Association Between Proxy- or Self-Reported Cognitive Decline and Cognitive Performance in Memory Clinic Visitors

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.

Patient-reported cognitive function among hematopoietic stem cell transplant and cellular therapy patients: a scoping review

PURPOSE

Cognitive dysfunction is a known complication following cellular therapies (CT), which can be assessed through performance based and patient-reported measures. We performed a systematic scoping review to assess self-reported cognitive function measures used among adult CT patients and describe long-term results, including associations with clinical outcomes.

METHODS

Library databases were searched from inception to February 2020 according to PRISMA guidelines. Additional studies were identified through reference lists and trial protocols. Two members of the research team screened titles and abstracts and resolved discrepancies. Articles that met eligibility criteria continued to full-text review, with 25% double screening. Articles were removed if they (1) were not original research, peer-reviewed articles; (2) were the wrong disease, age, or treatment-specific patient population; (3) did not use patient-reported outcomes; (4) did not separately report cognitive function outcomes.

RESULTS

Of the1952 articles, 56 were included. Twenty-one patient-reported measures of cognitive function were used; most frequently the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30), which includes a two-item cognitive function subscale (57%; n = 32). Thirteen studies collected performance-based and self-reported measures and of those (n = 6) who assessed associations found moderate correlations (range r = .13-.58). Longitudinal patterns showed declines in cognitive function soon after treatment (< 1 month) returning to baseline at 1 year. Cognitive function was often associated with other quality of life measures, chiefly depression (n = 5).

CONCLUSIONS

EORTC-QLQ-C30 is the most commonly used to measure, though there remain numerous measures used, including several measures with little previous validation and investigator developed items.

Measures of physical performance as mediators between personality and cognition in two prospective studies

Few studies have examined the pathways linking personality to cognition. This study aimed to examine whether measures of physical performance (gait speed, peak expiratory flow (PEF), and grip strength) mediated the association between five-factor model personality traits and cognition (memory performance, subjective memory, and informant-rated cognition). Participants were aged 57 to 95 years from the Health and Retirement Study (HRS, N = 4,109) and the English Longitudinal Study of ageing (ELSA, N = 3,584). In HRS, personality and demographic factors were assessed in 2008/2010, physical performance in 2012/2014, and memory performance and subjective memory in 2016/2018. Informant-rated cognition was obtained in 2016 for an HRS subsample. In ELSA, personality and demographic factors were assessed in 2010/2011, physical performance in 2012/2013, and objective and subjective memory in 2014/2015. Informant-rated cognition was obtained in 2018 for an ELSA subsample. With a few exceptions, replicable patterns of mediation were found across HRS and ELSA. Slower gait speed partially mediated the association between higher neuroticism, lower conscientiousness and worse scores on all three cognitive measures (memory performance, subjective memory, and informant-rated cognition). Slower gait also partially mediated the association between openness and both objective and subjective memory. There was less replicable evidence for a mediating role of PEF and grip strength. The present study advances knowledge on the pathways linking personality to cognition in older adults and supports the hypothesis that personality associations with better physical function can help support healthy cognitive aging.

Self-reported cognitive decline among middle and older age autistic adults

Very little is known about autistic adults as they age. Early evidence suggests a potentially high risk for dementia and atypical cognitive decline in autistic middle and older age adults. Research in the general population indicates that self-reported cognitive decline may predict future dementia earlier than performance-based measures. Nevertheless, self-report dementia screeners have not been used to date in autism research. In a sample of middle and older age autistic adults (N = 210), participants completed a self-rated dementia screener, the AD8, to describe the rate of cognitive decline, examine associations of cognitive decline with age, educational level, sex designated at birth, and autistic traits, and document the psychometrics of a dementia screener in autistic adults. We found high rates of cognitive decline with 30% of the sample screening positive. The most common symptoms were declining interest in leisure activities, and increases in everyday problems with thinking, memory, and judgment. There was evidence that autistic individuals designated female at birth may be more vulnerable to cognitive decline than autistic individuals designated male at birth. Notably, reports of cognitive decline did not vary by age or educational level. Modestly elevated autistic traits were found in those screening positive versus negative for cognitive decline. Finally, the dementia screener showed good psychometrics, including convergent validity with an independent measure of current memory problems. These results could signal an emerging public health crisis in autistic adults as they age, and support the potential utility of self-report measures for early screening for cognitive decline in this population.

A Simple Single Item Rated by an Interviewer Predicts Incident Dementia Over 15 Years

Subjective memory is useful to detect cognitive deficits not apparent on objective tests. This research evaluates whether memory rated by an interviewer predicts incident dementia. Health and Retirement Study participants without cognitive impairment at baseline whose memory was rated by the interviewer were analyzed (N = 12,749). Worse interviewer-rated memory was associated with higher risk of incident dementia over 15 years (HR = 1.40, 95% CI = 1.27-1.54). The association was evident even among participants in the top quartile of objective memory performance (HR = 1.71, 95% CI = 1.26-2.32). Interviewer-rated memory may be a low-cost supplement to neuropsychological evaluation to predict dementia risk beyond self-reports and objective cognitive testing.

Hippocampal Volume and Episodic Associative Memory Identify Memory Risk in Subjective Cognitive Decline Individuals in the CIMA-Q Cohort, Regardless of Cognitive Reserve Level and APOE4 Status

BACKGROUND

Subjective cognitive decline (SCD) was proposed to identify older adults who complain about their memory but perform within a normal range on standard neuropsychological tests. Persons with SCD are at increased risk of dementia meaning that some SCD individuals experience subthreshold memory decline due to an underlying progression of Alzheimer's disease (AD).

OBJECTIVE

Our main goal was to determine whether hippocampal volume and APOE4, which represent typical AD markers, predict inter-individual differences in memory performance among SCD individuals and can be used to identify a meaningful clinical subgroup.

METHODS

Neuropsychological assessment, structural MRI, and genetic testing for APOE4 were administered to one hundred and twenty-five older adults over the age of 65 from the CIMAQ cohort: 66 SCD, 29 individuals with mild cognitive impairment (MCI), and 30 cognitively intact controls (CTRLS). Multiple regression models were first used to identify which factor (hippocampal volume, APOE4 allele, or cognitive reserve) best predicted inter-individual differences in a Face-name association memory task within the SCD group.

RESULTS

Hippocampal volume was found to be the only and best predictor of memory performance. We then compared the demographic, clinical and cognitive characteristics of two SCD subgroups, one with small hippocampal volume (SCD/SH) and another with normal hippocampal volume (SCD/NH), with MCI and CTRLS. SCD/SH were comparable to MCI on neuropsychological tasks evaluating memory (i.e., test of delayed word recall), whereas SCD/NH were comparable to CTRLS.

CONCLUSION

Thus, using hippocampal volume allows identification of an SCD subgroup with a cognitive profile consistent with a higher risk of conversion to AD.

Do informant-reported subjective cognitive complaints predict progression to mild cognitive impairment and dementia better than self-reported complaints in old adults? A meta-analytical study

BACKGROUND

Subjective cognitive complaints (SCCs) are considered a risk factor for objective cognitive decline and conversion to dementia. The aim of this study was to determine whether self-reported or informant-reported SCCs best predict progression to mild cognitive impairment (MCI) and/or dementia.

METHODS

We reviewed prospective longitudinal studies of Cognitively Unimpaired (CU) older adults with self-reported and informant-reported SCCs at baseline, assessed by questions or questionnaires that considered the transition to MCI and/or dementia. A random-effects meta-analysis was performed to obtain pooled estimates and 95% CIs.

RESULTS

Both self-reported and informant-reported SCCs are associated with an elevated risk of transition from CU to MCI and/or dementia. The association appears stronger and more robust for informant-reported data [1.38, with a 95% CI of 1.16 -1.64, p < 0.001] than for self-reported data [1.27 (95% CI 1.06 - 1.534, p = 0.011].

CONCLUSIONS

Our results suggest that corroborated information from one informant could provide important details for distinguishing between normal aging and clinical states.

A systematic review of subjective cognitive characteristics predictive of longitudinal outcomes in older adults

BACKGROUND AND OBJECTIVES

Subjective cognitive decline (SCD) is a common experience of self-perceived decline without objective cognitive impairment among older adults. SCD has been conceptualized as very early Alzheimer's disease (AD), but the specific SCD features predictive of clinical or cognitive decline remain unclear. This systematic review is the first to characterize specific SCD features and their relation to longitudinal outcomes.

RESEARCH DESIGN AND METHODS

Multiple electronic databases were searched from inception until August 2021 for longitudinal studies of adults aged >50 (mean>60) and free of dementia, with baseline SCD measurement and clinical or cognitive follow-up. Studies were screened for inclusion criteria and assessed for risk of bias using weight-of-evidence ratings.

RESULTS

570 potentially relevant studies were identified, and 52 studies evaluated for eligibility after initial screening. Thirty-three studies with medium to high weight-of-evidence ratings were included and results narratively synthesized. Measurement methods varied substantially across studies: the majority (n=27) assessed SCD symptom types and intensity, and consistently reported that higher symptom burden increased the risk for MCI and dementia. The evidence was less compelling for cognitive outcomes. A handful of studies (n=5) suggested a predictive role for SCD symptom consistency and informant corroboration.

DISCUSSION AND IMPLICATIONS

SCD symptom intensity emerged from our review as the most reliable predictor of future clinical outcomes. Combinations of SCD-Plus symptoms also had predictive utility. No single symptom was uniquely prognostic. Our findings support the quantitative evaluation of SCD symptoms in the assessment of risk for progression to MCI or dementia.

Self- and Partner-Reported Subjective Memory Complaints: Association with Objective Cognitive Impairment and Risk of Decline

Background

Episodic memory decline is a hallmark of Alzheimer's disease (AD). Subjective memory complaints (SMCs) may represent one of the earliest signs of impending cognitive decline. The degree to which self- or partner-reported SMCs predict cognitive change remains unclear.

Objective

We aimed to evaluate the relationship between self- and partner-reported SMCs, objective cognitive performance, AD biomarkers, and risk of future decline in a well-characterized longitudinal memory center cohort. We also evaluated whether study partner characteristics influence reports of SMCs.

Methods

758 participants and 690 study partners were recruited from the Penn Alzheimer's Disease Research Center Clinical Core. Participants included those with Normal Cognition, Mild Cognitive Impairment, and AD. SMCs were measured using the Prospective and Retrospective Memory Questionnaire (PRMQ), and were evaluated for their association with cognition, genetic, plasma, and neuroimaging biomarkers of AD, cognitive and functional decline, and diagnostic progression over an average of four years.

Results

We found that partner-reported SMCs were more consistent with cognitive test performance and increasing symptom severity than self-reported SMCs. Partner-reported SMCs showed stronger correlations with AD-associated brain atrophy, plasma biomarkers of neurodegeneration, and longitudinal cognitive and functional decline. A 10-point increase on baseline PRMQ increased the annual risk of diagnostic progression by approximately 70%. Study partner demographics and relationship to participants influenced reports of SMCs in AD participants only.

Conclusion

Partner-reported SMCs, using the PRMQ, have a stronger relationship with the neuroanatomic and cognitive changes associated with AD than patient-reported SMCs. Further work is needed to evaluate whether SMCs could be used to screen for future decline.

Neuroticism predicts informant reported cognitive problems through health behaviors

OBJECTIVE

Personality traits have been linked to cognitive impairment, though work is needed to understand the mechanisms involved. Research also needs to consider alternative markers of cognitive impairment, such as informant report measures. The aim of the current study was to examine the role of health behaviors and social engagement as mediators for the relationship between personality and informant reported cognitive problems. It was expected that neuroticism would predict cognitive problems through negative health behaviors, while conscientiousness might predict cognitive problems through positive health behaviors.

METHODS

Using data from the St. Louis Personality and Aging Network study at three time points, spanning approximately 2.27 years (N = 829, M age = 65.95), correlations were computed between the Big Five personality traits and health behaviors at wave 1, social engagement at wave 2, and informant reported cognitive problems at wave 3. Mediation tests examined whether health behaviors and social engagement explained the relationships found between personality and informant reported cognitive problems.

RESULTS

Findings showed that neuroticism at wave 1 significantly predicted informant reported cognitive problems at wave 3 and that health behaviors, specifically wellness maintenance, partially explained this relationship. No significant associations were found between informant reported cognitive problems and conscientiousness, agreeableness, extraversion, openness, or social engagement.

CONCLUSION

This study supports claims that neuroticism predicts later cognitive problems and expands on previous literature by demonstrating this relationship using an informant report measure. Furthermore, we found that health behaviors, and specifically wellness maintenance, account for some of the relationship between neuroticism and informant reported cognitive problems.

Subjective Cognitive Decline: Level of Risk for Future Dementia and Mild Cognitive Impairment, a Meta-Analysis of Longitudinal Studies

Subjective Cognitive Decline (SCD) in older adults has been identified as a risk factor for dementia, although the literature is inconsistent, and it is unclear which factors moderate progression from SCD to dementia. Through separate meta-analyses, we aimed to determine if SCD increased the risk of developing dementia or mild cognitive impairment (MCI). Furthermore, we examined several possible moderators. Longitudinal studies of participants with SCD at baseline, with data regarding incident dementia or MCI, were extracted from MEDLINE and PsycINFO. Articles were excluded if SCD occurred solely in the context of dementia, MCI, or as part of a specific disease. Pooled estimates were calculated using a random-effects model, with moderator analyses examining whether risk varied according to SCD definition, demographics, genetics, recruitment source, and follow-up duration. Risk of study bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. 46 studies with more than 74,000 unique participants were included. SCD was associated with increased risk of developing dementia (HR = 1.90, 95% CI 1.52-2.36; OR = 2.48, 95% CI 1.97-3.14) and MCI (HR = 1.73, 95% CI 1.18-2.52; OR = 1.83, 95% CI 1.56-2.16). None of the potential moderating factors examined influenced the HR or OR of developing dementia. In contrast, including worry in the definition of SCD, younger age, and recruitment source impacted the OR of developing MCI, with clinic samples demonstrating highest risk. SCD thus represents an at-risk phase, ideal for early intervention, with further research required to identify effective interventions for risk reduction, and cognitive-behavioural interventions for cognitive management. PROSPERO, protocol number: CRD42016037993.

Subjective cognitive assessments and N-back are not correlated, and they are differentially affected by anxiety and depression

Cognitive function (CF) is a core feature related to all psychiatric disorders. However, self-report scales of CF (SRSC) may not always correlate with CF's objective measures and may have different mediators. Tools to select for evaluating CF in diverse psychiatric populations and their determinants need to be studied. In this study, we aimed to assess the association of SRSC (Perceived Deficit Questionnaire-Depression (PDQ-D), and World Health Organization's Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) and its inattentiveness subscale) with Letter-N-back as an objective measure of CF, and to analyze their association with psychopathology. Two hundred nine (131 nonclinical, and 78 clinical with a psychiatric diagnosis of ICD10 F31-39 [mood disorders excluding Bipolar I] or F40-F49 [neurotic, stress-related or psychosomatic disorder] categories) participants were evaluated with PDQ-D, ASRS, Beck Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI), and N-back. Both groups' data were included in the analysis. PDQ-D showed a small correlation with N-back scores, whereas ASRS showed no correlation. PDQ-D and ASRS showed a large correlation. Age and BAI scores significantly predicted both PDQ-D and ASRS, whereas the cognitive subscale of BDI predicted PDQ-D, but not ASRS. Only BAI scores predicted N-back results. The mediation model revealed that 2-back scores of N-back task directly affects PDQ-D scores, independent of BDI scores. However, the cognitive subscale of BDI moderated 2-back and PDQ-D association. On the contrary, BAI scores significantly mediated the association of 2-back scores with PDQ-D. The direct effect of 2-back scores in PDQ-D was insignificant in the mediation of BAI scores. Our study validates the discordance between SRSC and an objective measurement of CF. Anxiety may affect both self-report and objective measurement of CF, whereas depressive thought content may lead to higher cognitive dysfunction reports in nondemented participants.

Proton therapy for selected low grade glioma patients in the Netherlands

Proton therapy offers an attractive alternative to conventional photon-based radiotherapy in low grade glioma patients, delivering radiotherapy with equivalent efficacy to the tumour with less radiation exposure to the brain. In the Netherlands, patients with favourable prognosis based on tumour and patient characteristics can be offered proton therapy. Radiation-induced neurocognitive function decline is a major concern in these long surviving patients. Although level 1 evidence of superior clinical outcome with proton therapy is lacking, the Dutch National Health Care Institute concluded that there is scientific evidence to assume that proton therapy can have clinical benefit by reducing radiation-induced brain damage. Based on this decision, proton therapy is standard insured care for selected low grade glioma patients. Patients with other intracranial tumours can also qualify for proton therapy, based on the same criteria. In this paper, the evidence and considerations that led to this decision are summarised. Additionally, the eligibility criteria for proton therapy and the steps taken to obtain high-quality data on treatment outcome are discussed.

Self-Reported Personality Traits and Informant-Rated Cognition: A 10-Year Prospective Study

Personality traits, such as higher Neuroticism and lower Conscientiousness, are associated with risk of Alzheimer's disease and other dementias. A diagnosis of dementia relies, in part, on informant ratings of the individual's cognitive status. Here we examine whether self-reported personality traits are associated with four measures of informant-rated cognition up to a decade later. Participants from the Health and Retirement Study (N = 2,536) completed a five-factor model measure of personality in 2006 or 2008. Informants completed the 2016 Harmonized Cognitive Assessment Protocol (HCAP), which included ratings of the participant's current cognitive functioning and change in cognitive function over the last decade assessed with the IQCODE, Blessed, 1066, and CSID. Controlling for characteristics of the participant, informant, and their relationship, higher Neuroticism and lower Conscientiousness were associated consistently with worse informant-rated cognition. The association between Openness and better informant-rated cognition was due primarily to higher baseline cognitive function. Extraversion and Agreeableness were associated with better informant-rated cognition only among participants who were cognitively intact at follow-up. The present research suggests that knowledgeable informants are able to detect cognitive deficits associated with personality.

Cognitive impairments in patients with persistent symptoms attributed to Lyme disease

Background

Persistent symptoms attributed to Lyme borreliosis often include self-reported cognitive impairment. However, it remains unclear whether these symptoms can be substantiated by objective cognitive testing.

Methods

For this observational study, cognitive performance was assessed in 280 adults with persistent symptoms attributed to Lyme borreliosis (as part of baseline data collected for the Dutch PLEASE study). Cognitive testing covered the five major domains: episodic memory, working memory / attention, verbal fluency, information-processing speed and executive function. Patients’ profiles of test scores were compared to a large age-, education- and sex-adjusted normative sample using multivariate normative comparison. Performance validity was assessed to detect suboptimal effort, and questionnaires were administered to measure self-reported cognitive complaints, fatigue, anxiety, depressive symptoms and several other psychological factors.

Results

Of 280 patients, one was excluded as the test battery could not be completed. Of the remaining 279 patients, 239 (85.4%) displayed sufficient performance validity. Patients with insufficient performance validity felt significantly more helpless and physically fatigued, and less orientated. Furthermore, they had a lower education level and less often paid work. Of the total study cohort 5.7% (n = 16) performed in the impaired range. Among the 239 patients who displayed sufficient performance validity, 2.9% (n = 7) were classified as cognitively impaired. No association between subjective cognitive symptoms and objective impairment was found.

Conclusions

Only a small percentage of patients with borreliosis-attributed persistent symptoms have objective cognitive impairment. Performance validity should be taken into account in neuropsychological examinations of these patients. Self-report questionnaires are insufficiently valid to diagnose cognitive impairment.

Trial registration

ClinicalTrials.gov NCT01207739. Registered 23 September 2010.