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Ben-Ami L, Ravona-Springer R, Tsarfaty G, Raizman R, Shumacher A, Sharvit-Ginon I, Greenbaum L, Bendlin BB, Okun E, Heymann A, Schnaider Beeri M, Livny A. Neural correlates of subjective cognitive decline in adults at high risk for Alzheimer's disease. Front Aging Neurosci 2023; 15:1067196. [PMID: 36819726 PMCID: PMC9930909 DOI: 10.3389/fnagi.2023.1067196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Recently, interest has emerged in subjective cognitive decline (SCD) as a potential precursor to Alzheimer's disease (AD) dementia. Whether individuals with SCD harbor brain alterations in midlife, when AD-related pathology begins, is yet to be elucidated. Furthermore, the role of apolipoprotein ε4 (APOE ε4) allele, a robust AD risk factor, in the relationship between SCD and brain alterations is unknown. We examined whether APOE genotype modulates the association of SCD with brain measures in individuals at high AD risk. Methods Middle-aged adults with parental history of AD dementia underwent magnetic resonance imaging (MRI) and the Memory Functioning Questionnaire. Regression analysis tested the extent to which SCD was associated with activation during an functional MRI (fMRI) working-memory task, and white-matter microstructure. APOE ε4 genotype was tested as a moderator. Results Among APOE ε4 carriers, but not among non-carriers, SCD was associated with higher activation in the anterior cingulate (p = 0.003), inferior, middle, and superior frontal cortices (p = 0.041, p = 0.048, p = 0.037, respectively); and with lower fractional anisotropy in the uncinate fasciculus (p = 0.002), adjusting for age, sex, and education. Conclusion In middle aged, cognitively normal individuals at high AD risk, higher SCD was associated with greater brain alterations possibly reflecting incipient AD pathology. When accompanied by a family history of AD and an APOE ε4 allele, SCD may have important clinical value, allowing a window for early intervention and for participants' stratification in AD prevention clinical trials.
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Affiliation(s)
- Liat Ben-Ami
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel,The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel,Memory Clinic, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Tsarfaty
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Raizman
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Aleeza Shumacher
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Inbal Sharvit-Ginon
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Lior Greenbaum
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Barbara B. Bendlin
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Eitan Okun
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel,The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
| | - Anthony Heymann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Maccabi Healthcare Services, Tel Aviv, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Abigail Livny
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel,The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel HaShomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel,*Correspondence: Abigail Livny,
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Pang T, Zhao X, He X, Kan CN, Venketasubramanian N, Cheng CY, Yuan C, Chen C, Xu X. The discriminant validity of single-question assessments of subjective cognitive complaints in an Asian older adult population. Front Aging Neurosci 2022; 14:901592. [PMID: 36004002 PMCID: PMC9393535 DOI: 10.3389/fnagi.2022.901592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the discriminant validity of three different single-question assessments of subjective cognitive complaints (SCC) for dementia in a community-based older adult population in Singapore. Methods Eligible older adults aged ≥60 were recruited into phase I for identifying those who require further assessment using the Abbreviated Mental Test (AMT) and progressive forgetfulness question (PFQ). Participants who failed either tests entered phase II and were administered various single-question assessments of SCC, such as the 8th question on the patient Ascertain Dementia 8 (AD8-8pt), informant AD8 (AD8-8info), and the 10th item on the Geriatric Depression Scale (GDS-10), followed by the Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery to identify the participant’s cognitive status by a research diagnosis and DSM-IV criteria. Differences in characteristics among diagnostic groups were compared. All discriminatory indices (sensitivity, specificity, positive, and negative predictive values, overall accuracy) for these single-question assessments and their combinations with the MoCA were calculated and reported to confirm their discriminant validity in identifying the existence of subjective complaints and objective impairment. Results A total of 3,780 participants were assessed at phase I, of which 957 entered and completed phase II. Of whom, 911 were dementia-free and 46 had dementia. The MoCA (13/14) displayed good sensitivity (95.6%), specificity (81.5%), and overall accuracy (82.1%) for dementia detection. The GDS-10 and AD8-8pt showed poor discriminant validity, while the AD8-8info had the highest specificity (83.2%) and the greatest overall accuracy (82.5%) for dementia. Compensatory combination of the AD8-8info with MoCA, the sensitivity and positive predictive values were optimized (100%), while the conjunctive combination of two tools achieved excellent specificity (96.3%) and overall accuracy (94.8%) in discriminating dementia patients. Conclusion and implications Combining a reliable single-question SCC assessment with an objective tool can efficiently discriminate dementia patients from healthy older adults in the community.
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Affiliation(s)
- Ting Pang
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuhao Zhao
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Xindi He
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Cheuk Ni Kan
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Narayanaswamy Venketasubramanian
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Changzheng Yuan
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Christopher Chen
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin Xu
- School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Xin Xu,
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Kryscio RJ, Abner EL, Cooper GE, Fardo DW, Jicha GA, Nelson PT, Smith CD, Van Eldik LJ, Wan L, Schmitt FA. Self-reported memory complaints: implications from a longitudinal cohort with autopsies. Neurology 2014; 83:1359-65. [PMID: 25253756 PMCID: PMC4189103 DOI: 10.1212/wnl.0000000000000856] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/12/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed salience of subjective memory complaints (SMCs) by older individuals as a predictor of subsequent cognitive impairment while accounting for risk factors and eventual neuropathologies. METHODS Subjects (n = 531) enrolled while cognitively intact at the University of Kentucky were asked annually if they perceived changes in memory since their last visit. A multistate model estimated when transition to impairment occurred while adjusting for intervening death. Risk factors affecting the timing and probability of an impairment were identified. The association between SMCs and Alzheimer-type neuropathology was assessed from autopsies (n = 243). RESULTS SMCs were reported by more than half (55.7%) of the cohort, and were associated with increased risk of impairment (unadjusted odds ratio = 2.8, p < 0.0001). Mild cognitive impairment (dementia) occurred 9.2 (12.1) years after SMC. Multistate modeling showed that SMC reporters with an APOE ε4 allele had double the odds of impairment (adjusted odds ratio = 2.2, p = 0.036). SMC smokers took less time to transition to mild cognitive impairment, while SMC hormone-replaced women took longer to transition directly to dementia. Among participants (n = 176) who died without a diagnosed clinical impairment, SMCs were associated with elevated neuritic amyloid plaques in the neocortex and medial temporal lobe. CONCLUSION SMC reporters are at a higher risk of future cognitive impairment and have higher levels of Alzheimer-type brain pathology even when impairment does not occur. As potential harbingers of future cognitive decline, physicians should query and monitor SMCs from their older patients.
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Affiliation(s)
- Richard J Kryscio
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
| | - Erin L Abner
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Gregory E Cooper
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - David W Fardo
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Gregory A Jicha
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Peter T Nelson
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Charles D Smith
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Linda J Van Eldik
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Lijie Wan
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
| | - Frederick A Schmitt
- From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY
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