Prevalence and determinants of subjective cognitive decline in a representative Greek elderly population

Subjective Cognitive Decline and Genetic Propensity for Dementia beyond Apolipoprotein ε4: A Systematic Review

Subjective cognitive decline (SCD) has been described as a probable early stage of dementia, as it has consistently appeared to precede the onset of objective cognitive impairment. SCD is related to many risk factors, including genetic predisposition for dementia. The Apolipoprotein (APOE) ε4 allele, which has been thoroughly studied, seems to explain genetic risk for SCD only partially. Therefore, we aimed to summarize existing data regarding genetic factors related to SCD, beyond APOE ε4, in order to improve our current understanding of SCD. We conducted a PRISMA systematic search in PubMed/MEDLINE and Embase databases using the keywords "subjective cognitive decline" and "genetic predisposition" with specific inclusion and exclusion criteria. From the 270 articles identified, 16 were finally included for the qualitative analysis. Family history of Alzheimer's disease (AD) in regard to SCD was explored in eight studies, with conflicting results. Other genes implicated in SCD, beyond APOE ε4, were investigated in six studies, which were not strong enough to provide clear conclusions. Very few data have been published regarding the association of polygenic risk for AD and SCD. Thus, many more genes related to AD must be studied, with polygenic risk scores appearing to be really promising for future investigation.

Depressive symptoms in the entire spectrum of cognitive ageing in Greece: evidence from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD)

OBJECTIVES

To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data.

METHODS

The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model.

RESULTS

Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly.

CONCLUSIONS

Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.

Face-to-face vs. Telerehabilitation language and cognitive training in patients with multi-domain amnestic mild cognitive impairment

The recent coronavirus emergency raised the question of whether telerehabilitation could be as effective as conventional face-to-face intervention. The aim of the present study was to compared language and cognitive training delivered to patients from a distance, through telecommunication systems, for the same intervention conducted on a face-to-face mode in patients with multi domain amnestic MCI (md-aMCI). To this end, 30 patients diagnosed with md-aMCI took part in the present study. The participants divided into two groups; one group received conventional face-to-face training and the other group received Telerehabilitation training. Both groups received language training using paper and pencil tasks and cognitive training using the Rehacom software. The training lasted 15 weeks and was delivered twice a week, for 60 minutes per session. The conventional face-to-face mode had a significant impact on cognitive (delayed and working memory, processing speed, executive function, and attention) and language domains (naming, word recognition, and semantic fluency). The telerehabilitation method had a beneficial impact on delayed memory, naming, and semantic fluency. The results of our study provide evidence that both telerehabilitation and face-to-face language and cognitive training seem to have a positive impact in patients with md-aMCI, with face-to-face training improving more domains than telerehabilitation.

Understanding older adults' smartphone addiction in the digital age: empirical evidence from China

Background

Despite the fact that an increasing number of older adults are addicted to smartphones, the existing addiction literature still focuses primarily on adolescents. To address this issue, this study draws from the perspectives of subjective cognitive decline and family relationship conflict to examine older adults' smartphone addiction based on their key characteristics.

Methods

This study investigates the effects of subjective cognitive decline and family relationship conflict on older adults' smartphone addiction through a survey of 371 subjects in China.

Results

The results show that subjective cognitive decline and family relationship conflict affect older adults' smartphone addiction through a sense of alienation. In addition, older adults' perceived power moderates the relationship between alienation and smartphone addiction.

Discussion

This study offers new perspectives on the study of smartphone addiction from the perspective of older adults, and sheds light on how to improve the older adults' quality of life in their later years.

Subjective Memory Complaints Predict Decline in Memory, Instrumental Activities of Daily Living, and Social Participation in Older Adults: A Fixed-Effects Model

IMPORTANCE

Although subjective memory complaints (SMCs) have been suggested to be associated with future memory impairment, limitations in instrumental activities of daily living (IADLs), and social participation restriction, these associations are still inconclusive.

OBJECTIVE

To determine whether changes in SMCs over time predict decline in memory, IADLs, and social participation in older adults.

DESIGN

Longitudinal study.

SETTING

Community.

PARTICIPANTS

Sample 1 included 2,493 community-dwelling older adults drawn from the Health and Retirement Study (HRS) data collected between 2004 and 2018. Sample 2 included 1,644 community-dwelling older adults drawn from the HRS data collected between 2008 and 2018.

OUTCOMES AND MEASURES

Self-reported SMCs, memory function, self-reported IADL performance, and self-reported social participation.

RESULTS

The mean age of Sample 1 at baseline was 70.16 yr; 1,468 (58.88%) were female. In Sample 1, immediate and delayed memory (all ps < .001) and IADL performance (p < .01) declined over time. Increases in SMCs over time significantly predicted future immediate and delayed memory declines (p < .01 and p < .001, respectively) and future IADL performance decline (p < .001), after controlling for depressive symptoms. The mean age of Sample 2 at baseline was 71.52 yr; 928 (56.45%) were female. In Sample 2, social participation declined over time (all ps < .001). Increases in SMCs over time significantly predicted future social participation decline (p < .05), after controlling for depressive symptoms.

CONCLUSIONS AND RELEVANCE

Increases in SMCs predict future decline in memory, IADL performance, and social participation after accounting for depressive symptoms. What This Article Adds: SMCs can be used as an early indicator of future memory impairment, IADL limitations, and social participation restrictions in older adults. Furthermore, interventions that minimize SMCs may help older adults achieve successful aging.

Companion robots to mitigate loneliness among older adults: Perceptions of benefit and possible deception

Objective

Given growing interest in companion robots to mitigate loneliness, large-scale studies are needed to understand peoples' perspectives on the use of robots to combat loneliness and attendant ethical issues. This study examines opinions about artificial companion (AC) robots regarding deception with dementia and impact on loneliness.

Methods

Data are from a survey of 825 members of the OHSU Research via Internet Technology and Experience cohort (response rate = 45%). Sixty percent (n = 496) of the age diverse sample (range = 25-88; M = 64; SD = 13.17) is over 64, allowing us to compare across age and consider current and future older adults. Ordinal logistic regressions examined relationships between age, health, and other socio-demographic characteristics and perceptions of impact on loneliness and comfort with deception.

Results

Most participants (68.7%) did not think an AC robot would make them feel less lonely and felt somewhat-to-very uncomfortable (69.3%) with the idea of being allowed to believe that an artificial companion is human. In adjusted models, one additional year of age was associated with lower likelihood of perceived benefit of reducing loneliness [Odds Ratio (OR) = 0.98; (0.97-0.99), p = 0.003] and lower comfort with deception [OR = 0.99; (0.97-1.00), p = 0.044]. Being female was associated with lower likelihood of comfort with deception [OR = 0.68; (0.50-0.93), p = 0.014] and high confidence using computers with greater comfort [OR = 2.18; (1.42-3.38), p < 0.001].

Discussion

There was not strong support for AC robots to mitigate loneliness. Most participants were uncomfortable with this form of deception, indicating need for design solutions for those who want to avoid this possibility, as well as greater attentiveness to desirability and comfort across age and gender.

Evaluation of the Efficacy and Feasibility of a Telerehabilitation Program Using Language and Cognitive Exercises in Multi-Domain Amnestic Mild Cognitive Impairment

OBJECTIVE

The aim of the present study was to investigate the efficacy and feasibility of a telerehabilitation program in multi-domain amnestic Mild Cognitive Impairment (md-aMCI). The study sample consisted of 30 patients with md-aMCI and aged 60-80 years.

METHODS

The participants were randomly divided into two groups. The Training Group (TG), which received cognitive training by using the RehaCom software as well as paper-pencil language training and the Control Group (CG) which received standard clinical care (e.g., psychotherapy or/and physiotherapy). Duration of the telerehabilitation intervention was 15 weeks (twice a week for 60 min/session).

RESULTS

Our results revealed that the neuropsychological performance of the TG group after the telerehabilitation intervention improved on a statistically significant level on the domains of delayed and working memory, confrontation naming, verbal fluency, and global cognition. Comparison between the TG and CG revealed a significant impact of the telerehabilitation program on the domains of memory (delay and working) and language (naming and verbal fluency) as well as global cognition performance.

CONCLUSION

The findings of the study are promising in that the telerehabilitation intervention appears to be a useful method in improving or stabilizing cognitive decline in md-aMCI individuals and was a particularly effective alternative approach during the period of the pandemic lockdown. Specifically, the beneficial impact of the telerehabilitation intervention on episodic memory (which is one of the first domains to show impairment in md-aMCI patients) provides us with hope and evidence that these types of interventions may be applied with similar success using face-to-face interventions.

Development of a simple screening tool for determining cognitive status in Alzheimer's disease

Cognitive screening is often a first step to document cognitive status of patients suspected having Alzheimer's disease (AD). Unfortunately, screening neuropsychological tests are often insensitivity in the detection. The goal of this study was to develop a simple and sensitive screening neuropsychological test to facilitate early detection of AD. This study recruited 761 elderly individuals suspected of having AD and presenting various cognitive statuses (mean age: 77.69 ± 8.45 years; proportion of females: 65%; cognitively unimpaired, CU, n = 133; mild cognitive impairment, MCI, n = 231; dementia of Alzheimer's type, DAT, n = 397). This study developed a novel screening neuropsychological test incorporating assessments of the core memory deficits typical of early AD and an interview on memory function with an informant. The proposed History-based Artificial Intelligence-Show Chwan Assessment of Cognition (HAI-SAC) was assessed in terms of psychometric properties, test time, and discriminative ability. The results were compared with those obtained using other common screening tests, including Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA), and an extracted Mini-Mental State Examination score from CASI. HAI-SAC demonstrated acceptable internal consistency. Factor analysis revealed two factors: memory (semantic and contextual) and cognition-related information from informants. The assessment performance of HAI-SAC was strongly correlated with that of the common screening neuropsychological tests addressed in this study. HAI-SAC outperformed the other tests in differentiating CU individuals from patients with MCI (sensitivity: 0.87; specificity: 0.58; area under the curve [AUC]: 0.78) or DAT (sensitivity: 0.99; specificity: 0.89; AUC: 0.98). Performance of HAI-SAC on differentiating MCI from DAT was on par with performances of other tests (sensitivity: 0.78; specificity: 0.84; AUC: 0.87), while the test time was less than one quarter that of CASI and half that of MoCA. HAI-SAC is psychometrically sound, cost-effective, and sensitive in discriminating the cognitive status of AD.

Subjective cognitive decline and anxious/depressive symptoms during the COVID-19 pandemic: what is the role of stress perception, stress resilience, and β-amyloid?

Background

The COVID-19 pandemic may worsen the mental health of people reporting subjective cognitive decline (SCD) and therefore their clinical prognosis. We aimed to investigate the association between the intensity of SCD and anxious/depressive symptoms during confinement and the underlying mechanisms.

Methods

Two hundred fifty cognitively unimpaired participants completed the Hospital Anxiety and Depression Scale (HADS) and SCD-Questionnaire (SCD-Q) and underwent amyloid-β positron emission tomography imaging with [18F] flutemetamol (N = 205) on average 2.4 (± 0.8) years before the COVID-19 confinement. During the confinement, participants completed the HADS, Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), and an ad hoc questionnaire on worries (access to primary products, self-protection materials, economic situation) and lifestyle changes (sleep duration, sleep quality, eating habits). We investigated stress-related measurements, worries, and lifestyle changes in relation to SCD. We then conducted an analysis of covariance to investigate the association of SCD-Q with HADS scores during the confinement while controlling for pre-confinement anxiety/depression scores and demographics. Furthermore, we introduced amyloid-β positivity, PSS, and BRS in the models and performed mediation analyses to explore the mechanisms explaining the association between SCD and anxiety/depression.

Results

In the whole sample, the average SCD-Q score was 4.1 (± 4.4); 70 (28%) participants were classified as SCD, and 26 (12.7%) were amyloid-β-positive. During the confinement, participants reporting SCD showed higher PSS (p = 0.035) but not BRS scores (p = 0.65) than those that did not report SCD. No differences in worries or lifestyle changes were observed. Higher SCD-Q scores showed an association with greater anxiety/depression scores irrespective of pre-confinement anxiety/depression levels (p = 0.002). This association was not significant after introducing amyloid-β positivity and stress-related variables in the model (p = 0.069). Amyloid-β positivity and PSS were associated with greater HADS irrespective of pre-confinement anxiety/depression scores (p = 0.023; p < 0.001). The association of SCD-Q with HADS was mediated by PSS (p = 0.01).

Conclusions

Higher intensity of SCD, amyloid-β positivity, and stress perception showed independent associations with anxious/depressive symptoms during the COVID-19 confinement irrespective of pre-confinement anxiety/depression levels. The association of SCD intensity with anxiety/depression was mediated by stress perception, suggesting stress regulation as a potential intervention to reduce affective symptomatology in the SCD population in the face of stressors.

Initial Data and a Clinical Diagnosis Transition for the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration (ALBION) Study

Background and Objectives: This article presents data from the ongoing Aiginition Longitudinal Biomarker Investigation of Neurodegeneration study (ALBION) regarding baseline clinical characterizations and CSF biomarker profiles, as well as preliminary longitudinal data on clinical progression. Materials and Methods: As of March 2022, 138 participants who either were cognitively normal (CN, n = 99) or had a diagnosis of mild cognitive impairment (MCI, n = 39) had been recruited at the specialist cognitive disorders outpatient clinic at Aiginition Hospital. Clinical characteristics at baseline were provided. These patients were followed annually to determine progression from CN to MCI or even dementia. CSF biomarker data (amyloid β1-42, phosphorylated tau at threonine 181, and total tau) collected using automated Elecsys® assays (Roche Diagnostics) were available for 74 patients. These patients were further sorted based on the AT(N) classification model, as determined by CSF Aβ42 (A), CSF pTau (T), and CSF tTau (N). Results: Of the 49 CN patients with CSF biomarker data, 21 (43%) were classified as exhibiting “Alzheimer’s pathologic change” (A+Τ− (Ν)−) and 6 (12%) as having “Alzheimer’s disease” (A+T−(N)+, A+T+(N)−, or A+T+(N)+). Of the 25 MCI patients, 8 (32%) displayed “Alzheimer’s pathologic change”, and 6 (24%) had “Alzheimer’s disease”. A total of 66 individuals had a mean follow-up of 2.1 years (SD = 0.9, min = 0.8, max = 3.9), and 15 of those individuals (22%) showed a clinical progression (defined as a worsening clinical classification, i.e., from CN to MCI or dementia or from MCI to dementia). Overall, participants with the “AD continuum” AT(N) biomarker profile (i.e., A+T−(N)−, A+T−(N)+, A+T+(N)−, and A+T+(N)+) were more likely to clinically progress (p = 0.04). Conclusions: A CSF “AD continuum” AT(N) biomarker profile is associated with an increased risk of future clinical decline in CN or MCI subjects.

Control Matters in Elder Care Technology:: Evidence and Direction for Designing It In

Studies find that older adults want control over how technologies are used in their care, but how it can be operationalized through design remains to be clarified. We present findings from a large survey (n=825) of a well-characterized U.S. online cohort that provides actionable evidence of the importance of designing for control over monitoring technologies. This uniquely large, age-diverse sample allows us to compare needs across age and other characteristics with insights about future users and current older adults (n=496 >64), including those concerned about their own memory loss (n=201). All five control options, which are not currently enabled, were very or extremely important to most people across age. Findings indicate that comfort with a range of care technologies is contingent on having privacy- and other control-enabling options. We discuss opportunities for design to meet these user needs that demand course correction through attentive, creative work.

Cross-Cultural Longitudinal Study on Cognitive Decline (CLoCODE) for Subjective Cognitive Decline in China and Germany: A Protocol for Study Design

Background: Subjective cognitive decline (SCD) is considered as the first symptomatic manifestation of Alzheimer’s disease (AD), which is also affected by different cultural backgrounds. Establishing cross-cultural prediction models of SCD is challenging. Objective: To establish prediction models of SCD available for both the Chinese and European populations. Methods: In this project, 330 SCD from China and 380 SCD from Germany are intended to be recruited. For all participants, standardized assessments, including clinical, neuropsychological, apolipoprotein E (APOE) genotype, blood, and multi-parameter magnetic resonance imaging (MRI) at baseline will be conducted. Participants will voluntarily undergo amyloid positron emission tomography (PET) and are classified into amyloid-β (Aβ) positive SCD (SCD+) and Aβ negative SCD (SCD-). First, baseline data of all SCD individuals between the two cohorts will be compared. Then, key features associated with brain amyloidosis will be extracted in SCD+ individuals, and the diagnosis model will be established using the radiomics method. Finally, the follow-up visits will be conducted every 12 months and the primary outcome is the conversion to mild cognitive impairment or dementia. After a 4-year follow-up, we will extract factors associated with the conversion risk of SCD using Cox regression analysis. Results: At present, 141 SCD from China and 338 SCD from Germany have been recruited. Initial analysis showed significant differences in demographic information, neuropsychological tests, and regional brain atrophy in SCD compared with controls in both cohorts. Conclusion: This project may be of great value for future implications of SCD studies in different cultural backgrounds. Trial registration: ClinicalTrials.gov, NCT04696315. Registered 3 January 2021.

Exploring Network Properties Across Preclinical Stages of Alzheimer’s Disease Using a Visual Short-Term Memory and Attention Task with High-Density Electroencephalography: A Brain-Connectome Neurophysiological Study

Background: Visual short-term memory (VSTMT) and visual attention (VAT) exhibit decline in the Alzheimer’s disease (AD) continuum; however, network disruption in preclinical stages is scarcely explored. Objective: To advance our knowledge about brain networks in AD and discover connectivity alterations during VSTMT and VAT. Methods: Twelve participants with AD, 23 with mild cognitive impairment (MCI), 17 with subjective cognitive decline (SCD), and 21 healthy controls (HC) were examined using a neuropsychological battery at baseline and follow-up (three years). At baseline, the subjects were examined using high density electroencephalography while performing a VSTMT and VAT. For exploring network organization, we constructed weighted undirected networks and examined clustering coefficient, strength, and betweenness centrality from occipito-parietal regions. Results: One-way ANOVA and pair-wise t-test comparisons showed statistically significant differences in HC compared to SCD (t (36) = 2.43, p = 0.026), MCI (t (42) = 2.34, p = 0.024), and AD group (t (31) = 3.58, p = 0.001) in Clustering Coefficient. Also with regards to Strength, higher values for HC compared to SCD (t (36) = 2.45, p = 0.019), MCI (t (42) = 2.41, p = 0.020), and AD group (t (31) = 3.58, p = 0.001) were found. Follow-up neuropsychological assessment revealed converge of 65% of the SCD group to MCI. Moreover, SCD who were converted to MCI showed significant lower values in all network metrics compared to the SCD that remained stable. Conclusion: The present findings reveal that SCD exhibits network disorganization during visual encoding and retrieval with intermediate values between MCI and HC.

Difference in Amyloid Load Between Single Memory Domain and Multidomain Subjective Cognitive Decline: A Study from the SILCODE

Background: Subjective cognitive decline (SCD), an at-risk condition of Alzheimer’s disease (AD), can involve various cognitive domains, such as memory, language, planning, and attention. Objective: We aims to explore the differences in amyloid load between the single memory domain SCD (sd-SCD) and the multidomain SCD (md-SCD) and assess the relationship of amyloid pathology with quantitative SCD scores and objective cognition. Methods: A total of 63 SCD participants from the SILCODE study underwent the clinical evaluation, neuropsychological assessment, and 18F-florbetapir PET scan. Global amyloid standard uptake value ratio (SUVr) was calculated. Additionally, regional amyloid SUVr was quantified in 12 brain regions of interests. A nonparametric rank ANCOVA was used to compare the global and regional amyloid SUVr between the md-SCD (n = 34) and sd-SCD (n = 29) groups. A multiple linear regression analysis was conducted to test the relationship of amyloid SUVr with quantitative SCD scores and objective cognition. Results: Compared with individuals with sd-SCD, individuals with md-SCD had increased global amyloid SUVr (F = 5.033, p = 0.029) and regional amyloid SUVr in the left middle temporal gyrus (F = 12.309, p = 0.001; Bonferroni corrected), after controlling for the effects of age, sex, and education. When pooling all SCD participants together, the increased global amyloid SUVr was related with higher SCD-plus sum scores and lower Auditory Verbal Learning Test-delayed recall scores. Conclusion: According to our findings, individuals with md-SCD showed higher amyloid accumulation than individuals with sd-SCD, suggesting that md-SCD may experience a more advanced stage of SCD. Additionally, increased global amyloid load was predictive of a poorer episodic memory function in SCD individuals.

Influencing Factors of Subjective Cognitive Impairment in Middle-Aged and Older Adults

The purpose of this study was to identify the factors affecting subjective cognitive impairment. We analyzed data from the 2019 Korea Community Health Survey and enrolled 68,546 middle-aged adults, aged 50 to 64 years, and 74,547 older adults, aged 65 years and older, in this study. Multiple logistic regression analysis was performed to identify factors influencing subjective cognitive impairment. Of the participants, 11,926 (17.4%) middle-aged and 21,880 (29.4%) older adults living in the community reported subjective cognitive impairment. Major factors that influenced subjective cognitive impairment in both middle-aged and older adults were gender, subjective stress, depressive symptoms, and alcohol drinking. In contrast to middle-aged adults, the marital status of older adults affected subjective cognitive impairment. Therefore, the factors affecting subjective cognitive impairment in middle-aged and older adults need to be considered for screening and management to prevent cognitive impairment and dementia. In particular, it is necessary to evaluate and manage stress and depressive symptoms from middle age to prevent subjective cognitive impairment.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Memory awareness in patients with Major Depressive Disorder

BACKGROUND

Subjective Memory Complaints (SMC) along with cognitive deficits are frequently observed in patients with Major Depressive Disorder (MDD). The relationship between SMC and objective memory performance in patients with MDD was evaluated, in comparison with patients with Mild Cognitive Impairment due to Alzheimer's Disease (MCI-AD) and healthy controls (HC).

METHODS

Patients with MDD (n = 47), MCI-AD (n = 43) and HC (n = 45) were assessed with a self-report memory complaints scale (SMCS) and underwent a comprehensive clinical and neuropsychological assessment. A discrepancy score between the Logical Memory delayed recall and the SMCS total score was calculated as a measure of memory awareness.

RESULTS

Patients with MDD (12.5 ± 4.4) and patients with MCI-AD (10.9 ± 4.1) had not significantly different SMCS total scores, whereas HC showed significantly lower scores (4.0 ± 3.0). As much as 74.5% of patients with MDD patients and 65.1% of patients with MCI-AD reported prominent memory complaints, whereas only 4.4% of HC did. Patients with MDD had relatively preserved memory tests, resulting in a higher discrepancy score than both patients with MCI-AD and HC. The SMCS total score correlated positively with depressive symptoms in the 3 groups of participants.

CONCLUSIONS

Patients with MDD showed inaccurate memory self-awareness as they under-estimated their memory functioning, a pattern distinct from both patients with MCI-AD and HC.

Subjective cognitive failures and their psychological correlates in a large Italian sample during quarantine/self-isolation for COVID-19

Objective

The quarantine/self-isolation measures implemented to retard the spread of the 2019 coronavirus disease (COVID-19) may negatively affect the mental health of the population. The present study aimed to explore the impact of the psychological symptoms on the occurrence of cognitive failures in a large sample of home-dwelling Italian individuals during quarantine/self-isolation for COVID-19.

Methods

We employed an online questionnaire using a virtual platform of Google Moduli. The questionnaire included an assessment of cognitive failures evaluated by the Perceived Memory and Attentional Failures Questionnaire (PerMAFaQ) and of resilience, coping style, depression, anger, and anxiety.

Results

The online questionnaire was completed by 4175 participants revealing that about 30% of participants complained of cognitive failures at least sometimes during quarantine/self-isolation, whereas some respondents reported very frequent cognitive failures. Moreover, resilience was found to mediate the relationships between depressive and anger symptoms and cognitive failures. Although no difference was found on PerMAFaQ among smart-workers, non-smart-workers, and those currently not at work, people not working at the moment complained of more frequent cognitive failures.

Conclusions

These findings indicate the need to implement psychological support intervention, particularly for vulnerable groups, to reduce anxiety, depression, and anger, and of psychoeducational interventions to enhance resilience reducing possible long-term cognitive consequences of the quarantine.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-021-05268-1.

Frailty and Prodromal Parkinson's Disease: Results From the HELIAD Study

BACKGROUND

To investigate the association between frailty, Parkinson's disease (PD), and the probability of prodromal Parkinson's disease (prodromal PD) in Greek community-dwelling older individuals.

METHODS

Parkinson's disease diagnosis was reached through standard clinical research procedures. Probability of prodromal PD was calculated according to the International Parkinson and Movement Disorder Society's research criteria for PD-free participants. Frailty was evaluated according to definitions of the phenotypic and multidomain approach. Logistic and linear regression models were performed to investigate associations between frailty (predictor) and the probability of prodromal PD, either continuous or dichotomous (≥30% probability score), or PD (outcome).

RESULTS

Data from 1765 participants aged 65 and older were included in the present analysis. Parkinson's disease and prodromal PD prevalence were 1.9% and 3.0%, respectively. Compared to nonfrail participants, those who were frail, as identified with either the Fried frailty phenotype or Frailty Index had approximately 4 (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.54-10.89) and 12 times (OR 12.16, 95% CI 5.46-27.09) higher odds of having a PD diagnosis, respectively. Moreover, compared to the nonfrail, frail participants as identified with either the Fried frailty phenotype or Frailty Index had 2.8 (OR 2.83, 95% CI 1.09-7.37) and 8.3 times (OR 8.39, 95% CI 4.56-15.42) higher odds of having possible/probable prodromal PD, respectively.

CONCLUSIONS

Frailty status was associated with prodromal PD and PD, suggesting common characteristics or underlying mechanisms of these conditions. Although prospective studies are warranted, acknowledging the possible association of frailty, PD, and prodromal PD may improve their clinical management.

Estimating prevalence of subjective cognitive decline in and across international cohort studies of aging: a COSMIC study

Background

Subjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer’s disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts.

Methods

We combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence.

Results

The sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3–24.4%) and IRT (25.6%, 95%CI = 25.1–26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1–7.0%, to 52.7%, 95%CI = 47.4–58.0%; IRT: 7.8%, 95%CI = 6.8–8.9%, to 52.7%, 95%CI = 47.4–58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades.

Conclusions

SCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field.

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

AIMS

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

DESIGN

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

METHODS

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

RESULTS/FINDINGS

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

CONCLUSION

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

IMPACT

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

Prevalence and psychosocial correlates of subjectively perceived decline in five cognitive domains: Results from a population-based cohort study in Germany

OBJECTIVE

Subjective cognitive decline (SCD) was frequently investigated for memory in healthy aging or in relation to diseases like dementia. It was found to be related to sociodemographic and psychological variables as well as cognitive abilities. The prevalence of SCD in other cognitive domains and their relation to these variables is largely unknown to date. The present study aimed to fill this gap.

METHODS

A total of 807 subjects (18-85 years of age, M = 57.8 years, female: 43%) completed the Juelich Questionnaire on Subjective Cognitive Decline, to investigate SCD in memory, attention, language, motor, and executive functions. Logistic regression analyses were used to estimate association of depressive symptomatology, emotionality, and general cognitive performance as well as age, gender, and educational attainment with domain-specific SCD.

RESULTS

The highest prevalence rate was obtained for the memory domain (65.9%), followed by the attention (54.6%), motor (52.9%), executive (39.7%), and language domain (31.5%). Of the psychosocial factors, only age, depressive symptomatology and emotionality were consistently and strongly associated with domain-specific SCD prevalence.

CONCLUSIONS

SCD is prevalent not only in the memory domain, but also in other major cognitive domains. Our results also suggest that the suspicion from previous research, that subjective memory decline might be more strongly associated with depressive symptomatology and emotionality than with actual decline of cognitive performance, might also apply to the attention, motor, executive, and language domain. Further investigations using neuropsychological testing for specific cognitive functions and employing longitudinal designs are required for substantiating this suspicion.

Pharmacogenomics of Cognitive Dysfunction and Neuropsychiatric Disorders in Dementia

Symptomatic interventions for patients with dementia involve anti-dementia drugs to improve cognition, psychotropic drugs for the treatment of behavioral disorders (BDs), and different categories of drugs for concomitant disorders. Demented patients may take >6–10 drugs/day with the consequent risk for drug–drug interactions and adverse drug reactions (ADRs >80%) which accelerate cognitive decline. The pharmacoepigenetic machinery is integrated by pathogenic, mechanistic, metabolic, transporter, and pleiotropic genes redundantly and promiscuously regulated by epigenetic mechanisms. CYP2D6, CYP2C9, CYP2C19, and CYP3A4/5 geno-phenotypes are involved in the metabolism of over 90% of drugs currently used in patients with dementia, and only 20% of the population is an extensive metabolizer for this tetragenic cluster. ADRs associated with anti-dementia drugs, antipsychotics, antidepressants, anxiolytics, hypnotics, sedatives, and antiepileptic drugs can be minimized by means of pharmacogenetic screening prior to treatment. These drugs are substrates, inhibitors, or inducers of 58, 37, and 42 enzyme/protein gene products, respectively, and are transported by 40 different protein transporters. APOE is the reference gene in most pharmacogenetic studies. APOE-3 carriers are the best responders and APOE-4 carriers are the worst responders; likewise, CYP2D6-normal metabolizers are the best responders and CYP2D6-poor metabolizers are the worst responders. The incorporation of pharmacogenomic strategies for a personalized treatment in dementia is an effective option to optimize limited therapeutic resources and to reduce unwanted side-effects.

Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION): study design, cohort description, and preliminary data

Objectives: Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION) is a longitudinal ongoing study initiated in 2018 that takes place in the Cognitive Disorders Clinic of Aiginition Hospital of the National and Kapodistrian University of Athens. Its aim is to address several research questions concerning the preclinical and prodromal stage of Alzheimer's disease and explore potential markers for early detection, prediction, and primary prevention of dementia. Methods: We here present the design and the preliminary baseline characteristics of ALBION. The sample of our study consists of people aged over 50 who are concerned about their memory but are cognitively normal (CN) or have mild cognitive deficits. Each participant undergoes an extensive assessment including several demographic, medical, social, environmental, clinical, nutritional, neuropsychological determinants and lifestyle activities. Furthermore, we are collecting data from portable devices, neuroimaging techniques and biological samples (blood, stools, CSF). All participants are assessed annually for a period of 10 years. Results: In total, 47 participants have completed the initial evaluation up to date and are divided in two groups, CN individuals (N = 26) and MCI patients (N = 21), based on their cognitive status. The participants are, on average, 64 years old, 46.3% of the sample is male with an average of 12.73 years of education. MCI patients report more comorbidities and have a lower score in the MMSE test. Regarding APOE status, 2 participants are ε4 homozygotes and 10 ε4 heterozygotes. CSF analyses (Aβ42, Τ-tau, P-tau) revealed no differences between the two groups. Conclusion: The ALBION study offers an opportunity to explore preclinical dementia and identify new and tailored markers, particularly relating to lifestyle. Further investigation of these populations may provide a wider profile of the changes taking place in the preclinical phase of dementia, leading to potentially effective therapeutic and preventive strategies.

Multi-omics signature of brain amyloid deposition in asymptomatic individuals at-risk for Alzheimer's disease: The INSIGHT-preAD study

BACKGROUND

One of the biggest challenge in Alzheimer's disease (AD) is to identify pathways and markers of disease prediction easily accessible, for prevention and treatment. Here we analysed blood samples from the INveStIGation of AlzHeimer's predicTors (INSIGHT-preAD) cohort of elderly asymptomatic individuals with and without brain amyloid load.

METHODS

We performed blood RNAseq, and plasma metabolomics and lipidomics using liquid chromatography-mass spectrometry on 48 individuals amyloid positive and 48 amyloid negative (SUVr cut-off of 0·7918). The three data sets were analysed separately using differential gene expression based on negative binomial distribution, non-parametric (Wilcoxon) and parametric (correlation-adjusted Student't) tests. Data integration was conducted using sparse partial least squares-discriminant and principal component analyses. Bootstrap-selected top-ten features from the three data sets were tested for their discriminant power using Receiver Operating Characteristic curve. Longitudinal metabolomic analysis was carried out on a subset of 22 subjects.

FINDINGS

Univariate analyses identified three medium chain fatty acids, 4-nitrophenol and a set of 64 transcripts enriched for inflammation and fatty acid metabolism differentially quantified in amyloid positive and negative subjects. Importantly, the amounts of the three medium chain fatty acids were correlated over time in a subset of 22 subjects (p < 0·05). Multi-omics integrative analyses showed that metabolites efficiently discriminated between subjects according to their amyloid status while lipids did not and transcripts showed trends. Finally, the ten top metabolites and transcripts represented the most discriminant omics features with 99·4% chance prediction for amyloid positivity.

INTERPRETATION

This study suggests a potential blood omics signature for prediction of amyloid positivity in asymptomatic at-risk subjects, allowing for a less invasive, more accessible, and less expensive risk assessment of AD as compared to PET studies or lumbar puncture. FUND: Institut Hospitalo-Universitaire and Institut du Cerveau et de la Moelle Epiniere (IHU-A-ICM), French Ministry of Research, Fondation Alzheimer, Pfizer, and Avid.