18 - Functional memory complaints: hypochondria and disorganization

Summary

Subjects complaining of ‘poor memory’ (or whose ‘bad’ memory is complained of by others) are frequently met with in medical practice. Neuropsychological assessment will ascertain the complaint in a sizeable proportion of cases. In this group, age remains a reasonable aetiological indicator: if older than 60, some form of chronic disease of the brain (usually a form of dementia) is often found, although significant depressive illness (or combinations thereof) may play a role. Amongst the under 40s, however, functional psychiatric disorders or organic disorder of the brain other than dementia become prominent (Spiegel et al., 1993). In those falling in the range 40–60, aetiology can go either way.

In not all cases with memory complaints, however, can an objective memory deficit be demonstrated: in some doubts remain as to the reality or extent of the memory deficit; in others the team may feel that no deficit actually exists. Clinical attitudes differ vis-à-vis these two groups but it is common practice to reassess the ‘doubtful’ group sometime in the future. Attitudes towards the second group, i.e. to the persistent memory complainers with negative neurological, neuropsychological and neuropsychiatric assessments tend to be harsher, particularly in memory clinics whose objective is to collect patients for dementia drug trials. But being told that ‘nothing is the matter with them’, rarely reassures these subjects who may proceed to reject promotions, retire early or adopt some form of illness behaviour compatible with their belief that ‘they are developing dementia’ (Dartigues et al., 1997). Perusal of the literature also suggests that, from the therapeutic viewpoint, these patients have been neglected as ‘they do not fit’ into any ongoing definition of ‘disorder of memory’.