largely agrees with his report. He states that over the past few years, he has had
problems with his memory, such as forgetfulness, losing his train of thought, and
misplacing his keys and other items. He retired from work 3 years ago, but never
received any poor work evaluations. He drives and manages familyfinances, his
medications, and appointments, all without difficulty. He does not feel sad, but his
wife states that he is more irritable and socially withdrawn. He and his wife are
concerned that these problems are a sign of early dementia.
Vignette 3: Memory Complaints in an Elderly Woman
An 80-year-old female has an appointment with a neuropsychologist and brings her
husband and daughter. She reports that she has been referred for this evaluation
because her family members feel that she has memory problems. She thinks that her
memory is justfine“for her age,”but admits that her thinking is a bit slowed.
According to the daughter, the patient’s memory has declined over the past 2–
3 years, and the patient frequently repeats herself in conversation and forgets the
names of family members. She has also exhibited behavioral changes such as
decreased motivation, irritability, and losing interest in activities that she used to
enjoy, such as playing cards. According to the husband, the patient has difficulty
completing daily tasks. For instance, she is unable to prepare a meal or set up her
pillbox without assistance. On a family trip a few years ago, the patient became
disoriented and had difficultyfinding her way to her hotel room. The husband and
daughter are concerned that the patient has dementia.
These vignettes illustrate the diversity of clinical scenarios that involve subjective
memory complaints (SMC). SMC are important because, as with most symptoms, it
is a person’s subjective experience that brings them to clinical attention. Complaints
also cause distress and worry. The person experiencing the memory problems wants
to understand the significance of the memory problems and whether they are
indicative of a true problem. From a research perspective, there is interest in the
concurrent validity of SMC (can individuals accurately perceive their own memory
function) and the predictive validity of SMC (whether complaints portend future
declines or a clinical memory disorder). Understanding whether SMC are a proxy for
true cognitive changes is complicated by the fact that many neurological conditions
that negatively impact cognition, such as stroke, traumatic brain injury, and many
dementias, are associated withanosognosia, a lack of awareness of deficits.
SMC are quite common. Estimates vary considerably, ranging from 25 to 50%,
depending on the populations sampled (Commissaris et al. 1998 ; Jonker et al.
2000 ). The prevalence of SMC increases with age, occurring in nearly one-third of
young and middle-aged adults (Ponds et al. 1997 ), nearly half of those aged 65–74,
and nearly 90% of those over the age of 85 (Bassett and Folstein 1993 ; Cutler and
Grams 1988 ). SMC are associated with psychiatric illness, particularly depression
(Feehan et al. 1991 ; Kahn et al. 1975 ), and personality factors, such as neuroticism
276 M.T. Weber and P.M. Maki