ABSTRACT. Objective. To investigate to what extent subjective memory complaints and APOE-epsilon4 predict future cognitive decline in cognitively intact elderly, evaluating both their separate and combined effects. Methods. We selected 1,168 subjects from the population-based Longitudinal Aging Study Amsterdam (LASA), aged 62-85 years, with no obvious cognitive impairment at baseline (Mini-Mental State Examination (MMSE) >= 27). Memory complaints and APOE phenotypes were assessed at baseline. We studied cognitive decline using the MMSE, the Auditory Verbal Learning Test (memory: immediate and delayed recall) and the Coding Task (information processing speed). Follow-up data were collected after three and six years. Data were analyzed with Generalized Estimating Equations (GEE), adjusted for age, sex, education and depression. Results. Baseline memory complaints were reported by 25.5% of the cognitively intact elderly. Overall, 25.3% were carrier of at least one APOE-epsilon4 allele. Memory complaints were associated with a greater rate of decline on all cognitive measures, except on immediate recall. Also, APOE-epsilon4 carriers showed a greater rate of decline on MMSE and information processing speed after six years. The effects of both memory complaints and APOE-epsilon4 were additive, with an almost two times higher decline compared to subjects without both factors. Conclusions. Both memory complaints and APOE-epsilon4 predict cognitive decline at an early stage. This highlights the importance of subjective memory complaints, also at an early stage when objective tests are still unable to detect cognitive deficits, and especially in elderly with APOE-epsilon4 since they carry an additional risk.
