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Paradise et al. BMC Psychiatry 2011, 11:108
http://www.biomedcentral.com/1471-244X/11/108

RESEARCH ARTICLE

Open Access

Subjective memory complaints, vascular risk factors
and psychological distress in the middle-aged:
a cross-sectional study
Matt B Paradise1*, Nick S Glozier1, Sharon L Naismith1, Tracey A Davenport2 and Ian B Hickie1

Abstract
Background: Subjective memorycomplaints (SMC) are common but their significance is still unclear. It has been
suggested they are a precursor of mild cognitive impairment (MCI) or dementia and an early indicator of cognitive
decline. Vascular risk factors have an important role in the development of dementia and possibly MCI. We
therefore aimed to test the hypothesis that vascular risk factors were associated with SMC, independentof
psychological distress, in a middle-aged community-dwelling population.
Methods: A cross-sectional analysis of baseline data from the 45 and Up Study was performed. This is a cohort
study of people living in New South Wales (Australia), and we explored the sample of 45, 532 participants aged
between 45 and 64 years. SMC were defined as ‘fair’ or ‘poor’ on a self-reported five-point Likertscale of memory
function. Vascular risk factors of obesity, diabetes, hypertension, hypercholesterolemia and smoking were identified
by self-report. Psychological distress was measured by the Kessler Psychological Distress Scale. We tested the
model generated from a randomly selected exploratory sample (n = 22, 766) with a confirmatory sample of equal
size.
Results: 5, 479/45, 532 (12%) ofrespondents reported SMC. Using multivariate logistic regression, only two vascular
risk factors: smoking (OR 1.18; 95% CI = 1.03 - 1.35) and hypercholesterolaemia (OR 1.19; 95% CI = 1.04 - 1.36)
showed a small independent association with SMC. In contrast psychological distress was strongly associated with
SMC. Those with the highest levels of psychological distress were 7.00 (95% CI = 5.41 -9.07) times more likely to
have SMC than the non-distressed. The confirmatory sample also demonstrated the strong association of SMC with
psychological distress rather than vascular risk factors.
Conclusions: In a large sample of middle-aged people without any history of major affective illness or stroke,
psychological distress was strongly, and vascular risk factors only weakly, associated withSMC, although we cannot
discount psychological distress acting as a mediator in any association between vascular risk factors and SMC.
Given this, clinicians should be vigilant regarding the presence of an affective illness when assessing middle-aged
patients presenting with memory problems.

Background
Subjective memory complaints (SMC) are common and
strongly associated with age.Estimates of their community prevalence have ranged from 11% [1] in 65 to 85
year olds to over 88% in those over the age of 85 years
[2]. In Australia, Jorm et al. [3] found a prevalence of
10% in those with an average age of 62 years. There is
* Correspondence: matthew.paradise@sydney.edu.au
1
Brain & Mind Research Institute, The University of Sydney, Building F, 94
Mallet Street, Camperdown, NSW2050, Australia
Full list of author information is available at the end of the article

uncertainty regarding the significance of SMC. They may
be an early marker of cognitive decline with an underlying pathological basis, a feature of normal ageing and/or
a reflection of psychological distress.
Cross-sectional studies have not consistently found an
independent association between SMC andobjective cognitive impairment [4]. In contrast, longitudinal studies
have reported a strong association between SMC and the
subsequent development of dementia or cognitive decline
over periods of one to seven years [4-7]. Support for the
pathological basis of SMC is further supported by recent

© 2011 Paradise et al; licensee BioMed Central Ltd. This is an Open Access article distributed...