We propose a four year prospective, community-based study of Age Associated Memory Impairment (AAMI) designed to discover its characteristics, prevalence, incidence, and clinical significance. The 1,000 subjects will be drawn from a sample of 1,250 elderly adults currently participating in a cardiovascular health study in which extensive demographic and medical data are being collected. Diagnosis will be made on the basis of neuropsychological testing, subjective report and interview. Two levels of AAMI will be distinguished: The first, an age-appropriate decline in memory from presumed optimum young adult levels, is expected to be present in 25-65% of the population. The second, a more profound decline specific to memory and resulting in memory test performance which is impaired even when compared with that of their age-peers, will be much less common (probably 5-10%). The extent to which these represent qualitatively distinct entities, rather than different degrees of impairment, will be considered. The possibility that the atypical form is the forerunner of an impending dementia will be investigated. Evaluations will be repeated after 18 months (in year three) to discover the extent to which AAMI is progressive, how it progresses and to look for now incident cases. The relationship between AAMI, cardiovascular disease, depression and other forms of comorbidity will be examined. Two additional studies involving small subsets of the AAMI sample will be integrated into the core project. One will be a cognitive neuropsychological study of memory impaired subjects designed to discover the extent to which the memory impairment of AAMI qualitatively resembles that seen in dementia. The other substudy will be a treatment trial investigating the extent to which training in the use of external memory aids, and other compensatory techniques can reduce the impact of AAMI on daily life.
