The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits.

Objective To study the unawareness of cognitive deficits in patients with mild dementia of Alzheimer type (DAT). Design Retrospective study. We surveyed the medical records of outpatients meeting the NINCDS–ADRDA criteria for probable DAT who were able to complete the Cognitive Difficulties Scale (CDS) and had a close informant relative (IR) who could complete the family form of the same questionnaire. Setting A department of neurology in a general teaching hospital. Subjects Eighty‐eight patients, aged 73.2±8.6 years with a mean MMSE score of 22.5±3.2. Fifty‐two of the 88 patients had a follow‐up examination after a mean interval of 21 months. Methods Awareness of cognitive deficits was mainly assessed as the difference between the scores on the CDS completed by the IR and the patient (Index of Unawareness, IU). Two secondary assessments of unawareness were performed: (1) an assessment by the clinician on the basis of the patient's answers to questions probing the awareness of memory deficits; (2) an evaluation by the IR of the frequency of behavioural manifestations of unawareness in everyday life. SPECT was performed in 78 patients to study the relationship between unawareness and the topography of perfusion deficits. Results Awareness of the cognitive deficits varied greatly between patients, according to the assessment method used and the stage of progression of the disease. Most patients with mild DAT were cognitively aware of their cognitive deficits but failed to appraise their severity and their consequences in everyday life. Decreased awareness was positively correlated with age and perfusion deficits in the frontal regions and negatively with the anxious symptomatology. However, the main correlate of unawareness was apathy. Conclusion The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits. Copyright © 1999 John Wiley & Sons, Ltd.

Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age.

Objective To compare the quantitative and qualitative aspects of memory complaints in cognitively normal subjects aged under and above 50 years. Setting A memory clinic located in a general hospital in a suburb of Paris offering direct access to subjects. Design Retrospective review of the files of consecutive patients who attended the clinic during one year. Participants Subjects were included if (a) they presented with memory complaints, (b) they had normal general cognitive functioning according to age and educational level, (c) they were devoid of present or past history of neurologic or psychiatric disorders. Methods Subjects rated the severity of memory complaints as major or minor and filled in a 8‐item questionnaire assessing various memory difficulties in everyday life. Relationship between severity of memory complaints and demographic data, memory performance and affective status was compared in 183 non‐depressed, non‐cognitively impaired healthy adults aged 50 years and over, and in 77 younger adults. Results Semiologic aspects and correlates of memory complaints were similar in younger and older adults. No close relationship was found between severity of memory complaints and memory performance. In both age groups, memory complaints were strongly related to affective status, mainly to the severity of anxious symptomatology. Memory complaints were related to gender in younger subjects, and to subjective assessment of well‐being in older. Conclusion Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age. Copyright © 1999 John Wiley & Sons, Ltd.

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