Objectives: Subjective memory complaint (SMC) is central to the diagnosis of mild cognitive impairment (MCI). People with MCI are at a higher risk of progressing to dementia, and research on SMC is contradictory in terms of the accuracy of SMC and its predictive role for future dementia. One possible reason for these contradictory findings is that the level of awareness of memory function may vary among people with MCI. This review examines whether the level of awareness of memory functioning varies amongst people classified as having MCI and whether there is support for the suggestion that the level of awareness in MCI predicts future progression to dementia. Method: Sixteen studies were identified which evaluate the awareness level in people classified as having MCI in either a clinical or research setting. In addition to the outcome of each study, the conceptualization of awareness, ‘object’ of awareness and methodology were also considered. Results: There is evidence to show that the level of awareness in MCI does vary, and this may have implications for future progression to dementia. Conclusions: Given the increased risk of progression to dementia for those identified as having MCI, the role of awareness should be explored further with due consideration given to the conceptualisation of awareness and the methodology employed. The finding of variability in awareness has implications for the use of SMC in the diagnostic criteria for MCI.
© 2009 S. Karger AG, Basel
- Alzheimer’s disease
- Petersen RC: Mild Cognitive Impairment: aging to Alzheimer’s Disease. New York, Oxford University Press, 2004.
- Petersen RC: Mild cognitive impairment: transition between aging and Alzheimer’s disease. Neurologia 2000;15:93–101.
- Grober E, Hall CB, Lipton RB, Zonderman AB, Resnick SM, Kawas C: Memory impairment, executive dysfunction, and intellectual decline in preclinical Alzheimer’s disease. J Int Neuropsychol Soc 2008;14:266–278.
- Guarch J, Marcos T, Salamero M, Gastó C, Blesa R: Mild cognitive impairment: a risk indicator of later dementia, or a preclinical phase of the disease? Int J Geriatr Psychiatry 2008;23:257–265.
- Perri R, Serra L, Carlesimo GA, Caltagirone C: Amnestic mild cognitive impairment: difference of memory profile in subjects who converted or did not convert to Alzheimer’s disease. Neuropsychology 2007;21:549–558.
- Gabryelewicz T, Styczynska M, Luczywek E, Barczak A, Pfeffer A, Androsiuk W, et al: The rate of conversion of mild cognitive impairment to dementia: predictive role of depression. Int J Geriatr Psychiatry 2007;22:563–567.
- Robert PH, Berr C, Volteau M, Bertogliati C, Benoit M, Sarazin M, Legrain S, Dubois B: Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: a one year follow up study. Clin Neurol Neurosurg 2006;108:733–736.
- Wilson RS, Schneider JA, Arnold SE, Bienias JL, Bennet DA: Conscientiousness and the incidence of Alzheimer’s disease and mild cognitive impairment. Arch Gen Psychiatry 2007;64:1204–1212.
- Apostolova LG, Cummings JL: Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dement Geriatr Cogn Disord 2008;25:115–126.
- Flicker C, Ferris S, Reisberg B: Mild cognitive impairment in the elderly: predictors of dementia. Neurology 1991;41:1006–1009.
- Petersen RC, Smith GE, Waring SC, Ivnick RJ, Kokmen E, Tangalos EG: Aging, memory and mild cognitive impairment. Int Psychogeriatr 1997;9:65–69.
- Petersen RC, Smith GE, Waring SC, Ivnick RJ, Tangalos EG, Kokmen E: Mild cognitive impairment – clinical characterization and outcome. Arch Neurol 1999;56:303–308.
- Petersen RC, Stevens J, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST: Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133–1142.
- Clare L: The construction of awareness in early-stage Alzheimer’s disease: a review of concepts and models. Br J Clin Psychol 2004;43:155–175.
- Marková IS, Berrios GE: The ‘object’ of insight assessment: relationship to insight ‘structure’. Psychopathology 2001;34:245–252.
- Clare L: Neuropsychological Rehabilitation and People with Dementia. Hove, Psychology Press, 2007.
- Clare L, Markova I, Verhey F, Kenny G: Awareness in dementia: a review of assessment methods and measure. Aging Ment Health 2005;9:394–413.
- Clare L: Awareness in early-stage Alzheimer’s disease: a review of methods and evidence. Br J Clin Psychol 2004;43:177–196.
- Clement F, Belleville S, Gauthier S: Cognitive complaint in mild cognitive impairment and Alzheimer’s disease. J Int Neuropsychol Soc 2008;14:222–232.
- Jonker C, Geerlings MI, Schmand B: Are memory complaints predictive for dementia? A review of clinical and population based studies. Int J Geriatr Psychiatry 2000;15:983–991.
- Podewils LJ, McLay RN, Rebook GW, Lyketsos CG: Relationship of self-perceptions of memory and worry to objective measures of memory and cognition in the general population. Psychosomatics 2003;44:461–470.
- Jorm AF, Christensen H, Korten AE, Jacomb PA, Mackinnon A: Do cognitive complaints either predict future cognitive decline or reflect past cognitive decline? A longitudinal study of an elderly community sample. Psychol Med 1997;27:91–98.
- Schmand B, Jonker C, Geerlings MI, Lindeboom J: Subjective memory complaints in the elderly: depressive symptoms and future dementia. Br J Psychiatry 1997;171:373–376.
- Geerlings MI, Jonker C, Bouter LM, Adèr HJ, Schmand B: Association between memory complaints and incident Alzheimer’s disease in elderly people with normal baseline cognition. Am J Psychiatry 1999;156:531–537.
- Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
- Minett TSC, Da Silva RV, Ortiz KZ, Bertolucci PHF: Subjective memory complaints in an elderly sample: a cross-sectional study. Int J Geriatr Psychiatry 2007;23:49–54.
- Sarazin M, Berr C, De Rotrou J, Fabrigoule C, Pasquier F, Legrain S, Michel B, Puel M, Volteau M, Touchon J, Verny M, Dubois B: Amnestic syndrome of the medial temporal type identifies prodromal AD: a longitudinal study. Neurology 2007;69:1859–1867.
- Reid LM, MacLullich AMJ: Subjective memory complaints and cognitive impairment in older people. Dement Geriatr Cogn Disord 2006;22:471–485.
- Cook S, Marsiske M: Subjective memory beliefs and cognitive performance in normal and mildly impaired older adults. Aging Ment Health 2006;10:413–423.
- Crowe M, Andel R, Wadley V, Cook S, Unverzagt F, Marsiske M, Ball K: Subjective cognitive function and decline among older adults with psychometrically defined amnestic MCI. Int J Geriatr Psychiatry 2006;21:1187–1192.
- Farias ST, Mungas D, Jagust W: Degree of discrepancy between self and other-reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy elders. Int J Geriatr Psychiatry 2005;20:827–834.
- Hanyu H, Sakurai H, Iwamoto T: Are subjective memory complaints mandatory for the diagnosis of mild cognitive impairment? Intern Med 2007;46:791–792.
- Hanyu H, Sakurai H, Hirao K, Shimizu S, Iwamoto T: Unawareness of memory deficits depending on cerebral perfusion pattern in mild cognitive impairment. J Am Geriatr Soc 2007;55:470–471.
- Kalbe E, Salmon E, Perani D, Holthoff V, Sorbi S, Elsner A, Weisenbach S, Brand M, Lenz O, Kessler J, Luedecke S, Ortelli P, Herholz K: Anosognosia in very mild Alzheimer’s disease but not in mild cognitive impairment. Dement Geriatr Cogn Disord 2005;19:349–356.
- Okonkwo OC, Wadley VG, Griffith HR, Belue K, Lanza S, Zamrini EY, Harrell LE, Brockington JC, Clark D, Raman R, Marson DC: Awareness of deficits in financial abilities in patients with mild cognitive impairment: going beyond self-informant discrepancy. Am J Geriatr Psychiatry 2008;16:650–659.
- Ready RE, Ott BR, Grace J: Insight and cognitive impairment: effects on quality-of-life reports from mild cognitive impairment and Alzheimer’s disease patients. Am J Alzheimers Dis Other Demen 2006;21:242–248.
- Purser JL, Fillenbaum GC, Wallace RB: Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10-year trajectories of functional disability, word recall, or short portable mental status questionnaire limitations. J Am Geriatr Soc 2006;54:335–338.
- Tabert MH, Albert SM, Borukhova-Milov L, Camacho Y, Pelton G, Liu X, Stern Y, Devanand DP: Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology 2002;58:758–764.
- Onor ML, Trevisiol M, Negro C, Aguglia E: Different perception of cognitive impairment, behavioural disturbances and functional disabilities between persons with mild cognitive impairment and mild Alzheimer’s disease and their caregivers. Am J Alzheimers Dis Other Demen 2006;21:333–338.
- Kessler H, Supprian T: Awareness of deficits in patients with dementia of the Alzheimer’s type. Fortschr Neurol Psychiatr 2003;71:541–548.
- Marri L, Modugno M, Iacono S, Renzetti C, De Vreese LP, Neri M: Metamemory and self-perceived health in mild cognitive impairment. Arch Gerontol Geriatr 2001;suppl 7:235–244.
- Perrotin A, Belleville S, Isingrini M: Metamemory monitoring in mild cognitive impairment: evidence of a less accurate episodic feeling-of-knowing. Neuropsychologia 2007;45:2811–2826.
- Ries ML, Jabbar BM, Schmitz TW, Trivedi MA, Gleason CE, Carlsson CM, Rowley HA, Asthana S, Johnson SC: Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. J Int Neuropsychol Soc 2007;13:450–461.
- Vogel A, Stokholm J, Gade A, Andersen BB, Hejl A, Waldemar G: Awareness of deficits in mild cognitive impairment and Alzheimer’s disease: do MCI patients have impaired insight? Dement Geriatr Cogn Disord 2004;17:181–187.
- Vogel A, Hasselbalch SG, Gade A, Ziebell M, Waldemar G: Cognitive and functional neuroimaging correlates for anosognosia in mild cognitive impairment and Alzheimer’s disease. Int J Geriatr Psychiatry 2005;20:238–246.
- Robert P H, Clairet S, Benoit M, Koutaich J, Bertogliati C, Tible O, Caci H, Borg M, Brocker P, Bedoucha P: The Apathy Inventory: assessment of apathy and awareness in Alzheimer’s disease, Parkinson’s disease and mild cognitive impairment. Int J Geriatr Psychiatry 2002;17:1099–1105.
- Ott B R, LaFleche G, Whelihan WM, Buongiorno GW, Albert MS, Fogel BS: Impaired awareness of deficits in Alzheimer’s disease. Alzheimer Dis Assoc Disord 1996;10:68–67.
- Pfeiffer E: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975;23:433–441.
- David A, Buchanan A, Reed A: The assessment of insight in psychosis. Br J Psychiatry 1992;161:599–602.
- Reed BR, Jagust WJ, Coulter L: Anosognosia in Alzheimer’s disease: relationships to depression, cognitive function, and cerebral perfusion. J Clin Exp Neuropsychol 1993;15:231–244.
- Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566–572.
- Michon A, Deweer B, Pillon B, Agid Y, Dubois B: Relation of anosognosia to frontal lobe dysfunction in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1994;57:805–809.
- Kumar R, Jorm AF, Parslow RA, Sachdev S: Depression in mild cognitive impairment in a community sample of individuals 60–64 years old. Int Psychogeriatr 2006;18:471–480.
- Lingler JH, Nightingale MC, Erlen JA, Kane AL, Reynolds CF, Schulz R, DeKosky ST: Making sense of mild cognitive impairment: a qualitative exploration of the patient’s experience. Gerontologist 2006;46:791–800.
- Corner L, Bond J: The impact of the label of mild cognitive impairment on the individual’s sense of self. Philos Psychiatr Psychol 2006;13:3–12.
- Dale W, Hougham GW, Hill EK, Sachs GA: High interest in screening and treatment for mild cognitive impairment in older adults: a pilot study. J Am Geriatr Soc 2006;54:1388–1394.
- Banningh LJ, Vernooij-Dassen M, Rikkert MO, Teunisse J: Mild cognitive impairment: coping with an uncertain label. Int J Geriatr Psychiatry 2008;23:148–154.
- Alladi S, Arnold R, Mitchell J, Nestor PJ, Hodges JR: Mild cognitive impairment: applicability of research criteria in a memory clinic and characterization of cognitive profile. Psychol Med 2006;36:507–515.
- Thompson SA, Hodges JR: Mild cognitive impairment: a clinically useful but currently ill-defined concept? Neurocase 2002;8:405–410.
- Gilewski MJ, Zelinski EM, Schaie KW: The Memory Functioning Questionnaire for assessment of memory complaints in adulthood and old age. Psychol Aging 1990;5:482–490.
- Dixon RA, Hultsch DF, Hertzog C: The Metamemory in Adulthood (MIA) questionnaire. Psychopharmacol Bull 1988;24:671–688.
- Lachman ME, Baltes PB, Nesselroade JR, Willis SL: Examination of personality-ability relationships in the elderly: the role of the contextual (interface) assessment mode. J Res Pers 1982;16:485–501.
- Jorm AF, Jacomb PA: The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med 1989;19:1015–1022.
- Kazui H, Watamori TS, Honda R: The validation of a Japanese version of the Everyday Memory Checklist (Japanese). No To Shinkei 2003;55:317–325.
- Sehulster JR: Structure and pragmatics of a self-theory of memory. Mem Cognit 1981;9:263–276.
- Crook TH, Feher EP, Larrabee GJ: Assessment of memory complaint in age associated memory impairment: the MAC-Q. Int Psychogeriatr 1992;4:165–175.
- Marson DC: Loss of financial competency in dementia: conceptual and empirical approaches. Aging Neuropsychol Cogn 2001;8:164–181.
- Marson DC, Sawrie SM, Snyder S, McInturff B, Stalvey T, Boothe A, Aldridge T, Chatterjee A, Harrell LE: Assessing financial capacity in patients with Alzheimer disease: a conceptual model and prototype instrument. Arch Neurol 2000;27:877–884.
- Marin RS, Biedrzycki RC, Firinciogullari S: Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res 1991;38:143–162.
- Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S: Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.
- Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.
- Squire LR, Zouzounis JA: Self-ratings of memory dysfunction: different findings in depression and amnesia. J Clin Exp Neuropsychol 1988;10:727–738.
- Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, 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 RC: Mild cognitive impairment – beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. J Intern Med 2004;256:240–246.
Prof. Linda Clare
School of Psychology, Bangor University
Bangor LL57 2AS (UK)
Tel. +44 1248 388 178, Fax +44 1248 382 599, E-Mail firstname.lastname@example.org
Accepted: April 27, 2009
Published online: August 13, 2009
Number of Print Pages : 15
Number of Figures : 0, Number of Tables : 2, Number of References : 73
Dementia and Geriatric Cognitive Disorders
Vol. 28, No. 2, Year 2009 (Cover Date: September 2009)
Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)
For additional information: http://www.karger.com/DEM
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.