THE AGE-ASSOCIATED MEMORY IMPAIRMENT CONSTRUCT REVISITED - COMMENTS AND RECOMMENDATIONS OF A FRENCH-SPEAKING WORKGROUP

This article reports the comments and recommendations of a French-spea king workgroup concerning the controversial 'age-associated memory imp airment' (AAMI) construct, proposed by crook et al. (1986) to describe the memory difficulties associated with ageing. This construct's rele vance and validity seem doubtful, and our workgroup met to discuss (i) the proposed causal link between age-associated memory changes and bi ological cerebral ageing, (ii) the psychometric criteria which could i mprove objective evaluation of age-related memory impairment (the init ial AAMI definition criteria being inadequate), (iii) the problems ass ociated with, and the clinical realities and implications of, 'memory complaint' in the elderly, (iv) how to improve definition and evaluati on of the psychoaffective factors contributing to decrease in memory p erformance, and (v) the specificity (or lack thereof) of this construc t. The following conclusions were reached: (i) no definite link betwee n age-associated memory changes and biological cerebral ageing has bee n demonstrated in either humans or animals, and therefore remains a hy pothesis; (ii) objective evaluation of age-related memory impairment c ould be improved by comparing subjects with both more appropriately de fined, education-matched young subjects (age: 25-34) and education-mat ched subjects of the same age. No agreement was reached concerning the validity of existing global tests, or concerning which and how many o f them should be used to detect AAMI; however, both verbal and non-ver bal tests should be employed and more specific memory tests with adequ ate validity need to be developed. Specific tests were proposed to imp rove detection of decreased memory performance; (iii) subjective memor y complaints in the elderly are not exclusively dependent on decreased memory performance and have multiple and complex determinants-the rol e of certain psychoaffective factors, such as anxiety, has been relati vely underestimated; (iv) improved detection of the many factors contr ibuting to decreased memory performance could be achieved by better pa tient screening, and (v) AAMI cannot currently be considered a specifi c disease entity. Should the AAMI construct be used to select patients for memory-enhancer drug trials, our workgroup proposed classifying e lderly subjects into five groups according to the presence or absence of memory complaint, and memory performance compared with education-ma tched young and education- and age-matched subjects: (i) normal elderl y subjects, (ii) subjects with purely subjective memory complaint (no objective impairment), (iii) subjects with memory complaint and object ive impairment compared with young but not age-matched subjects (score between one standard deviation above and below the mean of age- and e ducation-matched controls, ie age-consistent memory impairment), (iv) subjects with memory complaint and objective impairment compared with age-matched controls, ie late life forgetfulness), and (v) subjects wi th memory test performance below two standard deviations below the mea n of their age- and education-matched controls, in whom organic pathol ogy is likely in the absence of major psychoaffective disturbance.