Conceptual and Clinical Overview on Age-Associated Memory Impairment

ABSTRACT

It is sufficient to justify distinguishing age-appropriate and age-inappropriate forms of age-related memory decline. The former, of which AAMI is an example, represents a normal age-related phenomenon, whereas the latter, the true descendent of benign senescent forgetfulness, is by definition abnormal and possibly, pathological. Whether age-inappropriate forgetfulness is progressive, whether it can be distinguished from other concepts of mild cognitive decline by virtue of being specific to memory, and whether it is qualitatively different from normal memory or merely worse is not yet certain. The prevalence of age-inappropriate forgetfulness is undetermined, but it is certainly less common than AAMI. The construct of AAMI was introduced by an NIMH work group. It was the group's declared intention to facilitate communication and stimulate research into late-life memory loss, particularly its treatment. Completely satisfactory diagnostic criteria do not yet exist for AAMI. Improved criteria would take an individual's overall level of intellectual functioning or educational background into account when setting the standard against which to rate memory, distinguish age-appropriate from age-inappropriate decline. AAMI differs from BSF in several points. First, the AAMI criteria define impairment with respect to healthy young adult levels, not to those of the older individual's age peers as was implied in the description of BSF. Second, the term AAMI is non-specific with regard to etiology and does not necessarily imply that the disorder is non-progressive. Thus, patients whose memory impairment is subsequently shown to be the earliest stage of a dementing illness are not necessarily excluded from the category of AAMI, and it is sensible to ask how often AAMI is, in fact, a dementia prodrome.