Aging-Associated Cognitive Decline

In 1962, based on a study of nursing home residents, Kral suggested a distinction between benign and malignant senescent forgetfulness, the latter evolving to dementia and early death and the former remaining relatively static. Although this concept was never operationally described or validated, it clearly rang true with those working with the nascent specialty of geriatric psychiatry and rapidly entered standard textbooks on the subject. The burgeoning of interest in the elderly and the massive expansion of clinical and research work in the field of dementia in the eighties led to a widely expressed need for the development of criteria to categorize a group of subjects with memory problems falling short of dementia. The National Institute of Mental Health (NIMH) responded with the formation of a working group that published its suggested criteria for what Crook et al. (1986) called “age-associated memory impairment” (AAMI). Although some of the detailed components of these criteria have proved controversial, the term has been increasingly quoted in relevant literature and has given rise to specific studies. It has led to wide discussion, and related entities have been incorporated both in the draft of DSM-IV (as “aging-associated cognitive decline [AACD]” [American Psychiatric Association, 1993], an “additional condition that may be the focus of clinical attention”) and in the research criteria for ICD-10 (World Health Organization, 1993), where it is potentially classifiable under FO6.7 Mild Cognitive Disorder, although this does not specifically give aging as a cause. In arriving at our provisional criteria we have drawn to a great degree on these and other related publications that we are pleased to acknowledge.