M EM ORY COM PLAINTS AND TEST
PERFORM ANCE IN HEALTHY ELDERLY PERSONS
Paulo M at t os
1, Valéria Lino
2, Luciana Rizo
3,
Ângela Alf ano
3, Cát ia Araújo
4, Ronir Raggio
5ABSTRACT - In ord er to com p are the use of a structured self-rep ort q uestionnaire w ith d irect q uestioning ab out m em ory p rob lem s, 71 healthy and ind ep end ent ag ed ind ivid uals (63 w om en) from the com m unity w ithout risk factors for cog nitive d eficits w ere ob jectively asked ab out sub jective m em ory com p laints (SMC), g iven the Mem ory Com p laint Questionnaire (MAC-Q) and then sub m itted to the Rey Aud itory Verb al Learning Test (RAVLT). SMC p ositively correlated w ith hig her scores on MAC-Q, althoug h a sig nificant p ercentag e of the sam p le had SMC and low er scores on MAC-Q and also no SMC and hig her scores on MAC-Q. Perform ance on RAVLT w as sig nificantly w orse (p < 0.05) for the g roup p resenting SMC b ut not for the g roup w ith hig her scores on the MAC-Q. We conclud e that d irect q uestioning m ayb e m ore clinically sig nificant than a self rep ort q uestionnaire, at least for eld erly p ersons from the com m unity w ithout risk factors for cog nitive d ecline or d ep ression.
KEY WORDS: m em ory, cog nition, ag eing , neurop sycholog ical tests.
Queixas de memória de idosos saudáveis e desempenho em testes
RESUMO - Ob jetivand o com p arar o uso d e q uestionário estruturad o autop reenchid o com o q uestionam ento d ireto acerca d e p rob lem as d e m em ória, 71 ind ivíd uos id osos saud áveis (63 m ulheres) d a com unid ad e sem fatores d e risco p ara d éficits cog nitivos foram p erg untad os acerca d e q ueixas sub jetivas d e m em ória (SMC), sub m etid os ao Questionário d e Queixas d e Mem ória (MAC-Q) e ao Teste d e Ap rend izad o Aud itivo-Verb al d e Rey (RAVLT). Em b ora a p resença d e SMC tenha se correlacionad o com escores m ais altos no MAC-Q, um a p ercentag em sig nificativa d a am ostra ob teve escores b aixos ap esar d a p resença d e SMC, além d a existência d e ind ivíd uos sem SMC com escores altos no MAC-Q. O d esem p enho no RAVLT foi sig nificativam ente p ior no grup o com SMC (p < 0,05) m as não no grup o com escores altos no MAC-Q. Concluim os q ue o q uestionam ento d ireto p od e ser m ais significativo clinicam ente q ue um q uestionário autop reenchid o, ao m enos p ara ind ivíd uos id osos na com unid ad e sem fatores d e risco p ara d éficit cog nitivo ou d ep ressão.
PALAVRAS-CHAVE: m em ória, cog nição, envelhecim ento, testes neurop sicológ icos.
1Professor, Institute of Psychiatry - Fed eral University of Rio d e Janeiro, Rio d e Janeiro RJ, Brazil (UFRJ); 2Physician, Oswald o Cruz Found ation
Rio d e Jan eiro RJ, Brazil; 3Psych o lo g ist , In st it u t e o f Psych o lo g y, UFRJ; 4Psych o lo g ist , In st it u t e o f Mat h em at ics UFRJ; 5Pro fesso r, In st it u t e o f
St u d ies o f Pu b lic Healt h UFRJ.
Received 8 May 2003, received in fin al fo rm 11 Ju ly 2003. Accep t ed 4 Au g u st 2003.
Dr. Paulo M at t os - Rua Paulo Barret o 91 - 22280-010 Rio de Janeiro RJ - Brasil. E-mail: mat t os@at t global.net
Th e d eg ree o f in t ellect u al d eclin e in o ld ag e is st ro n g ly asso ciat ed w it h g en et ic an d en viro n m en t al factors1. A failure to cop e w ith tasks req uiring m
en-t al flexib ilien-t y an d sp eed in en-t h e p ro cessin g o f in fo r-m atio n can b e o b served d u rin g th is life p h ase. Th ere is also a d ecrease in t h e acq u isit io n an d in t h e sp o n -taneous recovery of verb al and non-verb al m aterials, as w ell as a fast er fo rg et fu ln ess o f t h em2. Rep o rt s
o f d ysm n esia b eco m e co m m o n an d req u ire th e p h y-sician to d ifferentiate b etween norm al changes associat ed w it h ag in g an d t h o se relat ed t o m o rb id p ro cesses. Com p laints ab out m em ory im p airm ent, com -m only known as subjective memory complaint (SMC)
are fairly co m m o n in eld erly p eo p le, b u t it s clin ical sig n ifica n ce is st ill a m a t t er o f co n t ro versy. So m e st u d ies su g g est t h a t t h e in d ivid u a ls m a kin g su ch co m p lain t s d isp lay a lo w er p erfo rm an ce in m em o ry t est s3 -7, b u t t h ere are co n flict in g fin d in g s in o t h er
stu d ies8. In t act m et am em o ry h as alread y b een d
e-m o n st rat ed in so e-m e early cases o f d ee-m en t ia, w h en in d ivid u als refer m o re SMC th an n o rm al eld erly p eo -p le9-11. The concept of m etam em ory refers to the
im p airm en t in t h is self p ercep t io n . Th e p o ssib ilit y o f a co rrect p ercep t io n o f su b t le m em o ry d eficit s w i-thout im p airm ent of p erform ance in m em ory tests12
should not b e overlooked , esp ecially in p atients w ho are n o t d ep ressed . In t h is case, m et am em o ry w o u ld b e co n sid ered n o rm al, an d t h e p ro b lem w o u ld lie o n lo w t est sen sit ivit y.
St u d ies o n m et am em o ry in t h e eld erly are o f t h e outm ost im p ortance for som e reasons. First, p ersons u n ab le t o m ake a co rrect ju d g m en t ab o u t t h eir o w n m em o ry m a y rem a in en g a g ed in p o t en t ia lly risky activities or restrain their own autonom y too m uch12.
Th o se u n aw are o f t h e d eficit s w ill n o t seek m ed ical h elp early, t o o . Seco n d , m o re d at a is n eed ed t o h elp clin ician s co rrect ly in t erp ret m em o ry co m p lain t s (o r it s ab sen ce) in everyd ay p ract ice. Am o n g t h e m an y exist in g crit eria fo r d ysm n esia in t h e eld erly, o n e o f t h e m o st p o p u lar is t h e Ag eAsso ciat ed Mem o ry Im -p airm en t - AAMI13. Th e AAMI crit eria in clu d es ag e
over 50, presence of m em ory com plaints for everyday t asks as w ell as a d eclin e in p erfo rm an ce in m em o ry t est s, eit h er fo r verb al an d n o n -verb al m at erial. Th e Mem o ry Co m p lain t Qu est io n n aire (MAC-Q) w as d e-sig n ed t o ad d ress m em o ry co m p lain t s fo r t h e AAMI criteria14, the cut-off point established by the authors
b ein g 25. MAC-Q is a self-rep o rt q u est io n n aire o f 5 q u est io n s ad d ressin g d aily act ivit ies an d o n e q u es-t io n ad d ressin g o verall m em o ry fu n ces-t io n in g co m p a-rin g p resen t m o m en t t o w h en t h e p erso n w as 18 t o 20 years o ld . Resp o n d en t s m u st ch o o se o n e o f t h e 5 o p t io n s ra n g in g fro m much bet t er now t o much w orse now14. How ever, in clinical p ractice p hysicians
co m m o n ly ask t h eir in d ivid u als ab o u t t h eir m em o ry b u t d o n o t reg u larly u se q u est io n n aires. If t h e p h y-sician d ecid es t o u se sim p le an d very b rief m em o ry tests d uring consultation (like the item s in Mini-Men-t al SMini-Men-t aMini-Men-t e Exam in aMini-Men-t io n ), o n ly Mini-Men-t h o se in d ivid u als w iMini-Men-t h a sig n ifican t d eclin e w ill b e im p aired , sin ce t h eir sen -sivit y is co n sid ered t o o lo w fo r su b t le m em o ry d efi-cits. Referral for a com p lete neurop sycholog ical eva-lu at io n , w h ich is t im e-co n su m in g an d exp en sive, is n o t w arran t ed fo r every in d ivid u al p resen t in g SMC. Ho w ever, it is n o t clear fo r m o st p h ysician s w h en t o refer an eld er p at ien t w it h SMC t o n eu ro p sych o lo g i-cal evaluation. Due to the hig h freq uency of m em ory co m p lain t s in o ld ag e an d t o t h e im p o rt an ce o f a d ifferential d iagnosis b etween norm al and ab norm al cognitive decline, the purpose of this study is to check the relation b etween SMC and d ysm nesia ob jectively assessed b y t h e MAC-Q.
Th e o b ject ive o f t h is st u d y w as t o co m p are t h e an sw er t o t h e o n e q u est io n “have you been having memory dif f icult ies t hat upset your everyday lif e”
p o sed b y t h e in t erview er, t h e sco res o n t h e MAC-Q (g iven at t h e en d o f t h e in t erview ) an d t h e p erfo r-m an ce o n r-m er-m o ry t est s in o rd er t o evalu at e w h ich ap p roach (d irect q uestioning versus self-rep ort q ues-tionnaire) correlates better with m em ory functioning.
M ETHOD
75 co m m u n it y h ealt h y an d in d ep en d en t p erso n s ag ed 60 o r o ld er, reg u larly at t en d in g a p ro g ram fo r t h e eld erly at t h e Fed eral Un iversit y o f Rio d e Jan eiro resp o n d ed t o an in vit at io n t o p art icip at e o n “a st u d y o n m em o ry in t h e eld erly”. Th is p ro g ram co n sist ed o f ed u cat io n al an d re-creat io n al act ivit ies fo r t h e eld erly fro m t h e co m m u n it y livin g in t h e n earb y area. Th e st aff in t h e p ro g ram sim p ly invited the p articip ants w hen they arrived for the p rog ram act ivit ies an d n eit h er g o t in t o fu rt h er d et ails n o r asked q u est io n s a b o u t m em o ry fu n ct io n in g . Th ey w ere t h en re-ferred t o o u r facilit y w h ere t h ey in t erview ed b y eit h er a g eriat rician o r a p sych iat rist an d t h en su b m it t ed t o n eu -ro p sych o lo g ical evalu at io n b y a p sych o lo g ist b lin d t o t h e p resen ce o f m em o ry co m p lain t s. All p art icip an t s sig n ed an in fo rm ed co n sen t . Th e sam p le co n sist ed m ain ly (89%) o f w o m en , a w ell-kn o w n ch aract erist ic o f p ro g ram s fo r t h e eld erly in Brazil.
Inclusion criteria: 4 or m ore years of education; absence o f d ep ressio n [a sco re less t h an 5 o n t h e 15-it em Geriat ric Dep ressio n Sca le o f Yesa va g e15 o r 7 in t h e 21-it em Ham il-t o n Scale fo r Dep ressio n ] an d in d ep en d en ce [acil-t s w iil-t h o u il-t assistan ce o r su p ervisio n in th e fo llo w in g in stru m en tal ac-t iviac-t ies o f d a ily livin g : m a n a g em en ac-t o f o w n fin a n ces, ac-t h e a b ilit y t o g o o u t o f t h e h o u se a lo n e a n d d o o w n sh o p -p ing16]. Exclusion criteria: history of head traum a, any neu-ro lo g ical o r p sych iat ric illn ess; u se o f b en zo d iazep in es in t h e last 3 m o n t h s; u se o f illicit d ru g s; visu al, au d it o ry an d / o r m o t o r im p airm en t , Min i Men t al St at e Exam17 b elo w 18 fo r p art icip an t s w it h a 4 t o 7 years o f ed u cat io n , an d b elo w 26 fo r t h o se w it h 8 o r m o re years o f ed u cat io n , accord ing to b razilian norm ative d ata18; an y sym p t o m at ic cardiovascular condition. No physical exam was perform ed.
Int erview : Part icip an t s w ere in t erview ed p rio r t o t h e n eu ro p sych o lo g ical evalu at io n an d in clu sio n o r exclu sio n crit eria w ere in vest ig at ed . Au d it o ry o r visu al d eficit w ere in fo rm a lly eva lu a t ed a n d a sin g le q u est io n w a s p o sed ab out p rob lem s in the everyd ay life d ue to m nem ic d eficits (“Have you been having memory dif f icult ies t hat upset your everyday lif e?”). Th e vo lu n t eer w a s t h en cla ssified a s “w it h co m p lain t ” (C) o r “w it h n o co m p lain t ” (NC). Th e MAC-Q w a s g iven a t t h e en d o f t h e in t erview.
p erfo rm an ce is ch aract erized b y an in creasin g recall o f w o rd s t h ro u g h o u t t h e essa ys, u su a lly referred a s learning curve. List B is rea d a lo u d o n ly o n ce, a ft er t h e 5t h reco l-lect io n o f List A (A5) an d t h e p at ien t receives t h e sam e p revio u s in st ru ct io n s. List B is act u ally a d ist ract er t o p re-ven t reh earsal o f t h e m at erial b ein g h eld in sh o rt -t erm m em o ry. Th e exam in er t h en asks t h e p at ien t t o recall List A ag ain w it h o u t read in g it (im m ed iat e free recall, A6). After 15 m in u tes, an o th er free recall is asked (d elayed free reca ll, A7). Reco g n it io n , t h e la st st a g e o f t h e t est , co n sist s o f a list o f 30 w o rd s read alo u d b y t h e exam in er w h en t h e p at ien t m u st in d icat e w h ich w o rd s w ere o n List A.
St at ist ical analysis: Th e d ifferen ce b et w een SMC a n d MAC-Q t akin g in t o acco u n t ag e an d ed u cat io n w as an a-lyzed b y t h e n o n -p aram et ric Man n -Wh it n ey´ s U t est . Th e sam e t est w as u sed fo r an alyzin g t h e relat io n sh ip a m o n g SMC, MAC-Q a n d p erfo rm a n ce o n t h e RAVLT. Th e Qu i-square test was used to check the relationship am ong SMC, MAC-Q an d g en d er, an d to ch eck th e asso ciatio n b etw een SMC a n d MAC-Q (Ta b le 1). Th e sig n ifica n ce level w a s 5%, an d t h e p ro g ram em p lo yed w as SPSS fo r Win d o w s v.10.
RESULTS
Of t h e 75 eld erly p eo p le ch an n eled fo r t h e st u d y, 4 d id n o t co m p let e t h e evalu at io n , so t h at t h e d at a becam e available for 71 participants, of which 8 were m en (11%) an d 63 w ere w o m en (89%). Th e vo lu n -t eers’ m ean ag e w as 70, w i-t h a m in im al ag e o f 63 an d a m axim u m ag e o f 82. Th e averag e n u m b er o f years o f ed u cat io n w as 10.5. Th ere w ere 33 (46.5%) NC p articip ants and 38 (53.5%) C in the g roup , w he-reas 33 (46.5%) d isp layed a MAC-Q u n d er 25 an d
38 (53.5%) su m m ed u p 25 o r m o re m arks in t h e MAC-Q. No association was found between SMC and sex (p = 0 .8 3 2 ), a g e (p = 0 .6 0 7 ) o r ed u ca t io n (p = 0.477). Review o f t h e MAC-Q resu lt s in d icat ed t h ey w ere sim ilar fo r sex (p = 0.589), ag e (p = 0.831), an d ed u ca t io n (p = 0.428). Th ree q u est io n s h elp ed t o ad d ress t h e relat io n sh ip b et w een SMC, MAC-Q an d t h e p erfo rm an ce o n RAVLT.
1) Is there a relationship betw een SM C and M AC-Q? Tab le 1 reveals a st ro n g relat io n sh ip b et w een t h e p resen ce o f SMC an d t h e sco re in t h e MAC-Q. Th e m a jo rit y b u t n o t t h e t o t a lit y o f C in d ivid u a ls [29 (76.3%)] o b t ain ed 25 p o in t s o r m o re in t h e MAC-Q (p < 0.05).
2) Is M AC-Q predict ive of a low cognit ive perf or-mance? Tab le 2 sh o w s t h ere w as n o sig n ifican t d if-feren ce o n t h e RAVLT b et w een in d ivid u als w it h h i-g h er (= 25) an d lo w er sco res o n MAC-Q
3) Is SM C predict ive of a low cognit ive perf or-mance? The p erform ance on the RAVLT (Tab le 3) w as sim ilar b et w een t h e C an d NC g ro u p s in t h e n u m b er
Table 1. Relat ion bet w een SM C and M AC-Q.
N (%) MAC-Q < 25 N (%) MAC-Q > 25
C 9 (27.3%) 29 (76. 3%)
NC 24 (72.7%) 9 (23.7%)
To t al 33 (100%) 38 (100%)
Ch i-sq u are p < 0.05. NC- n o m em o ry co m p lain t s; C- m em o ry co m p lain t s.
Table 2. Average number of w ords recovered in t he t he M AC-Q and RAVLT.
A1 A5 A1-A5 B A6 A7 Rec
MAC-Q < 25 (n = 33) 5.45 10.87 5.42 4.51 7.93 8.03 27.15
MAC-Q > 25 (n = 38) 5.36 10.42 5.05 4.86 7.44 7.18 27.42
p (< 0.05) 0.986 0.434 0.381 0.778 0.520 0.242 0.481
A1, averag e w o rd s reco vered aft er t h e first t ry; A5, averag e w o rd s reco vered aft er t h e fift h t ry; A1-A5, m ean d ifferen ce o f reco veries b et w een t h e fift h an d t h e first t ry; B, averag e w o rd s reco vered fro m List B; A6, averag e w o rd s reco vered fro m List A aft er reco llect io n o f List B; A7, reco very o f List A aft er 15 m in u t es; Rec reco g n it io n .
Table 3. Average number of w ords recovered in t he SM C and RAVLT.
A1 A5 A1-A5 B A6 A7 Rec
NC (n = 33) 5.42 11.18 5.75 4.60 8.57 8.30 27.72
C (n = 38) 5.39 10.15 4.76 4.78 6.89 6.92 26.92
Sig n ifican ce (p < 0.05) 0.907 0.112 0.074 0.939 0.029 0.048 0.038
o f w o rd s reco llect ed aft er t h e first p resen t at io n o f List A (A1), w hose averag e results w ere, resp ectively, 5.42 an d 5.39, (p = 0.907). Th e sam e o ccu rred w it h List B, in which group s C and NC ob tained an average sp an o f 4.60 an d 4.78 w o rd s (p = 0.939). A t en d en cy to statistical significance was found (p = 0.074) in the am o u n t o f w o rd s learn t fro m A1 t o A5 (n o rm ally calcu lat ed b y A5 m in u s A1): C an d NC vo lu n t eers learnt 4.76 and 5.75 words, respectively. A significant d ifferen ce (p = 0.029) w as fo u n d in t h e reco very o f List A im m ed iat ely aft er reco llect io n o f List B (A6): C in d ivid u als o b t ain ed an averag e 6.89 an d NC in d i-vid u als acq u ired 8.57 w o rd s. In A7 (reco very o f List A aft er 15 m in u t es fro m A6), a sig n ifican t d ifferen ce w as also ob served b etw een the C and NC ind ivid uals (p = 0.048). Th is d iscrep an cy b et w een g ro u p s w as also seen in t h e reco g n it io n o f List A (p = 0.038).
DISCUSSION
Mem ory com plaints are com m on in elderly people an d req u ire t h e p h ysician t o evalu at e t h em p ro p erly in o rd er t o d ecid e if a fu rt h er an d t h o ro u g h ly eva-lu at io n is w arran t ed . Rep o rt s t h at SMCs are m o re co m m o n in w o m en1,7 m ay su g g est a p o ssib le co n
-n ectio -n to estro g e-n ic d ep rivatio -n i-n clim acteric p h a-se20. Th e relat io n sh ip b et w een g en d er an d t h e SMC
co u ld n o t b e est ab lish ed o n t h is st u d y b ecau se o f t h e sm all n u m b er o f m en in t h e sam p le. Ed u cat io n w as n o t asso ciat ed t o t h e p resen ce o f SMC o r t est p erfo rm an ce. Th e st ro n g relat io n sh ip b et w een SMC an d MAC-Q (sco res = 25) w as exp ect ed , sin ce t h e q u est io n n aire w as d evelo p ed t o d et ect m em o ry im -p airm en t in eld er -p eo -p le w it h o u t co g n it ive d eclin e (in d ivid u als p resen t in g MMSE b elo w n o rm al w ere e xclu d e d fro m o u r sa m p le ). As in d ivid u a ls w it h co n d it io n s t h at en t ail an im p airm en t o f m et am e-m o ry, su ch as d ep ressio n6 an d d ep en d en cy t o p
er-fo rm t h e act ivit ies o f everyd ay life12, h ad b een
ex-clu d ed fro m o u r sam p le, t h e p resen ce o f SMC w as p o sit ively asso ciat ed w it h h ig h er sco res o n MAC-Q. It is n o t ew o rt h y h o w ever t h at so m e in d ivid u als w it h SMC h ad n o rm al sco res o n MAC-Q, a fin d in g t h at has im p ortant clinical im p lications. The p resum p tion t h a t q u e st io n n a ire s (like MAC-Q) m a yb e m o re reliab le t h an d irect q u est io n in g w o u ld lead t o t h e co n clu sio n th at in d ivid u als w ith SMC an d lo w er sco -res o n MAC-Q d o n o t p -resen t sym p t o m at o lo g y t h at req u ires fu rt h er in vest ig at io n . Ho w ever, o u r st u d y show s exact ly t he opposit e: SMC - an d n o t sco res o n MAC-Q - w as asso ciat ed w it h a w o rse p erfo r-m an ce o n RAVLT. Th e p resen ce o f SMC p red ict ed a w o rse p erfo rm an ce o n RAVLT in asp ect s co n sid ered very sen sit ive t o m em o ry d eclin e: d elayed free recall
an d reco g n it io n . Sin ce t h e in d ivid u als w it h w o rse p erfo rm an ce o n RAVLT d id n o t h ave d em en t ia an d w e re o t h e rw ise h e a lt h y a n d in d e p e n d e n t , t h e ir resu lt s m ay su g g est so m e d eg ree o f su b clin ical co g -n it ive d ecli-n e t h at w arra-n t s fu rt h er i-n vest ig at io -n o r fo llo w -u p (all in d ivid u als are b ein g fo llo w ed u p fo r t h e co n t in u at io n o f t h is st u d y). Rap id fo rg et t in g , as m easured by delayed-recall in different m em ory tasks h as b een p ro p o sed as an im p o rt an t n eu ro p sych o lo -g ical m arker fo r t h e early an d d ifferen t ial d ia-g n o sis o f d em en t ia, in p art icu lar t h at o f Alzh eim er’s t yp e, t h e m o st p revalen t o n e21,22. Th e m easu res o f fo
r-g et t in r-g fo r d ist in r-g u ish in r-g n o rm al eld erly in d ivid u als fro m m ild ly d em en t ed h a ve t h e h ig h est a ccu ra cy ra t es a m o n g a ll m em o ry m ea su res, a cco rd in g t o Welsh et al.23, w h o u sed a list -learn in g t ask o f t h e
Co n so rt iu m t o Est ab ilish a Reg ist ry fo r Alzh eim er´ s Disease (CERAD) t o co m p are n o rm al eld erly ad u lt s an d m ild ly d em en t ed p at ien t s. Reco g n it io n o f a list -le a rn in g t e st sim ila r t o RAVLT [Ca lifo rn ia Ve rb a l Learn in g Test ] w as also alread y d o cu m en t ed t o b e im p aired in m ild d em en t ia b y Kram er et al.24. Th e
u se o f m e m o ry se lf-e va lu a t io n q u e st io n n a ire s in everyd ay life h as b een crit icized b y Su n d erlan d et a l.25, w h o ca rried o u t a sim ila r exp erim en t w it h a
g ro u p o f 60 year-o ld p erso n s p ro ceed in g fro m t h e co m m u n it y. Th ese au t h o rs h ave co n clu d ed t h at in sp it e o f ab n o rm al resp o n ses o n t h e q u est io n n aires, p erfo rm an ce in t est s w as n o rm al.
Th e fact t h at SMC in t h e eld erly w as relat ed t o a w o rse p erfo rm an ce o n RAVLT in o u r st u d y su g g est s accu racy in m et am em o ry, so m et h in g t h at h as b een previously reported26,27. Wang et al.7 studied the
Th e fin d in g s o f t h is st u d y sh o u ld b e in t erp ret ed w ith restraints. SMC, for instance, w as not id entified t h ro u g h sp o n t an eo u s rep o rt in g , b u t o t h erw ise b y d irect q u estio n in g . Th e au th o rs d ecid ed fo r th is p ro -ced u re in o rd er t o m im ic w h at is co m m o n ly d o n e in clinical p ractice w ith eld erly p atients. This p roced ure h o w ever m ay h ave elicit ed a p o sit ive resp o n se in so -m e in d ivid u als, in creasin g t h e n u -m b er o f p eo p le in t h e C g ro u p . Th e m et h o d o lo g y an d t h e size o f t h e sam p le d o n o t allo w u s t o g en eralize t h e p resen t resu lt s fo r t h e eld erly p o p u lat io n as a w h o le. Also , t h e sam p le co n sist ed o f vo lu n t eers fo r a m em o ry st u d y, n o t p at ien t s co m m o n ly seen in m ed ical p rac-t ice. Ou r resu lrac-t s su g g esrac-t rac-t h arac-t self-p ercep rac-t io n o f m em o ry iem p airem en t in everyd ay life em ayb e a u sefu l in -d icat o r o f act u al o r p o t en t ial co g n it ive p ro b lem s, at least in h ealt h y an d in d ep en d en t in d ivid u als fro m the com m unity. Direct questioning seem ed to be m o-re p o-red ict ive o f m em o ry im p airm en t t h an t h e u se o f a self-rep ort q uestionnaire. One p ossib le exp lanation is t h at h ig h er sco res o n MAC-Q ad d resses m em o ry d ecline (since com p ares p resent m em ory functioning t o t h e o n e w h en t h e in d ivid u al w as m u ch yo u n g er) b u t n o t n ecessarily m em o ry d eficit , w h ich is so m e-thing totally different. A person m ay correctly identify a d eclin e o f h is m em o ry fro m lat e ad o lescen ce o r early ad u lt h o o d t o sen escen ce an d yet d o n o t h ave any functional im p airm ent as a conseq uence. Several d ifferent factors m ay b e related to this p henom enon: o verest im at io n o f p revio u s m em o ry ab ilit ies, act u al su p erio r m em o ry ab ilit ies t h at h ave d eclin ed b u t are still in the norm al range, d ifferent life d em and s up on m em o ry in sen escen ce, am o n g o t h ers. SMC p ro m -pted by direct questioning in healthy elder individuals w it h o u t risk fa ct o rs fo r m e t a m o ry im p a irm e n t (m o st ly d ep ressio n ) sh o u ld b e co n sid ered an in d ica-t o r o f p o ssib le m em o ry d ysfu n cica-t io n , an d a sig n al callin g fo r t h e n eed o f a m o re co m p let e evalu at io n o r fo llo w -u p .
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