Presence Of Subjective Memory Complaints Research Articles

A - 100 Who Is at the Door? Clinical Presentations and Predictors of Dementia Diagnosis in a Specialist Dementia Service

Abstract Objective This service audit aimed to identify predictors associated with a dementia diagnosis and the diagnostic base rate in a UK-based, specialist Younger People with Dementia (YPWD) Service. Method All patients referred between July 2022 and 2023 to the YPWD service were included in the study. All 191 patients were under 65 years at the time of referral. 69 patients were excluded from analysis (e.g., if the patient withdrew from the service prior to assessment or if the referral was deemed inappropriate based on service guidelines). A quasi-experimental design was used, investigating the relative predictive value of factors such as demographics, presenting cognitive symptoms, comorbidities, or mental health to receiving a dementia diagnosis. Following definition, raters reviewed client case notes to establish the presence or absence of each criterion. Results Significant predictors of a dementia diagnosis in YPWD were functional change (p < 0.001), behavior change (p < 0.001), being accompanied to assessment (p < 0.001), diminished insight (p < 0.001), executive functioning difficulties (p < 0.05), cognitive screening test score below cut-off (p < 0.05) and previous radiological investigation prior to referral (p < 0.001). The diagnostic rate for YPWD was 15%. Conclusions Memory problems alone are an insufficient predictor for a dementia diagnosis in YPWD, unless accompanied by additional factors. Overreliance on the presence of subjective memory complaints in primary care as a percipient to referral for specialist assessment contributes to a low diagnostic rate for the service The presence of insight and attending appointments alone contraindicate the presence of an organic disorder. Results indicate that factors beyond diagnostic criteria may be clinically significant.

Individual posterior alpha rhythms and cognitive reserve as possible early prognostic markers in people with subjective memory complaints

Subjective memory complaints (SMCs) are a memory disorder that often precedes mild cognitive impairment (MCI) or Alzheimer’s disease (AD). Both individual alpha rhythms and cognitive reserve (CR) represent key features of SMCs and provide useful tools to characterize and predict the course of the disorder. We studied whether older people with SMCs may also present some abnormal resting state electroencephalogram (rsEEG) alpha rhythms, and whether alpha rhythms are associated with CR. To do this, eyes-closed rsEEG were recorded in 68 older people with and without SMCs. The individual alpha indexes alpha/theta transition frequency (TF) and individual alpha frequency peak (IAFp) were computed. TF and IAFp were also used to determine the alpha1, alpha2, and alpha3 power frequency. Results indicated no differences in TF or IAFp between older people with SMCs and controls. The SMCs group showed a reduction in alpha3 power in comparison with controls. Specifically, women with SMCs were characterized by a significant decrease in alpha3 power compared to control women. Furthermore, only in SMCs group, greater CR was associated with slow IAFp. In sum, these results suggest that TF and IAFp are two stable indexes that are not influenced by the presence of SMCs. However, the reduction in alpha3, as observed in women with SMCs, shows an abnormal posterior rsEEG at alpha power. Finally, the compensatory mechanisms of CR appear to interact with the neurophysiological mechanisms that underlie the regulation of alpha rhythms.

Auditory Event-Related Potentials in Older Adults with Subjective Memory Complaints.

Auditory event-related potentials (AERPs) have been suggested as possible biomarkers for the early diagnosis of Alzheimer's disease (AD). However, no study has investigated AERP measures in individuals with subjective memory complaints (SMCs), who have been suggested to be at a pre-clinical stage of AD. This study investigated whether AERPs in older adults with SMC can be used to objectively identify those at high risk of developing AD. AERPs were measured in older adults. Presence of SMC was determined using the Memory Assessment Clinics Questionnaire (MAC-Q). Hearing thresholds using pure-tone audiometry, neuropsychological data, levels of amyloid-β burden and Apolipoprotein E (APOE)ɛ genotype were also obtained A classic two-tone discrimination (oddball) paradigm was used to elicit AERPs (i.e., P50, N100, P200, N200, and P300). Sixty-two individuals (14 male, mean age 71.9±5.2 years) participated in this study, of which, 43 (11 male, mean age 72.4±5.5 years) were SMC and 19 (3 male, mean age 70.8±4.3 years) were non-SMC (controls). P50 latency was weakly but significantly correlated with MAC-Q scores. In addition, P50 latencies were significantly longer in Aβ+ individuals compared to Aβ- individuals. Results suggest that P50 latencies may be a useful tool to identify individuals at higher risk (i.e., participants with high Aβ burden) of developing measurable cognitive decline. Further longitudinal and cross-sectional studies in a larger cohort on SMC individuals are warranted to determine if AERP measures could be of significance for the detection of pre-clinical AD.

The impact of COVID‐19 restrictions after one year on modifiable risk factors related to brain health in older adults in The Netherlands

AbstractBackgroundCOVID‐19‐restrictions impact the lifestyle and mental health of people, which then might affect brain health and increase risk of cognitive decline particularly in older adults. Thereby, COVID‐19 might indirectly contribute to cognitive decline. We aimed to investigate changes in modifiable risk factors related to brain health in older adults after one year of COVID‐19‐restrictions.MethodAn online questionnaire was disseminated between February and March 2021 to registrants of the Dutch Brain Research Registry, aged ≥50, without a self‐reported diagnosis of mild cognitive impairment or dementia. Participants reported potential changes in behaviors during COVID‐19 pandemic concerning modifiable risk factors in eight domains (physical activity, sleep, memory, stress, feeling of loneliness, diet, alcohol consumption and smoking) compared to before the COVID‐19‐outbreak. We counted the number of reported detrimental and beneficial changes, and used multiple regression analyses to relate (socio)demographics, subjective memory complaints and COVID‐19 related aspects to increasing number of reported detrimental and beneficial changes, separately.Result3943 participants (66±8 years old, 76% female) completed the questionnaire. After one year of COVID‐19‐restrictions, 74% reported one or more detrimental changes and 60% reported at least on beneficial change. More specifically, participants reported more often detrimental changes for loneliness, sleep, physical activities, stress, memory complaints and smoking, while beneficial changes were more often reported for diet and alcohol consumption. More detrimental changes was associated lower age, (B = 0.02; 95%confidence interval = ‐0.03‐ ‐0.01), female sex (0.28;0.15–0.41), living alone (0.35;0.22–0.48), the presence of subjective memory complaints (0.69;0.54–0.84), a current or past COVID‐19 infection (0.35;0.14–0.56) and a fear of a COVID‐infection (0.54;0.42–0.65). In addition, those who were less satisfied with their income were more likely to report more detrimental changes (0.66;0.34‐1.00). More beneficial changes were only associated with female sex (0.16;0.06‐0.27).ConclusionThe COVID‐19 pandemic appears to have a differentially impact on older adults in the Netherlands, with people who are relatively younger, female, living alone, experiencing subjective memory complaints and those with a past or current or fear of a COVID‐19‐infection seem more vulnerable for more detrimental changes in modifiable risk factors related to brain health. Thus providing an opportunity for targeted prevention and health education.

Spouse-Appraised Memory Functioning Predicts Memory Decline Better Than Subjective Memory Complaints in Community Dwelling Older Adults at Genetic Risk for Alzheimer's Disease.

Objective: Alzheimer's disease (AD) begins with subtle memory decline, years before dementia onset. The presence of subjective memory complaints (SMC) has been proposed as a marker of preclinical AD. However, recent evidence has demonstrated early and progressive loss of awareness of memory difficulties in non-demented older adults harboring AD pathology. We investigated the respective contributions of SMC and spouse-appraised memory functioning (SAM) to predict memory decline in a large cohort of community dwelling older adults.Methods: The Wisconsin Longitudinal Study collected cognitive data from a community-based cohort of 3,583 participants in both 2005 and 2011. The participant and the participant's spouse were each asked to rate the participant's memory functioning using a Likert scale. We predicted change in objective episodic memory with models including baseline SMC, baseline SAM, or both SMC and SAM. We also evaluated an awareness index (SMC minus SAM). We then tested the interaction between Apolipoprotein E (APOE ε4) carrier status and SMC/SAM to evaluate whether the effects were driven by individuals at-risk for AD pathology.Results: In separate models, SMC (−0.081 ± 0.036, p = 0.025) and SAM (−0.084 ± 0.278, p = 0.003) were both associated with memory decline over ~6 years. However, the AI was not significantly associated with memory decline (0.031 ± 0.024, p = 0.19). When both predictors were included in the same model, SAM (−0.074 ± 0.03, p = 0.0092) was associated with memory decline, while SMC was not significant (−0.061 ± 0.04, p = 0.99). The association between SAM and memory decline was stronger in the APOE ε4 carriers than in the non-carriers (APOE-by-SAM interaction: F = 6.07; p = 0.002), and follow up analyses revealed that SAM was particularly predictive of decline only for APOE ε4 carriers. The association between SMC and memory decline was independent of APOE ε4 carrier status (APOE-by-SMC interaction: F = 2.29; p = 0.13).Conclusions: Spouse-appraised memory functioning was more predictive of memory decline than SMC or an awareness index, particularly in APOE ε4 carriers, who are at increased risk for AD pathology.

Spouse‐appraised memory functioning predicts memory decline better than subjective memory complaints in non‐demented older adults

AbstractBackgroundAlzheimer's disease (AD) begins with subtle memory decline, years before dementia onset. The presence of subjective memory complaints (SMC) has been proposed as a marker of preclinical AD. However, recent evidence has demonstrated early and progressive loss of awareness of memory difficulties in non‐demented older adults harboring AD pathology. We investigated the respective contributions of SMC and spouse‐appraised memory functioning (SAM) to predict memory decline in a large cohort of non‐demented older adults.MethodThe Wisconsin Longitudinal Study collected cognitive data from a community‐based cohort of 3607 participants in both 2005 and 2011. The participant and the participant’s spouse were each asked to rate the participant’s memory functioning using a Likert scale. We predicted change in objective episodic memory performance (immediate and delayed recall of 10 words) with models including baseline SMC, baseline SAM, or both SMC and SAM, adjusting for age, sex, and education. We also evaluated an awareness index (SAM minus SMC). We then tested the interaction between APOE4 carrier status and SMC/SAM to evaluate whether the effects were driven by the individuals at‐risk for AD pathology.ResultIn separate models, SMC (Figure 1A: ‐0.081±0.036, p=0.025) and SAM (Figure 1B ‐0.084±0.028, p=0.003) were both associated with memory decline over approximately six years, but the awareness index was not (‐0.028±0.025, p=0.25). When tested in the same model, only SAM (‐0.074±0.028, p=0.009) was associated with memory decline, while SMC was not significant (‐0.061±0.037, p=0.10). The association between SAM and memory decline was stronger in the APOE4 carriers than in the non‐carriers (Figure 2B: APOE‐by‐SAM interaction: F= 6.07; p= 0.002), demonstrating that SAM was particularly predictive for individuals at‐risk for AD pathology. The association between SMC and memory decline was not driven by APOE4 carriers (Figure 2A: APOE‐by‐SMC interaction: F=2.29; p= 0.13).ConclusionSpouse‐appraised memory functioning was more predictive of memory decline than SMC or an awareness index, particularly for APOE4 carriers, who are at increased risk for AD pathology.

Subjective Memory Complaints in APOE ɛ4 Carriers are Associated with High Amyloid-β Burden

APOEɛ4 genotype and aging have been identified as risk factors for Alzheimer's disease (AD). In addition, subjective memory complaints (SMC) might be a first clinical expression of the effect of AD pathology on cognitive functioning. To assess whether APOEɛ4 genotype, age, SMC, and episodic memory are risk factors for high amyloid-β (Aβ) burden in cognitively normal elderly. 307 cognitively normal participants (72.7 ± 6.8 years, 53% female, 55% SMC) from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study underwent amyloid PET and APOE genotyping. Logistic regression analyses were performed to determine the association of APOEɛ4 genotype, age, SMC, and episodic memory with Aβ pathology. Odds of high Aβ burden were greater at an older age (OR = 3.21; 95% CI = 1.68-6.14), when SMC were present (OR = 1.90; 95% CI = 1.03-3.48), and for APOEɛ4 carriers (OR = 7.49; 95% CI = 3.96-14.15), while episodic memory was not associated with odds of high Aβ burden. Stratified analyses showed that odds of SMC for high Aβ burden were increased in specifically APOEɛ4 carriers (OR = 4.58, 95% CI = 1.83-11.49) and younger participants (OR = 3.73, 95% CI = 1.39-10.01). Aging, APOEɛ4 genotype, and SMC were associated with high Aβ burden. SMC were especially indicative of high Aβ burden in younger participants and in APOEɛ4 carriers. These findings suggest that selection based on the presence of SMC, APOEɛ4 genotype and age may help identify healthy elderly participants with high Aβ burden eligible for secondary prevention trials.

Subjective memory complaints and the risk of stroke.

Persons with cognitive impairment, as assessed by cognitive tests, are at a higher risk of stroke. Subjective memory complaints might be an earlier marker for stroke, especially in persons with higher education. Their cognitive reserve might mask their cognitive impairment during cognitive testing. In a population-based setting, we investigated the association between subjective memory complaints and stroke. We simultaneously investigated the association between Mini-Mental State Examination and stroke. We also assessed whether these associations varied with educational level. 9152 participants from the Rotterdam Study (baseline 1990-1993 or 2000-2001) completed the subjective memory complaints questionnaire and underwent Mini-Mental State Examination assessment. Subsequently, the entire cohort was followed for incident stroke until 2012. We used Cox proportional hazard models to estimate the associations between subjective memory complaints and Mini-Mental State Examination, with stroke. During a follow-up of 111 593 person years, 1134 strokes were identified, of which 663 were ischemic and 99 hemorrhagic. In the fully adjusted model, presence of subjective memory complaints was independently associated with a higher risk of stroke (hazard ratio, 1.20; 95% confidence interval, 1.04-1.39), but a higher Mini-Mental State Examination was not (hazard ratio per point increase, 0.99; 95% confidence interval, 0.95-1.02). The association between subjective memory complaints and risk of stroke was modified by educational level, with a higher risk of stroke in persons with a higher level of education (hazard ratio, 1.39; 95% confidence interval, 1.07-1.81). Subjective memory complaints might be an early indicator of stroke risk, especially in highly educated individuals.

Do subjective memory complaints herald the onset of mild cognitive impairment in Parkinson disease?

Longitudinal studies on healthy participants have shown that subjective memory impairment (defined as subjective cognitive complaints with normal cognitive objective performance) might be a strong predictor of mild cognitive impairment (MCI). Parkinson disease (PD) also manifests cognitive disturbances, but whether subjective memory complaints may predict the development of MCI in PD has not yet been explored. We prospectively screened newly diagnosed, untreated patients with PD in order to evaluate whether subjective memory complaints may predict development of MCI over a 2-year follow-up evaluation. We enrolled 76 de novo untreated patients with PD. Of the 76 patients, 23 (30.3%) complained memory issues. Among the patients cognitively unimpaired at baseline, those with subjective complaints were more likely to develop MCI at follow-up. The regression model confirmed that presence of subjective memory complaints at baseline was an independent predictor of development of MCI at follow-up. This is the first prospective study to explore the relationship between subjective and objective cognitive deficits in newly diagnosed, untreated patients. Our results provide preliminary evidence that subjective memory complaints might predict future development of MCI.

The predictive value of self-rated health in the presence of subjective memory complaints on permanent nursing home placement in elderly primary care patients over 4-year follow-up

self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear. seven-hundred fifty-seven non-nursing home residents ≥65 years from general practices in Central Copenhagen were followed for 4 years (2002-2006). Patients gave information on SRH, cognition (SMC and MMSE), quality of life (EQ-5D) and socio-demographics. Information on comorbidities and permanent NH placement came from registries. The association between SRH (dichotomised into good versus poor) and SMC, and permanent NH placement was assessed using Cox proportional hazard regression adjusted for potential confounders. NH placement totaled 6.5% at 4-year follow-up. Poor SRH increased NH placement [hazard ratio (HR) = 2.07, 95% CI: 1.11-3.87] adjusted for age, SMC, MMSE, sex and comorbidities. SRH was not associated with NH placement if accounting for additional health information; however, SMC was (HR = 2.47, 95% CI: 1.26-4.86). Increased placement was seen for patients with good SRH and SMC (HR = 6.64, 95% CI: 2.31-19.12), but not among patients with poor SRH and SMC (HR = 1.37, 95% CI: 0.59-3.20) when compared with the reference group (good SRH and without SMC). both poor SRH and SMC were associated with permanent NH placement risk among elderly primary care patients. However, when SMC was present a reverse association was found for SRH: good SRH increased NH placement. Since SRH is integrated in widely used psychometric instruments, further research is needed to establish the mechanism and implications of this finding.

Subjective memory complaints in primary care patients and death from all causes: A four-year follow-up

Objective. To investigate the prognostic value of subjective memory complaints for all-cause mortality in order to determine whether elderly persons with subjective memory complaints may be regarded as a group of vulnerable patients who need close follow-up. Design. Prospective cohort study. Setting. Primary care units in the central district of Copenhagen, Denmark. Subjects. 758 community-dwellers aged 65 years and older consulting their general practitioner in October and November 2002. Main outcome measures. Information on subjective memory complaints, socio-demographics, and health-related quality of life were collected at the enrolment primary care consultation. Dates of death from all causes occurring during the four-year follow-up were retrieved from the national databases. Cox proportional hazard regression models on time to death (censored after four years) were used to examine the influence of subjective memory complaints on all-cause mortality. Results. 88 patients died during the four-year follow-up. The association between subjective memory complaints and mortality had a statistically not significant hazard ratio (HR) of 0.91, adjusting for known confounders. Statistically significant predictors for mortality were Age (HR = 1.43 for 75–84 years and HR = 3.39 for 85 + years), Sex (HR = 0.51 for women), Mobility (HR = 2.39 for some problems), Self-care (HR = 2.34 for some problems) and Comorbidity (HR = 2.06, 3.19 and 5.89 for a Charlson comorbidity index of 1, 2, or ≥ 3 respectively). Conclusion. In an elderly population presenting for primary care the presence of subjective memory complaints was not significantly associated with an increase in all-cause mortality.

Subjective memory complaints in elders: depression, anxiety, or cognitive decline?

To study the association of subjective memory complaints (SMC) with affective state and cognitive performance in elders. We studied community dwelling elderly persons with normal physical examination. Participants completed questionnaires regarding memory difficulties and lifestyle habits, the Geriatric Depression Scale (GDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Depending on their answers to the question about their memory condition, participants were divided into complainers and non-complainers and to five groups according to their MMSE scores. These data have been compared to objective cognitive performance according to Mindstreams - a computerized neuropsychological battery. A logistic regression was performed to evaluate odds ratios (OR) and 95% confidence intervals (CI) for those factors, which were associated with SMС (dependent variable). Of 636 consecutive subjects (61% females), 507 participants (79.7%) had SMС. Presence of SMC was inversely correlated with MMSE scores, (r=-0.108; P for trend=0.007). GDS and STAI scores were higher among subjects with SMC (OR=1.23: CI 95%: 1.1-1.36 and OR=1.03: CI 95%: 1.01-1.07, respectively). SMC did not correlate with objective cognitive performance measured by Mindstreams. Subjective memory complaints are associated with sub-syndromal depression and anxiety in healthy cognitively normal elders.

Neurocognitive and atrophic patterns in Parkinson’s disease based on subjective memory complaints

Ample evidence has suggested that individuals with subjective memory complaints are at a higher risk for cognitive decline. Nevertheless, the significance of subjective memory complaints in Parkinson’s disease has not been studied until now. We investigated whether the patterns of cognitive profiles and gray matter density differed in cognitively normal patients with Parkinson’s disease based on the presence of subjective memory complaints. Using a single question with a yes or no answer, cognitively normal patients with Parkinson’s disease were classified as with (n = 20) or without subjective memory complaints (n = 15). Cognitive profiles and gray matter density were examined using standardized neuropsychological tests and voxel-based morphometry. No significant differences in demographic characteristics were observed between groups. The detailed neuropsychological tests demonstrated that Parkinson’s disease patients with subjective memory complaints had significantly decreased verbal fluency and slightly lower scores on the backward digit-span test compared with those without subjective memory complaints. A voxel-based morphometry analysis revealed that Parkinson’s disease patients with subjective memory complaints had significantly decreased gray matter density in the anterior cingulate gyrus and right inferior parietal lobule compared with those without subjective memory complaints. Our data demonstrated that Parkinson’s disease patients with subjective memory complaints showed a poorer performance on tasks related to verbal fluency and attention with more severe cortical atrophy compared to those without subjective memory complaints, suggesting that subjective memory complaints in patients with Parkinson’s disease may represent an early manifestation of underlying Parkinson’s disease-related pathological changes.

Subjective memory complaints in general practice predicts future dementia: a 4‐year follow‐up study

Many older patients in general practice have subjective memory complaints (SMC); however, not all share this information with their general practitioner (GP). The association between SMC and future cognitive decline or dementia is not clear, especially in a general practice population. The aim of this study was to determine the risk for receiving a subsequent hospital-based dementia diagnosis on the basis of patients' reports of SMC in a primary care setting. Prospective cohort survey with 4-year register-based follow-up in general practice. All 17 practices with a total of 24 GPs working in the inner district of Copenhagen municipality, Denmark. A total of 40 865 patients were listed, and 2934 were 65 years or older. Cox proportional hazard models were used to examine the influence of risk factors for hospital-based dementia diagnosis. A total of 758 non-nursing home residents aged 65 years and older consulted their GP in October and November 2002, and, when asked, 177 (24%) reported memory problems, and 50 (6.6%) received a hospital-based dementia diagnosis within the 4-years follow-up. SMC had an adjusted Hazard Ratio (HR) of 2.27 for subsequent dementia diagnosis. Other statistical significant covariates were Mini Mental State Examination < 24 (HR 3.97), age (HR 2.73 for 75-84 years and HR 3.75 for 85+ years) and receiving home care (HR 3.24) This study indicates that the presence of SMC in an older general practice population is a significant independent predictor for subsequent hospital-based dementia diagnosis. Thus, the GP could consider inquiring for memory complaints to identify vulnerable older patients.

Cognition and beta-amyloid in preclinical Alzheimer's disease: Data from the AIBL study

The ‘preclinical’ phase of Alzheimer's disease is a future target for treatment, but additional research is essential to understand the relationship between β-amyloid burden and cognition during this time. We investigated this relationship using a large sample of apparently healthy older adults (N=177), which also enabled examination of whether the relationship differed according to age, gender, years of education, apolipoprotein E status, and the presence of subjective memory complaints. In addition to episodic memory, a range of cognitive measures (global cognition, semantic memory, visuospatial performance, and executive function) were examined. Participants were aged over 60 years with no objective cognitive impairment and came from the imaging arm of the Australian Imaging, Biomarkers, and Lifestyle (AIBL) study of ageing. 11C-PiB PET was used to measure β-amyloid burden and a PiB ‘cut-off’ level of 1.5 was used to separate participants with low PiB retention from those with high PiB retention. Thirty-three percent of participants had a PiB positive scan. PiB positive participants were 5 years older, twice as likely to carry an apolipoprotein E ɛ4 allele, and their composite episodic memory was 0.26 SD worse than PiB negative volunteers. Linear regressions with β-amyloid burden as a dichotomous predictor, revealed an interaction between β-amyloid burden and gender, as well as age and education effects, in predicting episodic memory and visuospatial performance. In females, but not in males, increased β-amyloid was related to worse episodic memory and visuospatial performance. Furthermore, an interaction between β-amyloid burden and APOE status was found in predicting visuospatial performance, whereby there was a trend for increased β-amyloid to relate to worse visuospatial performance for those without an APOE ɛ4 allele. There were no other main or interaction effects of β-amyloid on any of the other composite cognitive measures. These cross-sectional findings suggest that β-amyloid burden does not have a large effect on cognition in this subset of apparently healthy older people. The finding of gender differences deserves further research to answer definitively the important question of gender susceptibility to adverse cognitive effects from β-amyloid.

Subjective cognitive impairment: increased prefrontal cortex activation compared to controls during an encoding task

Subjective cognitive impairment (SCI) has been proposed as a clinical stage which may precede mild cognitive impairment in the clinical continuum of AD, and is characterised by the presence of subjective memory complaints in the absence of objective cognitive deficits. Specific memory-related brain activation differences have been reported in mild cognitive impairment and in cognitively normal individuals at known genetic risk of AD; our objective was to determine whether similar differences are present in people with SCI. We compared brain activation in a memory clinic sample of 10 SCI subjects and 10 controls during a verbal episodic memory encoding task using functional magnetic resonance imaging (fMRI). There were no differences between groups on measures of encoding success (recognition accuracy) nor was there evidence of altered semantic processing. Both groups activated left prefrontal cortex (PFC) and cerebellum during encoding. The SCI group also demonstrated activation in left medial temporal, occipitoparietal and medial frontal cortex. Group comparisons revealed increased activation in SCI in left PFC, where activation strength correlated with memory task performance. The activation differences reported in this study may reflect the employment of compensatory strategies in the face of early AD pathology, although a number of alternative explanations need to be considered. Further studies with larger samples may help to determine whether the observed activation changes are likely to be associated with early neuropathological processes or with other unrelated factors.

Association between subjective memory complaints and nursing home placement: a four‐year follow‐up

In order to evaluate whether elderly persons with subjective memory complaints may be regarded as a group of potentially vulnerable patients who need close follow-up, we investigated the risk of nursing home placement during a 4-year follow-up period. Prospective cohort survey with 4-year follow-up in general practice. Cox proportional hazard models were used to examine the influence of risk factors on nursing home placement. A total 758 non-nursing home residents aged 65 years and older consulted the General Practitioners in October and November 2002 of whom 50 nursing home placements were observed. Subjective memory complaints were associated with an adjusted Hazard Ratio (HR) of 2.59 for nursing home placement. Other statistical significant covariates were MMSE < 24 (HR = 3.95), Age (HR = 3.92 for 75-84 years and HR = 19.90 for 85 + years) and extreme anxiety/depression (HR = 4.74). The effect of subjective memory complaints is seen to moderate when subjects are older. The data of this study indicated that in an elderly primary care population the presence of subjective memory complaints was a significant independent predictor for nursing home placement together with other known risk factors.

Subjective memory complaints and cognitive performance in a sample of healthy elderly.

Memory loss is a major complaint among the elderly population. However, the clinical significance of this symptom is variable and also controversial in the scientific literature.ObjectiveTo compare the cognitive performance of two groups of healthy elderly, one group with and the other without, subjective memory complaints (SMC).MethodsSixty cognitively intact elderly individuals (39 females and 21 males), aged 69.9±6.3 years and with educational level of 8.5±5.5 years, were included in the study. Participants were submitted to the Mini-Mental State Examination and to the Cornell depression scale in order to rule out global cognitive impairment and depression, respectively. Moreover, they answered the MAC-Q, a questionnaire devised to evaluate subjective impression of memory function. Subsequently, they were submitted to the digit span forward and backward, the Brief Cognitive Screening Battery, and to the Frontal Assessment Battery.ResultsTwenty-seven individuals had MAC-Q scores <25 and thus were classified as not having SMC, while 33 had MAC-Q scores ≥25 and were considered to have SMC. No differences for age, gender, education and MMSE scores were found between the two groups. The comparison between the performance of the groups of complainers and non-complainers on the different cognitive tests yielded no significant difference, although there was a trend toward non-complainers performing better on incidental memory.ConclusionsThe presence of SMC was not associated to objective memory impairment or to other cognitive deficits in this group of elderly individuals.

Subjective Memory Complaints of Family Members of Patients with Alzheimer’s Disease and Depression

Background: First-degree relatives of patients with Alzheimer’s disease (AD) and major depression (MD) carry an increased genetic risk for the same disorders. Subjective memory complaints of the family members of patients might be an early sign or an indicator of an increased risk of either dementia or depression. Alternatively, they might be the consequence of the increased subjective awareness of relatives and spouses of patients of their own age-associated memory failures. To investigate the relevance of the above-mentioned hypotheses, the prevalence rates of subjective memory complaints of first-degree relatives and spouses of patients with AD, of patients with MD and of control subjects were compared. Methods: Personal interviews were conducted with 718 first-degree relatives and 196 spouses of 146 AD patients, 168 patients with MD and 136 control subjects from the general population. The prevalences of subjective memory complaints by relatives or spouses were compared using χ² tests. To control for differences of gender and age at onset, Cox proportional hazards analyses were performed. Results: There were no differences in the prevalence of subjective memory complaints by first-degree relatives of subjects with AD, MD and controls after controlling for age differences. The same applies to the subjective memory complaints in their spouses. Conclusion: Subjective memory complaints were frequent in family members. However, they were neither associated with the genetic risk of AD or of MD nor could they be explained by an increased awareness by having a demented spouse or relative. Consequently, familial factors seem to have a limited influence on the presence of subjective memory complaints in the elderly.