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| Even with direct questioning, 60% of those with dementia and 62% of those with mild cognitive impairment do not report simple memory problems, suggesting that loss of awareness of change occurs early in cognitive impairment. If general practitioners asked directly about problems with memory the majority of the patient group they were trying to identify would deny any difficulty, whereas 17% of healthy adults would answer positively. Do subjective memory symptoms indicate other problems? Older age, female sex, and low education level are more commonly associated with subjective memory problems in cross sectional community studies. In studies where participants were volunteers or had referred themselves to memory clinics, those with subjective memory problems tended to be younger and their symptoms correlated with depression rather than objective memory problems on cognitive tests. Subjective memory problems were strongly associated with depression, neurotic personality trait, or both, even when there was no association with objective cognitive performance, in 26 studies in one review. All five studies included in a systematic review reported an association between subjective memory problems and poorer quality of life. The Maastricht Aging Study also reported such an association that persisted over a period of nine years. These findings suggest that even if subjective memory problems are not a direct risk factor for dementia, they are not simply a characteristic of the "worried well" and should be taken seriously. Link to free full-text BMJ article PDF with references and tables BMJ 2010;340:c1425 © 2010 BMJ Publishing Group Ltd.
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