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1. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD ACMI A-MCI M-MCI N-MCI ARCD AAMI START DEM Demented Mental Disorder or Neurological Condition Other (Non-Memory) Cognitive Impairment Age 50-79 Other (Non-Memory) Cognitive Impairment BSF Long Term Memory Problem (Intact Recent Memory) Mental Disorder or Neurological Condition General Cognitive Decline Mental Disorder or Neurological Condition Mental Disorder or Neurological Condition Mental Disorder or Neurological Condition MMSE (Cut-off) MMSE 22-26 General Cognitive Decline General Cognitive Decline Subjective Memory Complaint General Cognitive Decline General Cognitive Decline SMC Impaired Activities of Daily Living Subjective Memory Complaint Impaired Activities of Daily Living Subjective Memory Complaint QD Other (Non-Memory) Cognitive Impairment Subjective Memory Complaint Impaired Activities of Daily Living Subjective Memory Complaint General Cognitive Decline Subjective Memory Complaint Other (Non-Memory) Cognitive Impairment Impaired Activities of Daily Living Subjective Memory Complaint Subjective Memory Complaint Other (Non-Memory) Cognitive Impairment Subjective Memory Complaint Anxiety Mental Disorder or Neurological Condition Impaired Activities of Daily Living Minor Errors in Orientation Other (Non-Memory) Cognitive Impairment Forgetfulness Gradual Decline (present for at least 6 months) Impaired Activities of Daily Living General Cognitive Decline Mental Status Questionnaire (score of at least 8/10) Mental Disorder or Neurological Condition Clinical Problem (i.e., depression &/or anxiety) Physical Disease (known to cause cerebral Dysfunction Incl. Parkinson’s & Stroke) MCD (ICD-10) LCD MCDi (GDS-3) MCDo (GDS-4) AACD CIND MNCD MD

2. START DEMENTIA A neurological disorder where the individual shows significant impairment in intellectual functioning resulting in interference in normal activities and relationships. Individuals can also lose their ability to solve problems and maintain emotional control and sometimes experience personality changes and behavioural problems. The three most common forms of dementia are Alzheimer's disease, vascular dementia and Lewy body dementia. Although common in very elderly individuals, it is not a normal part of the aging process. DEM Demented

3. START Demented BSF Long Term Memory Problem (Intact Recent Memory) BENIGN SENESCENT FORGETFULNESS [BSF] Here an individual shows a mild age-related inability to recall relatively unimportant data and parts of experience from the remote past (e.g., a name, place or date). However, the experience from which the forgotten data come from can be recalled. The individual is aware of their impairment and attempts to compensate for it. This condition is not rapidly progressive and does not result in an increased risk of institutionalisation. In time this condition may become malignant. Exclusion Criteria: NONE SPECIFIED. Reference Kral (1958; 1962)

4. START MINI MENTAL STATE EXAMINATION CUT-OFF [MMSE] TheMMSE is a brief assessment of cognitive status. The maximum score is 30. A score of 21 or less indicates likely dementia. Higher scores indicate better cognitive function. In CFAS a cut-off range of 22-26 was used to indicate mild impairment. Exclusion Criteria: NONE SPECIFIED. References Brayne & Calloway (1990) Folstein et al., (1975) Demented MMSE (Cut-off) MMSE 22-26

5. START Demented SMC Subjective Memory Complaint SUBJECTIVE MEMORY COMPLAINT [SMC] Complaints of memory loss in the absence of formal testing. Where formal testing indicates no impairment an individual would be classified as ‘worried well’. Exclusion Criteria: NONE SPECIFIED.

6. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD AAMI START • AGE ASSOCIATED MEMORY IMPAIRMENT [AAMI] • This identifies a group of individuals with both subjective and objective memory loss associated with normal ageing. AAMI is non-specific with regard to etiology. Classification is based on five diagnostic criteria: • 1. At least 50 years of age • 2. Complaints of gradual memory loss • 3. Memory test performance at least 1SD below the mean established for young adults • 4. Adequate intellectual function • 5. Absence of dementia and/or a neurological or medical problem that could affect memory or cognitiveprocessing • Exclusion Criteria: • a. Disturbances of consciousness including delirium and confusion • b. Neurological disorder or medical condition causing cognitive deterioration including: Alzheimer’s Disease, Parkinson’s Disease, stroke, intracranial haemorrhage, tumour, renal, respiratory, cardiac and hepatic disease, endocrine, hematologic or metabolic disturbances or uncontrolled diabetes • c. History of infective or inflammatory brain disease (viral, fungal or syphilitic etiologies) • d. History of cerebral vascular pathology • e. History of repeated minor head injury (i.e., boxing) or single injuring resulting in loss of consciousness for 1 or more hours • f. Depression, mania or any major psychiatric disorder • g. Use of psychotropic or other drugs that could affect cognitive function • In CFAS individuals with depression, anxiety, stroke, Parkinson’s disease, angina, anaemia, head injury (with loss of consciousness ≥1hr), history of boxing, asthma, chronic bronchitis, thyroid problems, meningitis/encephalitis, diabetes (untreated) or history of a heart attack were excluded. • Reference • Crook et al., (1996) Demented Mental Disorder or Neurological Condition General Cognitive Decline Subjective Memory Complaint

7. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD ACMI START Age 50-79 Demented Mental Disorder or Neurological Condition General Cognitive Decline Subjective Memory Complaint AGE CONSISTENT MEMORY IMPAIRMENT [ACMI] This identifies a subgroup of persons within the AAMI classification system whose memories appear to be ageing in accord with normative expectations. Classification is based on 5 criteria: 1. Aged between 50-79 years 2. Subjective memory disturbance 3. Performance within ±1SD of aged norms on 75% of tests (memory) 4. Preserved general intelligence Exclusion Criteria: Non-demented and no concurrent neurological or medical problem that could affect memory or cognitive processing including but not limited to: Alzheimer’s Disease, multi-infarct dementia, Parkinson’s disease, seizure disorder, delirium, any infective or inflammatory brain disease (viral, fungal or syphilitic etiologies), psychological or psychosocial stressors (e.g., depression, situational adjustment disorders), current or prior history of drug/alcohol dependence, history of caner (not including skin) and inadequately treated medical conditions such as gastrointestinal disease, kidney disease, lung disease, uncontrolled diabetes, hematologic disease, metabolic or endocrine disorder. In CFAS individuals with depression, anxiety, stroke, Parkinson’s disease, angina, anaemia,thyroid problems, meningitis/encephalitis or diabetes (untreated) were excluded. Reference Blackford & La Rue (1989)

8. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD N-MCI START Demented Other (Non-Memory) Cognitive Impairment Mental Disorder or Neurological Condition General Cognitive Decline Impaired Activities of Daily Living Subjective Memory Complaint NON-AMNESTIC MILD COGNITIVE IMPAIRMENT [N-MCI] This identifies individuals who show an objective impairment in one or more domains other than memory. Given this four other diagnostic criteria must be satisfied including: 1. Subjective memory complaint 2. Normal general cognitive function 3. Normal range of activities of daily living 4. Non-demented Exclusion Criteria: Exclusions are not uniquely specified in the defining criteria. Generally in studies where this classification has been used the following exclusions have been applied: history of major depressive disorder, bipolar disorder, schizophrenia, cerebrovascular disorders, stroke, a history of traumatic brain injury or other neurological disease (e.g., Parkinson’s disease, Huntington disease, seizure disorders), considerable medical problems (e.g., poorly controlled diabetes or hypertension, cancer and/or clinically significant renal, cardiac or pulmonary disorders). In CFAS individuals with depression, anxiety, stroke, Parkinson’s disease, thyroid problems or diabetes (untreated) were excluded. Reference Petersen et al., (2001, 2004)

9. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD A-MCI START Demented Other (Non-Memory) Cognitive Impairment Mental Disorder or Neurological Condition General Cognitive Decline Impaired Activities of Daily Living AMNESTIC MILD COGNITIVE IMPAIRMENT [A-MCI] This defines an intermediate condition between normal and impaired aging, particularly to diagnose prodromal dementia and prodromal Alzheimer’s disease. Five criteria have been proposed: 1. Memory complaint 2. Memory impaired for age 3. Normal general cognitive function 4. Normal range of activities of daily living 5. Non-demented Exclusion Criteria: Exclusions are not uniquely specified in the defining criteria. Generally in studies where this classification has been used the following exclusions have been applied: history of major depressive disorder, bipolar disorder, schizophrenia, cerebrovascular disorders, stroke, a history of traumatic brain injury or other neurological disease (e.g., Parkinson’s disease, Huntington disease, seizure disorders), considerable medical problems (e.g., poorly controlled diabetes or hypertension, cancer and/or clinically significant renal, cardiac or pulmonary disorders). In CFAS individuals with depression, anxiety, stroke, Parkinson’s disease, thyroid problems or diabetes (untreated) were excluded. References Petersen et al., (1999, 2001) Subjective Memory Complaint

10. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD M-MCI START Demented Other (Non-Memory) Cognitive Impairment Mental Disorder or Neurological Condition General Cognitive Decline Impaired Activities of Daily Living Subjective Memory Complaint MULTIPLE MILD COGNITIVE IMPAIRMENT [M-MCI] This system builds on Petersen’s et al’s., (1999, 2001) amnesic MCI criteria. Here in addition to memory impairment, impairment can be seen in other cognitive domains. Exclusion Criteria: Exclusions are not uniquely specified in the defining criteria. Generally in studies where this classification has been used the following exclusions have been applied: history of major depressive disorder, bipolar disorder, schizophrenia, cerebrovascular disorders, stroke, a history of traumatic brain injury or other neurological disease (e.g., Parkinson’s disease, Huntington disease, seizure disorders), considerable medical problems (e.g., poorly controlled diabetes or hypertension, cancer and/or clinically significant renal, cardiac or pulmonary disorders). In CFAS individuals with depression, anxiety, stroke, Parkinson’s disease, thyroid problems or diabetes (untreated) were excluded. References Petersen et al., (1999, 2001)

11. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START QUESTIONABLE DEMENTIA [QD] This represents the worst end of the MCI spectrum. QD is associated with a Clinical Dementia Rating (CDR) score of 0.5 from the Hughes et al., (1982) CDR Scale. Here an individual shows objective evidence of cognitive impairment but these impairments do not satisfy the criteria for dementia. Individuals are fully capable of self care. In the literature a diagnosis has been made in cases where individuals: (a) experience memory impairment that affects their social or occupational functioning but without other cognitive impairment; (b) experience cognitive impairment in one or more areas of functioning but this does not significantly interfere with life; or, (c) experience cognitive impairment 2SD below the mean in one or more cognitive domains with function disability. Exclusion Criteria: NONE SPECIFIED. References Hughes et al., (1982) Morris et al., (1993) Demented QD Other (Non-Memory) Cognitive Impairment Impaired Activities of Daily Living

12. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START AGE ASSOCIATED COGNITIVE DECLINE [AACD] This identifies a group individuals who experience cognitive decline which cannot be classified as dementia. Diagnostic criteria include: 1. Self or informant report of cognitive decline 2. Onset of decline is gradual and has been present for at least 6 months 3. Objective difficulties in any of the following domains: learning and memory, attention and concentration, thinking, language and visuospatial functioning. A cut-off of 1SD below age and education norms is specified. Exclusion Criteria: No diagnosis of dementia or Mild Cognitive Disorder. No cerebral disease, damage or dysfunction (or a systemic physical disorder known to cause cerebral dysfunction), no medical or neurological condition that may contribute to observed difficulties (including depression, anxiety, delirium, post encephalitic syndrome, postconcussional syndrome, organic amnestic disorder) or persisting cognitive impairment due to substance/drug use. In CFAS individuals with anxiety, depression, stroke, Parkinson’s disease, meningitis/encephalitis, diabetes (untreated) or history of a heart attack were excluded. Reference Levy et al., (1994) Demented General Cognitive Decline Subjective Memory Complaint Other (Non-Memory) Cognitive Impairment Mental Disorder or Neurological Condition Gradual Decline (present for at least 6 months) AACD

13. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START COGNITIVE IMPAIRMENT NO DEMENTIA [CIND] Individuals are cognitively impaired but do not meet the DSM-IV criteria for dementia. Cognitive impairment can be in one or multiple domains and can have a variety of aetiologies. This category is therefore more inclusive than Age Associated Memory Disorder (AAMI) and Age Related Cognitive Decline (ARCD). Exclusion Criteria: NONE SPECIFIED. Reference Ebly et al., (1995) Demented Subjective Memory Complaint Other (Non-Memory) Cognitive Impairment Impaired Activities of Daily Living CIND

14. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START MINIMAL DEMENTIA [MD] This corresponds closely to the classification of “questionable dementia” (CDR = 0.5) in the Clinical Dementia Rating of Hughes et al., (1982). Here an individual shows cognitive deficits in memory and minor and variable errors in orientation. There is no evidence of impairment in occupational or social functioning and self care is unimpaired. Clinical examination usually yields negative results. Emotional life and responses are well preserved. It is acknowledged that MD indicates some uncertainty in the diagnosis of dementia and the need for further investigation. Exclusion Criteria: NONE SPECIFIED. In CFAS individuals with anxiety or depression were excluded. Reference CAMDEX Demented Minor Errors in Orientation Impaired Activities of Daily Living Clinical Problem (i.e., depression &/or anxiety) MD

15. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START MILD COGNITIVE DISORDER (ICD-10) [MCD10] This is characterized by a decline in cognitive performance including memory impairment and learning or concentration difficulties. Complaint must be corroborated by cognitive tests. The disorder may precede, accompany or follow a wide variety of infections and/or physical disorders. This condition can be non-persistent (e.g., in cases where the individual recovers from the associated physical disorder). Exclusion Criteria: Evidence of dementia or probable dementia, delirium or amnestic syndrome, post encephalitic syndrome, postconcussional syndrome or other persisting cognitive impairment due to psychoactive substance use. In CFAS individuals with anxiety, depression, stroke, Parkinson’s disease, history of heart attack, meningitis/encephalitis or history of head injury (with loss of consciousness ≥1 hr) were excluded. References International Classification of Diseases 10 (ICD-10) Christensen et al., (1995) [APPENDIX, Page 585] Demented Subjective Memory Complaint Other (Non-Memory) Cognitive Impairment General Cognitive Decline Physical Disease (known to cause cerebral Dysfunction Incl. Parkinson’s & Stroke) MCD (ICD-10)

16. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START Demented LIMITED COGNITIVE DISTURBANCE [LCD] This condition contrasts with pervasive cognitive disturbance or dementia. Five criteria are required to be fulfilled in addition to no interference in daily living. These include: 1. Reported decline in memory 2. Increase reliance on reminders (i.e., notes) 3. Occasional forgetfulness (< than once/month including for example names, appointments and placement of objects 4. Occasional destructive lapses in memory (< than once/month such as burning cooking or leaving taps on) 5. One or two errors on cognitive testing (all errors specified were related to memory and no tests were recommended) Exclusion Criteria: NONE SPECIFIED. Reference Gurland et al., (1982) Impaired Activities of Daily Living Subjective Memory Complaint Forgetfulness LCD

17. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START MILD COGNITIVE DECLINE [MCDi] Stage 3 of the Global Deterioration Scale. This represents the earliest stage of clinical decline. Individuals show objective evidence of a memory deficit resulting in decreased performance in demanding employment and social situations. Individuals may also get seriously lost in unfamiliar locations. These patients show mild to moderate anxiety. Exclusion Criteria: NONE SPECIFIED. Reference Reisberg et al., (1982) Demented Impaired Activities of Daily Living Anxiety Mental Status Questionnaire (score of at least 8/10) MCDi (GDS-3)

18. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START MODERATE COGNITIVE DECLINE [MCDo] Stage 4 of the Global Deterioration Scale. This represents a late confusional phase where a clear deficit is apparent. Patients at this stage almost always make 3 or more errors on the Mental Status Questionnaire. Exclusion Criteria: NONE SPECIFIED. Reference Reisberg et al., (1982) Demented Impaired Activities of Daily Living Anxiety Mental Status Questionnaire (score of at least 8/10) MCDo (GDS-4)

19. Below Healthy Young Norms > 1SD Within ±1SD Objective Memory Impairment Non Impaired Memory < 1SD Aged Norms < 2SD < 1SD START MILD NEUROCOGNITIVE DISORDER [MNCD] Impairment arises as a consequence of a general medical condition. The report of cognitive impairment must be corroborated by formal testing and deficits must be observed in at least two areas of cognitive functioning. Furthermore, the cognitive deficits causes marked distress or interference with the individual’s social, occupational, or other areas of functioning and represents a decline from a previous level of performance. Exclusion Criteria: The cognitive disturbance does not meet the criteria of delirium, a dementia or an amnestic disorder and is not better accounted for by another mental disorder (e.g., a Substance-Related Disorder or Major Depressive Disorder). In CFAS individuals with anxiety, depression, stroke, or Parkinson’s disease were excluded. Reference DSM-IV-R (2000) Demented Impaired Activities of Daily Living Subjective Memory Complaint Other (Non-Memory) Cognitive Impairment Mental Disorder or Neurological Condition MNCD