Clinical Review

Subjective memory problems

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1425 (Published 19 March 2010) Cite this as: BMJ 2010;340:c1425
  1. Steve Iliffe, professor of primary care for older people1, chief investigator 2,
  2. Louise Pealing, general practitioner3
  1. 1University College London, London WC1E 6BT
  2. 2Evidence-based Interventions in Dementia (EVIDEM) programme
  3. 3London School of Hygiene and Tropical Medicine, London
  1. Correspondence to: S Iliffe s.iliffe{at}ucl.ac.uk
  • Accepted 8 March 2010

Summary points

  • Subjective memory problems are much more common in later life than the objective problems that suggest minor cognitive impairment or dementia

  • Subjective memory problems are not simply a characteristic of the “worried well” and should be taken seriously

  • Depression is associated with subjective memory problems, as are older age, female sex, and low educational attainment

  • Depression is itself a risk factor for dementia, making the diagnostic task even more difficult

  • Subjective memory problems are a poor predictor of dementia syndrome (loss of memory and one other aspect of cognition sufficient to cause impairment)

  • When deciding whether to refer to specialist services, practitioners need to rely on rules of thumb to evaluate the extent and possible significance of symptoms or subjective memory loss

The National Dementia Strategy for England, published in 2009,1 urges general practitioners to become skilled at recognising dementia at an early stage and to promptly refer those at risk to specialist memory services. The implementation of the strategy includes a public awareness campaign to reduce the stigma of dementia and encourage people to approach their GP if they have concerns about their memory. Subjective memory loss, which is seen as the cardinal symptom of dementia by the public, is likely to be the main problem reported by those who consult their doctor. However, the findings of the Kungsholmen cohort study, which included 1435 people aged 75-95 years without dementia, suggest that only 18% of future cases of dementia will be identified in the preclinical phase by investigating those who screen positive for memory problems.2

What evidence is available to guide GPs in management and referral decisions for patients with subjective memory loss? This clinical review is based on the findings of five systematic reviews, three of which3 4 5 investigated the association between subjective memory …

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