Research Article Subjective memory impairment in older adults predicts future dementia independent of baseline memory performance: Evidence from the Betula prospective cohort study Michael R€ onnlund a, *, Anna Sundstr€ om b,c , Rolf Adolfsson d , Lars-G€ oran Nilsson e,f a Department of Psychology, Ume  a University, Ume  a, Sweden b Centre for Population Studies/Ageing and Living Conditions, Ume  a University, Ume  a, Sweden c Department of Psychology, Ume  a University, Ume  a, Sweden d Division of Psychiatry, Department of Clinical Sciences, Ume  a University, Ume  a, Sweden e Aging Research Center, Karolinska Institutet, Stockholm, Sweden f Ume  a Center for Functional Brain Imaging, Ume  a University, Ume  a, Sweden Abstract Background: The objective was to examine whether subjective memory impairment (SMI) predicts all-cause dementia or Alzheimer’s disease (AD) in a population-based study with long-term follow- up (median 5 10 years). Methods: A total of 2043 initially dementia-free participants ( 60 years) made three memory rat- ings (“compared with others”, “compared with five years ago”, and “complaints from family/ friends”) at baseline. During follow-up, 372 participants developed dementia (208 with AD). Results: Cox regression revealed that subjective memory impairment ratings predicted all-cause de- mentia in models adjusting for age and sex (hazard ratio or HR from 2.04 to 3.94), with even higher values for AD (HR from 2.29 to 5.74). The result persisted in models including other covariates, including baseline episodic memory performance, and in analyses restricted to participants with long time to dementia diagnosis ( 5 years). Conclusions: The findings underscore the usefulness of subjective memory assessment in combina- tion with other factors in identifying individuals at risk for developing dementia. Ó 2015 The Alzheimer’s Association. Published by Elsevier Inc. All rights reserved. Keywords: Subjective memory impairment; Objective memory; Dementia; Alzheimer’s disease 1. Introduction Given that medical treatments designed to slow down the disease process of dementia disorders such as Alzheimer’s disease (AD) are available, early detection of signs of impend- ing disease is crucial. With the advent of more effective treat- ments, developing methods that aid in identifying preclinical stages of dementia will become even more important. A potential source of information regarding early signs is the individual’s own awareness of and expressed concerns about minor cognitive deficits. Such concerns may, for example, pertain to episodic memory functioning, known to be affected in the preclinical stage of dementia disorders such as AD [1]. The hope that reports of subjective memory impairment (SMI) [2] may help in identifying individuals at risk for future dementia may seem hampered by findings indicating that subjective ratings often show weak, if any, correspon- dence with concurrent objective test performance, but instead show a consistent relationship with mood state and personality factors, such as neuroticism [3–5]. Despite reports of a poor association between subjective and objective memory measures in cross-sectional studies, SMI tends to be more consistently related to longitudinal Conflict of interest None. *Corresponding author. Tel.: 146-90-786 76 13; Fax: 146-90-786 66 95. E-mail address: michael.ronnlund@psy.umu.se http://dx.doi.org/10.1016/j.jalz.2014.11.006 1552-5260/Ó 2015 The Alzheimer’s Association. Published by Elsevier Inc. All rights reserved. Alzheimer’s & Dementia - (2015) 1-8