Alzheimer's disease (AD) is characterized by a progressive loss of controlled cognitive processes (processes requiring mental effort and attentional resources), and functional neuroimaging at early stages of AD provides an opportunity to tease out the neural correlates of controlled processes. Controlled and automatic memory performance was assessed with the Process Dissociation Procedure in 50 patients diagnosed with questionable Alzheimer's disease (QAD). The patients' brain glucose metabolism was measured using FDG-PET. After a follow-up period of 36 months, 27 patients had converted to AD, while 23 remained stable. Both groups showed a similar decrease in controlled memory processes but preserved automatic processes at entry into the study, suggesting that impairment of controlled memory would not be specific for AD. Patients who subsequently converted to Alzheimer type dementia showed significantly decreased brain metabolism at baseline compared to stable QAD in associative cortices known to be involved in AD (the left precuneus, the right inferior parietal lobule and bilateral middle temporal cortex).Voxel-based cognitive and metabolic correlations showed that a decrease in controlled memory processes was preferentially correlated with lower activity in the dorsomedial prefrontal and posterior cingulate cortices in very early AD patients. The dorsomedial prefrontal cortex would play a role in controlled memory processes as they relate to reflective and monitoring processes, while the posterior cingulate cortex is involved in the controlled access to previously encoded episodes. In stable QAD patients, reduced controlled performance in verbal memory correlated with impaired activity in the left anterior hippocampal structure, which would alter the reactivation of associations created at encoding.