Subjective cognitive complaints and mortality: does the type of complaint matter?

Self-reported anterograde memory loss in older persons that is not validated on neuropsychological assessment: Considerations for a dissociative diagnosis

The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory clinics with a primary complaint of self-reported memory loss without an antecedent neurological event (e.g., stroke) who produce neuropsychological test profiles that lack evidence of such impairment. Since the latter part of the 19th century, a confusing array of changing terminology, criteria, and perceived causation have been ascribed to patients with unverified medical symptoms to implicate psychological causation. Such terms are often misperceived by laypersons as reflecting character flaws or malingering. Of import for clinical neuropsychologists, the 11th edition of the International Classification of Diseases added cognitive to symptoms eligible for a diagnosis of the modern formulation, dissociative neurological symptom disorder. One dissociative option for referrals with self-reported neurocognitive symptoms not validated on neuropsychological testing is functional memory disorder, conceived as a psychological disorder where emotional distress is plausibly related to the perceived memory loss but is of less severity than would warrant a major depressive or anxiety diagnosis. If evidence of psychological distress or behavioral impairment is not present the referral likely reflects the increased public awareness of age-related dementias interacting with the high base rate of self-perceived memory loss in the general population. In such cases, a dissociative diagnosis should be avoided as there is evidence of neither a medical nor a psychological disorder. A summary statement of not dementia or similar is likely sufficient to help the patient.

Effectiveness of Early Multimodal Non-pharmacological Interventions in Cognitive Preservation in the Elderly

INTRODUCTION

Multimodal non-pharmacological interventions (MNPI) have been determined as effective in delaying cognitive deterioration. The effectiveness of timing of such interventions in elderly is less discussed. We compared the different effectiveness of MNPI in cognitive preservation in elderly subjects with and without dementia.

METHODS

We enrolled volunteer the elderly subjects. Subjects were classified as dementia group and non-dementia group by instrument of ascertainment of dementia 8. All were assigned to attend 3 hours of MNPI (physical fitness training, Chinese capillary, and Chinese drawings and paintings) twice a week over a 16-week period. Neuropsychiatric tests, including Mini-Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), clinical dementia rating (CDR), and neuropsychiatric inventory (NPI), were administered before and 1 year after MNPI. We demonstrated the changes of cognition and behavioral and psychological symptoms of dementia (BPSD) before and after MNPI. We compared the different effectiveness of cognition preservation between two groups.

RESULTS

In total, there were 43 participants in our study, including 18 with non-dementia and 25 with dementia. The non-dementia group had a significantly higher proportion of cognitive preservation in remote memory (100.0% vs 68.0%, P = .007), orientation (94.4% vs 48.0%, P = .001), drawing (94.4% vs 64.0%, P = .021) and language (77.8% vs 48.0%, P = .049) than the dementia group. The highest proportion of preserved cognition after MNPI was remote memory (100%), followed by orientation (94.4%) and drawing (94.4%) in the non-dementia group. The highest proportion of preserved cognition after MNPI was attention (72%) followed by remote memory (68%), recent memory (64%) and drawing (64%) in the dementia group. Overall, their improved rate in behavioral and psychological symptoms was 55.6%.

CONCLUSION

Our study concluded the benefits of early MNPI in cognition preservation in the elderly, especially in the field of remote memory, orientation, drawing and language.

Subjective cognitive complaints and blood biomarkers of neurodegenerative diseases: a longitudinal cohort study

BACKGROUND

Subjective cognitive complaints (SCC) have been mostly studied in the context of Alzheimer's disease in memory clinic settings. The potential of combining SCC with genetic information and blood biomarkers of neurodegenerative diseases for risk assessment of dementia and depression in the absence of dementia among community-dwelling older adults has so far not been explored.

METHODS

Data were based on a population-based cohort of 6357 participants with a 17-year follow-up (ESTHER study) and a clinic-based cohort of 422 patients. Participants of both cohorts were grouped according to the diagnosis of dementia (yes/no) and the diagnosis of depression in the absence of dementia (yes/no). Participants without dementia included both cognitively unimpaired participants and cognitively impaired participants. Genetic information (APOE ε4 genotype) and blood-based biomarkers of neurodegenerative diseases (glial fibrillary acidic protein; GFAP, neurofilament light chain; NfL, phosphorylated tau181; p-tau181) were available in the ESTHER study and were determined with Simoa Technology in a nested case-control design. Logistic regression models adjusted for relevant confounders were run for the outcomes of all-cause dementia and depression in the absence of dementia.

RESULTS

The results showed that persistent SCC were associated both with increased risk of all-cause dementia and of depression without dementia, independently of the diagnostic setting. However, the results for the ESTHER study also showed that the combination of subjective complaints with APOE ε4 and with increased GFAP concentrations in the blood yielded a substantially increased risk of all-cause dementia (OR 5.35; 95%CI 3.25-8.81, p-value < 0.0001 and OR 7.52; 95%CI 2.79-20.29, p-value < 0.0001, respectively) but not of depression. Associations of NfL and p-tau181 with risk of all-cause dementia and depression were not statistically significant, either alone or in combination with SCC, but increased concentrations of p-tau181 seemed to be associated with an increased risk for depression.

CONCLUSION

In community and clinical settings, SCC predict both dementia and depression in the absence of dementia. The addition of GFAP could differentiate between the risk of all-cause dementia and the risk of depression among individuals without dementia.

Prevalence and risk factors for subjective cognitive decline and the correlation with objective cognition among community-dwelling older adults in China: Results from the Hubei memory and aging cohort study

INTRODUCTION

The prevalence and risk factors for subjective cognitive decline (SCD) and its correlation with objective cognition decline (OCD) among community-dwelling older adults is inconsistent.

METHODS

Older adults underwent neuropsychological and clinical evaluations to reach a consensus on diagnoses.

RESULTS

This study included 7486 adults without mild cognitive impairment and dementia (mean age: 71.35 years [standard deviation = 5.40]). The sex-, age-, and residence-adjusted SCD prevalence was 58.33% overall (95% confidence interval: 58.29% to 58.37%), with higher rates of 61.25% and 59.87% in rural and female subgroups, respectively. SCD global and OCD language, SCD memory and OCD global, SCD and OCD memory, and SCD and OCD language were negatively correlated in fully adjusted models. Seven health and lifestyle factors were associated with an increased risk for SCD.

DISCUSSION

SCD affected 58.33% of older adults and may indicate concurrent OCD, which should prompt the initiation of preventative intervention for dementia.

HIGHLIGHTS

SCD affects 58.33% of older adults in China. SCD may indicate concurrent objective cognitive decline. Difficulty finding words and memory impairments may indicate a risk for AD. The presence of SCD may prompt preventative treatment initiation of MCI or dementia. Social network factors may be initial targets for the early prevention of SCD.

Subjective cognitive difficulties and posttraumatic stress disorder interact to increase suicide risk among middle-aged and older US military veterans

OBJECTIVES

To examine the role of subjective cognitive difficulties (SCD), posttraumatic stress disorder (PTSD), and their interaction in predicting suicidal ideation and current suicidal intent in middle-aged and older United States (US) military veterans.

DESIGN

Population-based cross-sectional study.

SETTING AND PARTICIPANTS

Data were analyzed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3602 US veterans aged 50 years and older (mean age = 69.0).

MEASUREMENTS

Questionnaires including the Medical Outcomes Study Cognitive Functioning Scale (SCD), PTSD Checklist for DSM-5 (PTSD), Patient Health Questionnaire-9 (suicidal ideation in the previous two weeks), and the Suicide Behaviors Questionnaire-Revised (current suicidal intent).

RESULTS

A total of 154 (4.4%) veterans screened positive for current PTSD, 239 (6.7%) reported past two-week suicidal ideation, and 37 (1.0%) reported current suicidal intent. The probability of suicidal ideation among veterans with both SCD and PTSD was more than six times higher than that observed in the full sample (44.5% vs. 6.7%) and more than 2.5 times higher than that observed in veterans with SCD and no PTSD (44.5% vs. 17.5%). Veterans with both subjective memory and concentration difficulties were more likely to report suicidal intent, though the interaction between SCD and PTSD was not significantly associated with suicidal intent.

CONCLUSION

Middle-aged and older U.S. veterans with subjective cognitive impairment and PTSD report higher rates of suicidal ideation than those with SCD alone. Interventions targeting SCD and PTSD may mitigate suicide risk among middle-aged and older veterans.

MASCoD-Multidimensional Assessment of Subjective Cognitive Decline

Subjective cognitive decline (SCD) is a subclinical cognitive impairment that is complained by the individual without being objectively supported at clinical, diagnostic, and neuropsychological levels. It can negatively impact on patient's frailty and quality of life, as well as on the caregiver's burden. Moreover, it can be prodromal to Mild Cognitive Impairment or dementia. Although the clinical manifestations of SCD can differ along with several cognitive domains, to date there are only screening tools to investigate subjective memory complaints. Thus, the first aim of this paper is to propose a preliminary English and Italian version of a new screening tool called MASCoD (Multidimensional Assessment of Subjective Cognitive Decline); the second aim is to propose its preliminary adoption on a pilot sample. This schedule is a brief test derived from the review of the literature and the clinical experience provided by an experts panelist. From pilot tests, it seems promising as it can help the professional to make differential diagnosis and to predict the risk of developing severe cognitive impairment over time, developing a personalized care path. This screening tool is brief, easily embeddable in usual clinical assessment, and administrable by different professionals. Furthermore, following validation, it will allow to collect manifold cognitive manifestations of SCD, addressing the shortage of previous validated instruments globally assessing cognition affected by this condition.

An application study-subjective cognitive decline Questionnaire9 in detecting mild cognitive impairment (MCI)

Objective: Subjective cognitive decline (SCD) complaints as the early manifestation of mild cognitive impairment (MCI) may be harbingers of objective cognitive decline. SCD-questinnaire9 (SCD-Q9) is developed to investigate the early sign for MCI. However, few studies have reported its power for discriminating MCI from healthy controls (HCs). Therefore, this study aims to investigate the discrimination power of SCD-Q9 as a brief screening tool for early detection of SCD in MCI.Methods: 84 HCs and 205 people with MCI were recruited. Their demographic information and scores of SCD-Q9 were compared. A binary logistic regression model was used to analyze the potential affecting factors of MCI, and the Receiver Operating Characteristic analysis was applied to test the discrimination powers of those factors, including SCD-Q9.Results: (1) Single and total scores of SCD-Q9 were all lower in the MCI group than those in the HC group. (2) Ageing, lower education and higher total scores of SCD-Q9 were associated with MCI. (3) Area Under the Curves (AUC) of SCD-Q9 for discriminating MCI from HC group was 0.815 and when integrating age and education, the AUC improved slightly and reached 0.839. Additionally, the sensitivity and specificity were 68.8% and 85.7%, respectively when a cut-off value of 3 was applied. Conclusions: SCD-Q9 may be able to detect the subjective cognitive decline in MCI early, but it may be used together with other screening questionnaires to improve its sensitivity and further verification of its power is needed.

The utilization of a nurse-led clinic by older people with cognitive complaints: Do they follow our advice?

AIM

Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community-based nurse-led cognitive assessment service in Hong Kong.

METHODS

A cross-sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined.

RESULTS

Two hundred and twenty-three clients attended the clinic. Of the 133 who completed the telephone follow-up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety-six percent (190/198) were satisfied with the overall services.

CONCLUSION

Cognitive assessment services in nurse-led clinics could provide a self-referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels.

Sex Differences in the Relation Between Subjective Memory Complaints, Impairments in Instrumental Activities of Daily Living, and Risk of Dementia

BACKGROUND

Older people with subjective memory complaints (SMC) and Instrumental Activities of Daily Living impairments (IADL-I) have an increased risk of developing dementia. Previous reports suggest that the predictive value of SMC and IADL-I may differ between sexes, leaving possible consequences for personalized risk prediction and prognosis. However, none of these studies addressed the competing risk of death, which may substantially differ between sexes.

OBJECTIVE

We investigated sex-differences in the association between IADL-I, SMC, and incident dementia and mortality as competing risk.

METHODS

3,409 community-dwelling older people without dementia (mean age 74.3±2.5), were followed for 6.7 years (median). Baseline SMC were assessed using the 15-item Geriatric Depression Scale memory question, and IADL-I using the Academic Medical Center Linear Disability Score. Potential sex-differences in the predictive value of SMC and IADL-I were assessed using Cox regression models with an interaction term for sex.

RESULTS

HRs for isolated SMC and SMC + IADL-I and risk of dementia were higher in women (HR: 2.02, 95% CI = 0.91-4.46, p = 0.08; HR:2.85, 95% CI = 1.65-4.91, p < 0.001) than in men (HR:1.52, 95% CI = 0.86-2.69, p = 0.18; HR:1.24, 95% CI = 0.62-2.49, p = 0.54), but these sex-differences were not significant. Conversely, HRs for isolated IADL-I and risk of mortality were higher in men (HR:1.56, 95% CI = 1.18-2.05, p = 0.002) than in women (HR:1.14, 95% CI = 0.80-1.62, p = 0.48), but again, these sex-differences were not significant.

CONCLUSION

The predictive value of SMC and IADL-I for the risk of dementia and mortality was not significantly modified by sex. However, the competing risk of death for these factors differed considerably between men and women, suggesting it is an essential factor to consider when comparing sex-differences in IADL/dementia risk.

Adaptation and Validation of the Memory Alteration Test (M@T) in Greek Middle-Aged, Older, and Older-Old Population with Subjective Cognitive Decline and Mild Cognitive Impairment

BACKGROUND

The Memory Alteration Test (M@T) is a verbal episodic and semantic memory screening test able to detect subjective cognitive decline (SCD) and Mild Cognitive Impairment (MCI).

OBJECTIVE

To adapt M@T, creating a Greek version of the Memory Alteration Test (M@T-GR), and to validate M@T-GR compared to the Mini-Mental State Examination (MMSE), and Subjective Cognitive Decline- Questionnaire (SCD-Q) MyCog and TheirCog.

METHODS

232 people over 55 years old participated in the study and they were classified as healthy controls (HC, n = 65), SCD (n = 78), or MCI (n = 89).

RESULTS

The ANCOVA showed that the M@T-GR's total score was significantly different in HC and SCD (I-J = 2.26, p = 0.032), HC and MCI (I-J = 6.16, p < 0.0001), and SCD compared to MCI (I-J = 3.90, p < 0.0001). In particular, a cut-off score of 46.50 points had an 81%sensitivity and 61%specificity for discriminating HC from SCD (AUC = 0.76, p < 0.0001), while a cut-off score of 45.50 had a sensitivity of 92%and a specificity of 73%for discriminating MCI (AUC = 0.88, p < 0.0001), and a cut-off score of 45.50 points had a sensitivity of 63%and a specificity of 73%for discriminating SCD from those with MCI (AUC = 0.69, p < 0.0021). Exploratory factor analysis indicated that there was one factor explaining 38.46%of the total variance. Internal consistency was adequate (α= 0.75), while convergent validity was found between M@T-GR and MMSE (r = 0.37, p < 0.0001) and SCD-Q TheirCog (r = -0.32, p < 0.0001).

CONCLUSION

The M@T-GR is a good to fair screening tool with adequate discriminant validity for administration in people with SCD and MCI in Greece.

Late-life depression, subjective cognitive decline, and their additive risk in incidence of dementia: A nationwide longitudinal study

OBJECTIVE

Late-life depression and subjective cognitive decline (SCD) are significant risk factors for dementia. However, studies with a large sample size are needed to clarify their independent and combined risks for subsequent dementia.

METHODS

This nationwide population-based cohort study included all individuals aged 66 years who participated in the National Screening Program between 2009 and 2013 (N = 939,099). Subjects were followed from the day they underwent screening to the diagnosis of dementia, death, or the last follow-up day (December 31, 2017).

RESULTS

Depressive symptom presentation, recent depressive disorder, and SCD independently increased dementia incidence with adjusted hazard ratio (aHR) of 1.286 (95% CI:1.255-1.318), 1.697 (95% CI:1.621-1.776), and 1.748 (95% CI: 689-1.808) respectively. Subjects having both SCD and depression had a higher risk (aHR = 2.466, 95% CI:2.383-2.551) of dementia than having depression (aHR = 1.402, 95% CI:1.364-1.441) or SCD (aHR = 1.748, 95% CI:1.689-1.808) alone.

CONCLUSIONS

Depressive symptoms, depressive disorder, and SCD are independent risk factors for dementia. Co-occurring depression and SCD have an additive effect on the risk of dementia; thus, early intervention and close follow up are necessary for patients with co-occurring SCD and depression.

The roles of study setting, response bias, and personality in subjective memory complaints of cognitively normal older adults

OBJECTIVES

This study investigated subjective memory complaints in older adults and the roles of setting, response bias, and personality.

DESIGN

Cognitively normal older adults from two settings completed questionnaires measuring memory complaints, response bias, and personality.

SETTINGS

(A) Neuroimaging study with community-based recruitment and (B) academic memory clinic.

PARTICIPANTS

Cognitively normal older adults who (A) volunteer for research (N = 92) or (B) self-referred to a memory clinic (N = 20).

MEASUREMENTS

Neuropsychological evaluation and adjudication of normal cognitive status were done by the neuroimaging study or memory clinic. This study administered self-reports of subjective memory complaints, response bias, five-factor personality, and depressive symptoms. Primary group differences were examined with secondary sensitivity analyses to control for sex, age, and education differences.

RESULTS

There was no significant difference in over-reporting response bias between study settings. Under-reporting response bias was higher in volunteers. Cognitive complaints were associated with response bias for two cognitive complaint measures. Neuroticism was positively associated with over-reporting in evaluation-seekers and negatively associated with under-reporting in volunteers. The relationship was reversed for Extraversion. Under-reporting bias was positively correlated with Agreeableness and Conscientiousness in volunteers.

CONCLUSION

Evaluation-seekers do not show bias toward over-reporting symptoms compared to volunteers. Under-reporting response bias may be important to consider when screening for memory impairment in non-help-seeking settings. The Memory Functioning Questionnaire was less sensitive to reporting biases. Over-reporting may be a facet of higher Neuroticism. Findings help elucidate psychological influences on self-perceived cognitive decline and help seeking in aging and may inform different strategies for assessment by setting.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America

BACKGROUND

In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru.

METHODS

1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru.

FINDINGS

Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, ηp 2  = 0.031); while Blacks reported experiencing discrimination more often (p < .001, ηp 2  = 0.050). Blacks and Latinos reported more positive coping (p < .001, ηp 2  = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination.

INTERPRETATION

The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact.

FUNDING

Massachusetts General Hospital Department of Psychiatry.

Interaction between Subjective Memory Decline and Depression Symptom Intensity in Older People. Results of the Second Wave of Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS)

Background: Prevalence of subjective memory impairment (SMC), with or without objective memory impairment, and the mediating role of depression symptom intensity was examined in older people. Methods: n = 205 subjects (60 years old and older) were examined and followed up at two years. Cognitive function was examined using the Montreal Cognitive Assessment (MoCA) Delayed Recall (DR) subtest. Geriatric Depression Scale (GDS) was used as a screening tool for depression. Statistical analysis was performed using linear mixed models. Results: A total of 144 subjects (70.24%) had SMC. MoCA Delayed Recall scores were not significantly changed in relation to time and SMC. Dynamics of SMC significantly influenced changes in GDS score (p = 0.008). Conclusions: SMC and objective memory impairment do not fully overlap each other. Subjects without SMC for longer than two years noted less intensity of depression symptoms in comparison to subgroup with SMC. However, occurrence of SMC in subjects who were previously free of SMC, was not related to increase in depression symptom intensity.

Trajectory of Unawareness of Memory Decline in Individuals With Autosomal Dominant Alzheimer Disease

IMPORTANCE

Recent studies have suggested that unawareness, or anosognosia, of memory decline is present in predementia stages of Alzheimer disease (AD) and may serve as an early symptomatic indicator of AD.

OBJECTIVE

To investigate the evolution of anosognosia of memory decline in individuals who carry the PSEN1 E280A variant for autosomal dominant AD compared with family members who do not carry the variant.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study investigated a total of 2379 members of a Colombian kindred with autosomal dominant AD who were part of the Alzheimer's Prevention Initiative Registry. Assessments were completed at the University of Antioquia, Colombia, with data collected between January 1, 2000, and July 31, 2019.

MAIN OUTCOMES AND MEASURES

Awareness of memory function was operationalized using the discrepancy between self-report and study partner report on a memory complaint scale. Linear mixed effects models were used to assess memory self-awareness over age separately in variant carriers and noncarriers.

RESULTS

This study included 396 variant carriers (mean [SD] age, 32.7 [11.9] years; 200 [50.5%] female), of whom 59 (14.9%) were cognitively impaired, and 1983 cognitively unimpaired noncarriers (mean [SD] age, 33.5 [12.5] years; 1129 [56.9%] female). The variant carriers demonstrated increased awareness until the mean (SD) age of 35.0 (2.0) years and had anosognosia at approximately 43 years of age, approximately 6 years before their estimated median age of dementia onset (49 years; 95% CI, 49-51 years). Cognitively unimpaired noncarriers reported more complaints than their study partners aged 20 and 60 years (10.1 points, P < .001). On the awareness index, a decrease with age (mean [SE] estimate, -0.04 [0.02] discrepant-points per years; t = -2.2; P = .03) in the noncarriers and in the variant carriers (mean [SE] estimate, -0.21 [0.04] discrepant-points per years; t = -5.1; P < .001) was observed.

CONCLUSIONS AND RELEVANCE

In this cohort study, increased participant complaints were observed in both groups, suggesting that increased awareness of memory function was common and nonspecific to AD in this cohort. In variant carriers, awareness of memory function decreased in the predementia stages, reaching anosognosia close to the age of mild cognitive impairment onset, providing support for the usefulness of awareness of memory decline.

Subjective cognitive decline in diabetes: Associations with psychological, sleep, and diabetes-related factors

AIMS

To determine whether psychological, sleep, and diabetes-related factors were associated with subjective cognitive decline (SCD) in adults with type 2 diabetes (T2D).

DESIGN

A secondary analysis with a cross-sectional, correlational design.

METHODS

Data from two parent studies were combined. A total of 105 adults with diabetes were recruited from a Midwestern city in the United States from September 2013-March 2014 and September 2016-September 2017. Subjective cognitive decline was measured with the psychological-cognitive symptom subscale of the Diabetes Symptom Checklist-Revised. Psychological factors (diabetes distress, fatigue, and depressive symptoms) and sleep were measured using the Diabetes Distress Scale and Patient-Reported Outcomes Measurement Information System. Diabetes-related factors were measured with body mass index and glycaemia control. Quantile regression was used to examine the associations.

RESULTS/FINDINGS

The mean age of the participants was 58.10 (SD 7.92) years and 58.1% were women. The participants' mean psychological-cognitive symptom score was 1.41 (SD 1.13). After controlling for age and gender, sleep disturbance, sleep-related impairment, and body mass index were associated with SCD in lower cognitive symptom quantile groups (5th to 30th percentiles). In contrast, fatigue and depressive symptoms were more strongly associated with SCD in higher quantile groups (70th to 95th percentiles).

CONCLUSION

In adults with T2D, SCD was differentially associated with psychological, sleep, and diabetes-related factors depending on cognitive symptom percentiles. Adults with T2D require regular screening for SCD. If they complain of cognitive symptoms at clinical visits, different underlying factors should be assessed according to their symptom severity.

IMPACT

Findings from this study provided evidence for early identification of SCD and its influencing factors, which may help to develop nursing interventions to recognize and/or delay the onset of cognitive impairment in adults with T2D.

Examining the temporal associations between self-reported memory problems and depressive symptoms in older adults

Objectives: Older adults commonly report problems with their memory which can elicit sadness and worry about future development of cognitive impairment. Conversely, ongoing depressive symptoms can negatively impact older adults' perceptions of their memory performance. The current study examined the longitudinal associations between self-reported memory problems and depressive symptoms to explore which symptom tends to appear first.Method: Two datasets from ongoing observational, longitudinal studies of aging (Memory and Aging Project; Minority Aging Research Study) were used for secondary analyses. Older adults (n = 1,724; M_age = 77.03; SD = 7.54; 76.80% female; 32.26% Black) completed up to 18 annual assessments of self-reported memory (two items: perceived decline in memory and frequency of memory problems) and depressive symptoms. Multilevel models were used to examine intra-individual variability and time-lagged relationships between self-reported memory and depressive symptoms.Results: Concurrently, self-reported memory problems and depressive symptoms were significantly related; at times when older adults reported poorer memory, they also reported more depressive symptoms, regardless of the type of memory self-report. Prospectively, perceived memory decline predicted future depressive symptoms, but depressive symptoms did not predict future reports of memory decline. Self-reported frequency of memory problems did not predict future depressive symptoms or vice versa.Conclusion: The current study's findings suggest a temporal relationship between perceived memory decline and depressive symptoms, such that perceived memory decline can lead to future depressive symptoms. These findings can inform future studies focused on developing a standardized assessment of self-reported memory that is separable from depressive symptoms.

Trajectories of subjective cognitive decline, and the risk of mild cognitive impairment and dementia

BACKGROUND

In cognitively normal individuals, subjective cognitive decline (SCD) has been reported to predict MCI and dementia (MCI/dementia). However, prior studies mostly captured SCD at single time-points without considering the longitudinal course of SCD. This study examined whether the trajectories of SCD provide any added information-beyond one-time assessments of SCD-on the risk of MCI/dementia.

METHODS

This cohort study included 5661 participants from the Alzheimer's Disease Centers across the USA, who were ≥ 50 years and had normal cognition in the first-four annual visits (year 1 to year 4). The participants were evaluated for SCD in the first-four annual visits (year 1 to year 4), and followed-up almost annually (year 4 up to year 14) for incident MCI/dementia. SCD trajectories (as identified from latent-class-growth-curve-analysis) were included in Cox regression to estimate their risks of MCI/dementia, with analyses further stratified by age (< 75 years versus ≥ 75 years; based on median-split).

RESULTS

Compared to those without SCD (in the first-four annual visits), Intermittent SCD (i.e., reported in 1-2 of the first-four annual visits) predicted a higher risk (HR 1.4) and Persistent SCD (i.e., reported in 3-4 of the first-four annual visits) predicted the highest risk (HR 2.2), with the results remaining significant even after adjusting for baseline SCD. Age-stratified analysis revealed that the risk associated with Intermittent SCD was only present in older individuals, while risk related to Persistent SCD was consistently present across the younger and older age groups. Age compounded the effects of the trajectories, whereby older individuals with Persistent SCD had > 75% probability of developing MCI/dementia by 10 years, in contrast to < 25% probability by 10 years in younger individuals with No SCD.

CONCLUSIONS

The findings demonstrate the utility of SCD trajectories-especially when used in combination with age strata-in identifying high-risk populations for preventive interventions and trials. They also suggest a potential modification in the current SCD criteria, with the inclusion of "persistent SCD over several years" as a feature of SCD plus.

Subjective cognitive decline, anxiety symptoms, and the risk of mild cognitive impairment and dementia

BACKGROUND

Subjective cognitive decline (SCD) and anxiety symptoms both predict neurocognitive disorders, but the two correlate strongly with each other. It is unclear whether they reflect two independent disease processes in the development of neurocognitive disorders and hence deserve separate attention. This cohort study examined whether SCD and anxiety symptoms demonstrate independent risks of mild cognitive disorder and dementia (MCI/dementia).

METHODS

The study included 14,066 participants aged ≥ 50 years and diagnosed with normal cognition at baseline, recruited from Alzheimer's Disease Centers across the USA. The participants were evaluated for SCD and anxiety symptoms at baseline and followed up almost annually for incident MCI/dementia (median follow-up 4.5 years; interquartile range 2.2-7.7 years). SCD and anxiety symptoms were included in Cox regression to investigate their independent risks of MCI/dementia.

RESULTS

SCD and anxiety symptoms demonstrated independent risks of MCI/dementia, with HR 1.9 (95% CI 1.7-2.1) and 1.3 (95% CI 1.2-1.5), respectively. Co-occurring SCD and anxiety symptoms demonstrated the highest risk (HR 2.4, 95% CI 1.9-2.9)-participants in this group had a 25% probability of developing MCI/dementia by 3.1 years (95% 2.4-3.7), compared to 8.2 years among those without SCD or anxiety (95% CI 7.9-8.6). The results remained robust even in the sensitivity analyses that took into account symptom severity and consistency of symptoms in the first 2 annual visits.

CONCLUSIONS

The findings suggest that clinicians should not dismiss one over the other when patients present with both SCD and anxiety and that both constructs may potentially be useful to identify high-risk populations for preventive interventions and trials. The findings also point to the need for further research to clarify on the neurobiological distinctions between SCD and anxiety symptoms, which may potentially enrich our understanding on the pathogenesis of neurocognitive disorders.

Association Between Cognitive Test Performance and Subjective Cognitive Decline in a Diverse Cohort of Older Adults: Findings From the KHANDLE Study

BACKGROUND

Subjective cognitive decline (SCD) may represent a low-burden indicator of dementia risk. The value of SCD as a proxy marker, however, depends on the consistency of associations between subjective and objective cognitive measures across sociodemographic and psychological factors.

METHODS

We evaluated baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study (n=1615). SCD was measured using the 12-item Everyday Cognition (ECog) scale. Using linear regression models with interaction terms, we evaluated 6 potential modifiers (age, sex, race/ethnicity, educational attainment, family history of dementia, and depressive symptoms) of the association between cognitive performance (episodic memory, executive function) and SCD.

RESULTS

Lower episodic memory and executive function scores were associated with higher log(ECog scores) (more SCD). Older age and elevated depressive symptoms were associated with higher log(ECog scores). Age (interaction P=0.002) and education (interaction P=0.01) modified the association between executive function and log(ECog scores). Specifically, associations between executive function and log(ECog scores) were stronger among participants with more education and less pronounced among older participants.

CONCLUSIONS

The association between cognitive performance and log(ECog scores) differed little across sociodemographic and psychological factors. SCD as measured by the ECog may be a valuable proxy for cognitive performance in diverse older adults.

Subjective Cognitive Decline Below and Above the Age of 60: A Multivariate Study on Neuroimaging, Cognitive, Clinical, and Demographic Measures

Subjective cognitive complaints in cognitively normal individuals are a relevant predictor of Alzheimer's disease (AD), cerebrovascular disease, and age-related tauopathy. Complaints starting after the age of 60 increase the likelihood of preclinical AD. However, this criterion is arbitrary and current data show that neurodegenerative disorders likely start before that age. Further, data on the role of subjective complaints below the age of 60 in individuals qualifying for subjective cognitive decline (SCD) are lacking. We investigated the association of subjective cognitive complaints with an extensive number of neuroimaging, demographic, clinical, and cognitive measures in individuals fulfilling criteria for SCD below and above the age of 60. Nine complaints were scored in 416 individuals. Complaints were related to a higher load of white matter signal abnormalities, and this association was stronger the more subclinical changes in personality, interest, and drive were reported. In individuals <60 years, complaints were associated with lower global cognitive performance. In individuals ≥60 years, complaints were related to greater global brain atrophy and smaller total intracranial volume, and this association was stronger the more subclinical difficulties in activities of daily living were reported. Also, complaints were associated with increased depressive symptomatology irrespective of age. We conclude that complaints below the age of 60 may be associated with subtle signs of brain pathology. In the community, screening for risk of future cognitive decline should include subjective cognitive complaints, depressive symptomatology, and subclinical reduced cognition (<60 years)/activities of daily living (≥60 years), supported by basic neuroimaging examinations.

Longitudinal relationships among depressive symptoms and three types of memory self-report in cognitively intact older adults

OBJECTIVES

The current study examined whether self-reported memory problems among cognitively intact older adults changed concurrently with, preceded, or followed depressive symptoms over time.

DESIGN

Data were collected annually via in-person comprehensive medical and neuropsychological examinations as part of the Einstein Aging Study.

SETTING

Community-dwelling older adults in an urban, multi-ethnic area of New York City were interviewed.

PARTICIPANTS

The current study included a total of 1,162 older adults (Mage = 77.65, SD = 5.03, 63.39% female; 74.12% White). Data were utilized from up to 11 annual waves per participant.

MEASUREMENTS

Multilevel modeling tested concurrent and lagged associations between three types of memory self-report (frequency of memory problems, perceived one-year decline, and perceived ten-year decline) and depressive symptoms.

RESULTS

Results showed that self-reported frequency of memory problems covaried with depressive symptoms only in participants who were older at baseline. Changes in perceived one-year and ten-year memory decline were related to changes in depressive symptoms across all ages. Depressive symptoms increased the likelihood of perceived ten-year memory decline the next year; however, perceived ten-year memory decline did not predict future depressive symptoms. Additionally, no significant temporal relationship was observed between depressive symptoms and self-reported frequency of memory problems or perceived one-year memory decline.

CONCLUSION

Our findings highlight the importance of testing the unique associations of different types of self-reported memory problems with depressive symptoms.

Memory impairment and Alzheimer's disease pathology in individuals with MCI who underestimate or overestimate their decline

OBJECTIVES

The aim of this study was to examine whether the discrepancy between participant and informant estimation of memory decline can predict MCI prognosis.

METHODS

Analyses involved data from individuals with MCI enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI) who filled the Everyday Cognition questionnaire. Participants who underestimated (N = 112) and overestimated (N = 157) their memory decline were compared on memory tasks, brain volume, and cerebrospinal markers, at study entry and after 24 months.

RESULTS

Individuals who underestimated their memory decline performed more poorly on memory tests, had smaller hippocampus volume, and greater Alzheimer's disease pathology than did individuals who overestimated their cognitive decline. Longitudinal comparisons demonstrated that individuals who underestimated their decline deteriorated more significantly in memory and in brain measures.

CONCLUSIONS

Underestimation of memory decline should raise clinicians' suspicion of the existence of AD pathology in individuals with MCI.

Memory complaints and depressive symptoms over time: a construct-level replication analysis

BACKGROUND

Memory complaints and depressive symptoms are frequently associated in older adults and both serve as potential indicators of future cognitive decline. However, the temporal ordering of the development of these two symptoms remains unclear. The goal of the current study was to examine concurrent and temporal relationships between memory complaints and depressive symptoms in older adults.

METHODS

Data were drawn from two longitudinal, nationally representative datasets and included cognitively intact older adults aged 65 and over. The datasets in the current study were from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Using an integrative analytic framework, we tested bidirectional temporal relationships between memory complaints (memory ratings and perceived memory decline) and depressive symptoms over 6 to 9 years of data in over 5000 older adults across these two samples.

RESULTS

Across both datasets, perceived memory decline predicted future depressive symptoms whereas memory ratings did not. Additionally, results showed that at times when depressive symptoms tended to be higher, memory complaints were also higher, but depressive symptoms did not predict future memory complaints. One finding that was inconsistent across datasets was memory ratings predicting depressive symptoms. After accounting for covariates, this relationship was only significant in one dataset.

CONCLUSIONS

Cognitively intact older adults who report memory decline may be at risk for developing depressive symptoms in the future. Furthermore, our findings highlight the importance of using immediate replication of results across datasets to determine the generalizability of conclusions.

Functional cognitive disorders: a systematic review

Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.

Subjective memory impairment, instrumental activities of daily living and longitudinal effect on mortality among older adults in a population-based cohort study: The HUNT Study

Background: Subjective impairment in memory and instrumental activities in daily living (IADL) are associated with future cognitive decline and poorer mental health in older adults, but their association with mortality is uncertain. Our aim was to examine the associations between subjective memory and IADL impairments and all-cause mortality, as well as the mortality risk for reporting both memory and IADL impairments. Methods: Data from the 70-year-old and older cohort in the third survey of a population-based study, the Nord-Trøndelag Health Study (HUNT3), were linked to the Norwegian Causes of Death Registry. A total of 5802 older adults had complete data from HUNT3 (70.8% of the 70+ cohort). The mean follow-up time was 8.0 years, and 1870 respondents had died. Associations between subjective memory and ADL impairments with mortality were analysed in Cox regression models adjusted for covariates with attained age as the timescale. Analyses were performed separately for two age groups - 70-79 and 80+ years - to fulfil the proportional hazards assumption. Results: Subjective impairments in short-term memory and IADL were significantly associated with mortality both separately and combined. These associations were strongest in the 70- to 79-year-old group, where reporting impairment on one short-term memory item increased the mortality risk by 51% (hazard ratio=1.51; 95% confidence interval 1.20-1.91). Long-term memory impairments were not associated with mortality in the adjusted models. Conclusions: Subjective short-term memory impairments and IADL impairments are associated with increased mortality risk. Neither of these symptoms should be regarded as benign aspects of ageing, and concerns should be properly addressed.

The Impact of Exercise, Lifestyle, and Clinical Factors on Perceived Cognitive Function in Patients with Rheumatoid Arthritis: Results from a Prospective Cohort Study

Objective

Lifestyle factors, such as inactivity and obesity, contribute to cognitive decline in the general population, but little is known about how these factors may affect individuals with a chronic inflammatory condition such as rheumatoid arthritis (RA). We studied the clinical and functional risk factors related to a worsening of perceived cognitive function in patients with RA.

Methods

We collected clinical and functional questionnaire data over 10 years in a prospective RA cohort including yearly self‐reported memory, concentration, and word‐finding difficulties graded from “never” to “often.” Generalized estimating equation models examined the role of exercise (defined as those meeting the Department of Health and Human Services physical activity guidelines of 75 minutes of vigorous or 150 minutes of moderate aerobic activity per week), body mass index (BMI), sleep, depression (Mental Health Index‐Depression), Disease Activity Score (DAS)28–c‐reactive protein (CRP)3 score, disease‐modifying antirheumatic drug, and corticosteroid use from the previous year as predictors of cognitive complaints that progressed to “often” compared with the previous year (the first year (T_i) progressed to “often” 1 year later (T_i+1)).

Results

Of 1219 RA subjects, 127 (10.4%) described either poor memory, concentration, or word‐finding difficulties as affecting them “often” at study entry. RA patients (n = 1092, mean age = 56.5 years, 82% female, 58% college educated) were less likely to report word‐finding difficulties, poor memory, and concentration as “often” if they were physically active (p = 0.0001, P = 0.01, P < 0.0001, respectively). Female RA patients developed more concentration complaints compared with males (P = 0.03); patients taking an anti–tumor necrosis factor therapy were less likely to complain of poor memory (P = 0.01). Sleep, BMI, fatigue, depression, DAS28‐CRP3, methotrexate, and corticosteroid use were not independently associated with a worsening of any cognitive complaints.

Conclusion

RA patients who are physically active are less likely to report cognitive difficulties. Our study suggests potential modifiable risk factors for the prevention of cognitive dysfunction in RA.

Depression, subjective cognitive decline, and the risk of neurocognitive disorders

BACKGROUND

Depression and subjective cognitive decline (SCD) both predict neurocognitive disorders (NCD). However, the two correlate strongly with each other. It remains uncertain whether they reflect independent neurobiological underpinnings which deserve separate attention. This study evaluated the independent risks of NCD associated with depression and SCD.

METHODS

This cohort study included 13,462 participants who were ≥ 50 years and had normal cognition at baseline. The participants were evaluated for depression and SCD and followed up almost annually for incident mild cognitive impairment or dementia (MCI/dementia) (median follow-up = 4.4 years). Depression and SCD were included in Cox-regression to investigate their independent risks of MCI/dementia.

RESULTS

At baseline, 1307 participants (9.7%) had depression and 3582 (26.6%) had SCD. During follow-up, 1490 (11.1%) developed MCI/dementia. Depression and SCD demonstrated independent risks of MCI/dementia (HR 1.4 and 2.0 respectively). The risk was highest when depression and SCD co-occur (HR 2.8), with half of the participants in this group developing MCI/dementia within 7.2 years of follow-up (compared to 12.2 years in participants without depression or SCD).

CONCLUSIONS

The findings may change the clinical approach in managing SCD in depression, suggesting the need for greater emphasis on detecting prodromal NCD. They may also have implications to our understanding of NCD, suggesting the need for further research to delineate the commonalities and distinctions in the neurobiological pathways of depression and SCD.

Electrophysiological brain signatures for the classification of subjective cognitive decline: towards an individual detection in the preclinical stages of dementia

BACKGROUND

Alzheimer's disease (AD) prevalence is rapidly growing as worldwide populations grow older. Available treatments have failed to slow down disease progression, thus increasing research focus towards early or preclinical stages of the disease. Subjective cognitive decline (SCD) is known to increase the risk of developing AD and several other negative outcomes. However, it is still very scarcely characterized and there is no neurophysiological study devoted to its individual classification which could improve targeted sample recruitment for clinical trials.

METHODS

Two hundred fifty-two older adults (70 healthy controls, 91 SCD, and 91 MCI) underwent a magnetoencephalography scan. Alpha relative power in the source space was employed to train a LASSO classifier and applied to distinguish between healthy controls and SCD. Moreover, MCI participants were used to further validate the previously trained algorithm.

RESULTS

The classifier was significantly associated to SCD with an AUC of 0.81 in the whole sample. After randomly splitting the sample in 2/3 for discovery and 1/3 for validation, the newly trained classifier was also able to correctly classify SCD individuals with an AUC of 0.75 in the validation sample. The regions selected by the algorithm included medial frontal, temporal, and occipital areas. The algorithm trained to select SCD individuals was also significantly associated to MCI diagnostic.

CONCLUSIONS

According to our results, magnetoencephalography could be a useful tool for distinguishing individuals with SCD and healthy older adults without cognitive concerns. Furthermore, our classifier showed good external validity, being not only successful for an unseen SCD sample, but also in a different population with MCI cases. This supports its utility in the context of preclinical dementia. These findings highlight the potential applications of electrophysiological techniques to improve sample recruitment at the individual level in the context of clinical trials.

Subjective ratings of cognitive and emotional functioning in patients with mild cognitive impairment and patients with subjective memory complaints but normal cognitive functioning

In a retrospective chart review, 39 patients referred for a clinical neuropsychological examination were identified as showing either mild cognitive impairment of the amnestic type (MCI-A; N = 21) or subjective memory complaints but with normal memory function (SMC; N = 18). During the clinical interview, patients and informants were routinely asked to make subjective ratings regarding the patient's cognitive and affective functioning in everyday life. The purpose of this study was to determine whether these two patient groups (and their informants) significantly differed in their subjective reports about level of cognitive and affective difficulties. It was predicted that SMC patients would report higher levels of cognitive and emotional dysfunction than MCI-A patients. It was further predicted that MCI-A patients would underreport cognitive difficulties (compared to informant reports); SMC patients would demonstrate the opposite pattern. Results supported these predictions and suggest that routine assessment of subjective experiences of patients in conjunction with informant ratings may aid clinical diagnosis, particularly when the primary complaint is a decline in memory.

Symptom clusters of subjective cognitive decline amongst cognitively normal older persons and their utilities in predicting objective cognitive performance: structural equation modelling

BACKGROUND AND PURPOSE

Prior literature on subjective cognitive decline (SCD) has mostly focused on memory complaints. It is uncertain whether the other non-memory complaints are equally relevant and can be used, alongside memory complaints, to identify populations at high risk of cognitive impairment. How the memory and non-memory complaints of SCD cluster with each other amongst community-dwelling individuals was investigated, and the differential utility of the symptom clusters of SCD in predicting objective cognitive performance was evaluated.

METHODS

This study included 736 participants who were ≥60 years and had normal cognition, using the baseline data of an ongoing cohort study. Participants completed baseline assessments which comprised an SCD scale, a global cognitive measure and neuropsychological tests. Symptom clusters of SCD - as identified from exploratory and confirmatory factor analyses - were included in structural equation models to predict baseline changes in neuropsychological tests.

RESULTS

The symptoms of SCD were split into two distinct factors, of which factor 1 was reported much more frequently than factor 2. Each standard deviation (SD) increment in factor 1 led to a 0.16-0.50 SD increase in global cognition, immediate memory, visuospatial abilities, language, attention and delayed memory (P < 0.05). In contrast, each SD increment in factor 2 worsened some of the cognitive domains by 0.18-0.37 SD.

CONCLUSIONS

The various complaints of SCD can have different implications amongst cognitively normal older persons and may possibly be classified into age-related symptoms and pathological symptoms. The findings highlight the need for caution when selecting SCD measures, and illustrate the potential utility of SCD subtypes to inform on the underlying neurobiology.

Depressed mood and cognitive deficits as distinct mechanisms of subjective memory and executive complaints

Background

Subjective cognitive decline (SCD) is the sense of deterioration in cognitive functioning in terms of memory, executive function, attention, etc. SCD is reported by nearly 70% of the population. Very intensive research on the predictive role of SCD in the development of dementia and determinants SCD did not bring common solutions. For exploration of the phenomenon, studies were undertaken in order to identify: a) on the basis of which factors a high level of SCD can be predicted, and b) whether these factors have similar prognostic value for two types of SCD, i.e. concerning executive function (SED) and memory (SMD).

Participants and procedure

The study involved 274 Polish people aged 18 to 84 years (M = 53.23, SD = 16.8). For the evaluation of SCD three methods were used: memory self-assessment scales (ProCog and MARS), and an executive functions self-assessment scale (DEX-S). Subtests of the WAIS-PL to assess cognitive function were used, and GDS-15 or BECK II to assess the severity of depressive mood. In the first stage, two separate cluster analyses (k-means method) were performed: the first related to the results of the memory self-assessment scale (ProCog and MARS), the second to the subjective difficulty of executive functions (DEX-S). In step II a logistic regression analysis of the forward selection with the likelihood ratio and interaction effects was performed – separately for the two types of self-reports.

Results

The results indicate that higher depressed mood increases the likelihood of both the SMD and SED. Higher efficiency attention-al processes reduce the possibility of formulating the SED, and higher efficiency of the delayed memory, abstract thinking, or certain aspects of language functions reduces the possibility of SMD.

Conclusions

There are two independent mechanisms of SCD – emotional and cognitive.

The AD8 (Dementia Screening Interview) is a valid and reliable screening scale not only for dementia but also for mild cognitive impairment in the Turkish geriatric outpatients

ABSTRACTIntroduction:There is still a need for short, practical, and daily-appropriate scales to distinguish between normal cognitive aging, mild cognitive impairment (MCI), or dementia for patients with memory complaints. This study aimed to determine validity and reliability of AD8 (Dementia Screening Interview) to detect both MCI and dementia in Turkish geriatric outpatients.

METHODS

Comprehensive geriatric assessment was performed in 334 patients, who attended with their informants to the geriatric outpatient clinic for memory complaints. In addition to the AD8, they were screened using Clinical Dementia Rating scale (CDR) and Mini-Mental State Examination. The diagnosis of dementia and MCI was made according to the Diagnostic and Statistical Manual of Mental Disorders - fifth edition (DSM-5) criteria.

RESULTS

The mean age of the patients was 74.5±8.5. Of them, 156 were considered as non-cognitive impairment, 60 as MCI, and 118 as dementia. Cronbach's α value of the AD8 was 0.928. The total AD8 scores were found to be negatively correlated with the MMSE scores (r = -0.801), and positively correlated with CDR score (r = 0.879) (p &lt; 0.001, for each). The area under the receiver-operating characteristics curve was 0.979 for cognitive impairment, and 0.999 for dementia. We found that AD8 can show dementia and MCI when the cut-off values are ≥5 and 3-4, respectively, with a sensitivity of 100% and 81.67% and specificity of 96.3% and 93.59%.

CONCLUSION

AD8 is one of the fast, simple, and sensitive screening methods for detecting both minor and major cognitive impairments. With regard to these features, it can be used in older adults attending the primary care settings with memory complaints.

Lifestyle Factors Are Important Contributors to Subjective Memory Complaints among Patients without Objective Memory Impairment or Positive Neurochemical Biomarkers for Alzheimer's Disease

Background/Aims

Many patients presenting to a memory disorders clinic for subjective memory complaints do not show objective evidence of decline on neuropsychological data, have nonpathological biomarkers for Alzheimer's disease, and do not develop a neurodegenerative disorder. Lifestyle variables, including subjective sleep problems and stress, are factors known to affect cognition. Little is known about how these factors contribute to patients' subjective sense of memory decline. Understanding how lifestyle factors are associated with the subjective sense of failing memory that causes patients to seek a formal evaluation is important both for diagnostic workup purposes and for finding appropriate interventions and treatment for these persons, who are not likely in the early stages of a neurodegenerative disease. The current study investigated specific lifestyle variables, such as sleep and stress, to characterize those patients that are unlikely to deteriorate cognitively.

Methods

Two hundred nine patients (mean age 58 years) from a university hospital memory disorders clinic were included.

Results

Sleep problems and having much to do distinguished those with subjective, but not objective, memory complaints and non-pathological biomarkers for Alzheimer's disease.

Conclusions

Lifestyle factors including sleep and stress are useful in characterizing subjective memory complaints from objective problems. Inclusion of these variables could potentially improve health care utilization efficiency and guide interventions.

Subjective memory complaints and future depression in primary care patients: A four-year follow-up study

OBJECTIVE

To investigate the predictive value of subjective memory complaints (SMCs) for having a hospital-based diagnosis of a single depressive episode over a four-year follow-up period.

METHODS

A prospective register-based cohort study in general practice. All 17 practices in Inner city Copenhagen participated in the study. They had 40,865 registered patients, 2934 aged 65 years or older. Information on SMCs and socio-demographics was collected during two months at enrolment in primary care. Diagnoses of single depressive episodes were retrieved from the Danish Psychiatric Central Research Register. Cox proportional hazard regression models were used to examine risk factors for a hospital-based diagnosis of a single depressive episode.

RESULTS

758 patients aged 65 years or older consulted their GP in October and November 2002. According to our definition, 177 (23%) had SMCs at enrolment, 12 (6.9%) of whom received a diagnosis of a single depressive episode within the follow-up period. In three multivariate models, SMCs were significantly associated with single depressive episodes. In the fully controlled model SMCs had a hazard ratio (HR) of 2.59 for receiving a subsequent depression diagnosis.

CONCLUSIONS

In an older general practice population, SMCs are associated with increased risk of receiving a hospital-based diagnosis of a single depressive episode.

Subjective Cognitive Decline Prediction of Mortality: Results from the Einstein Aging Study

BACKGROUND

The relation of pre-dementia stages to mortality has not been fully explored. Previous work examining subjective cognitive decline (SCD) and mortality is limited and mixed regarding methods used and consistency of findings.

OBJECTIVE

To examine SCD and mortality in a longitudinal, community-based cohort, using item response theory (IRT) methodology to form a composite SCD measure. Also, to assess whether this relationship was independent of clinical cognitive status.

METHODS

The Einstein Aging Study is a diverse longitudinal cohort of adults aged ≥70. SCD items were extracted from baseline CERAD questionnaires and a composite score was formed using IRT methodology. A total of 1,741 participants with complete data were clinically diagnosed as cognitively normal, or as having amnestic mild cognitive impairment (aMCI), nonamnestic mild cognitive impairment (naMCI), or dementia. 645 deaths occurred over a period of 8,912 person-years of follow-up. Cox proportional hazard models predicted time to death adjusting for covariates.

RESULTS

A one standard deviation unit increase in level of SCD was associated with >20% higher risk of mortality. However, when models were adjusted for clinical cognitive status, the association was no longer significant. Both dementia and aMCI predicted mortality. Furthermore, when analyses focused only on those without cognitive impairment, SCD level did not predict mortality.

CONCLUSIONS

The association of SCD with mortality may be due to the association of SCD with clinical cognitive status. Thus, SCD may be used as a community-based screen to initially identify those with cognitive impairment who may be at greatest risk for death.

Memory-related subjective cognitive symptoms in the adult population: prevalence and associated factors - results of the LIFE-Adult-Study

Background

Subjectively perceived memory problems (memory-related Subjective Cognitive Symptoms/SCS) can be an indicator of a pre-prodromal or prodromal stage of a neurodegenerative disease such as Alzheimer’s disease. We therefore sought to provide detailed empirical information on memory-related SCS in the dementia-free adult population including information on prevalence rates, associated factors and others.

Methods

We studied 8834 participants (40–79 years) of the population-based LIFE-Adult-Study. Weighted prevalence rates with confidence intervals (95%-CI) were calculated. Associations of memory-related SCS with participants’ socio-demographic characteristics, physical and mental comorbidity, and cognitive performance (Verbal Fluency Test Animals, Trail-Making-Test, CERAD Wordlist tests) were analyzed.

Results

Prevalence of total memory-related SCS was 53.0% (95%-CI = 51.9–54.0): 26.0% (95%-CI = 25.1–27.0) of the population had a subtype without related concerns, 23.6% (95%-CI = 22.7–24.5) a subtype with some related concerns, and 3.3% (95%-CI = 2.9–3.7) a subtype with strong related concerns. Report of memory-related SCS was unrelated to participants’ socio-demographic characteristics, physical comorbidity (except history of stroke), depressive symptomatology, and anxiety. Adults with and without memory-related SCS showed no significant difference in cognitive performance. About one fifth (18.1%) of the participants with memory-related SCS stated that they did consult/want to consult a physician because of their experienced memory problems.

Conclusions

Memory-related SCS are very common and unspecific in the non-demented adult population aged 40–79 years. Nonetheless, a substantial proportion of this population has concerns related to experienced memory problems and/or seeks help. Already available information on additional features associated with a higher likelihood of developing dementia in people with SCS may help clinicians to decide who should be monitored more closely.

As queixas subjetivas de memória num cuidado de saúde primário: Um estudo follow up

Objetivo

As queixas subjetivas de memória (QSM) são um fator clínico relevante e uma das principais queixas feitas aos médicos de família por adultos e adultos idosos. Este estudo, realizado numa Unidade de Saúde Familiar da Região Centro de Portugal, teve como objetivo caracterizar as QSM em função de variáveis sociodemográficas, clínicas, cognitivas, emocionais e de qualidade de vida.

Método

Este estudo, de coorte prospetivo em dois momentos, procurou explorar a evolução das QSM durante 18 meses e quais os fatores que se associam. Foi levado a cabo numa amostra de 19 adultos e de adultos idosos com idades compreendidas entre os 55 e os 81 anos (79.2% do sexo feminino). Os dados foram recolhidos por entrevistas semiestruturadas e sempre que possível foram consultados os processos clínicos. Foram utilizados como instrumentos de medida o Mini Mental State Examination (MMSE), o Montreal Cognitive Assessment (MoCA), a Escala de Queixas de Memória (EQM), a Escala de Depressão Geriátrica (GDS), o Inventário de Ansiedade Geriátrica (GAI), a Avaliação de Qualidade de Vida da Organização Mundial de Saúde (WHOQOL-Bref) e por um questionário sociodemográfico e clínico construído para o efeito.

Resultados

No segundo momento avaliativo, todos os participantes evidenciam QSM, sendo estas influenciadas significativamente pela idade. Houve ainda um aumento da sintomatologia depressiva e ansiógena, dos valores da Hemoglobina glicosilada (HbA1c) e do número de medicamentos consumidos, com particular ênfase nos anti hipertensores.

Conclusão

As QSM deverão ser objeto de preocupação e vigilância do médico de família, uma vez que podem representar um sintoma relevante para a identificação precoce de um processo demencial.

Spontaneously Reported Symptoms by Informants Are Associated with Clinical Severity in Dementia Help-Seekers

OBJECTIVES

To investigate the predictive value of symptoms of dementia that the person or an informant noticed spontaneously in determining the clinical severity of dementia.

DESIGN

Cross-sectional.

SETTING

Community-based open-referral dementia assessment service in Hong Kong between 2005 and 2013.

PARTICIPANTS

Help-seekers for dementia assessment service and their informants (N = 965 dyads).

MEASUREMENTS

Participants underwent a clinical dementia interview based on the Clinical Dementia Rating. Spontaneous complaints that the person and the informant made that had prompted their help-seeking of groups with interview results suggestive of no impairment, mild cognitive impairment, and dementia were compared. Logistic regression was used to evaluate the predictive value of spontaneous complaints for clinical severity. Independent raters blinded to clinical results coded spontaneously reported symptoms into theoretical themes: memory, executive function, language, time and place orientation, neuropsychiatric, mood, and avolition.

RESULTS

Memory problems were the most frequently reported complaints for participants (87.7%) and their informants (95.5%), followed by self-reported language (33.0%) and informant-reported orientation (33.0%) difficulties. Informant-reported but not self-reported symptoms predicted clinical severity. Compared with the persons themselves, informants reported more pervasive symptoms corresponding to clinical severity. Persons with dementia self-reported fewer types of symptoms than their healthy or mildly impaired counterparts. Spontaneously reported language and orientation symptoms by the informant distinguished persons with mild or worse dementia (P < .001, Nagelkerke coefficient of determination = 29.7%, percentage correct 85.6%).

CONCLUSION

The type and pervasiveness of symptoms spontaneously that informants reported predicted clinical severity. This may provide a quick reference for triage.

Differences in quantitative methods for measuring subjective cognitive decline - results from a prospective memory clinic study

BACKGROUND

Cognitive complaints occur frequently in elderly people and may be a risk factor for dementia and cognitive decline. Results from studies on subjective cognitive decline are difficult to compare due to variability in assessment methods, and little is known about how different methods influence reports of cognitive decline.

METHODS

The Subjective Memory Complaints Scale (SMC) and The Memory Complaint Questionnaire (MAC-Q) were applied in 121 mixed memory clinic patients with mild cognitive symptoms (mean MMSE = 26.8, SD 2.7). The scales were applied independently and raters were blinded to results from the other scale. Scales were not used for diagnostic classification. Cognitive performances and depressive symptoms were also rated. We studied the association between the two measures and investigated the scales' relation to depressive symptoms, age, and cognitive status.

RESULTS

SMC and MAC-Q were significantly associated (r = 0.44, N = 121, p = 0.015) and both scales had a wide range of scores. In this mixed cohort of patients, younger age was associated with higher SMC scores. There were no significant correlations between cognitive test performances and scales measuring subjective decline. Depression scores were significantly correlated to both scales measuring subjective decline. Linear regression models showed that age did not have a significant contribution to the variance in subjective memory beyond that of depressive symptoms.

CONCLUSIONS

Measures for subjective cognitive decline are not interchangeable when used in memory clinics and the application of different scales in previous studies is an important factor as to why studies show variability in the association between subjective cognitive decline and background data and/or clinical results. Careful consideration should be taken as to which questions are relevant and have validity when operationalizing subjective cognitive decline.

Ascertaining Subjective Cognitive Decline: A Comparison of Approaches and Evidence for Using an Age-Anchored Reference Group

BACKGROUND

Subjective cognitive decline (SCD) is increasingly considered promising to detect preclinical Alzheimer's disease. How SCD is ascertained is critical for determining its potential utility in identifying at-risk individuals, yet SCD measures differ along several dimensions.

OBJECTIVE

We aimed to examine the extent to which reports of SCD in healthy elderly may be influenced by the characteristics of the SCD measures. We investigated variations in rates of SCD endorsement across different measures, including an open-ended question. We also examined the association of responses across measures, and the degree to which specific SCD items were associated with objective memory performance.

METHODS

99 healthy elderly completed a series of questionnaires from which 10 items examining SCD for memory and other aspects of cognition were drawn. We applied Cochran's Q tests to assess differences in rates of SCD, correlation analyses to examine association of SCD responses, and regression models to determine the association between SCD items and delayed verbal memory.

RESULTS

Rates of SCD varied as a function of the assessment format, ranging from 1 to 7% for memory and 5 to 20% for concentration. SCD was lower for memory versus non-memory domains. SCD items were associated both within and across domains. The most accurate predictor of memory was memory-related SCD in comparison to others the same age.

CONCLUSION

Characteristics of SCD items influence rates of endorsement. Querying SCD using an "age-anchored" question may provide the most accurate reflection of actual cognitive performance.

Subjective Cognitive Impairment and Affective Symptoms: A Systematic Review

PURPOSE OF STUDY

Subjective cognitive impairment (SCI) has been argued to reflect affective symptoms (i.e., depression and anxiety) rather than actual cognitive issues. Although a number of studies exist that look at the associations between SCI and affective symptoms, no review is available to aggregate this disparate literature. We addressed this gap by conducting a systematic review to better understand the relationships among SCI and affective symptoms among older adults in both community and clinical settings.

DESIGN AND METHODS

We reviewed available literature per the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Weight of evidence (WoE) ratings and narrative synthesis were completed for 58 articles.

RESULTS

A majority of studies focused on community-based samples (n = 40). Approximately half (53%) of the articles reviewed met high WoE criteria for the current review. Cross-sectional findings consistently identified a positive relationship among SCI and affective symptoms. Findings from available longitudinal studies (n = 9) were mixed but suggested a possible reciprocal relationship among SCI and depression. The relationship between SCI and anxiety appeared to be driven by fears over loss of function. Following consultation with health professionals, the association between SCI and anxiety was diminished or eliminated.

IMPLICATIONS

Although SCI is consistently related to affective symptoms in older adults cross-sectionally, more longitudinal work is needed to understand their temporal relationship. Improved measurement of SCI would support a deeper understanding of the impact of SCI on psychological well-being.

From Subjective Cognitive Complaints to Dementia: Who is at Risk?: A Systematic Review

Subjective cognitive complaints (SCCs) are frequent in the elderly population. The majority of individuals with subjective complaints never progress to significant cognitive decline, but some of them have a higher risk of progression to objective cognitive impairment than persons with no cognitive concerns. We performed a systematic review of community-based studies that focused on the progression risk associated with SCC and on the complainers’ characteristics associated with progression. Seventeen studies were included. As a group, SCCs are associated with a significantly higher risk of progression to dementia. Worried complainers, persons who refer an impact of their complaints on activities of daily living, and those whose complaints are also noticed by an informant have the highest risk of progression. Taking into account the fluctuating course of SCC and their frequent reversion, care should be taken to not overvaluate them. Further studies are necessary to better define risk features.

Education modifies the type of subjective memory complaints in older people

OBJECTIVE

The aim of the study is to analyze the relationship between the level of education and the profile of subjective memory complaints (SMC).

METHODS

Participants were healthy volunteers aged >50 years old, from a community-based sample. Educational attainment was self-reported, and participants were subsequently assembled in four groups, according to the highest grade achieved in school. Additionally, they were questioned about their own memory abilities using an SMC scale (total score 0-21) and assessed for the presence of depressive symptoms.

RESULTS

A total of 841 participants aged 50-92 years old were included. The mean total score on the SMC scale was 5.3 ± 3.2, and 80.4% of the subjects reported at least one minor complaint about their memory. There was no correlation between total SMC score and higher educational level, even after accounting for the presence of depressive symptoms. However, regarding specific SMC, the use of notes to avoid forgetting was more frequent in higher levels of education, whereas the opposite trend was observed for complaints of transient confusion.

CONCLUSION

Educational attainment possibly modulates the frequency and type of SMC in normal aging. Because these complaints are a major symptom for the diagnosis of cognitive decline, it seems relevant to consider the level of education when interpreting subjective reports on memory.

Incident Subjective Cognitive Decline Does Not Predict Mortality in the Elderly--Results from the Longitudinal German Study on Ageing, Cognition, and Dementia (AgeCoDe)

OBJECTIVE

Subjective cognitive decline (SCD) might represent the first symptomatic representation of Alzheimer's disease (AD), which is associated with increased mortality. Only few studies, however, have analyzed the association of SCD and mortality, and if so, based on prevalent cases. Thus, we investigated incident SCD in memory and mortality.

METHODS

Data were derived from the German AgeCoDe study, a prospective longitudinal study on the epidemiology of mild cognitive impairment (MCI) and dementia in primary care patients over 75 years covering an observation period of 7.5 years. We used univariate and multivariate Cox regression analyses to examine the relationship of SCD and mortality. Further, we estimated survival times by the Kaplan Meier method and case-fatality rates with regard to SCD.

RESULTS

Among 971 individuals without objective cognitive impairment, 233 (24.0%) incidentally expressed SCD at follow-up I. Incident SCD was not significantly associated with increased mortality in the univariate (HR = 1.0, 95% confidence interval = 0.8-1.3, p = .90) as well as in the multivariate analysis (HR = 0.9, 95% confidence interval = 0.7-1.2, p = .40). The same applied for SCD in relation to concerns. Mean survival time with SCD was 8.0 years (SD = 0.1) after onset.

CONCLUSION

Incident SCD in memory in individuals with unimpaired cognitive performance does not predict mortality. The main reason might be that SCD does not ultimately lead into future cognitive decline in any case. However, as prevalence studies suggest, subjectively perceived decline in non-memory cognitive domains might be associated with increased mortality. Future studies may address mortality in such other cognitive domains of SCD in incident cases.

Subjective memory impairment and well-being in community-dwelling older adults

BACKGROUND

The relationship between subjective memory impairment (SMI), future cognitive decline, and negative health status provides an opportunity for interventions to reduce memory complaints in high-risk groups. This study aimed to examine the relationship between SMI and indicators of well-being in older adults enrolled in an exercise trial. Additionally, the study examined whether two different modes of exercise training, aerobic walking and non-aerobic flexibility, toning, and balance, differentially influenced subjective memory across the trial.

METHODS

Community-dwelling older adults (n = 179, mean age = 66.4 years) were randomly assigned to a walking or flexibility, toning, and balance group for 12 months. Subjective memory, happiness, perceived stress, and symptom reporting were measured at baseline, 6 months, and 12 months.

RESULTS

A main effect of subjective memory indicated that individuals with the fewest memory complaints had lower perceived stress (P < 0.001), lower physical symptom reporting (P < 0.001), and higher happiness levels (P < 0.001) across all measurement occasions. Both main and interaction effects of time and group on SMI were not significant, suggesting SMI remained stable across the intervention and was not significantly impacted by participation in exercise training.

CONCLUSIONS

SMI was not responsive to exercise interventions, and the relationship between SMI and negative well-being demonstrates a need for interventions to reduce memory complaints in high-risk groups.

Subjective Memory Complaint and Depressive Symptoms among Older Adults in Portugal

Background. Older adults report subjective memory complaints (SMCs) but whether these are related to depression remains controversial. In this study we investigated the relationship between the SMCs and depression and their predictors in a sample of old adults. Methods. This cross-sectional study enrolled 620 participants aged 55 to 96 years (74.04 ± 10.41). Outcome measures included a sociodemographic and clinical questionnaire, a SMC scale (QSM), a Geriatric Depression Scale (GDS), a Mini-Mental Status Examination (MMSE), and a Montreal Cognitive Assessment (MoCA). Results. The QSM mean total score for the main results suggests that SMCs are higher in old adults with depressed symptoms, comparatively to nondepressed old adults. The GDS scores were positively associated with QSM but negatively associated with education, MMSE, and MoCA. GDS scores predicted almost 63.4% of variance. Scores on QSM and MoCA are significantly predicted by depression symptomatology. Conclusion. Depression symptoms, lower education level, and older age may be crucial to the comprehension of SMCs. The present study suggested that depression might play a role in the SMCs of the older adults and its treatment should be considered.

Subjective cognitive complaints included in diagnostic evaluation of dementia helps accurate diagnosis in a mixed memory clinic cohort

OBJECTIVE

Our objective was to examine the quantity and profile of subjective cognitive complaints in young patients as compared with elderly patients referred to a memory clinic.

METHODS

Patients were consecutively recruited from the Copenhagen University Hospital Memory Clinic at Rigshospitalet. In total, 307 patients and 149 age-matched healthy controls were included. Patients were classified in 4 diagnostic groups: dementia, mild cognitive impairment, affective disorders and no cognitive impairment. Subjective memory was assessed with subjective memory complaints (SMC) scale. Global cognitive functions were assessed with the Mini-mental state examination (MMSE) and Addenbrooke's cognitive examination (ACE), and symptoms of depression were rated with Major Depression Inventory (MDI). All interviews and the diagnostic conclusion were blinded to the SMC score.

RESULTS

We found that young patients with dementia have a significantly higher level and a different profile of subjective cognitive complaints as compared with elderly patients with dementia. Furthermore, young patients, diagnosed with an affective disorder, had the highest level of subjective cognitive complaints of all patients in a memory clinic. The age of the patients and MDI score (but not MMSE or ACE) had significant impact on the level of subjective cognitive complaints.

CONCLUSIONS

We have established that young patients with dementia have a different profile of subjective cognitive complaints than elderly patients, and further studies are needed to clarify possible relation to specific subtypes of dementia. Altogether, a systematic interview on subjective cognitive complaints may contribute to the diagnostic evaluation of patients referred to a memory clinic.