The Utility of Subset of Subjective Memory Complaint Questionnaire and Mini-Mental State Examination for Dementia Screening

OBJECTIVE: Purpose of this study was to assess the potential added values of Subjective Memory Complaint Questionnaire (SMCQ) combined with Mini-Mental State Examination (MMSE) in developing a brief screening battery to improve the early detection rate of dementia in community setting. METHODS: Non-depressed community-dwelling Korean elderly aged 65 years and older who 945 randomly selected and 734 voluntarily involved were recruited. Dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Diagnostic ability of 10 point SMCQ subscale for everyday memory (SMCQ-E) for dementia was evaluated. Additive values of SMCQ-E combined with MMSE for dementia screening and the economic benefits of SMCQ-E and its combination with MMSE were also evaluated. RESULTS: Overall area under the curve values of SMCQ-E were 0.605 (0.565–0.646) for nonrandom sample and 0.836 (0.783–0.890) for random sample. When SMCQ-E was combined with MMSE using ‘AND’ rule, accuracy, specificity, positive predictive values and positive likelihood ratio were increased than those of MMSE. While SMCQ-E was combined the MMSE using ‘OR’ rule, sensitivity and negative predictive values were increased and negative likelihood ratio were decreased than those of SMCQ-E and MMSE. When SMCQ-E and MMSE combined with AND rule, total cost for dementia screening was reduced to about 80% compared to MMSE single use model. CONCLUSION: Results of this study showed that brief SMCQ-E and its combination with MMSE could be used to dementia screening with cost effective manner.

The perception feature and influence factors in people with subjective memory complaints / 中华行为医学与脑科学杂志

Objective To study the memory disorder perception characteristics of subjective memo-ry complaints(SMCs)and to analyze the influencing factors. Methods 302 subjects conforming to the in-clusion criteria were selected.All the subjects completed the illness perception questionnaire-memory of Chi-nese version(IPQ-M). Results (1)There was no statistical difference between the score of social compari-son(2.95±0.78)and the middle value 3.The differences between the score of the remaining dimensions of memory impairment perception(timeline acute/chronic(3.57 ± 0.89),consequences(2.24 ± 0.77),timeline stability/decline(3.71±0.88),personal control(blame)(3.61±0.92),personal control(helplessness)(3.31± 0.73),emotional representation(2.29 ± 0.70),treatment control(2.78 ± 0.67),illness coherence(3.14 ± 0.64))and the middle value 3 were statistically significant(all P<0.05).(2)Gender,education level,living condition,marital status,economic condition,family history of dementia and knowledge education of dementia were the influencing factors of memory perception of SMCs. Conclusion The memory complaining people are less aware of the related knowledge of memory decline,and there are more errors and negative percep-tions.The factors that affect the perception of memory disorders are complex.

Association of Source of Memory Complaints and Increased Risk of Cognitive Impairment and Cognitive Decline: A Community-Based Study / 中华医学杂志(英文版)

<p><b>Background</b>Memory complaint is common in the elderly. Recently, it was shown that self-report memory complaint was predictive of cognitive decline. This study aimed to investigate the predictive value of the source of memory complaints on the risk of cognitive impairment and cognitive decline in a community-based cohort.</p><p><b>Methods</b>Data on memory complaints and cognitive function were collected among 1840 Chinese participants (aged ≥55 years old) in an urban community at baseline interview and 5-year follow-up. Incident cognitive impairment was identified based on education-adjusted Mini-Mental State Examination score. Logistic regression model was used to estimate the association between the source of memory complaints and risk of cognitive impairment conversion and cognitive decline, after adjusting for covariates.</p><p><b>Results</b>A total of 1840 participants were included into this study including 1713 normal participants and 127 cognitive impairment participants in 2009. Among 1713 normal participants in 2009, 130 participants were converted to cognitive impairment after 5 years of follow-up. In 2014, 606 participants were identified as cognitive decline. Both self- and informant-reported memory complaints were associated with an increased risk of cognitive impairment (odds ratio [OR] = 1.60, 95% confidence interval [CI]: 1.04-2.48) and cognitive decline (OR = 1.30, 95% CI: 1.01-1.68). Furthermore, this association was more significant in males (OR = 2.10, 95% CI: 1.04-4.24 for cognitive impairment and OR = 1.87, 95% CI: 1.20-2.99 for cognitive decline) and in higher education level (OR = 1.79, 95% CI: 1.02-3.15 for cognitive impairment and OR = 1.40, 95% CI: 1.02-1.91 for cognitive decline).</p><p><b>Conclusions</b>Both self- and informant-reported memory complaints were associated with an increased risk of cognitive impairment conversion and cognitive decline, especially in persons with male gender and high educational background.</p>

A Study of Factors Influencing Subjective Memory Complaints among Community Dwelling Elderly

OBJECTIVE: We examined the factors influencing subjective memory complaints among community dwelling elderly in urban area. METHODS: The subjects of this research were 160 community-dwelling elderly people without dementia and major depressive disorder. The questionnaires regarding the socio-demographic characteristics were conducted by each person. They include Korean version of Subjective Memory Complaints Questionnaires (SMCQ), Korean version of Short Geriatric Depression Scale (SGDS-K) and Korean version of Mini-Mental State Examination (K-MMSE). Subjective memory complaints were defined as above 4 points of SMCQ. RESULTS: 39.38% of the subjects had subjective memory complaints. There were significant associations between subjective memory complaints and SGDS-K (p < 0.001), physical illness (p=0.001), but there was no association with K-MMSE (p=0.383). CONCLUSION: There is a discrepancy between subjective memory complaints and actual cognitive impairments. This discrepancy suggests that the depressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the subjective memory complaints rather than actual cognitive impairments in community-dwelling elderly people. Therefore, the treatments for the depressive disorders should be considered in dealing with the subjective memory complaints.

Brain plasticity of structural and functional in elderly with subjective memory complaints / 中华行为医学与脑科学杂志

Subjective memory complaints (SMC) is increasingly recognized as the earliest prodromal stage of Alzheimer's disease.Individuals with SMC whose memory without measurable cognitive deficits,however,demonstrated some neurodegenerative brain changes.It would be more appropriate to prevent or postpone the AD process by interventing in this earlier stage of SMC,while relatively little is known about the brain plasticity in elderly with SMC.Therefore,further research is necessary in understanding the brain plasticity in SMC on the basis of further elucidating the pathophysiological mechanisms in this group of individuals.

The influence of help-seeking behavior in people with subjective memory complaints / 中华护理杂志

Objective To explore the influence factors of help-seeking behavior in people with subjective memory complaints (SMCs).Methods A total of 305 eligible SMCs people were recruited and investigated with illness perception questionnaire-memory (IPQ-M),GDS-15,Mini-mental State Examination (MMSE),auditory verbal learning test(AVLT).Subjects were comprised of two groups:help-seeking group(n=44) and non-help-seeking group(n=261).Results The ratio of SMCs people for help-seeking was very low,only accounted for 14.4％.The ratio for going to hospital to see a specialist memory clinic accounted for only 2.0％.Logistic regression analysis showed 6 related factors were prime motivators for help-seeking behavior,which were symptom (OR=1.455),treatment control (OR=2.456),emotional representation (OR=2.268),accepting dementia education (OR=1.576),lacking of blood supply to the brain(OR=1.115),not using brain(OR=2.079).Three causal attributions were obstructive factors for help-seeking behavior,which were loneliness (OR=0.253),aging (OR=0.450),and chance or bad luck (OR=0.374).Conclusion Illness perception-memory in subjects with SMCs had some prediction for help-seeking behavior.Community nurses should attach importance to illness perception-memory of SMCs people and help them promote help-seeking,so as to facilitate earlv screening,identification and prevention of dementia.

Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly

Objective: To investigate whether the level of awareness of memory deficits is useful for discriminating between major depressive disorder (MDD) and mild cognitive impairment (MCI) in the elderly. Methods: Sixty-three consecutively referred patients (38 women and 25 men) with memory concerns comprising three groups (clinical control, MDD and MCI) underwent a memory test (Rey Auditory Verbal Learning Test [RAVLT]) and completed the Memory Assessment Complaints-Questionnaire (MAC-Q). Level of awareness was estimated by the difference between the MAC-Q score and the score on the fifth presentation of the RAVLT. Memory performance, Mini-Mental State Examination (MMSE) and depressive symptoms (Geriatric Depression Scale [GDS]) were also assessed. Results: The control (n=25), MDD (n=16), and MCI (n=22) groups were similar in age, educational level, and MMSE (p > 0.05). Among the groups, the MDD group had the most memory complaints, whereas the MCI group had the worst objective memory performance. Level of awareness was capable of discriminating between MDD and MCI (p < 0.05), but not between MDD and clinical controls (p > 0.05). MDD subjects tended to underestimate their memory functioning as compared to controls (p < 0.05). Conclusion: Level of awareness of memory deficits was significantly useful to discriminate between MCI and MDD, which is a common difficulty faced by clinicians. Future studies with larger samples are needed to confirm these findings.

The reliability and validity of Chinese version of the illness perception questionnaire-memory / 中华行为医学与脑科学杂志

Objective To introduce the illness perception questionnaire-memory (IPQ-M) and translate it into Chinese and to evaluate its reliability and validity.Methods The Chinese version of IPQ-M was translated from the original,back translated and adjusted for culture adaptation.A total of 152 community-dwelling people with subjective memory complaints (SMCs),who were aged 50 years or above,were investigated with the Chinese version of IPQ-M.40 participants among them were re-evaluated 2 weeks later.Results Exploratory factor analysis got 9 factors which could explain 70.757％ of the total variance.The factor loading of each item on the corresponding factors was higher than 0.4.The correlation between Chinese version of IPQ-M and GDS were-0.208 to 0.763 (P＜0.01).The Cronbach's α coefficient was 0.872,the testretest reliability was 0.894,and the Spearman-Brown split coefficient was 0.890.Conclusion The Chinese version of IPQ-M has good reliability and validity,and it can be used in Chinese elderly people with SMCs.

Effects of the Combination Herbal Extract on Working Memory and White Matter Integrity in Healthy Individuals with Subjective Memory Complaints : A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

OBJECTIVES: The combination extract of four kinds of herbs, Gastrodia elata, Liriope platyphylla, Dimocarpus longan, and Salvia miltiorrhiza, has shown to have memory improving effects in mice. The aim of this study was to investigate the efficacy and safety of the herbal mixture for improving working memory as well as microstructural changes in white matter integrity in individuals with subjective memory complaints. METHODS: Seventy-five individuals with subjective memory complaints were assigned to receive either placebo (n = 15) or herbal mixture (low-dose group, n = 30 and high-dose group, n = 30) supplementation in an 8-week, randomized, double-blind, placebo-controlled clinical trial. Changes in working memory performance and fractional anisotropy (FA) values reflecting white matter integrity from baseline to 8-week endpoint were assessed. RESULTS: The herbal mixture group showed an increase in working memory performance compared to the placebo group (p for interaction = 0.001). In addition, the herbal mixture group showed an increase in FA values in the temporo-parietal regions (corrected p < 0.05), which are crucially involved in working memory function and are among the most affected regions in patients with cognitive impairments. CONCLUSIONS: Findings from this study indicate that the herbal mixture may be a promising therapeutic option for individuals with subjective memory complaints.

Relations between memory complaints, depressive symptoms and cognitive performance among community dwelling elderly / Relações entre queixas de memória, sintomas depressivos e desempenho cognitivo em idosos residentes na comunidade

Backgroun: Memory complaints are quite common among the elderly; yet, the clinical relevance of these complaints to diagnose cognitive decline is debatable, since several different factors could be associated with them. Objective: The present paper examined the correlations between memory complaints, depressive symptoms and cognitive performance in a group of 301 elderly individuals who lived in the district of Ermelino Matarazzo, São Paulo, and who participated in the population-based survey entitled Profiles of Frailty in Elderly Brazilians by the FIBRA Network. Methods: Cognitive performance was assessed with the memorization test involving 10 common pictures, the Mini Mental State Examination (MMSE), the Verbal Fluency (VF) test, and the Clock Drawing Test, which comprise the Brief Cognitive Screening Battery (BCSB). Memory complaints were assessed with the Memory Complaint Questionnaire (MAC-Q), and depressive symptoms with the Geriatric Depression Scale (GDS). Results: Female participants had higher rates of memory complaints when compared to male participants (p = 0.013). Subjects with less years of schooling had more severe memory complaints and poorer cognitive performance than those with more years of schooling (p < 0.003). The presence of depressive symptoms was associated with poorer memory assessment scores (r = 0.39, p < 0.001). Discussion: Memory complaints were correlated with sex, schooling and depressive symptoms among elderly individuals residing in the community. No correlation was found between complaints and cognitive performance.

Contexto: A queixa de memória é comum entre pessoas idosas, entretanto sua relevância clínica para o diagnóstico de alterações cognitivas é questionável, visto que diversos fatores podem se associar às queixas. Objetivo: O presente estudo avaliou a relação entre queixas de memória, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Objetivo: O presente estudo avaliou a relação entre queixas de memória, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Métodos: O desempenho cognitivo foi avaliado por meio dos testes de memorização de 10 figuras comuns, Miniexame do Estado Mental (MEEM), Fluência Verbal (FV) e Teste do Desenho do Relógio, que compõem a Bateria Breve de Rastreio Cognitivo (BBRC). As queixas de memória foram avaliadas pelo Questionário de Queixas de Memória (MAC-Q) e os sintomas depressivos, pela Escala de Depressão Geriátrica (EDG). Resultados: Participantes do sexo feminino apresentaram maior índice de queixas de memória, comparado ao dos homens (p = 0,013). Idosos menos escolarizados apresentaram queixas de memória mais intensas e pior desempenho cognitivo, comparados aos de maior escolaridade (p < 0,003). A presença de sintomas depressivos associou-se à pior avaliação da memória (r = 0,39, p < 0,001). Conclusão: As queixas de memória se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Não houve associação entre queixas e desempenho cognitivo. Conclusão: As queixas de memória se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Não houve associação entre queixas e desempenho cognitivo.

Memory complaint scale (MCS): proposed tool for active systematic search / Escala de queixa de memória (EQM): proposta de um instrumento para busca ativa e sistematizada

Subjective Memory Complaints (SMC) are frequent among adults and elderly and are associated with poor qualityof life. The etiology and clinical significance of SMCs are unclear, but these complaints are associated with objective cognitivedecline or with depression, anxiety and psychosocial stressors. Biological and physiological brain alterations resembling thosein Alzheimer?s Disease have been found in SMC. SMC can evolve with different outcomes and represent the initial symptomor a risk factor of dementia. Active systematic search can be useful for early screening of candidates for preventive ortherapeutic interventions. Objective: To propose a Memory Complaints Scale (MCS) as an instrument for actively searchingfor memory complaints and to investigate its utility for discriminating demented from cognitively normal elderly. Methods: Atotal of 161 patients from a teaching behavioral neurology outpatient unit of a tertiary hospital were studied. The MCS wasused in two ways, by direct application to the patient and by application to the patient?s companion. Cognitive tests assessingdepression and daily living activities were also applied. Results: High Cronbach?s alpha coefficients were found for the twoapplication methods. Correlations between the two versions and the other instruments administered for patients grouped bytype and severity of dementia were also found. Conclusion: The MCS is a useful scale for identifying memory complaintsand discriminating demented from cognitively normal elderly. Further studies confirming these findings are warranted.

Queixa Subjetiva de Memória (QSM) é frequente entre adultos e idosos e está associada a pior qualidade de vida.Etiologia e significado clínico são incertos, sendo associada a perdas cognitivas objetivas ou a depressão, ansiedade eestressores psicossociais. Foram demonstradas alterações biológicas e fisiológicas encefálicas semelhantes às da doençade Alzheimer. Pode ter diferentes desfechos e representar sintoma inicial ou fator de risco para demência. A busca ativae sistematizada pode ser útil na identificação precoce de pessoas que poderão receber intervenções preventivas outerapêuticas. Objetivo: Propor a Escala de Queixa de Memória (EQM) como um instrumento para a busca de queixa dememória e investigar se é útil para discriminar idosos demenciados de normais. Métodos: Foram estudados 161 pacientesde um ambulatório didático de neurologia comportamental de um hospital terciário. A EQM foi utilizada nas duas formas,uma diretamente aplicada ao paciente e a outra aplicada ao acompanhante sobre o paciente. Também foram aplicadostestes cognitivos, para depressão e para atividades diárias. Resultados: Foram encontrados altos coeficientes alfa deCronbach para as duas formas. Também foram encontradas correlações entre as duas formas e os outros instrumentos,para os pacientes agrupados conforme tipo e gravidade da demência. Conclusão: A EQM é uma escala útil para identificarqueixa de memória e pode ser útil para discriminar idosos demenciados de normais. Estudos subsequentes deverão serrealizados para verificar essas informações.

Multistrategic Memory Training with the Metamemory Concept in Healthy Older Adults

OBJECTIVE: According to the increase of older people, the need for effective methods to maintain or improve cognitive functions in the elderly has increased. These cognitive enhancing methods may contribute to the prevention of elderly cognitive decline by aging and dementing illness as well. This study aimed to examine the effectiveness of multistrategic memory training with the metamemory concept on cognitive functions in the normal health elderly in Korea. METHODS: The program used in this study was developed by psychiatrists and psychologists in accordance with Korean situations. We applied the training program to the community-dwelling elderly with subjective memory complaints. Twenty participants were randomly received the intervention with 20 non-treatment controls. This program consisted of 10 sessions and was administered once a week. We examined the effects of this memory training for verbal memory, visuospatial memory, working memory, and verbal fluency ability by repeated ANOVA. RESULTS: There were significant improvements in Word List Short-term Delayed Free and Cued Recall, Word list Long-term Delayed Free and Cued Recall and visuospatial recognition memory. Performance improvements in visuospatial span forwards and the Categorical Fluency Test were also significant. These improvements were still significant after adjusting for depression improvement exact categorical fluency. CONCLUSION: This study shows that multistrategic memory training with the metamemory concept may improve memory ability and other cognitive functions which are not trained and that these improvements may be achieved by pure cognitive training effects.

Queixas de memória de idosos e sua relação com escolaridade, desempenho cognitivo e sintomas de depressão e ansiedade / The relation between memory complaints in the elderly and education, cognitive performance, and symptoms of depression and anxiety

CONTEXTO: Idosos que apresentam prejuízo mnemônico, em tese, podem queixar-se da memória com mais frequência. A queixa pode ser mais comum entre idosos de baixa escolaridade em razão de maior vulnerabilidade para o declínio cognitivo. OBJETIVOS: Investigar se as queixas mnemônicas do idoso variam de acordo com sua escolaridade e avaliar se essas queixas estão associadas a seu desempenho cognitivo e a sintomas de depressão e ansiedade. MÉTODOS: Sessenta e sete idosos, com idades entre 60 e 75 anos, foram subdivididos em três grupos: 1-4 anos de escolaridade (n = 23), 4-8 anos (n = 20) e 9 anos ou mais (n = 24). O protocolo incluiu o Mini-Exame do Estado Mental (MEEM), a Bateria Cognitiva Breve (BCB) - memorização de 10 figuras, Fluência Verbal Categoria Animais (FV), Teste do Desenho do Relógio (TDR) -, um questionário de frequência de esquecimentos, o Questionário de Queixas de Memória (MAC-Q), a Escala de Depressão Geriátrica (GDS) e a Escala Beck de Ansiedade (BAI). RESULTADOS: Observou-se diferença significativa entre os três grupos para o MEEM, para o reconhecimento das 10 figuras, para FV e TDR, e não foram detectadas diferenças significativas para frequência de esquecimentos e MAC-Q. Também não houve associação entre queixas e desempenho cognitivo nem entre queixas e sintomas de depressão, mas a correlação entre frequência de esquecimentos e sintomas de ansiedade foi significativa. CONCLUSÃO: As queixas de memória não se associaram a escolaridade, desempenho cognitivo nem a sintomas depressivos, mas estiveram associadas a sintomas de ansiedade.

BACKGROUND: Older adults with mnemonic deficits may complain about memory more frequently. Memory complaints may be more frequent among older adults with lower education, due to greater vulnerability to cognitive decline. OBJECTIVES: To investigate if memory complaints vary as a function of education, and to evaluate if memory complaints are associated with cognitive performance, and symptoms of depression and anxiety. METHODS: Sixty seven older adults (between 60-75 years) were divided into three groups: 1-4 years of education (n = 23), 4-8 years (n = 20), and 9 or more (n = 24). The protocol included the Mini-Mental State Examination (MMSE), Brief Cognitive Battery (BCB) - memorization of 10 pictures, Verbal Fluency Animal Category (VF), Clock Drawing Test (CDT) -, a questionnaire about frequency of forgetting, the Memory Complaint Questionnaire (MAC-Q), the Geriatric Depression Scale (GDS), and the Beck Anxiety Inventory (BAI). RESULTS: Significant differences were observed among the three groups for the MMSE, 10-picture recognition, VF, and CDT, and no significant differences were found for frequency of forgetting and MAC-Q. Also, there was no association between complaints and cognitive performance, or complaints and depressive symptoms, however, the correlation between frequency of forgetting and symptoms of anxiety was significant. DISCUSSION: Memory complaints were not associated to education, cognitive performance, or depressive symptoms, yet, they were associated with anxiety symptoms.

Relationship Between Subjective Memory Complaints and Cognition in the Elderly

OBJECTIVES: We aimed to investigate the relationship between subjective memory complaints and cognition in the elderly. METHODS: Data obtained from 1,496 subjects (510 men and 986 women) aged above 60 years was analyzed from the Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS). All subjects completed the study questionnaire including demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), and Short Form Korean version of Geriatric depression scale (SGDS-K). Subjective memory complaints were defined in two different ways; worse than others (SMC-O) and worse than one's past (SMC-P). RESULTS: On analysis of covariance, there was significant difference of estimated marginal means of K-MMSE score among five SMC-P groups (much improve:18.0, little improve:21.3, not changed:21.2, little worse:21.1, much worse:20.2) after adjusting age, sex, educational level and depression (F=9.63, df=4, p<0.0001, adjusted R2=0.375). There was significant difference of estimated marginal means of K-MMSE score among three SMC-O groups (below peer's average:20.4, peer's average:20.9, above peer's average:21.8) after adjusting age, sex, educational level and depression (F=4.89, df=2, p=0.043, adjusted R2=0.0.361). CONCLUSION: These results suggest that subjective memory complaints may be an indicator of objective cognitive impairment in the elderly.

Predictors for Subjective Memory Complaints in the Elderly: The Results from Korean Longitudinal Study on Health and Aging (KLoSHA) / 신경정신의학

OBJECTIVES: We investigated the predictors of subjective memory complaints in the community-dwelling normal elderly. METHODS: This study was conducted as a part of Korean Longitudinal Study on Health and Aging (KLoSHA). 747 nondemented community-dwelling elderly aged 65 years or older were recruited. All participants underwent clinical evaluation for dementia and psychiatric disorder conformed to the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Clinical Assessment Battery and Korean version of Mini-International Neuropsychiatric Interview, respectively. Word list recall test, frontal assessment battery, Mini Mental Status Examination (MMSE-KC) and Korean version of Geriatric depression scale (GDS-K) were administered to evaluate episodic memory, frontal function, global cognition and depression, respectively. Subjective memory complaint was defined in two different ways: worse than one's past (SMC-P) and worse than others of one's age (SMC-O). RESULTS: In highly educated elderly, minor depressive disorder (OR=7.23, 95% C.I.= 2.29-22.86) and frontal dysfunction (OR=2.48, 95% C.I.=1.29-4.77) significantly increased the risk of SMC-O. However, they did not influence the risk of SMC-P. In low educated elderly, both the minor depressive disorder and frontal dysfunction did not influence the risk of SMC-O as well as that of SMC-P. CONCLUSION: SMC-O can be a sensitive subjective recognition of mild depression and/or frontal dysfunction in highly educated normal elderly.