Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies

The impact of technology-based compensatory behaviors on subjective cognitive decline in older adults with a family history of dementia

The current study examined whether greater use of technology to help with daily tasks is associated with less subjective cognitive decline (SCD), especially in individuals with a family history of Alzheimer's disease (AD). Individuals over the age of 50 (n = 102; age range 50-85) completed surveys about their digital and analog approaches to daily tasks, physical activity, and SCD. Participants with and without family histories of AD were matched on age, education, sex, and family history of AD using the R package MatchIt. There was no main effect of technology-based behavioral strategies on SCD (p = 0.259). However, a family history of AD moderated the association between technology use and SCD even when controlling for another protective lifestyle factor, physical activity. In individuals with a family history of AD, more reliance on technology-based behavioral strategies was associated with less SCD (p = 0.018), but this relationship was not significant in individuals without family history of AD (p = 0.511). Our findings suggest that technology-based behavioral strategies are associated with less SCD in individuals with a family history of AD, independent of another protective lifestyle factor. Future recommendations provided by healthcare providers to address SCD in cognitively unimpaired older adults might include focusing on technological assistance.

Mnemonic brain state engagement is diminished in healthy aging

Healthy older adults typically show impaired episodic memory - memory for when and where an event occurred. This selective episodic memory deficit may arise from differential engagement in the retrieval state, a brain state in which attention is focused internally in an attempt to access prior knowledge, and the encoding state, a brain state which supports the formation of new memories and that trades off with the retrieval state. We hypothesize that older adults are biased toward a retrieval state. We recorded scalp electroencephalography while young, middle-aged and older adults performed a memory task in which they were explicitly directed to either encode or retrieve on a given trial. We used multivariate pattern analysis of spectral activity to decode retrieval vs. encoding state engagement. We find that whereas all age groups can follow task demands to selectively engage in encoding or retrieval, mnemonic brain state engagement is diminished for older adults relative to young and middle-aged adults. These findings suggest that differential mnemonic state engagement may underlie age-related memory changes.

Social context matters: Neighborhood environment as a moderator of the longitudinal relationship between edentulism and cognitive function among older adults in the United States

BACKGROUND

Previous research has shown poor oral health and neighborhood environment are both risk factors for cognitive decline among older adults. Little research has assessed the synergistic effects of poor oral health and neighborhood environment on cognitive health. This study examined whether neighborhood environment moderates the relationship between edentulism and cognitive function over time.

METHODS

Using data from the Health and Retirement Study, we analyzed 9,994 adults aged 60 and older with 39,976 person-wave observations over 14 years (2006-2020). Cognitive function was measured using the modified Telephone Interview for Cognitive Status. Edentulism status was self-reported complete tooth loss. Neighborhood environment included perceived neighborhood cohesion and disorder. We used linear mixed-effect models to examine the moderation effect of neighborhood environment on the association between edentulism and cognitive function over time.

RESULTS

Edentulous participants (22.4 %) showed an accelerated decline over time in cognitive function compared to dentate participants (β = -0.57, 95 % CI: -0.98, -0.16). The analysis revealed that neighborhood cohesion moderated the relationship between edentulism and cognitive function over time (β = 0.08, 95 % CI: 0.01, 0.15). Specifically, among individuals reporting higher neighborhood cohesion, the negative effect of edentulism on cognitive decline was attenuated. Neighborhood disorder had no significant associations with cognitive function.

CONCLUSIONS

This study demonstrates the relationship between edentulism and cognitive function varies by levels of neighborhood cohesion. The findings highlight the significance of neighborhood context in understanding the relationship between oral health and cognitive aging and suggest interventions addressing community environment may be particularly relevant for older adults with oral health challenges.

Towards characterizing subjective cognitive decline in older adults

BackgroundSubjective cognitive decline (SCD), where older adults perceive a persistent decline of cognitive abilities without showing an objective cognitive impairment, may represent a preclinical stage of Alzheimer's disease (AD) in some individuals.ObjectiveThe complex characteristics of SCD cannot only be revealed by existing self-report questionnaires. Rather, it is necessary to involve individuals affected in the research process with methods like focus group discussions (FGDs).MethodsStudy conduction took place in three steps: telephone interview, neuropsychological assessment and questionnaires, four FGDs with 16 older adults (11 female, 5 male) affected by SCD. FGDs were analyzed with qualitative content analysis using an inductive - deductive code system.ResultsAlthough the neuropsychological assessments did not indicate a cognitive impairment, participants reported a decline for all cognitive domains within the FGDs, especially for the memory- and speech domain, with declining word-finding abilities as the most salient symptom. Participants reported strong concerns related to SCD and difficulties in social participation.ConclusionsSCD seems to go beyond age-related cognitive changes, but as individuals do not show an objective cognitive impairment (yet), their symptoms are often not taken seriously enough. The FGDs revealed information that questionnaires or neuropsychological tests do not capture. The gained insight into SCD symptoms, related coping strategies and concerns is important to be able to develop measures for identifying individuals at risk for a transition to AD and to develop intervention measures that aim at delaying a further decline and increasing the quality of life of individuals affected.

Distinct trajectories of subjective cognitive decline before diagnosis of neurocognitive disorders: Longitudinal modelling over 18 years

BACKGROUND

Subjective cognitive decline (SCD) is an established predictor of neurocognitive disorders (NCD) (i.e. mild cognitive impairment and dementia). Yet, its construct remains contentious. Many individuals with SCD do not progress to NCD, leading to an alternative term in the literature - 'functional cognitive disorders' - to describe the SCD experience in these individuals.

OBJECTIVES

To examine the distinct differences in trajectories of SCD between those who did and did not eventually develop NCD.

DESIGN

Case-control study.

SETTING

Alzheimer's Disease Centers across USA.

PARTICIPANTS

A total of 5,167 participants aged ≥50 years were followed up near-annually to evaluate for SCD and NCD (median follow-up=8.1 years; range=1.0-18.0). Cases were defined as those who developed incident NCD during follow-up; controls completed ≥10 years of follow-up and had normal cognition throughout follow-up period.

MEASUREMENTS

SCD was evaluated with a yes/no question based on "perceived decline in memory relative to previously attained abilities". The trajectories of SCD were modelled with mixed-effect logistic regression, using a backward timescale.

RESULTS

Those who developed NCD (cases) had new onset of SCD within past 20 years, which became particularly noticeable 13-14 years before diagnosis, and became even more evident in the last 4 years. Those who did not develop NCD (controls) reported SCD since younger age, with the probability of SCD remaining constant over time. The distinctive trajectories were consistent across Alzheimer's and non-Alzheimer's disease, and among those with higher baseline rates of SCD due to psychiatric conditions.

CONCLUSIONS

SCD exhibits distinctive trajectories among those who do and do not progress to NCD. These distinctive trajectories can inform NCD risk for early interventions, and guide public health messaging to distinguish high-risk SCD from normal ageing. Future SCD scales may possibly need to evaluate symptom changes over a longer, 20-year horizon to better capture the new onset of SCD within this longer timeframe.

Longitudinal deterioration of subjective cognitive decline in apolipoprotein ε4 carriers and improvement of subjective cognitive decline by multi-domain intervention for prevention of dementia: The cognitive function instrument assessment

BackgroundSubjective cognitive decline represents an early stage of mild cognitive impairment, with the Cognitive Function Instrument (CFI) serving to subjectively evaluate the decline in daily living activities associated with this minor cognitive decline.ObjectiveTo examine how CFI scores change with apolipoprotein E ε4 (ApoE4) carriage, objective cognitive decline, and dementia prevention intervention. We aimed to assess CFI's usefulness in the early dementia risk identification.MethodsThis study involved 196 older adults with normal cognition in a randomized controlled intervention trial. CFI was assessed every six months from baseline to 18 months, using the Alzheimer's Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite (ADCS-PACC) to measure cognitive decline. We employed a mixed model for repeated measures to compare the CFI scores at 18 months in the ApoE4, ADCS-PACC, and allocation groups.ResultsCFI scores increased in ApoE4 carriers and decreased in the intervention group, with significant differences observed in the CFI score changes at 18 months between carriers and non-carriers and among the allocation groups (p = 0.002, p = 0.026, respectively). However, there was no significant difference in the CFI score change among ADCS-PACC groups (p = 0101).ConclusionsWe observed CFI scores worsening over time in individuals with ApoE4 and showing a tendency to deteriorate over time in those with objective cognitive decline. These findings suggest that the CFI may be able to identify high-risk individuals for dementia at an early stage. Furthermore, the improvement in the CFI score is considered a significant finding when considering future measures for subjective cognitive decline.

Enhanced associations between subjective cognitive concerns and blood-based AD biomarkers using a novel EMA approach

BACKGROUND

Subjective cognitive concerns (SCC) have emerged as important early indicators of Alzheimer's disease (AD) risk. Traditional measures of SCC rely on recall-based assessments, which may be limited in capturing real-time fluctuations in cognitive concerns. Ecological Momentary Assessment (EMA) offers a promising alternative by providing real-time data. This study aimed to link SCC assessed via EMA and traditional measures with blood-based AD biomarkers in a diverse, dementia-free, community-based sample based in the Bronx, NY.

METHODS

Einstein Aging Study (EAS) participants underwent in-person, recall-based assessments of SCC during an in-clinic visit. Additionally, EMA SCC assessments were collected once per day over two weeks. Linear regressions were conducted to examine the relationships between SCC variables and plasma biomarkers adjusted for demographics and mild cognitive impairment (MCI) status.

RESULTS

In N = 254 participants, EMA-reported SCCs demonstrated significant associations with AD biomarkers, particularly p-tau181 (β = 0.21, p = 0.001). Further, significant associations remain across both cognitive (cognitively unimpaired vs. MCI) and racial groups. In contrast, traditional SCC measures exhibited limited associations with these biomarkers. The findings highlight the added value of EMA in capturing SCCs that could indicate early ADRD risk.

CONCLUSIONS

EMA provides a more dynamic and potentially sensitive method for detecting early AD risk compared to traditional SCC assessments. These real-time measures could enhance early detection and clinical intervention, particularly in diverse and under-resourced populations. This study underscores the potential of EMA for broad applicability and inclusivity in monitoring AD progression and facilitating early therapeutic interventions.

Psychometric Properties of the Chinese Version of Everyday Cognition Scale (ECog) in Taiwanese Older Adults

BACKGROUND AND OBJECTIVES

The Everyday Cognition Scale (ECog) is widely employed for the subjective rating of functional activities of daily living in older adults. This study aimed to examine the psychometric properties of both informant-rated and self-rated ECog in Taiwanese older individuals to assess its applicability in this context.

RESEARCH DESIGN AND METHODS

A total of 1,166 subjects, including older adults (n = 583) and their primary caregivers or family members (n = 583), were recruited. Both self-rated and informant-rated ECog assessments were administered twice within a 1-month period. The study evaluated internal consistency, test-retest reliability, random measurement error, discriminative validity, construct validity, and concurrent validity using the Mini-Mental State Examination (MMSE) as a gold standard.

RESULTS

The informant-rated ECog demonstrated high internal consistency, acceptable to good test-retest reliability, small to moderate random measurement error, good discriminative validity, and moderate correlations with the MMSE. Additionally, a 7-factor model of the informant-rated ECog was supported. Conversely, the self-rated ECog exhibited high internal consistency, acceptable test-retest reliability, moderate to large random measurement error, adequate discriminative validity, and small correlations with the MMSE. Notably, only the domains of memory, verbal, planning, and organization were supported by a one-factor model.

DISCUSSION AND IMPLICATIONS

The psychometric properties of the informant-rated ECog surpassed those of the self-rated ECog. However, the self-rated ECog is recommended as a supplementary tool for assessing individuals' awareness of their cognitive function, particularly in the domain of memory.

Electrocardiographic markers in Motoric Cognitive Risk syndrome

Introduction

Presence of cardiovascular disease is linked to the prevalence and incidence of Motoric Cognitive Risk syndrome (MCR), a pre-dementia syndrome characterized by cognitive complaints and slow gait. Electrocardiograms (ECGs) may offer a cost-effective, non-invasive, and reliable method for detecting cardiovascular abnormalities in individuals with MCR. This approach can not only diagnose cardiovascular disease but also facilitate timely interventions to prevent further cognitive decline in MCR cases.

Methods

We examined the association of ECG abnormalities with prevalent MCR in 451 older adults with ECGs participating in the Kerala Einstein Study (KES), based in Indian state of Kerala. Logistic regression analysis adjusted for age and sex were used to examine associations, and reported as odds ratios (OR) with 95% confidence intervals (CI).

Results

ECG abnormalities were present in 191 (42.4%) participants. Of the 43 participants diagnosed with MCR, 23 (53.5%) had ECG abnormalities. Abnormal Q waves (OR 5.1, 95% CI 1.7-14.9) and heart block (OR 6.0, 95% CI 2.1-17.4) were more common in individuals with MCR compared to controls. There were no statistically significant group differences in the prevalence of other ECG abnormalities.

Conclusion

ECG abnormalities are common in MCR patients, and can be considered for cardiovascular disease risk-stratification in MCR cases.

Alterations in functional connectivity in individuals with subjective cognitive decline and hippocampal atrophy

OBJECTIVES

The aim of this study was to determine whether individuals with Subjective Cognitive Decline (SCD), particularly those with a neurostructural marker of risk for AD (SCD+), exhibit differences in the functional connectivity of the Default-Mode Network (DMN) relative to controls, as this network is known to be altered in the AD continuum.

DESIGN

Cross-sectional study.

SETTING

Galicia, Northwest Spain.

PARTICIPANTS

The sample compromised 133 participants: 69 controls, 51 SCD and 13 SCD+.

MEASUREMENTS

Seed-to-voxel analysis was conducted using four DMN ROIs. Dynamic independent component analysis of the DMN was also performed.

RESULTS

The SCD and SCD+ groups exhibited DMN hyperconnectivity, which was more extensive in the SCD+ group. Increased anti-correlations between DMN and task-positive parietal regions were related to poorer executive scores in SCD+ and a tendency for higher DMN recurrence in SCD+.

CONCLUSIONS

Hippocampal atrophy as a SCD+ biomarker is associated with extensive DMN hyperconnectivity and increased anti-correlations between DMN and task-positive network regions.

Cognitive Performance Among Older Adults with Subjective Cognitive Decline

Objectives: The main objective of this cross-sectional study was to investigate if there are significant differences in cognition between a group of older adults with subjective cognitive decline (SCD) and cognitively intact controls. Methods: An initial sample of 132 older people underwent an extensive neuropsychological evaluation (memory, executive functions, and language) and were classified according to diagnostic criteria. Two groups of 33 subjects each, controls and SCD, were formed using an a priori case-matching procedures in different variables: age, biological sex, years of education, cognitive reserve, and Mini-Mental State Exam. Results: The mean age and standard deviation in the control group were equal to 70.39 ± 4.31 years, while in the SCD group, they were 70.30 ± 4.33 years. The number of males (n = 9) and females (n = 24) was equal in both groups; the means of years of education were also quite similar. SCD participants have a significantly lower mood than the controls. Significant differences between groups were obtained in delayed recall, inhibitory control, and comprehension of sentences not fitted to canonical word order in Spanish. A logistic regression revealed that a lower score on the Stroop's interference condition is associated with a higher likelihood of having SCD. Finally, ROC analysis provided a model that performs better than random chance, and a cut-off score in Stroop's interference condition equal to 49 was suggested for clinically differentiating the two groups. Conclusions: This study highlights that, compared to a matched control group, participants with SCD showed subtle but significant neuropsychological differences.

Just as expected? Older adults' aging expectations are associated with subjective cognition

OBJECTIVES

This study investigated the relationship between older adults' expectations regarding aging and subjective cognition. Specifically, we examined whether the three domains of aging expectations (physical health, mental health, and cognitive function) were associated with two aspects of subjective cognition: current subjective cognition and subjective cognitive decline (SCD).

METHOD

An online survey was conducted among U.S. adults aged 65-90 (N = 581; Mage=71.4, SD ± 4.81; 51% female). Measures included the 12-item Expectations Regarding Aging scale, the 8-item PROMIS Cognitive Abilities scale (current subjective cognition), and the 12-item Everyday Cognition scale (SCD). We used generalized linear models to examine associations between overall aging expectations and its three domains with current subjective cognition ratings and SCD.

RESULTS

We found that more positive expectations regarding physical health, mental health, and cognitive function in aging were associated with higher ratings of current subjective cognition as well as lower SCD. The magnitude of effects across aging expectations domains were similar for both aspects of subjective cognition.

CONCLUSION

Aging expectations are malleable and influence an individual's perceptions of their cognitive functioning. Modifying older adults' aging expectations could support healthier cognitive aging through increased awareness and accurate assumptions about the aging process.

WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study

As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.

Event-related potential markers of subjective cognitive decline and mild cognitive impairment during a sustained visuo-attentive task

Subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease stages lack well-defined electrophysiological correlates, creating a critical gap in the identification of robust biomarkers for early diagnosis and intervention. In this study, we analysed event-related potentials (ERPs) recorded during a sustained visual attention task in a cohort of 178 individuals (119 SCD, 40 MCI, and 19 healthy subjects, HS) to investigate sensory and cognitive processing alterations associated with these conditions. SCD patients exhibited significant attenuation in both sensory (P1, N1, P2) and cognitive (P300, P600, P900) components compared to HS, with cognitive components showing performance-related gains. In contrast, MCI patients did not show a further decrease in any ERP component compared to SCD. Instead, they exhibited compensatory enhancements, reversing the downward trend observed in SCD. This compensation resulted in a non-monotonic pattern of ERP alterations across clinical conditions, suggesting that MCI patients engage neural mechanisms to counterbalance sensory and cognitive deficits. These findings support the use of electrophysiological markers in support of medical decision-making, enhancing personalized prognosis and guiding targeted interventions in cognitive decline.

Sex differences in the relationship between olfactory and cognitive impairment among subjects with subjective cognitive decline and mild cognitive impairment

BACKGROUND

Odor identification (OI) deficits are observed in both individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI), and serve as risk factors for dementia. Compared with males, females typically demonstrate superior OI performance and different risks of dementia. However, the role of sex in the relationship between OI dysfunction and cognitive impairment remains uncertain.

METHODS

In total, 121 subjects with SCD (41 males and 80 females), and 169 subjects with MCI (59 males and 110 females) underwent the Sniffin' Sticks Screen 16 test and comprehensive neuropsychological examination. The relationships between olfactory and cognitive impairment were analyzed via partial correlation, multiple linear regression and moderating effects.

RESULTS

In both SCD and MCI subjects, males performed better in language and females performed better in memory. The correlation between OI and cognition tended to be stronger in MCI subjects than in SCD subjects. In MCI subjects, the correlation tended to be stronger in females. For MCI females, better OI performance was correlated with higher short-term memory and attention scores. For MCI males, better OI performance was correlated with higher short-term memory scores. The OI was correlated with language in SCD males and with attention in SCD females. Sex played a moderating role in the relationship between OI dysfunction and language in MCI subjects and the relationship between OI dysfunction and short-term delayed recall memory and language in SCD subjects.

CONCLUSION

These findings revealed significant sex differences between OI dysfunction and cognitive impairment in SCD and MCI subjects. Sex differences should be considered when utilizing OI in clinical settings to predict cognitive function.

Neuroanatomical and clinical factors predicting future cognitive impairment

Identifying cognitively normal (CN) older adults who will convert to cognitive impairment (CI) due to Alzheimer's disease is crucial for early intervention. Clinical and neuroimaging measures were acquired from 301 CN adults who converted to CI within 15 years of baseline, and 294 who did not. Regional volumes and brain age measures were extracted from T1-weighted magnetic resonance images. Linear discriminant analysis compared non-converters' characteristics against those of short-, mid-, and long-term converters. Conversion was associated with clinical measures such as hearing impairment and self-reported memory decline. Converters' brain volumes were smaller than non-converters' across 48 frontal, temporal, and subcortical structures. Brain age measures of 12 structures were correlated with shorter times to conversion. Conversion prediction accuracy increased from 81.5% to 90.5% as time to conversion decreased. Proximity to CI conversion is foreshadowed by anatomic features of brain aging that enhance the accuracy of predicting conversion.

The mobile everyday cognition scale (mECog): Development and pilot testing

Objective: Subjective cognitive decline (SCD) is an important part of the aging process and may be a sign of neurodegenerative disease. Current measures of SCD are subject to the limits of retrospective recall of symptoms over a long span of time, which might be addressed by using ecological momentary assessment (EMA) methods. However, there are no currently available measures of SCD validated for use in EMA. Thus, our goal was to develop and pilot test the mobile Everyday Cognition Scale (mECog). Method: 31 community-dwelling older adults completed in lab measures of cognition and mental health symptoms, followed by daily mECog ratings on a smart phone for 28 days. Results: Most participants completed at least 75% of mECog assessments (n = 27, 87%), and the average number of assessments completed was 22. Further, respondents rated the mobile assessment platform and measures as easy to use and non-interfering with daily life. Test-retest reliability of mECog scores was very strong (RKRN = .99), and within-person reliability was moderate (RCN = .41). mECog scores demonstrated strong positive associations with scores from the original ECog (ρ = .62-69, p < .001) and short form ECog (ρ = .63-.69, p < .001) and non-significant associations with demographics (ρ = -0.25-.04, p = .21-.94) and mental health symptoms (ρ = -0.06-.34, p = .08-.99). mECog scores also exhibited small-to-moderate negative correlations with objective cognitive test scores, though these relationships did not reach statistical significance (ρ = -0.32 to -0.22, p = .10-.27). Conclusions: Results suggest that mobile assessment of SCD via the mECog is feasible and acceptable. Further, mECog scores demonstrated good psychometric properties, including evidence of strong reliability, convergent validity, and divergent validity.

Dual-task-related gait patterns as possible marker of precocious and subclinical cognitive alterations in Parkinson disease

Subtle gait and cognitive dysfunction are common in Parkinson's disease (PD), even before most evident clinical manifestations. Such alterations can be assumed as hypothetical phenotypical and prognostic/progression markers. To compare spatiotemporal gait parameters in PD patients with three cognitive status: cognitively intact (PD-noCI), with subjective cognitive impairment (PD-SCI) and with mild cognitive impairment (PD-MCI) in order to detect subclinical gait differences. One hundred PD patients were consecutively enrolled and divided in three groups based on both the first item od MDS-UPDRS part I and an extensive neuropsychological evaluation: 41 PD-noCI, 15 PD-SCI and 44 PD-MCI. They were evaluated with gait analysis acquired in three different conditions (normal gait, motor and cognitive dual task). Spatiotemporal variables were extracted. A univariate statistical analysis (parametric ANOVA test or non-parametric Kruskal-Wallis test, as appropriate) with post-hoc analysis was carried out in order to evaluate the significant differences among the groups. In normal gait task, the three groups showed several differences, all due to the comparison between PD-MCI and PD-noCI, as disclosed by post-hoc analysis. In dual task conditions, mostly in the cognitive dual task, the three groups showed increased gait alterations that, at post-hoc analysis, mirrored the magnitude of cognitive dysfunction (PD-noCI < PD-SCI < PD-MCI). Peculiar prodromal gait patterns-especially those highlighted by cognitive dual task-could be considered possible markers to objectify self-reported symptoms-based construct, like SCI, and to early intercept subjects with different clinical evolutions and prognoses, even representing an innovative clustering/phenotyping tool for PD subtypes.

The interplay between gut microbiota composition and dementia

Recently, researchers have been interested in the potential connection between gut microbiota composition and various neuropsychological disorders. Dementia significantly affects the socioeconomics of families. Gut microbiota is considered as a probable factor in its pathogenesis. Multiple bacterial metabolites such as short-chain fatty acids, lipopolysaccharides, and various neurotransmitters that are responsible for the incidence and progression of dementia can be produced by gut microbiota. Various bacterial species such as Bifidobacterium breve, Akkermansia muciniphila, Streptococcus thermophilus, Escherichia coli, Blautia hydrogenotrophica, etc. are implicated in the pathogenesis of dementia. Gut microbiota can be a great target for imitating or inhibiting their metabolites as an adjunctive therapy based on their role in its pathogenesis. Therefore, some diets can prevent or decelerate dementia by altering the gut microbiota composition. Moreover, probiotics can modulate gut microbiota composition by increasing beneficial bacteria and reducing detrimental species. These therapeutic modalities are considered novel methods that are probably safe and effective. They can enhance the efficacy of traditional medications and improve cognitive function.

Brain microstructure alterations in subjective cognitive decline: a multi-component T2 relaxometry study

Previous research has revealed patterns of brain atrophy in subjective cognitive decline, a potential preclinical stage of Alzheimer's disease. However, the involvement of myelin content and microstructural alterations in subjective cognitive decline has not previously been investigated. This study included three groups of participants recruited from the Compostela Aging Study project: 53 cognitively unimpaired adults, 16 individuals with subjective cognitive decline and hippocampal atrophy and 70 with subjective cognitive decline and no hippocampal atrophy. Group differences were analysed across five MRI biomarkers derived from multi-component T2 relaxometry, each sensitive to variations in cerebral composition and microstructural tissue integrity. Although no significant differences in myelin content were observed between groups, the subjective cognitive decline with hippocampal atrophy group exhibited a larger free-water fraction, and reduced fraction and relaxation times of the intra/extracellular water compartment in frontal, parietal and medial temporal lobe brain regions and white matter tracts as compared with the other groups. Moreover, both subjective cognitive decline groups displayed lower total water content as compared with the control group and the subjective cognitive decline with hippocampal atrophy group showed lower total water content as compared with the subjective cognitive decline without hippocampal atrophy group. These changes are likely related to microstructural tissue differences related to neuroinflammation, axonal degeneration, iron accumulation or other physiologic variations, calling for further examinations.

Application and implementation of brief geriatric assessment in primary care and community settings: a scoping review

BACKGROUND

Comprehensive Geriatric Assessment is the gold standard of clinical care for older patients but its application in the primary care setting is limited, possibly due to its time-consuming process. Hence, a brief geriatric assessment could be a feasible alternative. We conducted a scoping review to identify which brief geriatric assessment tools have been evaluated or implemented in primary and community care settings and to identify the domains assessed including their reported outcomes.

METHODS

CENTRAL, PubMed and Embase were searched using specific text words and MeSH for articles published from inception that studied evaluation or implementation of brief geriatric assessments in primary care or community setting.

RESULTS

Twenty-five articles were included in the review, of which 11 described brief geriatric assessments implemented in community, nine in primary care and five in mixed settings. Physical health, functional, mobility/balance and psychological/mental emerged as four domains that are most assessed in brief geriatric assessments. Self-reported questionnaire is the key approach, but uncertainty remains on the validity of subjective cognitive assessments. Brief geriatric assessments have been administered by non-healthcare professionals. The duration taken to complete ranged from five to 20 min. Studies did not report significant change in the clinical outcomes of older adults except for better identification of those with higher needs.

CONCLUSION

The studies reported that brief geriatric assessments could identify older adults with unmet needs or geriatric syndromes, but they did not report improved health outcomes when combined with clinical intervention pathways. Clarity of brief geriatric assessments' questions is important to ensure the feasibility of using self-administered questionnaire by older adults. Future studies should determine which groups of older adults benefit the most from the brief assessments when these are paired with additional evaluations and interventions.

Two-Year Longitudinal Outcomes of Subjective Cognitive Decline in Hispanics Compared to Non-hispanic Whites

BACKGROUND

Subjective cognitive decline (SCD), considered a preclinical dementia stage, is less understood in Hispanics, a high-risk group for dementia. We investigated SCD to mild cognitive impairment (MCI) progression risk, as well as baseline and longitudinal features of depressive symptoms, SCD complaints, and objective cognitive performance among Hispanics compared to non-Hispanic Whites (NHW).

METHODS

Hispanic (n = 23) and NHW (n = 165) SCD participants were evaluated at baseline and 2-year follow-up. Evaluations assessed function, depressive symptoms, SCD, and objective cognitive performance.

RESULTS

Hispanics were at increased risk of progression to MCI (OR: 6.10, 95% CI 1.09-34.20, P = .040). Hispanic participants endorsed more depressive symptoms at baseline (P = .048) that worsened more longitudinally (OR: 3.16, 95% CI 1.18-8.51, P = .023). Hispanic participants had increased SCD complaints on the Brief Cognitive Rating Scale (BCRS) (β = .40 SE: .17, P = .023), and in specific BCRS domains: concentration (β = .13, SE: .07, P = .047), past memory (β = .13, SE: .06, P = .039) and functional abilities (β = .10, SE: .05, P = .037). In objective cognitive performance, Hispanic ethnicity associated with decline in MMSE (β = -.27, SE: .13, P = .039), MoCA (β = -.80 SE: .34, P = .032), Trails A (β = 2.75, SE: .89, P = .002), Trails B (β = 9.18, SE: 2.71, P = .001) and Guild Paragraph Recall Delayed (β = -.80 SE: .28, P = .005). Conclusions: Hispanic ethnicity associated with a significantly increased risk of 2-year progression of SCD to MCI compared to NHW. This increased risk associated with increased depressive symptoms, distinctive SCD features, and elevated amnestic and non-amnestic objective cognitive decline. This supports further research to refine the assessment of preclinical dementia in this high-risk group.

Subjective cognitive complaints and future risk of dementia and cognitive impairment, which matters most

Many older adults report subjective cognitive decline (SCD); however, the specific types of complaints most strongly associated with early disease detection remain unclear. This study examines which complaints from the Everyday Cognition Scales (ECog) are associated with progression from normal cognition to mild cognitive impairment (MCI)/dementia. 415 older adults were monitored annually for 5 years, on average. Cox proportional hazards models assessed associations between ECog complaints and progression to MCI/dementia. Follow-up models included depression as a covariate. Numerous Memory (5 items), Language (3 items), Visuospatial (1 item), Planning (2 items), and Organization (1 item) complaints were associated with diagnostic progression. After covarying for depression, remembering appointments and understanding spoken instructions remained significant predictors of diagnostic progression. While previous work has focused largely on memory-based SCD complaints, the current findings support a wider assessment of complaints may be useful in identifying those at risk for a neurodegenerative disease.

Psychological predictors of incident subjective cognitive complaints in community dwelling older adults

BACKGROUND

Subjective cognitive complaint (SCC) is associated with future cognitive decline and may be a marker for clinical intervention in the progression to dementia. Among the viable predictors of SCC, psychological factors are clinically relevant, non-invasive early indicators of older adults at elevated risk.    This aim of this study is to determine whether psychological symptoms: dysphoria and apathy precede incident SCC in the dementia pathway.

METHODS

Participants (n = 592) enrolled in the Central Control of Mobility in Aging Study were includes in the analyses, with prevalent cases excluded. Apathy and dysphoria scale scores were derived using confirmatory factor analysis of the Geriatric Depressive Scale. Cox regression analyses was used to determine the association between apathy and dysphoria scores and incident SCC.

RESULTS

Over a mean follow up of 1.90 years, 44 individuals (9.26%) developed incident SCC. Baseline apathy scale score was significantly associated with 4-fold increased risk of SCC (HR 4.39, 95%CI: 1.32-14.67), adjusted for cognition but not age and dysphoria scale score. Baseline dysphoria scale score was not associated with increased risk of SCC in adjusted analyses.

CONCLUSION

In this longitudinal analysis of community dwelling older adults, apathy was associated with an increased risk of SCC, when adjusting for cognition but not dysphoria. Finally, this study highlights apathy as an early risk factor, which may precede SCC in the progression to dementia and consequently, may identify a high risk group for clinical screening and intervention.

'With or without you': associations between noteworthy events and cognitive complaints across 100 days

OBJECTIVES

Daily noteworthy events have implications for physical and mental health, but less is known about the role daily events have for self-reported cognition and whether the involvement of close social partners differentiates these associations. The current study examined how daily positive and negative noteworthy events relate to subjective memory and attentional difficulties and whether close social partners moderated associations.

METHOD

We used data from a 100-day microlongitudinal web-based study of 104 older adults (Nobservations=7,051; Mage=63.13 years, SDage=7.81, 88.46% Female). Participants reported on exposure to and valence of noteworthy events, involvement of close social partners, and subjective cognitive complaints at the end of each day.

RESULTS

Logistic multilevel models revealed that days with a negative event were associated with increased odds of forgetting something and trouble concentrating whereas days with positive events were associated with decreased odds of trouble concentrating. Close social partner involvement did not moderate within-person associations.

CONCLUSION

Our results suggest that day-to-day events are correlates of cognitive complaints regardless of close social partner involvement in the events. Research should clarify the role of daily positive and negative events in personalized interventions and determine whether this person-centered approach to self-reported cognitive health helps inform diagnostic practices.

Views of Aging and Subjective Cognition in Middle-Aged and Older Adults: A Systematic Review

INTRODUCTION

Views of aging have been linked with many important outcomes in older adults. Subjective cognition, or one's perception of their cognitive functioning, may be a valuable indicator of cognitive changes as individuals age, but is known to be impacted by a variety of factors. The aim of this systematic review was to synthesize the evidence on relationships between views of aging and subjective cognition, including whether and how these relationships may differ based on age.

METHODS

Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we conducted a comprehensive literature search in four databases: PubMed, CINAHL, PsycINFO, and ProQuest Dissertations and Theses. Critical appraisal utilized the Critical Appraisal Skills Programme (CASP) checklists. Twenty sources (including 21 studies) met inclusion and exclusion criteria, from which data were systematically extracted and results narratively synthesized.

RESULTS

Seventeen out of the 21 identified studies (81%) found a relationship between more positive views of aging and better subjective cognition; however, some studies reported mixed results based on the domain of aging views. Domains that were consistently associated with subjective cognition were subjective age, attitudes toward one's own aging, aging well, and essentialist beliefs about aging. Only three studies reported age group differences or changes in associations over time, precluding conclusions about differences across middle- and older ages.

CONCLUSION

Most studies supported associations between views of aging and subjective cognition. More longitudinal as well as qualitative research is needed to advance understanding of factors that influence these relationships.

Total burden of cerebral small vessel disease predict subjective cognitive decline in patients with Parkinson's disease

Introduction

This study investigates the correlation between the total burden of Cerebral Small Vessel Disease (CSVD) and Subjective Cognitive Decline (SCD) in patients with Parkinson's disease (PD).

Methods

A cross-sectional design was employed, involving 422 patients with PD. Demographic and clinical data were collected. Brain magnetic resonance imaging (MRI) was conducted to identify CSVD markers. SCD was assessed using the Cognitive Complaints Inventory (CCI).

Results

Logistic regression analyses revealed that the total burden of CSVD and specific imaging markers, including Deep White Matter Hyperintensities (DWMH), Periventricular Hyperintensities (PVH), and Enlarged Perivascular Spaces (EPVS), were significant predictors of SCD. The total burden of CSVD demonstrated the highest predictive accuracy for SCD in PD patients.

Discussion

The findings suggest that the total burden of CSVD, as measured by MRI, could serve as a potential biomarker for early identification of cognitive decline in PD, highlighting the importance of considering vascular factors in the early detection of cognitive changes in PD.

Characterizing Cerebral Perfusion Changes in Subjective Cognitive Decline Using Single Photon Emission Computed Tomography: A Case-Control Study

Background/Objectives: Subjective cognitive decline (SCD) may serve as an early indicator of Alzheimer's disease (AD). This study investigates regional cerebral blood flow (rCBF) alterations in individuals with SCD using single photon emission computed tomography (SPECT). To characterize rCBF patterns in SCD patients compared to healthy controls and examine the relationship between rCBF and cognitive function. Methods: We compared rCBF in 20 SCD patients and 20 age- and sex-matched healthy controls using 99mTc-ECD SPECT imaging. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Geriatric Depression Scale (GDS), and Cognitive Abilities Screening Instrument (CASI). Results: SCD patients demonstrated significantly reduced rCBF in the right superior temporal gyrus (rSTG) (mean uptake ratio [UR] = 0.864 ± 0.090 vs. 1.030 ± 0.074, p < 0.001) and right caudate (mean UR = 0.783 ± 0.068 vs. 0.947 ± 0.062, p < 0.001) compared to controls. Additionally, negative correlations were observed between rCBF in these regions and CDR scores, particularly in the memory domain (rSTG: r = -0.37, p = 0.016; right caudate: r = -0.39, p = 0.011). Conclusions: Reduced rCBF in the rSTG and right caudate may represent early biomarkers for SCD, which could aid in the early detection of AD. These findings suggest that SPECT imaging might be a valuable tool for identifying individuals at risk of cognitive decline, potentially allowing for earlier intervention and targeted preventive strategies in the management of AD.

Subjective cognitive decline is associated with altered patterns of brain activity and connectivity during performance of an old/new recognition memory task

INTRODUCTION

Subjective Cognitive Decline (SCD) is considered a preclinical stage within the AD continuum. Knowledge about the functional changes in the brain associated with episodic memory retrieval and novelty recognition in people with SCD is currently very limited.

METHOD

The study aimed to evaluate behavioural and neurofunctional changes in individuals with SCD, measured relative to a control group, during successful episodic memory retrieval and novelty recognition, as well as to compare the functional connectivity patterns related to these cognitive processes within the Default Mode Network (DMN) in both groups. Participants performed an old/new recognition memory task with words while the BOLD signal was acquired.

RESULTS

No between-group differences were observed in the performance of the episodic memory task. However, during the successful recognition of old words, the SCD group showed brain hypoactivity in the right rolandic operculum and reduced functional connectivity between the DMN and the fronto-parietal control network (FPCN). During the correct identification of new words, the SCD group also showed reduced connectivity between the DMN and the FPCN, and lower connectivity within the DMN.

CONCLUSION

Despite the absence of objective evidence of cognitive impairment, people with SCD display several changes in brain activity and connectivity associated with episodic memory retrieval and novelty recognition.

Predicting brain atrophy and cognitive aging trajectories with baseline subjective cognitive concerns in cognitively normal older adults

Subjective cognitive concerns (SCC) are common even in cognitively normal older adults who lack objectively-detectable deficits on standard neuropsychological evaluation. The clinical relevance of these concerns, particularly considering the nature of concerns (e.g., memory versus non-memory), remains unclear. Thus, we examined whether baseline memory and non-memory SCC relate to longitudinal change in brain volume and neuropsychological test performance in 476 functionally-intact, objectively unimpaired older adults (Mage = 72y, 56 % female, follow-up time = 1 - 9 years). Mixed-effects models revealed that both higher baseline memory and non-memory SCC predicted greater atrophy in total gray matter and dorsolateral prefrontal cortex atrophy over time, while only memory SCC predicted steeper medial temporal lobe atrophy. Regarding neuropsychological performance, higher non-memory SCC predicted decline in processing speed performance, while memory SCC did not predict neuropsychological trajectories. SCC are a risk factor for more adverse brain and cognitive aging trajectories, even in functionally-intact, seemingly cognitively normal older adults.

Prevalence and risk factors of subjective cognitive decline in older adults in Baotou, China: a cross-sectional study

Objectives

Subjective cognitive decline (SCD) as a stage between healthy cognition and early neurocognitive disorders, has been proposed to be helpful in the diagnosis of prodromal neurocognitive disorders. To investigate the prevalence of SCD and the related risk factors on the prevalence.

Methods

A cross-sectional study involving 1,120 elderly subjects residing in Baotou, China. From June 2021 to June 2023, the data were gathered by research assistants with training utilizing standardized questionnaires. The following factors were evaluated: subjective cognitive decline, physical and cognitive activity levels, past medical history, demographics, instrumental activities of daily living, and cognitive function. Risk factors of SCD were used chi-square tests and multivariate logistic regression analysis.

Results

The prevalence of SCD was 43.8%. Permanent residence, marital status, BMI, dietary habits, average sleep duration per night, smoking, diabetes, coronary heart disease, and visual impairment were significantly associated with SCD (p < 0 0.05). Multivariable logistic regression analysis showed obesity, vegetarian-based, smoking for a long time, diabetes and coronary heart disease, visual impairment, no spouse, and average sleep duration per night <6 h were independent risk factors for SCD. Based on the gender analysis, the difference in marital status, dietary habits, average sleep duration per night, smoking, drinking, and hypertension was statistically significant (p < 0.001).

Conclusion

The prevalence of subjective cognitive decline was high among elder adults. We discovered significant differences in the prevalence or risk factors for SCD between men and women based on their sex. This study provides a more theoretical basis for the early prevention and screening of cognitive impairment diseases in the elderly population.

Confronting Alzheimer's Disease Risk in Women: A Feasibility Study of Memory Screening as Part of the Annual Gynecological Well-Woman Visit

Objective: Routine health care visits offer the opportunity to screen older adults for symptoms of Alzheimer's disease (AD). Many women see their gynecologist as their primary health care provider. Given this unique relationship, the Women's Preventive Services Initiative and the American College of Obstetrics and Gynecology advocate for integrated care of women at all ages. It is well-established that women are at increased risk for AD, and memory screening of older women should be paramount in this effort. Research is needed to determine the feasibility and value of memory screening among older women at the well-woman visit. Materials and Methods: Women aged 60 and above completed a 5-item subjective memory screener at their well-woman visit at the Columbia University Integrated Women's Health Program. Women who endorsed any item were considered to have a positive screen and were given the option to pursue clinical evaluation. Rates of positive screens, item endorsement, and referral preferences were examined. Results: Of the 530 women approached, 521 agreed to complete the screener. Of those, 17.5% (n = 91) were classified as positive. The most frequently endorsed item was difficulty with memory or thinking compared with others the same age. Among women with positive screens, 57.5% were interested in pursuing clinical referrals to a memory specialist. Conclusion: Results support the feasibility and potential value of including subjective memory screening as part of a comprehensive well-woman program. Early identification of memory loss will enable investigation into the cause of memory symptoms and longitudinal monitoring of cognitive change.

Mnemonic brain state engagement is diminished in healthy aging

Healthy older adults typically show impaired episodic memory - memory for when and where an event oc-curred - but intact semantic memory - knowledge for general information and facts. As older adults also have difficulty inhibiting the retrieval of prior knowledge from memory, their selective decline in episodic memory may be due to a tendency to over engage the retrieval state, a brain state in which attention is focused internally in an attempt to access prior knowledge. The retrieval state trades off with the encoding state, a brain state which supports the formation of new memories. Therefore, episodic memory declines in older adults may be the result of differential engagement in mnemonic brain states. Our hypothesis is that older adults are biased toward a retrieval state. We recorded scalp electroencephalography while young, middle-aged and older adults performed a memory task in which they were explicitly directed to either encode the currently presented object stimulus or retrieve a previously presented, categorically-related object stimulus. We used multivariate pattern analysis of spectral activity to decode engagement in the retrieval vs. encoding state. We find that all three age groups can follow top-down instructions to selectively engage in encoding or retrieval and that we can decode mnemonic states for all age groups. However, we find that mnemonic brain state engagement is diminished for older adults relative to middle-aged adults. Our interpretation is that a combination of executive control deficits and a modest bias to retrieve modulates older adults' mnemonic state engagement. Together, these findings suggest that dif-ferential mnemonic state engagement may underlie age-related memory changes.

The McCusker Subjective Cognitive Impairment Inventory (McSCI): a novel measure of perceived cognitive decline

BACKGROUND

Subjective cognitive decline (SCD), i.e. self/other-reported concerns on one's cognitive functioning without objective evidence of significant decline, is an indicator of dementia risk. There is little consensus on reliability and validity of the available SCD measures. Therefore, introducing a novel and psychometrically sound measure of SCD is timely.

OBJECTIVE

The psychometric properties of a new SCD measure, the McCusker Subjective Cognitive Impairment Inventory-Self-Report (McSCI-S), are reported.

METHODS

Through review of previously published measures as well as our clinical and research data on people with SCD, we developed a 46-item self-report questionnaire to assess concerns on six cognitive domains, namely, memory, language, orientation, attention and concentration, visuoconstruction abilities and executive function. The McSCI-S was examined in a cohort of 526 participants using factor analysis, item response theory analysis and receiver operating characteristic (ROC) curve.

RESULTS

A unidimensional model provided acceptable fit (CFI = 0.94, TLI = 0.94, RMSEA [90% CI] = 0.052 [.049, 0.055], WRMR = 1.45). The McSCI-S internal consistency was excellent (.96). A cut-off score of ≥24 is proposed to identify participants with SCDs. Higher McSCI-S scores were associated with poorer general cognition, episodic verbal memory, executive function and greater memory complaints and depressive scores (P < .001), controlling for age, sex and education.

CONCLUSIONS

Excellent reliability and construct validity suggest the McSCI-S estimates SCDs with acceptable accuracy while capturing self-reported concerns for various cognitive domains. The psychometric analysis indicated that this measure can be used in cohort studies as well as on individual, clinical settings to assess SCDs.

Subjective memory concerns and car collisions: A cross-sectional cohort study among older Japanese drivers

Background

A previous study suggested older drivers with subjective memory concerns (SMC) had increased odds of experiencing car collisions, but whether SMC in different contexts and the number of SMC applicable items change this association is unknown. The aim of this study was to examine the association between SMC and car collisions among older drivers in Japan.

Methods

This cross-sectional study was conducted using data from a Japanese community-based cohort study. Participants were community-dwelling older adults aged ≥60 years. SMC was assessed using five questions: 1) "Do you feel you have more problems with memory than most?" 2) "Do you have any difficulty with your memory?" 3) "Do you forget where you have left things more than you used to?" 4) "Do you forget the names of close friends or relatives?" and 5) "Do other people find you forgetful?" Participants were asked about their experiences with car collisions during the previous two years.

Results

A total of 13,137 older drivers (72.1 ± 5.5 years old, and 43.6 % female) were analyzed. Cochran-Armitage trend test showed that as the number of SMC applicable items increased, the percentage of the experiences of car collisions significantly increased (6.8 %-15.8 %, P < 0.001). Logistic regression models showed each SMC question was associated with an increased odds ratio (OR) of car collisions (OR 1.26 to 1.71, all P < 0.001) after adjusting for confounding factors. As the number of SMC applicable items increased, the OR of car collisions significantly increased (OR 1.19 to 2.28, all P < 0.05, P for trend <0.001).

Conclusions

This cross-sectional study among community-dwelling older drivers in Japan suggested each SMC question and the number of applicable items were associated with car collisions. SMC may be a sign of increased risk of traffic incidents for older drivers.

Effects of non-pharmacological interventions for adults with subjective cognitive decline: a network meta-analysis and component network meta-analysis

BACKGROUND

Non-pharmacological interventions have a myriad of available intervention options and contain multiple components. Whether specific components of non-pharmacological interventions or combinations are superior to others remains unclear. The main aim of this study is to compare the effects of different combinations of non-pharmacological interventions and their specific components on health-related outcomes in adults with subjective cognitive decline.

METHODS

PubMed, Embase, Cochrane, CINAHL, PsycINFO, CENTRAL, Web of Science, and China's two largest databases, CNKI and Wanfang, were searched from inception to 22nd, January 2023. Randomized controlled trials using non-pharmacological interventions and reporting health outcomes in adults with subjective cognitive decline were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias. Component network meta-analysis was conducted employing an additive component model for network meta-analysis. This study followed the PRISMA reporting guideline and the PRISMA checklist is presented in Additional file 2.

RESULTS

A total of 39 trials with 2959 patients were included (range of mean ages, 58.79-77.41 years). Resistance exercise might be the optimal intervention for reducing memory complaints in adults with subjective cognitive decline; the surface under the cumulative ranking p score was 0.888, followed by balance exercise (p = 0.859), aerobic exercise (p = 0.832), and cognitive interventions (p = 0.618). Music therapy, cognitive training, transcranial direct current stimulation, mindfulness therapy, and balance exercises might be the most effective intervention components for improving global cognitive function (iSMD, 0.83; 95% CI, 0.36 to 1.29), language (iSMD, 0.31; 95% CI, 0.24 to 0.38), ability to perform activities of daily living (iSMD, 0.55; 95% CI, 0.21 to 0.89), physical health (iSMD, 3.29; 95% CI, 2.57 to 4.00), and anxiety relief (iSMD, 0.71; 95% CI, 0.26 to 1.16), respectively.

CONCLUSIONS

The form of physical activity performed appears to be more beneficial than cognitive interventions in reducing subjective memory complaints for adults with subjective cognitive decline, and this difference was reflected in resistance, aerobic, and balance exercises. Randomized clinical trials with high-quality and large-scale are warranted to validate the findings.

TRIAL REGISTRATION

PROSPERO registry number. CRD42022355363.

Psychometric properties and normative data of the Italian version of the Cognitive Function at Work Questionnaire: a screening tool for detecting subjective cognitive complaints at work

INTRODUCTION

Considering the extension of working life due to socioeconomic and political factors, many people may experience cognitive complaints (CC) at their workplace, with severe consequences on their quality of life. The identification of workers reporting significative SCC is crucial to eventually address them to an objective neuropsychological evaluation and implement cognitive interventions to guarantee workers' well-being. Since no Italian questionnaires for detecting CC were designed for occupational settings, the aim of the study was to validate the Italian version of the Cognitive Function at Work Questionnaire (CFWQ) and to provide its normative data.

MATERIALS AND METHODS

Internal consistency, convergent and divergent validity, and factorial structure of the CFWQ were evaluated. A regression-based procedure served to compute percentiles of CFWQ and its subscales.

RESULTS

Four hundred twenty-one participants without psychiatric and/or neurological disorders completed the survey. We found that the Italian CFWQ included 26 items, with a good internal consistency (Cronbach's alpha = 0.897) and a six-factor structure (memory, language, processing speed, abstract thinking/behavioral control, behavioral inertia, planning ability). CFWQ score did not correlate with empathy but correlated strongly with memory scores and moderately with anxiety and depression scores.

CONCLUSIONS

The Italian CFWQ showed good psychometric properties, in analogy with the original English scale. Therefore, it can be successfully employed in organizational contexts to possibly identify workers with CC and therefore with possible co-occurrent psychological, behavioral, and cognitive consequences.

Association Between Subjective Cognitive Decline and Twice-Weekly Muscle-Strengthening Activities in Middle-Aged and Older US Adults: An Analysis of the 2019 Behavioral Risk Factor Surveillance System

PURPOSE

Adults with subjective cognitive decline (SCD), the self-reported concern of reduced cognitive function, are recommended to do physical activity for its brain health benefits. US adults aged ≥45 with SCD are less likely to meet the American College of Sports Medicine (ACSM) aerobic activity recommendations. Their engagement in muscle-strengthening activities is unknown. We aimed to identify if US adults aged ≥45 with SCD are less likely to do twice-weekly muscle-strengthening activities compared to those without SCD.

DESIGN

Secondary analysis of the 2019 Behavioral Risk Factor Surveillance System (BRFSS) data.

SAMPLE

114 164 respondents, representing approximately 59 million US adults aged ≥45.

MEASURES

SCD was indicated if the respondent reported confusion or memory loss during the past 12 months (yes/no). Respondents reported the frequency of muscle-strengthening activities, which we categorized as meeting the ACSM's recommendations (2+ times per week) or not (<2 times per week).

ANALYSIS

Crude and adjusted logistic regression models controlling for variables associated with SCD and muscle-strengthening activities. The models used sample weights to represent US adults in the included 31 states and Washington D.C.

RESULTS

US adults aged ≥45 with SCD were less likely to do twice-weekly muscle-strengthening activities than those without SCD (28.6% [SE: .8%] vs 33.5% [SE: .3%], adjusted OR, .9; 95% CI: .9-1.0).

CONCLUSION

Primary care providers should encourage middle-aged and older patients to engage in muscle-strengthening and aerobic activities.

White matter alterations and their associations with biomarkers and behavior in subjective cognitive decline individuals: a fixel-based analysis

BACKGROUND

Subjective cognitive decline (SCD) is an early stage of dementia linked to Alzheimer's disease pathology. White matter changes were found in SCD using diffusion tensor imaging, but there are known limitations in voxel-wise tensor-based methods. Fixel-based analysis (FBA) can help understand changes in white matter fibers and how they relate to neurodegenerative proteins and multidomain behavior data in individuals with SCD.

METHODS

Healthy adults with normal cognition were recruited in the Northeastern Taiwan Community Medicine Research Cohort in 2018-2022 and divided into SCD and normal control (NC). Participants underwent evaluations to assess cognitive abilities, mental states, physical activity levels, and susceptibility to fatigue. Neurodegenerative proteins were measured using an immunomagnetic reduction technique. Multi-shell diffusion MRI data were collected and analyzed using whole-brain FBA, comparing results between groups and correlating them with multidomain assessments.

RESULTS

The final enrollment included 33 SCD and 46 NC participants, with no significant differences in age, sex, or education between the groups. SCD had a greater fiber-bundle cross-section than NC (pFWE < 0.05) at bilateral frontal superior longitudinal fasciculus II (SLFII). These white matter changes correlate negatively with plasma Aβ42 level (r = -0.38, p = 0.01) and positively with the AD8 score for subjective cognitive complaints (r = 0.42, p = 0.004) and the Hamilton Anxiety Rating Scale score for the degree of anxiety (Ham-A, r = 0.35, p = 0.019). The dimensional analysis of FBA metrics and blood biomarkers found positive correlations of plasma neurofilament light chain with fiber density at the splenium of corpus callosum (pFWE < 0.05) and with fiber-bundle cross-section at the right thalamus (pFWE < 0.05). Further examination of how SCD grouping interacts between the correlations of FBA metrics and multidomain assessments showed interactions between the fiber density at the corpus callosum with letter-number sequencing cognitive score (pFWE < 0.01) and with fatigue to leisure activities (pFWE < 0.05).

CONCLUSION

Based on FBA, our investigation suggests white matter structural alterations in SCD. The enlargement of SLFII's fiber cross-section is linked to plasma Aβ42 and neuropsychiatric symptoms, which suggests potential early axonal dystrophy associated with Alzheimer's pathology in SCD. The splenium of the corpus callosum is also a critical region of axonal degeneration and cognitive alteration for SCD.

Associations between Informant-Reported Cognitive Complaint and Longitudinal Cognitive Decline in Subjective Cognitive Decline A 7-Year Longitudinal Study

OBJECTIVE

This study aimed to determine the predictive values of informant-reported memory decline (IMD) among subjective cognitive decline (SCD) older adults from a 7-year community-based cohort study.

METHOD

Ninety SCD participants were included. Demographic data and neuropsychological test scores at both baseline and 7-year follow-up were collected. Differences between SCD with IMD (+IMD) and SCD without IMD (-IMD) were compared. Logistic regression models were used to determine whether baseline IMD could predict diagnostic outcomes at 7-year follow-up.

RESULTS

Forty-one percent of SCD adults had IMD. At baseline, the +IMD group showed more depressive symptoms (p = 0.016) than the -IMD group. Furthermore, the Beijing-version Montreal Cognitive Assessment (MoCA), Digit Span Test-Forward, Visual Matching and Reasoning, and Wechsler Adult Intelligence Scale-RC Picture Completion (WAIS-PC) scores in the +IMD group were significantly lower than those in the -IMD group. Fifty-four percent of +IMD participants converted to mild cognitive impairment (MCI) or dementia at follow-up, and 22.6% of the -IMD participants converted to MCI. Follow-up Mini-Mental State Examination, MoCA, and Verbal Fluency Test scores of the +IMD group were significantly lower than those in the -IMD group. The +IMD group was more likely to progress to cognitive impairment at 7-year follow-up (OR = 3.361, p = 0.028).

CONCLUSIONS

SCD participants with +IMD may have poorer cognition and are more likely to convert to cognitive impairment over time. Our long-term follow-up study confirmed the importance of informants' perceptions of SCD, which can help clinicians identify individuals at risk of cognitive decline.

Validation of the Cognitive Assessment Instrument for Obsessions and Compulsions (CAIOC-13) in an Indian Sample

Background

Brief self-report measures of cognition are advantageous for flagging significant cognitive dysfunction without extensive neuropsychological assessments. The Cognitive Assessment Instrument for Obsessions and Compulsions (CAIOC-13) is a recently developed self-report that assesses everyday cognitive dysfunction in obsessive-compulsive disorder (OCD), for example, difficulties with reading, slowness, and decision-making. This study was undertaken to validate the CAIOC-13 in an Indian sample of OCD.

Material and Methods

75 subjects with OCD and 81 non-clinical controls completed CAIOC-13, Perceived Deficits Questionnaire (PDQ), and Dysfunctional Attitude Scale-Short Form (DAS-SF1). Convergent and divergent validity with PDQ and DAS-SF1 were established with Pearson's correlation; the Receiver Operating Characteristic (ROC) curve was used to analyze discriminant validity; and factorial structure was evaluated using the principal component analysis (PCA).

Results

CAIOC-13 scores showed a strong significant correlation (r = 0.56; p < .001) with PDQ and a moderate correlation with DAS-SF1 scores (r = 0.33; p = .003). CAIOC-13 could accurately discriminate between OCD and controls (area under curve = 0.92). PCA revealed strong loading on a single component.

Conclusion

CAIOC-13 is a valid tool for briefly assessing OCD-related cognitive dysfunction in Indian samples. Future studies may examine the correlation of CAIOC-13 with standardized neuropsychological assessments.

Perception of cognitive change by individuals with Parkinson's disease or essential tremor seeking deep brain stimulation: Utility of the cognitive change index

OBJECTIVE

The Cognitive Change Index (CCI-20) is a validated questionnaire that assesses subjective cognitive complaints (SCCs) across memory, language, and executive domains. We aimed to: (a) examine the internal consistency and construct validity of the CCI-20 in patients with movement disorders and (b) learn how the CCI-20 corresponds to objective neuropsychological and mood performance in individuals with Parkinson's disease (PD) or essential tremor (ET) seeking deep brain stimulation (DBS).

METHODS

216 participants (N = 149 PD; N = 67 ET) underwent neuropsychological evaluation and received the CCI-20. The proposed domains of the CCI-20 were examined via confirmatory (CFA) and exploratory (EFA) factor analyses. Hierarchical regressions were used to assess the relationship among subjective cognitive complaints, neuropsychological performance and mood symptoms.

RESULTS

PD and ET groups were similar across neuropsychological, mood, and CCI-20 scores and were combined into one group who was well educated (m = 15.01 ± 2.92), in their mid-60's (m = 67.72 ± 9.33), predominantly male (63%), and non-Hispanic White (93.6%). Previously proposed 3-domain CCI-20 model failed to achieve adequate fit. Subsequent EFA revealed two CCI-20 factors: memory and non-memory (p < 0.001; CFI = 0.924). Regressions indicated apathy and depressive symptoms were associated with greater memory and total cognitive complaints, while poor executive function and anxiety were associated with more non-memory complaints.

CONCLUSION

Two distinct dimensions were identified in the CCI-20: memory and non-memory complaints. Non-memory complaints were indicative of worse executive function, consistent with PD and ET cognitive profiles. Mood significantly contributed to all CCI-20 dimensions. Future studies should explore the utility of SCCs in predicting cognitive decline in these populations.

"Cognitive" Criteria in Older Adults With Slow Gait Speed: Implications for Motoric Cognitive Risk Syndrome

BACKGROUND

Motoric cognitive risk syndrome (MCR) is a predementia condition that combines slow gait speed and subjective cognitive concerns (SCC). The SCC criterion is presently unstandardized, possibly limiting risk detection. We sought to (a) characterize SCC practices through MCR literature review; (b) investigate the ability of SCC in slow gait individuals in predicting the likelihood of cognitive impairment in a demographically diverse sample of community-dwelling, nondemented older adults.

METHODS

First, we comprehensively reviewed the MCR literature, extracting information regarding SCC measures, items, sources, and cognitive domain. Next, Einstein Aging Study (EAS) participants (N = 278, Mage = 77.22 ± 4.74, %female = 67, Meducation = 15 ± 3.61, %non-Hispanic White = 46.3) completed gait, Clinical Dementia Rating Scale (CDR), and SCC assessment at baseline and annual follow-up (Mfollow-up = 3.5). Forty-two participants met slow gait criteria at baseline. Generalized linear mixed-effects models examined baseline SCC to predict cognitive impairment on CDR over follow-up.

RESULTS

We reviewed all published MCR studies (N = 106) and documented ambiguity in SCC criteria, with a prevalent approach being use of a single self-reported memory item. In EAS, high SCC endorsement on a comprehensive, validated screen significantly affected the rate of cognitive impairment (CDR; βinteraction = 0.039, p = .018) in slow gait individuals.

CONCLUSIONS

An assessment approach that queries across numerous SCC domains was found to predict future decline in clinical dementia status in slow gait older adults. Current SCC practices in MCR, which tend to utilize a single-memory item, may not be the optimal approach. We discuss the implications of SCC criteria validation and standardization to enhance early dementia detection in MCR.

Motoric Cognitive Risk Syndrome and the Risk of Incident Dementia: A Systematic Review and Meta-Analysis of Cohort Studies

BACKGROUND

Epidemiologic studies have indicated an association of motoric cognitive risk syndrome (MCR), a pre-dementia stage characterized by the presence of cognitive complaints and a slow gait, with increased risk of incident dementia.

OBJECTIVES

We aimed to clarify this association using meta-analysis.

METHODS

We systematically searched the PubMed, Embase, and Web of Science databases up to December 2022 for relevant studies that investigated the association between MCR and incident all-cause dementia and Alzheimer's disease (AD). The random-effects model was used to determine a pooled-effect estimate of the association.

RESULTS

We identified seven articles that corresponded with nine cohort studies investigating the association between MCR and the risk of dementia. Pooled analysis showed that MCR was associated with a significantly increased risk of incident all-cause dementia (HR = 2.28; 95% CI: 1.90-2.73) and AD (HR = 2.05; 95% CI: 1.61-2.61). Sensitivity analysis showed that there was no evidence that individual studies influenced the pooled-effect estimate, verifying the robustness of the results.

CONCLUSIONS

Our results confirm that MCR is an independent risk factor of incident all-cause dementia and AD. Future studies are needed to better understand the mechanisms underlying this association.

Blood levels of glial fibrillary acidic protein for predicting clinical progression to Alzheimer's disease in adults without dementia: a systematic review and meta-analysis protocol

BACKGROUND

There is urgent clinical need to identify reliable prognostic biomarkers that predict the progression of dementia symptoms in individuals with early-phase Alzheimer's disease (AD) especially given the research on and predicted applications of amyloid-beta (Aβ)-directed immunotherapies to remove Aβ from the brain. Cross-sectional studies have reported higher levels of cerebrospinal fluid and blood glial fibrillary acidic protein (GFAP) in individuals with AD-associated dementia than in cognitively unimpaired individuals. Further, recent longitudinal studies have assessed the prognostic potential of baseline blood GFAP levels as a predictor of future cognitive decline in cognitively unimpaired individuals and in those with mild cognitive impairment (MCI) due to AD. In this systematic review and meta-analysis, we propose analyzing longitudinal studies on blood GFAP levels to predict future cognitive decline.

METHODS

This study will include prospective and retrospective cohort studies that assessed blood GFAP levels as a prognostic factor and any prediction models that incorporated blood GFAP levels in cognitively unimpaired individuals or those with MCI. The primary outcome will be conversion to MCI or AD in cognitively unimpaired individuals or conversion to AD in individuals with MCI. Articles from PubMed and Embase will be extracted up to December 31, 2023, without language restrictions. An independent dual screening of abstracts and potentially eligible full-text reports will be conducted. Data will be dual-extracted using the CHeck list for critical appraisal, data extraction for systematic Reviews of prediction Modeling Studies (CHARMS)-prognostic factor, and CHARMS checklists, and we will dual-rate the risk of bias and applicability using the Quality In Prognosis Studies and Prediction Study Risk-of-Bias Assessment tools. We will qualitatively synthesize the study data, participants, index biomarkers, predictive model characteristics, and clinical outcomes. If appropriate, random-effects meta-analyses will be performed to obtain summary estimates. Finally, we will assess the body of evidence using the Grading of Recommendation, Assessment, Development, and Evaluation Approach.

DISCUSSION

This systematic review and meta-analysis will comprehensively evaluate and synthesize existing evidence on blood GFAP levels for prognosticating presymptomatic individuals and those with MCI to help advance risk-stratified treatment strategies for early-phase AD.

TRIAL REGISTRATION

PROSPERO CRD42023481200.

Determining optimal cutoff scores of Cognitive Abilities Screening Instrument to identify dementia and mild cognitive impairment in Taiwan

BACKGROUND

The early detection of dementia depends on efficient methods for the assessment of cognitive capacity. Existing cognitive screening tools are ill-suited to the differentiation of cognitive status, particularly when dealing with early-stage impairment.

METHODS

The study included 8,979 individuals (> 50 years) with unimpaired cognitive functions, mild cognitive impairment (MCI), or dementia. This study sought to determine optimal cutoffs values for the Cognitive Abilities Screening Instrument (CASI) aimed at differentiating between individuals with or without dementia as well as between individuals with or without mild cognitive impairment. Cox proportional hazards models were used to evaluate the value of CASI tasks in predicting conversion from MCI to all-cause dementia, dementia of Alzheimer's type (DAT), or to vascular dementia (VaD).

RESULTS

Our optimized cutoff scores achieved high accuracy in differentiating between individuals with or without dementia (AUC = 0.87-0.93) and moderate accuracy in differentiating between CU and MCI individuals (AUC = 0.67 - 0.74). Among individuals without cognitive impairment, scores that were at least 1.5 × the standard deviation below the mean scores on CASI memory tasks were predictive of conversion to dementia within roughly 2 years after the first assessment (all-cause dementia: hazard ratio [HR] = 2.81 - 3.53; DAT: 1.28 - 1.49; VaD: 1.58). Note that the cutoff scores derived in this study were lower than those reported in previous studies.

CONCLUSION

Our results in this study underline the importance of establishing optimal cutoff scores for individuals with specific demographic characteristics and establishing profiles by which to guide CASI analysis.

Measures of Subjective Memory for People with Epilepsy: A Systematic Review of Measurement Properties

People with epilepsy frequently express concern about the burden of memory problems in their everyday lives. Self-report memory questionnaires may provide valuable insight into individuals' perceptions of their everyday memory performance and changes over time. Yet, despite their potential utility, the measurement properties of self-report memory questionnaires have not been evaluated in epilepsy. This systematic review aimed to provide a critical appraisal of the measurement properties of self-report memory questionnaires for adults with epilepsy. Following protocol registration (PROSPERO CRD42020210967), a systematic search of PubMed, EMBASE, Web of Science, CINAHL, and PsychInfo from database inception until 27 May 2021 was conducted. Eligible studies were published in English-language peer-reviewed journals, recruited adults with epilepsy, and reported on the development or evaluation of the measurement properties of a self-report memory questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was used to evaluate each study of a measurement property, and results were qualitatively synthesised. In total, 80 articles and one test manual were located containing 153 studies of measurement properties pertinent to 23 self-report memory questionnaires. Overall, no scale could be recommended outright for the evaluation of subjective memory symptoms in adults with epilepsy. This was due to the near absence of dedicated content validation studies relevant to this population and shortcomings in the methodology and scientific reporting of available studies of structural validity. Recommendations to support the advancement and psychometric validation of self-report memory questionnaires for people with epilepsy are provided.

Predicting progression of cognitive decline to dementia using dyadic patterns of subjective reporting: evidence from the CompAS longitudinal study

Objective

To analyze the validity of self and informant reports, depressive symptomatology, and some sociodemographic variables to predict the risk of cognitive decline at different follow-up times.

Methods

A total of 337 participants over 50 years of age included in the CompAS and classified as Cognitively Unimpaired (CU), Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI) groups were assessed at baseline and three follow-ups. A short version of the QAM was administered to assess the severity of subjective cognitive complaints (SCCs), and the GDS-15 was used to evaluate the depressive symptoms. At each follow-up assessment, participants were reclassified according to the stability, regression or progression of their conditions. Logistic regression analysis was used to predict which CU, SCD and MCI participants would remain stable, regress or progress at a 3rd follow-up by using self- and informant-reported complaints, depressive symptomatology, age and education at baseline and 2nd follow-ups as the predictive variables.

Results

Overall, self-reported complaints predicted progression between the asymptomatic and presymptomatic stages. As the objective deterioration increased, i.e., when SCD progressed to MCI or dementia, the SCCs reported by informants proved the best predictors of progression. Depressive symptomatology was also a predictor of progression from CU to SCD and from SCD to MCI.

Conclusion

A late increase in self-reported complaints make valid estimates to predict subjective decline at asymptomatic stages. However, an early increase in complaints reported by informants was more accurate in predicting objective decline from asymptomatic stages. Both, early and late decrease in self-reported complaints successfully predict dementia from prodromic stage. Only late decrease in self-reported complaints predict reversion from prodromic and pre-symptomatic stages.

Biomarkers of Alzheimer's Disease and Cerebrovascular Disease in Relation to Depressive Symptomatology in Individuals With Subjective Cognitive Decline

BACKGROUND

Subjective cognitive decline (SCD) has gained recent interest as a potential harbinger of neurodegenerative diseases such as Alzheimer's disease (AD) and cerebrovascular disease (CVD). In addition, SCD can be related to depressive symptomatology. However, the association between AD and CVD biomarkers, depressive symptomatology, and SCD is still unclear. We investigated the association of AD and CVD biomarkers and depressive symptomatology with SCD in individuals with subjective memory complaints (SCD-memory group) and individuals with subjective concentration complaints (SCD-concentration group).

METHODS

We recruited a population-based cohort of 217 individuals (all aged 70 years, 53% female participants, 119 SCD-memory individuals, 23 SCD-concentration individuals, and 89 controls). AD and CVD were assessed through cerebrospinal fluid levels of the Aβ42/40 ratio and phosphorylated tau, and white matter signal abnormalities on magnetic resonance imaging, respectively. Associations between biomarkers, depressive symptomatology, and SCD were tested via logistic regression and correlation analyses.

RESULTS

We found a significant association between depressive symptomatology with SCD-memory and SCD-concentration. Depressive symptomatology was not associated with AD and CVD biomarkers. Both the phosphorylated tau biomarker and depressive symptomatology predicted SCD-memory, and the Aβ42/40 ratio and depressive symptomatology predicted SCD-concentration.

CONCLUSIONS

The role of depressive symptomatology in SCD may differ depending on the stage within the spectrum of preclinical AD (as determined by amyloid-beta and tau positivity), and does not seem to reflect AD pathology. Our findings contribute to the emerging field of subclinical depressive symptomatology in SCD and clarify the association of different types of subjective complaints with distinct syndromic and biomarker profiles.

Subjective cognitive and olfactory impairments predict different prospective dementia outcomes

Self-reported measures emerge as potential indicators for early detection of dementia and mortality. We investigated the predictive value of different self-reported measures, including subjective cognitive decline (SCD), subjective olfactory impairment (SOI), subjective taste impairment (STI), and self-reported poor health (SPH), in order to determine the risk of progressing to Alzheimer's disease (AD) dementia, Parkinson's disease (PD) dementia, or any-other-cause dementia. A total of 6,028 cognitively unimpaired individuals from the 8th wave of the English Longitudinal Study of Ageing (ELSA) were included as the baseline sample and 5,297 individuals from the 9th wave were included as 2-year follow-up sample. Self-rated measures were assessed using questions from the ELSA structured interview. Three logistic regression models were fitted to predict different the dementia outcomes. SCD based on memory complaints (OR = 11.145; P < 0.001), and older age (OR = 1.108, P < 0.001) significantly predicted the progression to AD dementia at follow-up. SOI (OR = 7.440; P < 0.001) and older age (OR = 1.065, P = 0.035) significantly predicted the progression to PD dementia at follow-up. Furthermore, SCD based on memory complaints (OR = 4.448; P < 0.001) jointly with complaints in other (non-memory) mental abilities (OR = 6.662; P < 0.001), and older age (OR = 1.147, P < 0.001) significantly predicted the progression to dementia of any other cause. Different types of complaints are specifically associated with different dementia outcomes. Our study demonstrates that self-reported measures are a useful and accessible tool when screening for individuals at risk of dementia in the general population.