What Happens to the Worried Well? Follow-Up of Subjective Cognitive Impairment

Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis

BACKGROUND

Qualitative studies have examined the experiences of subjective cognitive dysfunction in specific populations or specific disease stages, but there has not yet been a systematic synthesis and evaluation of findings related to perceptions of subjective cognitive dysfunction in nondementia-related chronic illnesses.

OBJECTIVE

The aim of this study was 2-fold: (1) to undertake a systematic review of experiences of subjective cognitive dysfunction in people with nondementia-related chronic disease and (2) to develop an explanatory framework to describe the experiences of living with subjective cognitive dysfunction.

METHODS

Four databases were systematically searched for studies on subjective cognitive dysfunction up to June 2023. Qualitative synthesis was conducted on the final sample (N = 25) using Sandelowski's adaptation of Nobilt and Hare's reciprocal transactional analysis method. Critical appraisal was completed using the Critical Appraisal Skills Programme checklist.

RESULTS

Through constant comparison of key concepts, findings were organized within 4 interrelated themes that informed a conceptual explanatory model of adapting to living with subjective cognitive dysfunction: (1) symptoms, (2) health care, (3) perceptions of self, and (4) relationships. Participants highlighted how subjective cognitive dysfunction affected interactions in health care settings and involved other symptoms that in turn complicated meaning, self-enhancement, and mastery.

CONCLUSIONS

Our model of the process of adapting provides a new way to conceptualize cognitive dysfunction in chronic illness and suggests opportunities for health care professionals to support patients and their families. The results highlight the need for more research to better understand the role of subjective cognitive dysfunction in nondementia-related chronic illnesses.The review protocol was registered in PROSPERO (CRD42021231410).

Base rates of low neuropsychological test scores in older adults with subjective cognitive impairment: Findings from a tertiary memory clinic

Base rates of low scores are typically determined from normative samples, which differ from clinical samples. We examined base rates of spuriously low scores for 93 older adults with subjective cognitive impairment presenting to a memory clinic. Crawford's Monte Carlo simulation algorithm was used to estimate multivariate base rates by calculating the percentage of cognitively intact memory clinic patients who produced normed scores at or below the 5th percentile. Neuropsychological tests included: Weschler Adult Intelligence Scale block design, digit span backwards, coding, Weschler Memory Scale logical memory immediate/delayed; California Verbal Learning Test immediate/delayed memory; Brief Visuospatial Memory Test immediate/delayed; and Delis-Kaplan Executive Functioning category switching, letter number sequencing, and inhibition/switching. An estimated 33.58% of the cognitively intact memory clinic population would have one or more low scores, 14.7% two or more, 6.55% three or more, 2.94% four or more, and 1.31% 5 or more due to chance. Base rates were then applied to a subset of clinical data: all with dementia and most with MCI had low scores that exceeded the base rates. Determining base rates of spuriously low scores on a neuropsychological battery in clinical samples could reduce false positives by using empirical adjustments for expected low scores.

Cognitive Performance at Time of AD Diagnosis: A Clinically Augmented Register-Based Study

We aimed to evaluate the feasibility of using real-world register data for identifying persons with mild Alzheimer’s disease (AD) and to describe their cognitive performance at the time of diagnosis. Patients diagnosed with AD during 2010–2013 (aged 60–81 years) were identified from the Finnish national health registers and enlarged with a smaller private sector sample (total n = 1,268). Patients with other disorders impacting cognition were excluded. Detailed clinical and cognitive screening data (the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery [CERAD-nb]) were obtained from local health records. Adequate cognitive data were available for 389 patients with mild AD (31%) of the entire AD group. The main reasons for not including patients in analyses of cognitive performance were AD diagnosis at a moderate/severe stage (n = 266, 21%), AD diagnosis given before full register coverage (n = 152, 12%), and missing CERAD-nb data (n = 139, 11%). The cognitive performance of persons with late-onset AD (n = 284), mixed cerebrovascular disease and AD (n = 51), and other AD subtypes (n = 54) was compared with that of a non-demented sample (n = 1980) from the general population. Compared with the other AD groups, patients with late-onset AD performed the worst in word list recognition, while patients with mixed cerebrovascular disease and AD performed the worst in constructional praxis and clock drawing tests. A combination of national registers and local health records can be used to collect data relevant for cognitive screening; today, the process is laborious, but it could be improved in the future with refined search algorithms and electronic data.