Skip to main content Accessibility help

Do Subjective Memory Complaints Lead or Follow Objective Cognitive Change? A Five-Year Population Study of Temporal Influence

  • Beth E. Snitz (a1), Brent J. Small (a2), Tianxiu Wang (a1), Chung-Chou H. Chang (a1), Tiffany F. Hughes (a1) and Mary Ganguli (a1)...


The relationship between subjective memory complaints (SM) and objective memory (OM) performance in aging has been variably characterized in a substantial literature, to date. In particular, cross-sectional studies often observe weak or no associations. We investigated whether subjective memory complaints and objectively measured cognition influence each other over time, and if so, which is the stronger pathway of change—objective to subjective, or subjective to objective—or whether they are both important. Using bivariate latent change score modeling in data from a population study (N=1980) over 5 annual assessment cycles, we tested four corresponding hypotheses: (1) no coupling between SM and OM over time; (2) SM as leading indicator of change in OM; (3) OM as leading indicator of change in SM; (4) dual coupling over time, with both SM and OM leading subsequent change in the other. We also extended objective cognition to two other domains, language and executive functions. The dual-coupling models best fit the data for all three objective cognitive domains. The SM–OM temporal dynamics differ qualitatively compared to other domains, potentially reflecting changes in insight and self-awareness specific to memory impairment. Subjective memory and objective cognition reciprocally influence each other over time. The temporal dynamics between subjective and objective cognition in aging are nuanced, and must be carefully disentangled to shed light on the underlying processes. (JINS, 2015, 21, 732–742)


Corresponding author

Correspondence and reprint requests to: Beth E. Snitz, Department of Neurology, University of Pittsburgh, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213. E-mail:


Hide All
Allerhand, M., Gale, C.R., & Deary, I.J. (2014). The dynamic relationship between cognitive function and positive well-being in older people: A prospective study using the English Longitudinal Study of Aging. Psychology and Aging, 29(2), 306.
Amariglio, R.E., Becker, J.A., Carmasin, J., Wadsworth, L.P., Lorius, N., Sullivan, C., & Sperling, R.A. (2012). Subjective cognitive complaints and amyloid burden in cognitively normal older individuals. Neuropsychologia, 50, 28802886.
Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. Developmental Psychology, 25(5), 729.
Benito-León, J., Mitchell, A.J., Vega, S., & Bermejo-Pareja, F. (2010). A population-based study of cognitive function in older people with subjective memory complaints. Journal of Alzheimer’s Disease, 22(1), 159170.
Boker, S.M., & McArdle, J. (1995). Statistical vector field analysis applied to mixed cross-sectional and longitudinal data. Experimental Aging Research, 21(1), 7793.
Burmester, B., Leathem, J., & Merrick, P. (2015). Assessing subjective memory complaints: A comparison of spontaneous reports and structured questionnaire methods. International Psychogeriatrics/IPA, 27, 6177.
Clare, L. (2004). Awareness in early-stage Alzheimer’s disease: A review of methods and evidence. British Journal of Clinical Psychology, 43(2), 177196. doi:10.1348/014466504323088042.
Crumley, J.J., Stetler, C.A., & Horhota, M. (2014). Examining the relationship between subjective and objective memory performance in older adults: A meta-analysis. Psychology and Aging, 29(2), 250.
Darby, D., Maruff, P., Collie, A., & McStephen, M. (2002). Mild cognitive impairment can be detected by multiple assessments in a single day. Neurology, 59(7), 10421046.
Dik, M.G., Jonker, C., Comijs, H.C., Bouter, L.M., Twisk, J.W., van Kamp, G.J., & Deeg, D.J. (2001). Memory complaints and APOE-epsilon4 accelerate cognitive decline in cognitively normal elderly. [Research Support, Non-U.S. Gov’t]. Neurology, 57(12), 22172222.
Dodge, H.H., Wang, C.-N., Chang, C.-C.H., & Ganguli, M. (2011). Terminal decline and practice effects in older adults without dementia The MoVIES project. Neurology, 77(8), 722730.
Dufouil, C., Fuhrer, R., & Alpérovitch, A. (2005). Subjective cognitive complaints and cognitive decline: Consequence or predictor? The Epidemiology of Vascular Aging Study. Journal of the American Geriatrics Society, 53(4), 616621. doi:10.1111/j.1532-5415.2005.53209.x
Ferrer, E., & McArdle, J.J. (2010). Longitudinal modeling of developmental changes in psychological research. Current Directions in Psychological Science, 19(3), 149154.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189198.
Freedman, M., Leach, L., Kaplan, E., Winocur, G., Shulman, K.I., & Delis, D.C. (1994). Clock drawing: A neuropsychological analysis. Cambridge: Oxford University Press.
Fuld, P.A. (1981). Fuld object-memory evaluation. Woodale, IL: Stoelting Company.
Galvin, J.E., Powlishta, K.K., Wilkins, K., McKeel, D.W., Xiong, C., Grant, E., & Morris, J.C. (2005). Predictors of preclinical Alzheimer disease and dementia: A clinicopathologic study. Archives of Neurology, 62(5), 758765.
Ganguli, M., Chang, C.-C., Snitz, B.E., Saxton, J.A., Vanderbilt, J., & Lee, C.-W. (2010). Prevalence of mild cognitive impairment by multiple classifications: The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) project. The American Journal of Geriatric Psychiatry, 18(8), 674683.
Ganguli, M., Dodge, H.H., Shen, C., & DeKosky, S.T. (2004). Mild cognitive impairment, amnestic type: An epidemiologic study. Neurology, 63(1), 115121.
Ganguli, M., Gilby, J., Seaberg, E., & Belle, S. (1995). Depressive symptoms and associated factors in a rural elderly population: The MoVIES Project. American Journal of Geriatric Psychiatry, 3, 144160.
Ganguli, M., Snitz, B., Vander Bilt, J., Chang, C.C., Ganguli, M., Snitz, B., & Chang, C.-C. (2009). How much do depressive symptoms affect cognition at the population level? The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. [Research Support, N.I.H., Extramural]. International Journal of Geriatric Psychiatry, 24(11), 12771284.
Ganguli, M., Snitz, B.E., Lee, C.-W., Vanderbilt, J., Saxton, J.A., & Chang, C.-C. (2010). Age and education effects and norms on a cognitive test battery from a population-based cohort: The Monongahela–Youghiogheny Healthy Aging Team. Aging and Mental Health, 14(1), 100107.
Geerlings, M.I., Jonker, C., Bouter, L.M., Ader, H.J., & Schmand, B. (1999). Association between memory complaints and incident Alzheimer’s disease in elderly people with normal baseline cognition.[see comment]. American Journal of Psychiatry, 156(4), 531537.
Ghisletta, P., & De Ribaupierre, A. (2005). A dynamic investigation of cognitive dedifferentiation with control for retest: Evidence from the Swiss Interdisciplinary Longitudinal Study on the Oldest Old. Psychology and Aging, 20(4), 671.
Grut, M., Jorm, A.F., Fratiglioni, L., Forsell, Y., Viitanen, M., & Winblad, B. (1993). Memory complaints of elderly people in a population survey: Variation according to dementia stage and depression. Journal of the American Geriatrics Society, 41, 12951300.
Hafkemeijer, A., Altmann-Schneider, I., Oleksik, A.M., van de Wiel, L., Middelkoop, H.A., van Buchem, M.A., & Rombouts, S.A. (2013). Increased functional connectivity and brain atrophy in elderly with subjective memory complaints. Brain Connectivity, 3(4), 353362.
Hannesdottir, K., & Morris, R.G. (2007). Primary and secondary anosognosia for memory impairment in patients with Alzheimer’s disease. Cortex, 43(7), 10201030.
Harwood, D.G., Sultzer, D.L., & Wheatley, M.V. (2000). Impaired insight in Alzheimer disease: Association with cognitive deficits, psychiatric symptoms, and behavioral disturbances. Cognitive and Behavioral Neurology, 13(2), 8388.
Herrmann, D.J. (1982). Know thy memory: The use of questionnaires to assess and study memory. Psychological Bulletin, 92(2), 434.
Hertzog, C., & Pearman, A. (2014). Memory complaints in adulthood and old age. In T.J. Perfect & D.S. Lindsay (Eds.), The SAGE handbook of applied memory. London: SAGE.
Hoffman, L., Hofer, S.M., & Sliwinski, M.J. (2011). On the confounds among retest gains and age-cohort differences in the estimation of within-person change in longitudinal studies: A simulation study. Psychology and Aging, 26(4), 778.
Hohman, T.J., Beason-Held, L.L., Lamar, M., & Resnick, S.M. (2011). Subjective cognitive complaints and longitudinal changes in memory and brain function. Neuropsychology, 25(1), 125.
Jessen, F., Amariglio, R.E., van Boxtel, M., Breteler, M., Ceccaldi, M., Chételat, G., & van der Flier, W.M. (2014). A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimer’s & Dementia, 10, 844852.
Jessen, F., Wiese, B., Bachmann, C., Eifflaender-Gorfer, S., Haller, F., & Kolsch, H., ... Germany study on Aging, Cognition and Dementia in Primary Care Patients Study Group (2010). Prediction of dementia by subjective memory impairment: Effects of severity and temporal association with cognitive impairment. Archives of General Psychiatry, 67(4), 414422.
Jorm, A., Christensen, H., Korten, A., Henderson, A., Jacomb, P., & Mackinnon, A. (1997). Do cognitive complaints either predict future cognitive decline or reflect past cognitive decline? A longitudinal study of an elderly community sample. Psychological Medicine, 27(1), 9198.
Jorm, A., Christensen, H., Korten, A., Jacomb, P., & Henderson, A. (2001). Memory complaints as a precursor of memory impairment in older people: A longitudinal analysis over 7-8 years. Psychological Medicine, 31(3), 441449.
Jungwirth, S., Fischer, P., Weissgram, S., Kirchmeyr, W., Bauer, P., & Tragl, K.-H. (2004). Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community. Journal of the American Geriatrics Society, 52(2), 263268.
Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test (2nd ed.). Philedelphia: Lippincott Williams & Wilkins.
Krall, J.R., Carlson, M.C., Fried, L.P., & Xue, Q.-L. (2014). Examining the dynamic, bidirectional associations between cognitive and physical functioning in older adults. American Journal of Epidemiology, 180, 838846.
Lam, L.C.W., Lui, V.W.C., Tam, C.W.C., & Chiu, H.F.K. (2005). Subjective memory complaints in Chinese subjects with mild cognitive impairment and early Alzheimer’s disease. International Journal of Geriatric Psychiatry, 20(9), 876882. doi:10.1002/gps.1370
Lautenschlager, N.T., Flicker, L., Vasikaran, S., Leedman, P., & Almeida, O.P. (2005). Subjective memory complaints with and without objective memory impairment: Relationship with risk factors for dementia. The American Journal of Geriatric Psychiatry, 13(8), 731734.
Lenehan, M.E., Klekociuk, S.Z., & Summers, M.J. (2012). Absence of a relationship between subjective memory complaint and objective memory impairment in mild cognitive impairment (MCI): Is it time to abandon subjective memory complaint as an MCI diagnostic criterion? International Psychogeriatrics, 24(09), 15051514.
Lopez, O.L., Becker, J.T., Somsak, D., Dew, M.A., & DeKosky, S.T. (1994). Awareness of cognitive deficits and anosognosia in probable Alzheimer’s disease. European Neurology, 34(5), 277282.
McArdle, J.J. (2009). Latent variable modeling of differences and changes with longitudinal data. Annual Review of Psychology, 60, 577605.
Minett, T.S., Dean, J.L., Firbank, M., English, P., & O’Brien, J.T. (2005). Subjective memory complaints, white-matter lesions, depressive symptoms, and cognition in elderly patients. The American Journal of Geriatric Psychiatry, 13(8), 665671.
Mitchell, A.J. (2008). Is it time to separate subjective cognitive complaints from the diagnosis of mild cognitive impairment? Age and Ageing, 37(5), 497499.
Mitchell, A.J., & Shiri-Feshki, M. (2009). Rate of progression of mild cognitive impairment to dementia – meta-analysis of 41 robust inception cohort studies. Acta Psychiatrica Scandinavica, 119(4), 252265. doi:10.1111/j.1600-0447.2008.01326.x
Mograbi, D.C., Brown, R.G., & Morris, R.G. (2009). Anosognosia in Alzheimer’s disease–The petrified self. Consciousness and Cognition, 18(4), 9891003.
Mol, M.E., van Boxtel, M., Willems, D., & Jolles, J. (2006). Do subjective memory complaints predict cognitive dysfunction over time? A six‐year follow‐up of the Maastricht Aging Study. International Journal of Geriatric Psychiatry, 21(5), 432441.
Morris, J.C. (1993). The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology, 43, 24112413.
Morris, R., & Hannesdottir, K. (2004). Loss of “awareness” in Alzheimer’s disease. Cognitive Neuropsychology of Alzheimer’s Disease, 275296.
Mousavi-Nasab, S.M.H., Kormi-Nouri, R., & Nilsson, L.-G. (2014). Examination of the bidirectional influences of leisure activity and memory in old people: A dissociative effect on episodic memory. British Journal of Psychology, 105(3), 382398. doi:10.1111/bjop.12044
Mungas, D., Marshall, S.C., Weldon, M., Haan, M., & Reed, B.R. (1996). Age and education correction of Mini-Mental State Examination for English and Spanish-speaking elderly. Neurology, 46(3), 700706.
Muthen, L.K., & Muthen, B.O. (2010). MPlus User’s Guide: (6th ed.). Los Angeles: Muthen & Muthen.
O’Connor, D.W., Pollitt, P.A., Roth, M., Brook, C.P.B., & Reiss, B.B. (1990). Memory complaints and impairment in normal, depressed, and demented elderly persons identified in a community survey. Archives of General Psychiatry, 47(3), 224.
Orfei, M.D., Blundo, C., Celia, E., Casini, A.R., Caltagirone, C., Spalletta, G., & Varsi, A.E. (2010). Anosognosia in mild cognitive impairment and mild Alzheimer’s disease: Frequency and neuropsychological correlates. The American Journal of Geriatric Psychiatry, 18(12), 11331140.
Pannu, J.K., & Kaszniak, A.W. (2005). Metamemory experiments in neurological populations: A review. Neuropsychology Review, 15(3), 105130.
Parisi, J.M., Gross, A.L., Rebok, G.W., Saczynski, J.S., Crowe, M., Cook, S.E., & Unverzagt, F.W. (2011). Modeling change in memory performance and memory perceptions: Findings from the ACTIVE study. Psychology and Aging, 26(3), 518.
Perrig-Chiello, P., Perrig, W., & Stahelin, H. (2000). Differential aspects of memory self-evaluation in old and very old people. Aging & Mental Health, 4(2), 130135.
Perrotin, A., Desgranges, B., Duval, C., La Joie, R., Mézenge, F., Landeau, B., & Eustache, F. (2011). The IMAP project: How does the awareness of memory deficits evolve in the course of Alzheimer’s disease? Insights from its relationships to PET β-amyloid and metabolism measurements. Alzheimer’s & Dementia, 7(4), S742S743.
Petersen, R.C., Smith, G.E., Waring, S.C., Ivnik, R.J., Tangalos, E.G., & Kokmen, E. (1999). Mild cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 56(3), 303308.
Purser, J.L., Fillenbaum, G.G., & Wallace, R.B. (2006). Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10‐year trajectories of functional disability, word recall, or short portable mental status questionnaire limitations. Journal of the American Geriatrics Society, 54(2), 335338.
Reid, L.M., & Maclullich, A.M.J. (2006). Subjective memory complaints and cognitive impairment in older people. Dementia & Geriatric Cognitive Disorders, 22(5-6), 471485.
Reisberg, B., Shulman, M.B., Torossian, C., Boksay, I., Khan, S., & Zhu, W. (2010). Which comes first: Subjective cognitive impairment (SCI) or cognitive change? and is SCI a frequently occurring stage in the evolution of Alzheimer-associated cognitive change? Alzheimer’s & Dementia, 6(4), S177S177.
Reisberg, B., Shulman, M.B., Torossian, C., Leng, L., Zhu, W., Reisberg, B., & Zhu, W. (2010). Outcome over seven years of healthy adults with and without subjective cognitive impairment. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. Alzheimer’s & Dementia, 6(1), 1124.
Roberts, J., Clare, L., & Woods, R. (2009). Subjective memory complaints and awareness of memory functioning in mild cognitive impairment: A systematic review. Dementia and Geriatric Cognitive Disorders, 28(2), 95109.
Rowe, C.C., Ellis, K.A., Rimajova, M., Bourgeat, P., Pike, K.E., Jones, G., & Villemagne, V.L. (2010). Amyloid imaging results from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging. Neurobiology of Aging, 31(8), 12751283. doi:
Salthouse, T.A., Schroeder, D.H., & Ferrer, E. (2004). Estimating retest effects in longitudinal assessments of cognitive functioning in adults between 18 and 60 years of age. Developmental Psychology, 40(5), 813.
Saykin, A.J., Wishart, H.A., Rabin, L.A., Santulli, R.B., Flashman, L.A., West, J.D., & Mamourian, A.C. (2006). Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. Neurology, 67(5), 834842.
Schofield, P.W., Marder, K., Dooneief, G., Jacobs, D.M., Sano, M., & Stern, Y. (1997). Association of subjective memory complaints with subsequent cognitive decline in community-dwelling elderly individuals with baseline cognitive impairment. American Journal of Psychiatry, 154(5), 609615.
Shaked, D., Farrell, M., Huey, E., Metcalfe, J., Cines, S., Karlawish, J., & Cosentino, S. (2014). Cognitive correlates of metamemory in Alzheimer’s disease. Neuropsychology, 28, 695705.
Small, B.J., Dixon, R.A., McArdle, J.J., & Grimm, K.J. (2012). Do changes in lifestyle engagement moderate cognitive decline in normal aging? Evidence from the Victoria Longitudinal Study. Neuropsychology, 26(2), 144.
Snitz, B.E., Morrow, L.A., Rodriguez, E.G., Huber, K.A., & Saxton, J.A. (2008). Subjective memory complaints and concurrent memory performance in older patients of primary care providers. Journal of the International Neuropsychological Society, 14(6), 10041013.
Snitz, B.E., Yu, L., Crane, P.K., Chang, C.-C.H., Hughes, T.F., & Ganguli, M. (2012). Subjective cognitive complaints of older adults at the population level: An item response theory analysis. Alzheimer Disease and Associated Disorders, 26(4), 344351.
St John, P., & Montgomery, P. (2002). Are cognitively intact seniors with subjective memory loss more likely to develop dementia? International Journal of Geriatric Psychiatry, 17(9), 814820.
Unverzagt, F.W., Morgan, O.S., Thesiger, C.H., Eldemire, D.A., Luseko, J., Pokuri, S., & Hendrie, H.C. (1999). Clinical utility of CERAD neuropsychological battery in elderly Jamaicans. Journal of the International Neuropsychological Society, 5(3), 255259.
Vogel, A., Stokholm, J., Gade, A., Andersen, B.B., Hejl, A.-M., & Waldemar, G. (2004). Awareness of deficits in mild cognitive impairment and Alzheimer’s disease: Do MCI patients have impaired insight? Dementia and Geriatric Cognitive Disorders, 17(3), 181187.
Wang, L., van Belle, G., Crane, P.K., Kukull, W.A., Bowen, J.D., McCormick, W.C., & Larson, E.B. (2004). Subjective memory deterioration and future dementia in people aged 65 and older. [see comment]. Journal of the American Geriatrics Society, 52(12), 20452051.
Weaver Cargin, J., Collie, A., Masters, C., & Maruff, P. (2008). The nature of cognitive complaints in healthy older adults with and without objective memory decline. Journal of Clinical and Experimental Neuropsychology, 30(2), 245257.
Wechsler, D. (1987). Wechsler Memory Scale Revised. San Antonio, TX: The Psychological Corporation.
Wilson, R.S., Segawa, E., Boyle, P.A., & Bennett, D.A. (2012). Influence of late-life cognitive activity on cognitive health. Neurology, 78(15), 11231129.
Zimprich, D., Martin, M., & Kliegel, M. (2003). Subjective cognitive complaints, memory performance, and depressive affect in old age: A change-oriented approach. The International Journal of Aging and Human Development, 57(4), 339366.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Snitz et al. supplementary material
Supplementary data

 Word (16 KB)
16 KB
Supplementary materials

Snitz et al. supplementary material
Supplementary tables

 Word (29 KB)
29 KB

Do Subjective Memory Complaints Lead or Follow Objective Cognitive Change? A Five-Year Population Study of Temporal Influence

  • Beth E. Snitz (a1), Brent J. Small (a2), Tianxiu Wang (a1), Chung-Chou H. Chang (a1), Tiffany F. Hughes (a1) and Mary Ganguli (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.