 189198.
Gagnon, M., Dartigues, J. F., Mazaux, J. M., Dequae, L., Letenneur, L., Giroire, J. M. & Barberger-Gateau, P. (1994). Self-reported memory complaints and memory performance in elderly French community residents: results of the PAQUID Research Program. Neuroepidemiology 13, 145154.
Gauthier, S., Reisberg, B., Zaudig, M., Petersen, R. C., Ritchie, K., Broich, K., Belleville, S., Brodaty, H., Bennett, D., Chertkow, H., Cummings, J. L., de Leon, M., Feldman, H., Ganguli, M., Hampel, H., Scheltens, P., Tierney, M. C., Whitehouse, P. & Winblad, B.; International Psychogeriatric Association Expert Conference on mild cognitive impairment (2006). Mild cognitive impairment. Lancet 367, 12621270.
Ghebremedhin, E., Schultz, C., Thal, D. R., Rub, U., Ohm, T. G., Braak, E. & Braak, H. (2001). Gender and age modify the association between APOE and AD-related neuropathology. Neurology 56, 16961701.
Hanninen, T., Reinikainen, K. J., Helkala, E. L., Koivisto, K., Mykkanen, L., Laakso, M., Pyorala, K. & Riekkinen, P. J. (1994). Subjective memory complaints and personality traits in normal elderly subjects. Journal of the American Geriatrics Society 42, 14.
Heun, R., Kolsch, H. & Jessen, F. (2006). Risk factors and early signs of Alzheimer's disease in a family study sample. Risk of AD. European Archives of Psychiatry and Clinical Neuroscience 256, 2836.
Hixson, J. E. & Vernier, D. T. (1990). Restriction isotyping of human apolipoprotein E by gene amplification and cleavage with HhaI. Journal of Lipid Research 31, 545548.
Jessen, F., Feyen, L., Freymann, K., Tepest, R., Maier, W., Heun, R., Schild, H. H. & Scheef, L. (2006). Volume reduction of the entorhinal cortex in subjective memory impairment. Neurobiology of Aging 27, 17511756.
Jonker, C., Geerlings, M. I. & Schmand, B. (2000). Are memory complaints predictive for dementia? A review of clinical and population-based studies. International Journal of Geriatric Psychiatry 15, 983991.
Jonker, C., Launer, L. J., Hooijer, C. & Lindeboom, J. (1996). Memory complaints and memory impairment in older individuals. Journal of the American Geriatrics Society 44, 4449.
Jorm, A. F., Butterworth, P., Anstey, K. J., Christensen, H., Easteal, S., Maller, J., Mather, K. A., Turakulov, R. I., Wen, W. & Sachdev, P. (2004 a). Memory complaints in a community sample aged 60–64 years: associations with cognitive functioning, psychiatric symptoms, medical conditions, APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities. Psychological Medicine 34, 14951506.
Jorm, A. F., Christensen, H., Korten, A. E., Jacomb, P. A. & Henderson, A. S. (2001). Memory complaints as a precursor of memory impairment in older people: a longitudinal analysis over 7–8 years. Psychological Medicine 31, 441449.
Jorm, A. F., Masaki, K. H., Davis, D. G., Hardman, J., Nelson, J., Markesbery, W. R., Petrovitch, H., Ross, G. W. & White, L. R. (2004 b). Memory complaints in nondemented men predict future pathologic diagnosis of Alzheimer disease. Neurology 63, 19601961.
Jungwirth, S., Fischer, P., Weissgram, S., Kirchmeyr, W., Bauer, P. & Tragl, K. H. (2004). Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community. Journal of the American Geriatrics Society 52, 263268.
Kaufman, L. & Rousseeuw, P. J. (2005). Finding Groups in Data. Wiley: New York.
Khachaturian, A. S., Corcoran, C. D., Mayer, L. S., Zandi, P. P. & Breitner, J. C.; Cache County Study Investigators (2004). Apolipoprotein E epsilon4 count affects age at onset of Alzheimer disease, but not lifetime susceptibility: the Cache County Study. Archives of General Psychiatry 61, 518524.
Markesbery, W. R., Schmitt, F. A., Kryscio, R. J., Davis, D. G., Smith, C. D. & Wekstein, D. R. (2006). Neuropathologic substrate of mild cognitive impairment. Archives of Neurology 63, 3846.
Mayeux, R., Small, S. A., Tang, M., Tycko, B. & Stern, Y. (2001). Memory performance in healthy elderly without Alzheimer's disease: effects of time and apolipoprotein-E. Neurobiology of Aging 22, 683689.
Morris, J. C., Heyman, A., Mohs, R. C., Hughes, J. P., van Belle, G., Fillenbaum, G., Mellits, E. D. & Clark, C. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 39, 11591165.
Moscovitch, M., Nadel, L., Winocur, G., Gilboa, A. & Rosenbaum, R. S. (2006). The cognitive neuroscience of remote episodic, semantic and spatial memory. Current Opinion in Neurobiology 16, 179190.
Nilsson, L. G., Adolfsson, R., Backman, L., Cruts, M., Nyberg, L., Small, B. J. & Van Broeckoven, C. (2006). The influence of APOE status on episodic and semantic memory: data from a population-based study. Neuropsychology 20, 645657.
O'Connor, D. W., Pollitt, P. A., Roth, M., Brook, P. B. & Reiss, B. B. (1990). Memory complaints and impairment in normal, depressed, and demented elderly persons identified in a community survey. Archives of General Psychiatry 47, 224227.
Ponds, R. W., Commissaris, K. J. & Jolles, J. (1997). Prevalence and covariates of subjective forgetfulness in a normal population in The Netherlands. International Journal of Aging and Human Development 45, 207221.
Reid, L. M. & MacLullich, A. M. (2006). Subjective memory complaints and cognitive impairment in older people. Dementia and Geriatric Cognitive Disorders 22, 471485.
Riedel-Heller, S. G., Matschinger, H., Schork, A. & Angermeyer, M. C. (1999). Do memory complaints indicate the presence of cognitive impairment? Results of a field study. European Archives of Psychiatry and Clinical Neuroscience 249, 197204.
Riley, K. P., Snowdon, D. A. & Markesbery, W. R. (2002). Alzheimer's neurofibrillary pathology and the spectrum of cognitive function: findings from the Nun Study. Annals of Neurology 51, 567577.
Riudavets, M. A., Rubio, A., Cox, C., Rudow, G., Fowler, D. & Troncoso, J. C. (2006). The prevalence of Alzheimer neuropathologic lesions is similar in Blacks and Whites. Journal of Neuropathology and Experimental Neurology 65, 11431148.
Rubinsztein, D. C. & Easton, D. F. (1999). Apolipoprotein E genetic variation and Alzheimer's disease: a meta-analysis. Dementia and Geriatric Cognitive Disorders 10, 199209.
Saykin, A. J., Wishart, H. A., Rabin, L. A., Santulli, R. B., Flashman, L. A., West, J. D., McHugh, T. L. & Mamourian, A. C. (2006). Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. Neurology 67, 834842.
van der Flier, W. M., van Buchem, M. A., Weverling-Rijnsburger, A. W., Mutsaers, E. R., Bollen, E. L., Admiraal-Behloul, F., Westendorp, R. G. & Middelkoop, H. A. (2004). Memory complaints in patients with normal cognition are associated with smaller hippocampal volumes. Journal of Neurology 251, 671675.
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L. O., Nordberg, A., Backman, L., Albert, M., Almkvist, O., Arai, H., Basun, H., Blennow, K., de Leon, M., DeCarli, C., Erkinjuntti, T., Giacobini, E., Graff, C., Hardy, J., Jack, C., Jorm, A., Ritchie, K., van Duijn, C., Visser, P. & Petersen, R. C. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine 256, 240246.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M. & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatry Research 17, 3749.
Zaudig, M. (1992). A new systematic method of measurement and diagnosis of ‘mild cognitive impairment’ and dementia according to ICD-10 and DSM-III-R criteria. International Psychogeriatrics 4 (Suppl. 2), 203219.
Zaudig, M. & Hiller, W. (1996). SIDAM-Handbook. Structured Interview for Diagnosis of Dementia of Alzheimer type, Multi-infarct dementia and dementia of other aetiology according to DSM-IIIR, DSM-IV and ICD-10 [in German]. Huber: Bern.


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