Subjective cognitive impairment

The translational power of Alzheimer's-based organoid models in personalized medicine: an integrated biological and digital approach embodying patient clinical history

Alzheimer's disease (AD) is a complex neurodegenerative condition characterized by a multifaceted interplay of genetic, environmental, and pathological factors. Traditional diagnostic and research methods, including neuropsychological assessments, imaging, and cerebrospinal fluid (CSF) biomarkers, have advanced our understanding but remain limited by late-stage detection and challenges in modeling disease progression. The emergence of three-dimensional (3D) brain organoids (BOs) offers a transformative platform for bridging these gaps. BOs derived from patient-specific induced pluripotent stem cells (iPSCs) mimic the structural and functional complexities of the human brain. This advancement offers an alternative or complementary approach for studying AD pathology, including β-amyloid and tau protein aggregation, neuroinflammation, and aging processes. By integrating biological complexity with cutting-edge technological tools such as organ-on-a-chip systems, microelectrode arrays, and artificial intelligence-driven digital twins (DTs), it is hoped that BOs will facilitate real-time modeling of AD progression and response to interventions. These models capture central nervous system biomarkers and establish correlations with peripheral markers, fostering a holistic understanding of disease mechanisms. Furthermore, BOs provide a scalable and ethically sound alternative to animal models, advancing drug discovery and personalized therapeutic strategies. The convergence of BOs and DTs potentially represents a significant shift in AD research, enhancing predictive and preventive capacities through precise in vitro simulations of individual disease trajectories. This approach underscores the potential for personalized medicine, reducing the reliance on invasive diagnostics while promoting early intervention. As research progresses, integrating sporadic and familial AD models within this framework promises to refine our understanding of disease heterogeneity and drive innovations in treatment and care.

Navigating memory problems and mild cognitive impairment in later life: A qualitative secondary data analysis

Many people experience memory concerns as they get older, which can produce uncertainty and confusion. Some seek help for memory concerns and receive diagnoses of Mild Cognitive Impairment or Subjective Cognitive Decline, while most do not. We aimed to explore the subjective experiences of people with cognitive concerns, and how memory impairment is understood in the context of ageing. We undertook a secondary data analysis of 18 in-depth semi-structured interviews with people aged 60+ living with memory concerns, 9 of whom had sought professional help. We thematically analysed the data, identifying three themes. 1. Situating Memory Concerns: people are required to situate their experiences within contradictory discourses: medicalised, diagnostic categories, and reassurances that symptoms are normal, part of ageing and distinct from dementia. 2. Affirming self in the face of memory loss: individuals refer to social roles in families, work, and associated activities to reaffirm identity. For some, activities were a vital anchor of identity, resulting in negative self-comparison to their past self if abilities declined. 3. Maintaining identity and Relationships; labelling memory concerns helped relatives seeking external validation of symptoms, but not the person experiencing them, for whom it brought no additional support. Consequently, some participants concealed memory concerns. We concluded that the subjective experiences of people with memory concerns were characterised by confusion, and diagnostic labels compounded this rather than offering reassurance, bringing tension to some relationships. Activities were often perceived as an outward sign of continuing identity, leading to distress when ability to continue them declined. We discuss these issues in relation to broader societal issues around age and ageing.

Effects of Persistent Depression on Recall Memory are Moderated by Subjective Age Levels: Evidence From Community-Dwelling Older Adults

Results concerning memory performance in older adults with persistent-depression versus other depressive states (i.e., no-depression, past-depression and current-depression) are disparate. This study examined if persistent-depression is linked with impaired memory (measured by recall), and whether this link is moderated by one's feeling older or younger (subjective age). The study used data from waves 5 and 6 of SHARE-Israel (Survey of Health, Ageing and Retirement in Europe), collected in 2013 and 2015. This representative sample focuses on adults aged 50 and above (N = 1254, mean age = 68.4 ± 9.02). Each wave assessed depression, immediate and delayed recall, fluency and numeracy; subjective age was assessed only at 2015. The main moderation effect was analysed with a hierarchical regression analysis. Memory impairments in the persistent-depression group were evident only for those feeling older. There were no effects of subjective age on fluency and numeracy tasks. Limitations include usage of self-report measures to assess depression, as well as applying a minimal inter-wave duration (2 years) to assess persistent depression. Results are aligned with a resource-stress account of subjective which claims that one's subjective age refelcts a ratio of resoucres-to-stress. Implications suggest that challenges of ageing in the shadow of depression can be compounded by feeling older, that memory (vs. other cognitive tasks) may be uniquely linked with subjective age, and that feeling older is a potential risk factor for impaired memory in persistent-depression. The importance of possible interventions aimed at lowering subjective age are mentioned.

Estimating Chronological Age From the Electrical Activity of the Brain: How EEG-Age Can Be Used as a Marker of General Brain Functioning

With an aging global population, the number of older adults with age-related changes in the brain, including dementia, will continue to increase unless we can make progress in the early detection and treatment of such conditions. There is extensive literature on the effects of aging on the EEG, particularly a decline in the Peak Alpha Frequency (PAF), but here, in a reversal of convention, we used the EEG power-frequency spectrum to estimate chronological age. The motivation for this approach was that an individual's brain age might act as a proxy for their general brain functioning, whereby a discrepancy between chronological age and EEG age could prove clinically informative by implicating deleterious conditions. With a sample of sixty healthy adults, whose ages ranged from 20 to 78 years, and using multivariate methods to analyze the broad EEG spectrum (0.1-45 Hz), strong positive correlations between chronological age and EEG age emerged. Furthermore, EEG age was a more accurate estimate and accounted for more variance in chronological age than well-established PAF-based estimates of age, indicating that EEG age could be a more comprehensive measure of general brain functioning. We conclude that EEG age could become a biomarker for neural and cognitive integrity.

A Mindfulness-Based Lifestyle Intervention for Dementia Risk Reduction: Protocol for the My Healthy Brain Feasibility Randomized Controlled Trial

BACKGROUND

Lifestyle behavior change and mindfulness have direct and synergistic effects on cognitive functioning and may prevent Alzheimer disease and Alzheimer disease-related dementias (AD/ADRD). We are iteratively developing and testing My Healthy Brain (MHB), the first mindfulness-based lifestyle group program targeting AD/ADRD risk factors in older adults with subjective cognitive decline. Our pilot studies (National Institutes of Health [NIH] stage 1A) have shown that MHB is feasible, acceptable, and associated with improvement in lifestyle behavior and cognitive outcomes.

OBJECTIVE

We will compare the feasibility of MHB versus an education control (health enhancement program [HEP]) in 50 older adults (aged ≥60 y) with subjective cognitive decline and AD/ADRD risk factors. In an NIH stage 1B randomized controlled trial (RCT), we will evaluate feasibility benchmarks, improvements in cognitive and lifestyle outcomes, and engagement of hypothesized mechanisms.

METHODS

We are recruiting through clinics, flyers, web-based research platforms, and community partnerships. Participants are randomized to MHB or the HEP, both delivered in telehealth groups over 8 weeks. MHB participants learn behavior modification and mindfulness skills to achieve individualized lifestyle goals. HEP participants receive lifestyle education and group support. Assessments are repeated after the intervention and at a 6-month follow-up. Our primary outcomes are feasibility, acceptability, appropriateness, credibility, satisfaction, and fidelity benchmarks. The secondary outcomes are cognitive function and lifestyle (physical activity, sleep, nutrition, alcohol and tobacco use, and mental and social activity) behaviors. Data analyses will include the proportion of MHB and HEP participants who meet each benchmark (primary outcome) and paired samples 2-tailed t tests, Cohen d effect sizes, and the minimal clinically important difference for each measure (secondary outcomes).

RESULTS

Recruitment began in January 2024. We received 225 inquiries. Of these 225 individuals, 40 (17.8%) were eligible. Of the 40 eligible participants, 21 (52.5%) were enrolled in 2 group cohorts, 17 (42.5%) were on hold for future group cohorts, and 2 (5%) withdrew before enrollment. All participants have completed before the intervention assessments. All cohort 1 participants (9/21, 43%) have completed either MHB or the HEP (≥6 of 8 sessions) and after the intervention assessments. The intervention for cohort 2 (12/21, 57%) is ongoing. Adherence rates for the Garmin Vivosmart 5 (128/147, 87.1% weeks) and daily surveys (105/122, 86.1% weeks) are high. No enrolled participants have dropped out. Enrollment is projected to be completed by December 2024.

CONCLUSIONS

The RCT will inform the development of a larger efficacy RCT (NIH stage 2) of MHB versus the HEP in a more diverse sample of older adults, testing mechanisms of improvements through theoretically driven mediators and moderators. The integration of mindfulness with lifestyle behavior change in MHB has the potential to be an effective and sustainable approach for increasing the uptake of AD/ADRD risk reduction strategies among older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05934136; https://www.clinicaltrials.gov/study/NCT05934136.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64149.

Risk of Stroke or Heart Attack in Mild Cognitive Impairment and Subjective Cognitive Impairment

BACKGROUND

The study aimed to identify Mild Cognitive Impairment (MCI) as an alert clinical manifestation of increased probability of major acute vascular events (MVEs), such as Ischemic Stroke and heart attack.

METHODS

In a longitudinal study, 181 (M = 81, F = 100; mean age of 75.8 ± 8.69 years) patients were enrolled and divided into three groups based on diagnosis: Subjective Cognitive Impairment (SCI), amnestic MCI Single Domain (aMCI-SD), and amnestic MCI More Domain (aMCI-MD). Clinical assessment and the presence of vascular risk factors were collected.

RESULTS

The distribution of MVEs showed a higher incidence in the first two years of follow-up of 7.4% in SCI, 12.17% in aMCI-SD, and 8.57% in aMCI-MD. Acute Myocardial Infarction showed a major incidence in one year of follow-up (41%) and in two years of follow-up (29%). Also, Ischemic Stroke showed a major incidence in one year of follow-up (30%) and in two years of follow-up (40%). A statistically significant difference in the progression to dementia was shown (SCI 3.75%; aMCI-SD 10.43%; aMCI-MD 37%; p-value < 0.001).

CONCLUSIONS

MCI is considered an expression of the systemic activation of mechanisms of endothelial damage, representing a diagnosis predictive of increased risk of MVEs.

The Congruence and Interrelationship: A Dyadic Perspective on the Subjective Cognitive Impairment in the Patients with Colorectal Cancer and Their Spousal Caregivers

OBJECTIVES

Patients with colorectal cancer (CRC) reported experiencing subjective cognitive impairment (SCI), and their spousal caregivers perceived the patients' SCI. This cross-sectional study assessed the congruence of SCI between the patients' self-reports and the spousal caregivers' perceptions and examined the factors affecting SCI from the dyadic perspective.

METHODS

A total of 200 dyads of patients with CRC and their spousal caregivers were invited to complete the survey, which evaluated the SCI, dyadic coping (DC), quality of life, anxiety, and depression for the dyads. Congruence was analyzed using the intraclass correlation coefficient (ICC) and paired-sample t test. Impacting factors analysis was conducted using Pearson correlations, hierarchical multiple regression, and actor-partner interdependence mediation model.

RESULTS

The congruency of SCI between the patient-reported and the spouse-perceived ranged from moderate to good (ICC = 0.75 to 0.86). After controlling demographic variables (the patients' gender and spouses' work status), the DC of both patients and spousal caregivers, and the emotional health of patients were significant predictors for patients' SCI (all P < .05). In the actor-partner interdependence mediation model, there was an actor effect between DC and SCI for both patients and spousal caregivers and a partner effect between DC and SCI for patients. Moreover, patients' emotional health (anxiety and depression) had the mediating effect between DC and SCI for both patients and spousal caregivers.

CONCLUSION

Spousal caregivers played a vital role in assessment and management in the SCI of patients. The DC of patients and spousal caregivers and the emotional health of patients (eg, anxiety and depression) were major predictors for the SCI of patients.

IMPLICATIONS FOR NURSING

Nursing providers should consider the importance of patients' and spousal caregivers' perspectives in assessing and managing SCI. This study supports nurses focusing on the congruence and interrelationship of SCI to enhance DC for CRC patients and their spousal caregivers. This approach aims to reduce emotional distress and develop cognitive interventions from a dyadic perspective.

Web-based cognitive interventions on subjective cognitive impairment in cancer survivors: A systemic review

Objective

Cancer survivors have experienced subjective cognitive impairment (SCI) when they received cancer diagnoses or treatments. Their psychosocial and emotional statuses were also impacted. With the advancement of web technologies, web-based cognitive interventions have been implemented in the management and the alleviation of the SCI, the psychosocial distress, and the emotional distress in cancer survivors. This review aimed to summarize the intervention contents of web-based cognitive interventions for SCI, and to explore the effects of the interventions on SCI, psychosocial status, and emotional health.

Methods

Six databases (CINAHL Plus, Cochrane Library, Embase, APA PsycInfo, PubMed and CNKI) were searched from the establishment of databases up to December 2023. Literature references were also manually searched for related articles.

Results

This review contained 21 studies that covered the contents of web-based cognitive interventions, such as computer-assisted cognitive training, online cognitive rehabilitation, cognitive behavior therapy with the Internet, telehealth physical exercise, and web-based mindfulness interventions. The effects of web-based cognitive interventions positively impacted SCI for cancer survivors. Also, these interventions showed varying degrees of effectiveness in alleviating psychosocial and emotional distresses.

Conclusion

By summarizing five types of cognitive intervention contents delivered via web technology, this review demonstrated that web-based cognitive interventions optimized SCI and overall psychosocial and emotional statuses for the cancer survivors. It is recommended that future research focus on the development of customized web-based cognitive interventions for individuals with SCI, along with their psychosocial and emotional statuses.

Subjective Cognitive Impairment and Physical Activity: Investigating Risk Factors and Correlations among Older Adults in Spain

Subjective cognitive impairment in older persons has a substantial influence on their quality of life and can progress to serious illnesses such as dementia. Physical activity level can help prevent cognitive decline and improve cognitive performance. The aim of this study was to investigate the association between frequency of physical activity and subjective cognitive impairment in Spanish adults aged 65 and over, and to identify different risk factors. Using data from the EHSS20 survey, the study focused on 7082 participants who provided information on cognitive impairment and physical activity. Key predictor variables included age, gender, BMI, marital status, and education level. A significant relationship was found between BMI category and gender, with 66.5% of the population being overweight or obese. Men were more likely to be overweight than women. Socio-demographic factors such as educational level, marital status, and physical activity frequency showed dependent associations with sex. Women had a higher prevalence of subjective cognitive impairment than men. A strong association was found between frequency of physical activity and subjective cognitive impairment, with inactive older people having the highest prevalence of subjective cognitive impairment. Older women who engage in little physical exercise and have less education are at risk for subjective cognitive impairment. Furthermore, for both men and women, being overweight was associated with a more reduced risk than obesity. Significant relationships were also discovered between subjective cognitive impairment, frequency of physical exercise, gender, BMI, and degree of education. In conclusion, older, sedentary women with high BMI and less education are more likely to experience subjective cognitive impairment.

Analysis of agreement between measures of subjective cognitive impairment and probable dementia in the National Health and Aging Trends Study

BACKGROUND

Subjective cognitive impairment (SCI) measures in population-based surveys offer potential for dementia surveillance, yet their validation against established dementia measures is lacking.

METHODS

We assessed agreement between SCI and a validated probable dementia algorithm in a random one-third sample (n = 1936) of participants in the 2012 National Health and Aging Trends Study (NHATS).

RESULTS

SCI was more prevalent than probable dementia (12.2% vs 8.4%). Agreement between measures was 90.0% and of substantial strength. Misclassification rates were higher among older and less-educated subgroups due to higher prevalence of false-positive misclassification but did not vary by sex or race and ethnicity.

DISCUSSION

SCI sensitivity (63.4%) and specificity (92.5%) against dementia were comparable with similar metrics for the NHATS probable dementia measure against the "gold-standard" Aging, Demographics, and Memory Study-based dementia criteria, implying that population-based surveys may afford cost-effective opportunities for dementia surveillance to assess risk and inform policy.

HIGHLIGHTS

The prevalence of subjective cognitive impairment (SCI) is generally higher than that of a validated measure of probable dementia, particularly within the youngest age group, females, Whites, and persons with a college or higher degree. Percent agreement between SCI and a validated measure of probable dementia was 90.0% and of substantial strength (prevalence- and bias-adjusted kappa, 0.80). Agreement rates were higher in older and less-educated subgroups, driven by the higher prevalence of false-positive disagreement, but did not vary significantly by sex or race and ethnicity. SCI's overall sensitivity and specificity were 63.4% and 92.5%, respectively, against a validated measure of probable dementia, suggesting utility as a low-cost option for dementia surveillance. Heterogeneity in agreement quality across subpopulations warrants caution in its use for subgroup analyses.

Perceived cognitive impairment is related to internalizing psychopathology but unrelated to objective cognitive performance among nongeriatric adults presenting for outpatient neuropsychological evaluation

Objective: This study investigated the relationship between perceived cognitive impairment, objective cognitive performance, and intrapersonal variables thought to influence ratings of perceived cognitive impairment. Method: Study sample comprised 194 nongeriatric adults who were seen in a general outpatient neuropsychology clinic for a variety of referral questions. The cognition subscale score from the WHO Disability Assessment Schedule served as the measure of perceived cognitive impairment. Objective cognitive performance was indexed via a composite score derived from a comprehensive neuropsychological battery. Internalizing psychopathology was indexed via a composite score derived from anxiety and depression measures. Medical and neuropsychiatric comorbidities were indexed by the number of different ICD diagnostic categories documented in medical records. Demographics included age, sex, race, and years of education. Results: Objective cognitive performance was unrelated to subjective concerns, explaining <1% of the variance in perceived cognitive impairment ratings. Conversely, internalizing psychopathology was significantly predictive, explaining nearly one-third of the variance in perceived cognitive impairment ratings, even after accounting for test performance, demographics, and number of comorbidities. Internalizing psychopathology was also highly associated with a greater discrepancy between scores on perceived and objective cognitive measures among participants with greater cognitive concerns. Clinically significant somatic symptoms uniquely contributed to the explained variance in perceived cognitive impairment (by ∼13%) when analyzed in a model with internalizing symptoms. Conclusions: These findings suggest that perceived cognitive impairment may be more indicative of the extent of internalizing psychopathology and somatic concerns than cognitive ability.

How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program

BACKGROUND

Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials.

METHODS

We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis.

RESULTS

We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients.

CONCLUSION

This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.

Optimizing the Implementation of a Lifestyle Dementia Prevention Intervention for Older Patients in an Academic Healthcare System

Background

Interventions that promote healthy lifestyles are critical for the prevention of Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). However, knowledge of the best practices for implementing AD/ADRD prevention in healthcare settings remains limited.

Objective

We aimed to qualitatively identify barriers and facilitators to implementing a clinical trial of a novel lifestyle intervention (My Healthy Brain) in our medical center for older patients with subjective cognitive decline who are at-risk for AD/ADRD.

Methods

We conducted focus groups with 26 healthcare professionals (e.g., physicians, psychology, nursing) from 5 clinics that treat older patients (e.g., memory care, psychiatry). Our qualitative analysis integrated two implementation frameworks to systematically capture barriers and facilitators to AD/ADRD prevention (Consolidated Framework for Implementation Science Research) that impact implementation outcomes of acceptability, appropriateness, and feasibility (Proctor's framework).

Results

We found widespread support for an RCT of My Healthy Brain and AD/ADRD prevention. Participants identified barriers related to patients (stigma, technological skills), providers (dismissiveness of "worried well," doubting capacity for behavior change), clinics (limited time and resources), and the larger healthcare system (underemphasis on prevention). Implementation strategies guided by Expert Recommendations for Implementing Change (ERIC) included: developing tailored materials, training staff, obtaining buy-in from leadership, addressing stigmatized language and practices, identifying "champions," and integrating with workflows and resources.

Conclusions

The results will inform our recruitment, enrollment, and retention procedures to implement the first randomized clinical trial of My Healthy Brain. Our study provides a blueprint for addressing multi-level barriers to the implementation of AD/ADRD prevention for older patients in medical settings.

A Longitudinal Study on Memory Enhancement in Subjective Cognitive Decline Patients: Clinical and Neuroimaging Perspectives

BACKGROUND

Subjective cognitive decline (SCD) refers to the self-reported persistent cognitive decline despite normal objective testing, increasing the risk of dementia compared to cognitively normal individuals.

OBJECTIVE

This study aims to investigate the attributes of SCD patients who demonstrated memory function improvement.

METHODS

In this prospective study of SCD, a total of 120 subjects were enrolled as part of a multicenter cohort study aimed at identifying predictors for the clinical progression to mild cognitive impairment or dementia (CoSCo study). All subjects underwent 18F-florbetaben PET and brain MRI scans at baseline and annual neuropsychological tests. At the 24-month follow-up, we classified SCD patients based on changes in memory function, the z-score of the Seoul verbal learning test delayed recall.

RESULTS

Of the 120 enrolled patients, 107 successfully completed the 24-month follow-up assessment. Among these, 80 patients (74.8%) with SCD exhibited memory function improvements. SCD patients with improved memory function had a lower prevalence of coronary artery disease at baseline and performed better in the trail-making test part B compared to those without improvement. Anatomical and biomarker analysis showed a lower frequency of amyloid PET positivity and larger volumes in the left and right superior parietal lobes in subjects with improved memory function.

CONCLUSIONS

Our prospective study indicates that SCD patients experiencing memory improvement over a 24-month period had a lower amyloid burden, fewer cardiovascular risk factors, and superior executive cognitive function. Identifying these key factors associated with cognitive improvement may assist clinicians in predicting future memory function improvements in SCD patients.

Virtual Assessment as a Way to Reduce Help-seeking Barriers in Older Adults With Subjective Cognitive Decline

Subjective cognitive decline (SCD), a potential early marker for neurodegenerative disease such as Alzheimer's disease, is common among older adults. Although it is often regarded as a personal health concern, most individuals with SCD do not seek help from a health care professional. Help-seeking (HS) is a complex, individualized process with significant life-course implications, and older adults often face several barriers to HS across personal, socioeconomic, and cultural domains. The pandemic exacerbated these barriers by imposing additional limitations on in-person care. In response, virtual assessment became a popular method to conduct remote care. We provide a narrative review of the challenges and triumphs that came with the transition from in-person, pen-paper cognitive assessments to virtual cognitive assessments. In addition, we address the impact virtual assessment had in tackling barriers that previously limited individuals with SCD from formal HS. We argue that virtual cognitive assessment helps alleviate health access barriers to HS (e.g., cost, transportation, and physician availability) and allows individuals with different coping styles to undergo assessment within more convenient environments. We hope the findings presented in this review inform health care practice, public education, and future research targeted towards the use of virtual assessment to facilitate HS in older adults with SCD.

Education as a Moderator of Help Seeking Behavior in Subjective Cognitive Decline

OBJECTIVE

Disparities in Alzheimer disease (AD) and differences in help seeking (HS) across sociodemographic groups warrant public health concern. Research addressing such disparities must shift toward the earliest clinical manifestations of AD to optimize diagnosis, intervention and care planning. Subjective cognitive decline (SCD), a risk state for AD, provides an important context in which to examine sociodemographic-related disparities in HS.

PARTICIPANTS AND METHODS

One hundred sixty-seven cognitively healthy older adults (M age =73, M education =16) (26.4% Black, Asian, or "Other") completed SCD questionnaire, HS questions, and mood measures (depression and anxiety). Binary logistic adjusted regressions examined: (a) the association between SCD and HS; and (b) the extent to which education moderated the relationship between SCD and HS. SCD [b = 0.06, SE=0.13, P <0.001, odds ratio=1.06, 95% CI (1.03, 1.08)] and education [b=0.32, SE=0.09, P <0.001, odds ratio=1.37, 95% CI (1.15, 1.64)] were independently associated with HS, with significant interaction between education and SCD on HS [b=0.2, SE=0.01, P =0.01, odds ratio=1.02, 95% CI (1.00, 1.03)].

CONCLUSIONS

Findings elucidate the importance of tailoring SCD-related psychoeducational resources depending on educational background as a preliminary stepping-stone in encouraging HS among older adults who may be at particular risk for developing dementia.

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.

Eliciting brain waves of people with cognitive impairment during meditation exercises using portable electroencephalography in a smart-home environment: a pilot study

Objectives

Meditation imparts relaxation and constitutes an important non-pharmacological intervention for people with cognitive impairment. Moreover, EEG has been widely used as a tool for detecting brain changes even at the early stages of Alzheimer's Disease (AD). The current study investigates the effect of meditation practices on the human brain across the AD spectrum by using a novel portable EEG headband in a smart-home environment.

Methods

Forty (40) people (13 Healthy Controls-HC, 14 with Subjective Cognitive Decline-SCD and 13 with Mild Cognitive Impairment-MCI) participated practicing Mindfulness Based Stress Reduction (Session 2-MBSR) and a novel adaptation of the Kirtan Kriya meditation to the Greek culture setting (Session 3-KK), while a Resting State (RS) condition was undertaken at baseline and follow-up (Session 1-RS Baseline and Session 4-RS Follow-Up). The signals were recorded by using the Muse EEG device and brain waves were computed (alpha, theta, gamma, and beta).

Results

Analysis was conducted on four-electrodes (AF7, AF8, TP9, and TP10). Statistical analysis included the Kruskal-Wallis (KW) nonparametric analysis of variance. The results revealed that both states of MBSR and KK lead to a marked difference in the brain's activation patterns across people at different cognitive states. Wilcoxon Signed-ranks test indicated for HC that theta waves at TP9, TP10 and AF7, AF8 in Session 3-KK were statistically significantly reduced compared to Session 1-RS Z = -2.271, p = 0.023, Z = -3.110, p = 0.002 and Z = -2.341, p = 0.019, Z = -2.132, p = 0.033, respectively.

Conclusion

The results showed the potential of the parameters used between the various groups (HC, SCD, and MCI) as well as between the two meditation sessions (MBSR and KK) in discriminating early cognitive decline and brain alterations in a smart-home environment without medical support.

Cognitive Effects of a Cognitive Stimulation Programme on Trained Domains in Older Adults with Subjective Memory Complaints: Randomised Controlled Trial

Age-related subjective memory complaints (SMC) are a common concern among older adults. However, little is known about the effects of cognitive stimulation (CS) interventions on subjective memory complaints. The aim of this study was to analyse the effectiveness of a CS programme on global cognition and cognitive functions of older adults with SMC. A randomised clinical trial was conducted on older adults with SMC, including 308 participants ≥65 years of age assessed 6 and 12 months after the intervention. The assessment instrument was the Spanish version of the Mini-Mental State Examination (MEC-35), and all domains of the instrument were assessed. For statistical analysis, the data were analysed using robust ANOVA with means truncated at 20% utilising a two-way repeated measures model, with between (groups) and within (measurements) factors. In post hoc tests, a Wilcoxon signed-rank test of exact permutations between groups and Bonferroni correction were applied. In post hoc between-group tests, significant differences were found: (1) post-treatment in MEC-35, temporal orientation, short-term memory (STM), global language and praxis, and language and praxis (p ≤ 0.005); (2) at 6 months in MEC-35, global orientation, temporal orientation, and STM (p = 0.005); (3) at 12 months in MEC-35, global orientation, temporal orientation, STM, global language and praxis, and language (p = 0.005). This study shows benefits in global cognition and orientation, temporal orientation, STM, and language in older adults with SMC.

Psychometric Properties of the Subjective Cognitive Decline Questionnaire (SCD-Q) and Its Invariance across Age Groups

Considering that a good sense of subjective cognitive decline seems to be crucial to prevent decline before clinical impairment, the interest in examining tools on this front were raised in the last decade. The aim of the present study is to examine the psychometric properties of the Subjective Cognitive Decline Questionnaire (SCD-Q) across age in its Spanish adaptation. It should be noted that two constructs were proposed in this context: mnestic processes and executive function factors. For this reason, a sample of 750 individuals aged from 18 to 82 years participated in the study. They were divided into three different groups: young, middle, and older adults. A confirmatory factor analysis (CFA) and invariance analysis were carried out. Moreover, a logistic regression was employed to address the role of age. The results support a good goodness of fit for both uni- and bifactorial models. The invariance analysis reached the structural covariances levels. Last, age did not predict the recognition of cognitive decline in the last two years, while the SCD-Q bifactorial model did. These results are of interest both on a theoretical level, to provide more information on models of cognitive impairment, and on a practical level, for screening.

A Cost-Benefit Analysis of a Group Memory Intervention for Healthy Older Adults with Memory Concerns

This study examines whether memory intervention programs can mitigate health care costs. Research suggests these programs translate to a decreased intention of older adults who are worried about age-normal memory changes to seek traditional outlets for medical/psychiatric help. We employed a cost-benefit analysis approach to analyze the effectiveness of a memory intervention program within Ontario. We leveraged estimates of decreased intentionality to seek physician care following a community-based memory intervention with physician billing profiles to calculate the potential cost savings to the province's health care system. The intervention studied was found to reduce provincial health care spending by $6,094 per program group. This amount exceeds $121.25 in direct costs per attendee associated with administering five program sessions. This analysis justifies further research on how community-based memory and aging programs can offer low-cost solutions to help individuals cope with subjective memory complaints and assist the health care system in prioritizing care for aging patients.

Characteristics of subjective cognitive decline associated with amyloid positivity

INTRODUCTION

The evidence for characteristics of persons with subjective cognitive decline (SCD) associated with amyloid positivity is limited.

METHODS

In 1640 persons with SCD from 20 Amyloid Biomarker Study cohort, we investigated the associations of SCD-specific characteristics (informant confirmation, domain-specific complaints, concerns, feelings of worse performance) demographics, setting, apolipoprotein E gene (APOE) ε4 carriership, and neuropsychiatric symptoms with amyloid positivity.

RESULTS

Between cohorts, amyloid positivity in 70-year-olds varied from 10% to 76%. Only older age, clinical setting, and APOE ε4 carriership showed univariate associations with increased amyloid positivity. After adjusting for these, lower education was also associated with increased amyloid positivity. Only within a research setting, informant-confirmed complaints, memory complaints, attention/concentration complaints, and no depressive symptoms were associated with increased amyloid positivity. Feelings of worse performance were associated with less amyloid positivity at younger ages and more at older ages.

DISCUSSION

Next to age, setting, and APOE ε4 carriership, SCD-specific characteristics may facilitate the identification of amyloid-positive individuals.

Cognitive training modified age-related brain changes in older adults with subjective memory decline

OBJECTIVES

Neuroimaging findings suggest that older adults with subjective memory decline (SMD) demonstrate some neurodegenerative brain changes and have high risk of developing dementia, but relatively little is known about the effectiveness of interventions for SMD. This study aimed to examine the effects of cognitive training on resting-state brain activity in SMD.

METHOD

This study employed the amplitude of low frequency fluctuations (ALFF) and resting state functional connectivity (rs-FC) analyses. After baseline evaluations, participants were randomly allocated to the intervention and control group to receive a four-week cognitive training and lectures on health and aging, respectively. All participants were scanned before and after training with an interval of about three months.

RESULTS

(1) Participants in the intervention group showed significant improvements on the Associative Learning Test (ALT) and the Digit Span Forward task compared to the control group; (2) ALFF in the occipital lobe for the control group increased significantly, while that for the intervention group remained the same; ALFF changes were negatively correlated with ALT performance in the control group; (3) The mean value of rs-FC for the intervention group decreased, while that for the control group showed a trend of increase; rs-FC changes were also negatively correlated with ALT performance in the control group.

CONCLUSIONS

Resting-state brain activities in occipital region increased with aging. The cognitive training could counteract this brain function changes associated with aging or even reverse the changes. These findings provide new insights into the understanding of brain plasticity in posterior areas in SMD.

TRIAL REGISTRATION

ChiCTR-IOR-15006165 in the Chinese Clinical Trial Registry.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Montreal Cognitive Assessment in Older Adults

Objective: Cognitive screening instruments (CSIs) are essential for everyday practice. The Quick Mild Cognitive Impairment (Qmci) screen, a short instrument designed to identify mild cognitive impairment, was recently translated into Greek (Qmci-Gr). The present study compared its diagnostic value against the Montreal Cognitive Assessment (MoCA) screen and examined its optimal cutoffs. Method: We recruited consecutive patients aged ≥55 years that presented with cognitive complaints from two outpatient clinics in Greece. The Qmci-Gr and MoCA were completed by all patients. Furthermore, they were assessed independently with a comprehensive flexible neuropsychological battery to establish a diagnostic classification. Results: In the current study, we assessed a total of 145 patients, with a median age of 70 years; 44 were classified as having Subjective Memory Complaints (SMC) but normal cognition, 32 with MCI and 69 with dementia. The Qmci-Gr had a higher accuracy compared to the MoCA in discriminating MCI from dementia, area under the curve (AUC) of 0.81 versus 0.75, respectively; however, this finding was marginally significant (p = 0.08). Its accuracy was marginally higher for distinguishing SMC from dementia, AUC of 0.94 versus 0.89 (p = 0.03). However, Qmci-Gr presented a lower accuracy than MoCa in differentiating SMC from MCI, AUC of 0.76 versus 0.94 (p = 0.006). Conclusions: The Qmci-Gr has comparable diagnostic accuracy to the MoCA regarding MCI and dementia groups. Further research, with larger and more diverse samples, may be necessary to ensure generalizability.

Coping strategies for memory problems in everyday life of people with cognitive impairment and older adults: A systematic review

OBJECTIVES

Dealing with memory loss is a major challenge for older people. Coping strategies for memory problems could enable cognitively impaired people to live independently for longer. We conducted a systematic review to summarize evidence on coping strategies for older people and people with cognitive impairment to stabilize everyday life functioning.

METHODS

We systematically searched the databases PubMed, PsychInfo, Scopus and WebofScience using a well-defined search string. Studies were included if they were published between January 1990 and February 2021 and written in English, German, Spanish, French, or Swedish language. Two blind researchers independently checked the studies for inclusion and exclusion criteria and evaluated the quality of the studies using Critical Appraisal Skills Programme-checklists. Evidence was summarized in a narrative synthesis.

RESULTS

A total of 16 relevant studies with adequate quality were identified. These studies reported on three categories of strategies: external, internal, and behavioral coping strategies. External strategies included reminder systems and integrated features in the environment and were used by people with and without cognitive impairments. Internal strategies such as visualization, verbalization, active remembering, and systematic thinking were reported less often by people with cognitive impairment than those without cognitive impairment. Behavioral strategies such as reducing expectations and acceptance of support was most frequently reported by people with cognitive impairment.

CONCLUSIONS

The findings of our systematic review show a great number of coping strategies, which seem to depend on cognitive status. Appropriate training tools incorporating these strategies should be developed.

Adaptation and virtual feasibility pilot of a mindfulness-based lifestyle program targeting modifiable dementia risk factors in older adults

OBJECTIVES

We developed a group-based program (My Healthy Brain, MHB) to engage older adults at-risk for dementia in healthy lifestyles. We report on a two-part study to adapt MHB by incorporating mindfulness skills, using mobile health technology to monitor and reinforce behaviors, and delivering it via live video.

METHODS

Participants were older adults (age ≥ 60) with subjective cognitive decline (SCD) and at least one lifestyle risk factor. In Aim 1 (n = 11, 2 groups), we conducted focus groups to obtain qualitative feedback on proposed adaptations. In Aim 2 (n = 10), we conducted a virtual open pilot with exit interviews to explore the feasibility and outcomes of the adapted MHB.

RESULTS

Thematic analysis revealed: (1) barriers and facilitators to healthy lifestyles, (2) positive impressions of MHB, (3) interest in mindfulness skills, and (4) openness to study technologies. MHB met a-priori feasibility benchmarks and was associated with improvements in cognition, lifestyle (e.g. physical function), and proposed mechanisms (e.g. mindfulness). Exit interviews confirmed high feasibility and satisfaction.

CONCLUSION

The integration of mindfulness, live video, and mobile health technologies was feasible and promising for improving healthier lifestyles. The results inform the next feasibility RCT of MHB to prepare for efficacy testing.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032600.

Impact of the ambulatory blood pressure monitoring profile on cognitive and imaging findings of cerebral small-vessel disease in older adults with cognitive complaints

We investigated ambulatory blood pressure (BP) monitoring (ABPM) profiles and magnetic resonance imaging (MRI) findings of cerebral small-vessel disease (cSVD) in older adults with cognitive complaints who were grouped as follows: subjective cognitive decline, mild cognitive impairment, and dementia of Alzheimer's type. Group comparisons and correlation analyses among demographic characteristics, cognitive and MRI findings, and ABPM profiles were performed. Furthermore, multivariate logistic regression analyses for dependent variables of (1) dementia or not and (2) MRI criteria of subcortical vascular dementia (SVaD) or not were conducted with independent variables of dichotomized ABPM profiles. A total of 174 subjects (55 males and 119 females) were included: mean age 75.36 ± 7.13 years; Mini-Mental State Examination (MMSE) score 20.51 ± 6.23. No MRI and ABPM findings except medial temporal atrophy were different between three groups. Twenty-four-hour systolic BP (sBP) was correlated with MMSE score (r = -0.182; p = 0.022) and the severity of white matter hyperintensity (WMH) (r = 0.157; p = 0.048). A higher daytime sBP was associated with dementia (odds ratio (OR): 3.734; 95% confidence interval (CI): 1.041-13.390; p = 0.043) and MRI finding of SVaD (OR: 10.543; 95% CI: 1.161-95.740; p = 0.036). Although there were no differences in ABPM profiles between three groups, a higher BP-especially a higher sBP-correlated with cognitive dysfunction and severity of WMH in older adults. Only higher daytime sBP was an independent predictor for dementia and MRI findings of SVaD. Among various ABPM profiles in this study, a higher BP, especially a higher sBP, may be considered the most important for clinical and MRI findings of cSVD.

Clinical Application of Plasma Neurofilament Light Chain in a Memory Clinic: A Pilot Study

Background and Purpose

Neurofilament light chain (NfL) has been considered as a biomarker for neurodegenerative diseases including Alzheimer’s disease (AD). We measured plasma NfL levels in older adults with cognitive complaints and evaluated their clinical usefulness in AD.

Methods

Plasma levels of NfL, measured by using the single molecule array method, were acquired in a total of 113 subjects consisting of subjective cognitive decline (SCD; n=14), mild cognitive impairment (MCI; n=37), or dementia of Alzheimer type (DAT; n=62). Plasma NfL level was compared among three groups, and its association with cognitive and functional status was also analyzed.

Results

After adjusting for age, plasma NfL level was higher in subjects with DAT (65.98±84.96 pg/mL), compared to in subjects with SCD (16.90±2.54 pg/mL) or MCI (25.53±10.42 pg/mL, p=0.004). NfL levels were correlated with scores of the mini-mental state examination (r=−0.242, p=0.021), clinical dementia rating (CDR) (r=0.291, p=0.005), or CDR-sum of boxes (r=0.276, p=0.008). Just for participants who performed amyloid positron emission tomography (PET), the levels were different between subjects with PET (−) (n=17, 25.95±13.25 pg/mL) and PET (+) (n=16, 63.65±81.90 pg/mL, p=0.010). Additionally, plasma NfL levels were different between vascular dementia and vascular MCI, and between Parkinson’s disease- dementia and no dementia.

Conclusions

This pilot study shows that in subjects with DAT, plasma NfL levels increase. Plasma NfL level correlated with cognitive and functional status. Further longitudinal studies may help to apply the plasma NfL levels to AD, as a potential biomarker for the diagnosis and predicting progression.

How are people with mild cognitive impairment or subjective memory complaints managed in primary care? A systematic review

BACKGROUND

Primary care is typically the first point of contact in the health care system for people raising concerns about their memory. However, there is still a lack of high-quality evidence and understanding about how primary care professionals (PCPs) currently manage people at higher risk of developing dementia.

OBJECTIVES

To systematically review management strategies provided by PCPs to reduce cognitive decline in people with mild cognitive impairment and subjective memory complaints.

METHOD

A systematic search for studies was conducted in December 2019 across five databases (EMBASE, Medline, PsycInfo, CINAHL and Web of Science). Methodological quality of included studies was independently assessed by two authors using the Mixed Methods Appraisal Tool.

RESULTS

An initial 11 719 were found, 7250 were screened and 9 studies were included in the review. Most studies were self-reported behaviour surveys. For non-pharmacological strategies, the most frequent advice PCPs provided was to increase physical activity, cognitive stimulation, diet and social stimulation. For pharmacological strategies, PCPs would most frequently not prescribe any treatment. If PCPs did prescribe, the most frequent prescriptions targeted vascular risk factors to reduce the risk of further cognitive decline.

CONCLUSION

PCPs reported that they are much more likely to provide non-pharmacological strategies than pharmacological strategies in line with guidelines on preventing the onset of dementia. However, the quality of evidence within the included studies is low and relies on subjective self-reported behaviours. Observational research is needed to provide an accurate reflection of how people with memory problems are managed in primary care.

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

OBJECTIVES

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

DESIGN

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

SETTINGS

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

Occupational performance issues in older adults with subjective cognitive decline

PURPOSE

To describe and categorize difficulties in daily activities of older adults with subjective cognitive decline (SCD) compared to individuals with mild cognitive impairment (MCI).

METHODS

Deductive quantitative content analysis was used to classify reported issues in the performance of meaningful daily activities, in older adults with SCD (n = 67; age= 70 ± 6.3) or MCI (n = 42; age= 72 ± 6.6). The occupational performance issues were identified using the Canadian Occupational Performance Measure, a semi-structured interview, and categorised using the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Both groups identified issues in all nine ICF "Activities and Participation" domains, with no significant group effects on seven of them. The most frequently affected "Activities and Participation" domains in both groups were "Self-care" (e.g. exercise and diet); "Community, social and civic life" (e.g. social-leisure activities); and "General tasks and demands" (e.g. time management). Over 90% of the issues in both groups were described in the context of difficulties in "Mental functions" (e.g. memory and higher-level cognitive functions).

CONCLUSIONS

Older adults with SCD, although independent, identified a variety of daily activities that they are not performing satisfactorily, remarkably similar in nature to the occupational performance issues described by older adults with MCI.Implications for RehabilitationOlder adults with SCD identified difficulties in performing social and leisure activities, maintaining healthy lifestyle behaviours, and managing multiple daily tasks.The daily challenges described by older adults with SCD are similar in nature to those identified by those with MCI.Older adults with SCD and MCI describe their daily challenges are related not only to memory problems, but also to executive dysfunction.Interventions for older adults with SCD should aim to improve self-identified problems in everyday functioning.

Event-related brain potential indexes provide evidence for some decline in healthy people with subjective memory complaints during target evaluation and response inhibition processing

In the preclinical stage of the Alzheimer's disease (AD) continuum, subjects report subjective memory complaints (SMCs), although with the absence of any objective decline, and have a higher risk of progressing to dementia than the general population. Early identification of this stage therefore constitutes a major focus of current AD research, to enable early intervention. In this study, healthy adult participants with high and low SMCs (HSMCs and LSMCs) performed a Go/NoGo task during electroencephalogram (EEG) recording. Relative to LSMC participants, HSMC participants performed the task slower (longer reaction times) and showed changes in the event-related potential (ERP) components associated with response preparation (lower readiness potential -RP- amplitude in the Go condition), and also related to response inhibition processes (lower N2-P3 amplitude in the NoGo condition). In addition, HSMC participants showed lower Go-N2 and NoGo-N2 peak-to-baseline amplitudes, however these results seem to be influenced by a negative tendency overlapping stimulus-related waveforms. The declines observed in this study are mostly consistent with those observed in aMCI participants, supporting the notion of the AD continuum regarding SMC state.

IN VIVO ASSESSMENT OF AMYLOID AND GLUCOSE SIGNATURES IN SUBJECTIVE COGNITIVE DECLINE SUBJECTS

Subjective cognitive decline (SCD), characterized by self-perceived subtle cognitive impairment ahead of the appearance of explicit and measurable cognitive deficits, is regarded as the preclinical manifestation of the pathological change continuum of Alzheimer’s disease (AD). We were committed to exploring the amyloid and glucose metabolic signatures related to imminent brain metabolic changes in SCD subjects. This study included 39 subjects (mean age = 71.9 years; 14 males and 25 females) diagnosed with SCD disease and 39 gender-matched healthy controls (HCs) (mean age = 75.2; 16 males and 23 females) with brain [18F] fluorodeoxyglucose positron emission tomography (PET) images and [18F] florbetapir PET images. The standardized uptake value ratios (SUVRs) of PET images within the regions of interest (ROIs) were calculated. Inter-group SUVR differences were assessed by two-sample [Formula: see text]-testing and receiver operating characteristic curve (ROC) analyses. A generalized linear model (GLM) was employed to evaluate the correlations between amyloid and FDG uptake. Compared with HCs, SCD subjects showed significantly increased amyloid SUVR, as well as significantly increased glucose SUVR in the olfactory, amygdala, thalamus, heschl gyrus, superior and middle temporal gyrus and temporal pole (all [Formula: see text]). The amyloid SUVR of thalamus was found to have a better ROC result (area under the curve (AUC): 0.77, 95% confidence interval (CI): 0.66–0.86) in the HC group, as was the case with the glucose SUVR of the middle temporal gyrus (AUC: 0.83, 95% CI: 0.73–0.91). There were significant positive correlations between amyloid and glucose SUVRs ([Formula: see text]). The amyloid SUVR of the thalamus showed a significantly better main effect (odd ratio [Formula: see text] 2.91, 95% CI: 1.44–6.7, [Formula: see text]), and the glucose SUVR of the heschl gyrus indicated an enhanced main effect (odd ratio [Formula: see text] 5.08, 95% CI: 1.86–18.15, [Formula: see text]). SCD subjects demonstrated significant amyloid accumulation and glucose hypermetabolism in specific brain regions, and amyloid pathology overlapped with regions of glucose abnormality. These findings may advance the understanding of imminent pathological changes in the SCD stage and help to provide clinical guidelines for interventional management.

Older adults show a higher heartbeat-evoked potential than young adults and a negative association with everyday metacognition

The ability to monitor internal bodily and cognitive processes is essential for everyday functioning and independence in older adults, because it allows for adjustments when lapses in performance are imminent. In the present study, age-related morphological changes to the heartbeat evoked potential (HEP), an electrophysiological cortical representation of cardiac signals, and its association with self-reported everyday cognition were examined. A community sample of older adults showed an increased HEP amplitude, which could reflect a stronger representation of early stages of cardiac interoception, and a more anterior scalp distribution of the HEP, suggesting a more widespread configuration of the underlying neural generators, compared to a group of young adults. Furthermore, in older adults, HEP amplitude was negatively correlated with self-estimated everyday cognitive functioning. Older adults with pronounced cortical representations of peripheral signals may thus be more likely to take note of lapses in their own bodily and cognitive function, leading to lower estimates of their cognitive abilities. These results provide novel insights into age-related changes in interoceptive processing and their association with metacognitive judgments, with potentially far-reaching implications for cognitive aging and age-related cognitive decline.

Amyloid-β misfolding as a plasma biomarker indicates risk for future clinical Alzheimer's disease in individuals with subjective cognitive decline

BACKGROUND

We evaluated Aβ misfolding in combination with Aβ42/40 ratio as a prognostic tool for future clinical progression to mild cognitive impairment (MCI) or dementia due to Alzheimer's disease (AD) in individuals with subjective cognitive decline (SCD).

METHODS

Baseline plasma samples (n = 203) from SCD subjects in the SCIENCe project and Amsterdam Dementia Cohort (age 61 ± 9 years; 57% male, mean follow-up time 2.7 years) were analyzed using immuno-infrared-sensor technology. Within 6 years of follow-up, 22 (11%) individuals progressed to MCI or dementia due to AD. Sensor readout values > 1646 cm- 1 reflected normal Aβ folding; readouts at ≤ 1646 cm- 1 reflected low and at < 1644 cm- 1 high misfolding. We used Cox proportional hazard models to quantify Aβ misfolding as a prognostic biomarker for progression to MCI and dementia due to AD. The accuracy of the predicted development of MCI/AD was determined by time-dependent receiver operating characteristic (t-ROC) curve analyses that take individual follow-up and conversion times into account. Statistical models were adjusted for age, sex, and APOEε4 status. Additionally, plasma Aβ42/40 data measured by SIMOA were statistically analyzed and compared.

RESULTS

All 22 patients who converted to MCI or AD-dementia within 6 years exhibited Aβ misfolding at baseline. Cox analyses revealed a hazard ratio (HR) of 19 (95% confidence interval [CI] 2.2-157.8) for future conversion of SCD subjects with high misfolding and of 11 (95% CI 1.0-110.1) for those with low misfolding. T-ROC curve analyses yielded an area under the curve (AUC) of 0.94 (95% CI 0.86-1.00; 6-year follow-up) for Aβ misfolding in an age, sex, and APOEε4 model. A similar model with plasma Aβ42/40 ratio yielded an AUC of 0.92 (95% CI, 0.82-1.00). The AUC increased to 0.99 (95% CI, 0.99-1.00) after inclusion of both Aβ misfolding and the Aβ42/40 ratio.

CONCLUSIONS

A panel of structure- and concentration-based plasma amyloid biomarkers may predict conversion to clinical MCI and dementia due to AD in cognitively unimpaired subjects. These plasma biomarkers provide a noninvasive and cost-effective alternative for screening early AD pathological changes. Follow-up studies and external validation in larger cohorts are in progress for further validation of our findings.

Acupuncture Therapy for Cognitive Impairment: A Delphi Expert Consensus Survey

BACKGROUND

Current research evidence challenges clinical decision-making when acupuncture is taken into consideration in the treatment of cognitive impairment (CI). Aiming to provide some viable recommendations for acupuncture practitioners in dealing with actual clinic issues, an expert consensus study was conducted.

METHODS

A clinical question investigation among 47 acupuncturists yielded 24 initial items. Subsequently, systematic reviews on acupuncture for CI were searched within three online databases. A panel of 30 authoritative experts were requested to respond with agreement, neutrality, or disagreement for each item. Consensus establishment was defined as the percentage of agreement on a given item >80%.

RESULTS

Following a 2-round Delphi survey, there were 21 items reaching consensus and three items resulting in no consensus; of which 10 items reached 90∼100% agreement, and 80∼90% expert agreement was achieved for 11 items. These items could be roughly categorized into six domains: (1) therapeutic effects of acupuncture, (2) therapeutic principles, (3) acupoint selection and combination, (4) acupuncture parameters, (5) considerable combined therapies, and (6) possible adverse events.

CONCLUSION

Without ready-made guidelines, this expert consensus may be conducive to guide acupuncturists in implementing clinical acupuncture practice for CI. Moreover, given the lack of high-quality research evidence and plenty of unresolved clinical issues in this field, it is of necessity to carry out more studies to better clarify the treatment algorithm.

GERO Cohort Protocol, Chile, 2017-2022: Community-based Cohort of Functional Decline in Subjective Cognitive Complaint elderly

BACKGROUND

With the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years. Cognitive complaint is considered a predictor for cognitive and functional decline, incident mild cognitive impairment, and incident dementia. The GERO cohort is the Chilean core clinical project of the Geroscience Center for Brain Health and Metabolism (GERO). The objective of the GERO cohort is to analyze the rate of functional decline and progression to clinical dementia and their associated risk factors in a community-dwelling elderly with subjective cognitive complaint, through a population-based study. We also aim to undertake clinical research on brain ageing and dementia disorders, to create data and biobanks with the appropriate infrastructure to conduct other studies and facilitate to the national and international scientific community access to the data and samples for research.

METHODS

The GERO cohort aims the recruitment of 300 elderly subjects (> 70 years) from Santiago (Chile), following them up for at least 3 years. Eligible people are adults not diagnosed with dementia with subjective cognitive complaint, which are reported either by the participant, a proxy or both. Participants are identified through a household census. The protocol for evaluation is based on a multidimensional approach including socio-demographic, biomedical, psychosocial, neuropsychological, neuropsychiatric and motor assessments. Neuroimaging, blood and stool samples are also obtained. This multidimensional evaluation is carried out in a baseline and 2 follow-ups assessments, at 18 and 36 months. In addition, in months 6, 12, 24, and 30, a telephone interview is performed in order to keep contact with the participants and to assess general well-being.

DISCUSSION

Our work will allow us to determine multidimensional risks factors associated with functional decline and conversion to dementia in elderly with subjective cognitive complain. The aim of our GERO group is to establish the capacity to foster cutting edge and multidisciplinary research on aging in Chile including basic and clinical research.

TRIAL REGISTRATION

NCT04265482 in ClinicalTrials.gov. Registration Date: February 11, 2020. Retrospectively Registered.

Cognitive complaints are associated with smaller right medial temporal gray-matter volume in younger postmenopausal women

OBJECTIVE

Menopause is associated with increasing cognitive complaints and older women are at increased risk of developing Alzheimer disease compared to men. However, there is difficulty in early markers of risk using objective performance measures. We investigated the impact of subjective cognitive complaints on the cortical structure in a sample of younger postmenopausal women.

METHODS

Data for this cross-sectional study were drawn from the baseline visit of a longer double-blind study examining estrogen-cholinergic interactions in normal postmenopausal women. Structural Magnetic Resonance Imaging was acquired on 44 women, aged 50-60 years and gray-matter volume was defined by voxel-based morphometry. Subjective measures of cognitive complaints and postmenopausal symptoms were obtained as well as tests of verbal episodic and working memory performance.

RESULTS

Increased levels of cognitive complaints were associated with lower gray-matter volume in the right medial temporal lobe (r = -0.445, P < 0.002, R = 0.2). Increased depressive symptoms and somatic complaints were also related to increased cognitive complaints and smaller medial temporal volumes but did not mediate the effect of cognitive complaints. In contrast, there was no association between performance on the memory tasks and subjective cognitive ratings, or medial temporal lobe volume.

CONCLUSIONS

The findings of the present study indicate that the level of reported cognitive complaints in postmenopausal women may be associated with reduced gray-matter volume which may be associated with cortical changes that may increase risk of future cognitive decline. : Video Summary:http://links.lww.com/MENO/A626.

"Falling through the cracks"; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention

OBJECTIVES

Many people live with an awareness of mild cognitive changes that increase their dementia risk. Previous authors describe the uncertainties of this liminal state, between cognitive health and dementia, where being "at risk" can itself be an illness. We ask how services respond to people with memory concerns currently, and how a future, effective and inclusive dementia prevention intervention might be structured for people with memory concerns.

METHODS/DESIGN

We conducted qualitative interviews with 18 people aged 60+ years with subjective or objective memory problems, six family members, 10 health and social care professionals and 11 third sector workers. Interviews were audio-recorded, transcribed and analysed using an inductive thematic approach.

RESULTS

Three main themes were identified: (1) acknowledging the liminal state, compounded by current, discordant health service responses: medicalising memory concerns yet situating responsibilities for their management with patients and families; (2) enabling change in challenging contexts of physical and cognitive frailty and social disengagement and (3) building on existing values, cultures and routines.

CONCLUSIONS

Effective dementia prevention must empower individuals to make lifestyle changes within challenging contexts. Programmes must be evidence based yet sufficiently flexible to allow new activities to be fitted into people's current lives; and mindful of the risks of pathologising memory concerns. Most current memory services are neither commissioned, financially or clinically resourced to support people with memory concerns without dementia. Effective, large scale dementia prevention will require a broad societal response.

Different patterns of short-term memory deficit in Alzheimer's disease, Parkinson's disease and subjective cognitive impairment

It has recently been proposed that short-term memory (STM) binding deficits might be an important feature of Alzheimer's disease (AD), providing a potential avenue for earlier detection of this disorder. By contrast, work in Parkinson's disease (PD), using different tasks, has suggested that the STM impairment in this condition is characterised by increased random guessing, possibly due to fluctuating attention. In the present study, to establish whether a misbinding impairment is present in sporadic late-onset AD (LOAD) and increased guessing is a feature of PD, we compared the performance of these patient groups to two control populations: healthy age-matched controls and individuals with subjective cognitive impairment (SCI) with comparable recruitment history as patients. All participants performed a sensitive task of STM that required high resolution retention of object-location bindings. This paradigm also enabled us to explore the underlying sources of error contributing to impaired STM in patients with LOAD and PD using computational modelling of response error. Patients with LOAD performed significantly worse than other groups on this task. Importantly their impaired memory was associated with increased misbinding errors. This was in contrast to patients with PD who made significantly more guessing responses. These findings therefore provide additional support for the presence of two doubly dissociable signatures of STM deficit in AD and PD, with binding impairment in AD and increased random guessing characterising the STM deficit in PD. The task used to measure memory precision here provides an easy-to-administer assessment of STM that is sensitive to the different types of deficit in AD and PD and hence has the potential to inform clinical practice.

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.

Familial mesial temporal lobe epilepsy in Mexico: Inheritance pattern and clinical features

PURPOSE

The objectives of this study were to determine the inheritance pattern by which familial mesial temporal lobe epilepsy (FMTLE) is segregated in Mexican families, and to identify if there was an association between the clinical characteristics and the inheritance pattern.

METHOD

We included a total of 25 families with two or more members affected with MTLE during two years and elaborated a family pedigree for each family. The inheritance pattern was classified as autosomal dominant (AD) or autosomal recessive (AR), considering the affected members. We used statistical analysis association and differences between clinical characteristics and inheritance patterns.

RESULTS

The affected families with the AD pattern were 15.7 fold times more likely to start seizures at 5 years of age or earlier than families with AR pattern, OR = 15.7 (IC 95% = 1.9-128.9). We observed a predominance and greater déjà vu association (64.4% vs 31.3%; p = 0.021), OR = 3.9 (CI 95% = 1.1-13.5) in patients with AD versus AR pattern. Finally, we identified that patients with AD pattern had a likelihood of presenting emotional alterations 5.6 times higher than AR (OR = 5.6, IC = 1.1-27.5).

CONCLUSION

FMTLE is a heterogeneous syndrome, both phenotypically and genotypically; thus, our findings may be helpful for clinical use to perform an early diagnosis, to provide timely treatment, and to prevent comorbidities associated to this disease. However, in order to identify the possible genetic causes underlying these inheritance patterns, the use of molecular studies is necessary.

HMPAO-SPECT Can Discriminate between Patients with Subjective Cognitive Complaints with and without Cognitive Deficits and those with Mild Cognitive Impairment

BACKGROUND

Growing evidence suggests that pathological processes leading to Alzheimer's disease occurs gradually and begins to develop decades before the earliest clinical symptoms occur. The use of biomarkers has been proposed to detect evidence of preclinical Alzheimer's pathologic change in asymptomatic subjects. Subjective cognitive complaints (SCC) i.e. self-reported cognitive decline with normal cognition have been reported as an indicator of future cognitive decline, however, this condition is unspecific.

OBJECTIVE

In the present study we used the regional brain perfusion measured by HMPAO-SPECT as Biomarker of neurodegeneration to compare the regional brain perfusion of patient with subjective cognitive complaints with and without minimal cognitive dysfunction (SCC+ and SCC- respectively) in respect to patients with mild cognitive impairment (MCI).

METHODS

We retrospectively examined 736 Patients who referred to our Memory Clinic because of suspected cognitive dysfunction. After exclusion of patients with overt dementia, automated, quantitatively assessed relative cerebral blood flow of 10 forebrain regions (thalamus, parietotemporal, medial temporal, posterior temporal, posterior cingulate gyrus, each region left hemispheric and right hemispheric) and neuropsychological assessment of 64 SCC (32 SCC+; 32 SCC-) and 28 MCI subjects were analysed.

RESULTS

.The most relevant differences between groups in cognitive performance concerned verbal memory. Left hemispheric medial temporal region could significantly discriminate between all three groups, with a progressive decrease n perfusion from SCC towards MCI. Area under the curve of left medial temporal region showed a sensitivity of 0,61 and a specificity of 0,78 for discriminating MCI from SCC.

CONCLUSION

Automated analysis of HMPAO-SPECT data of MCI and SCC+ patients showed significant perfusion differences in medial temporal region and impaired verbal memory, both of which are known features of Alzheimer's disease. Perfusion patterns and verbal memory performance in SCC+ are more similar to MCI than SCC-. Thus, SPECT analysis could distinguish those subjects whose perfusion pattern resembles that of an MCI from those who do not. In our opinion, this could identify two populations with a different risk of progression to AD, with SCC+ subjects needing further diagnostic examination and repeated follow-up.

Distribution and clinical impact of apolipoprotein E4 in subjective memory impairment and early mild cognitive impairment

The apolipoprotein E (APOE) e4 allele is the most common genetic variant associated with Alzheimer’s disease (AD). We sought to investigate the distribution of APOE genotypes across the full clinical AD spectrum including AD, late-stage amnestic mild cognitive impairment (L-aMCI), early-stage aMCI (E-aMCI), subjective memory impairment (SMI), and controls. We prospectively recruited 713 AD patients, 735 aMCI patients, 575 SMI patients, and 8,260 individuals as controls. The frequency of the APOE e4 allele revealed an ordered fashion in the AD (30.8%), L-aMCI (24.0%), E-aMCI (15.1%), SMI (11.7%), and control (9.1%) groups. APOE e3/e4 and e4/e4 genotype frequencies also appeared in an ordered fashion in the AD group (39.1% of e3/e4 and 10.9% of e4/e4), as well as the L-aMCI (28.3% and 9.4%), E-aMCI (22.3% and 3.7%), SMI (18.3% and 1.9%), and control (15.1% and 0.8%) groups. In the comparisons of APOE e3/e3 vs. e3/e4 genotypes, all patient groups had a higher frequency of APOE e3/e4 relative to the control group. Relative to the SMI and E-aMCI groups, the AD and L-aMCI groups had higher frequency of the APOE e3/e4 genotype, and the AD group had a higher frequency relative to the L-aMCI group. However, there was no significant difference between the E-aMCI and SMI groups. In our longitudinal data, APOE e4 carrier showed a steeper incline slope in a clinical dementia rating sum of boxes (CDR-SB) score than APOE e4 non-carrier in SMI (B = 0.0066, p = 0.0104), E-aMCI (B = 0.0313, p < 0.0001), and L-aMCI (B = 0.0178, p = 0.0007). APOE e4 carrier showed a steeper decline slope in the CDR-SB than APOE e4 non-carrier in AD (B = − 0.0309, p = 0.0003). These findings suggest that E-aMCI and SMI are associated with a similarly increased frequency of the APOE e4 allele compared to controls, suggesting a greater genetic risk for AD and the importance of monitoring the allele more closely.

APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme: Protocol

BACKGROUND

Observational studies indicate that approximately a third of dementia cases are attributable to modifiable cardiometabolic, physical and mental health, and social and lifestyle risk factors. There is evidence that intensive behaviour change interventions targeting these factors can reduce cognitive decline. [Figure: see text] METHODS AND ANALYSIS: We will design and test a low intensity, secondary dementia-prevention programme (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline, "APPLE-Tree") to slow cognitive decline in people with subjective cognitive decline with or without objective cognitive impairment. We will embed our work within social science research to understand how dementia prevention is currently delivered and structured. We will carry out systematic reviews and around 50 qualitative interviews with stakeholders, using findings to coproduce the APPLE-Tree intervention. We plan a 10-session group intervention, involving personalised goal-setting, with individual sessions for those unable or unwilling to attend groups, delivered by psychology assistants who will be trained and supervised by clinical psychologists. The coproduction group (including public and patient involvement [PPI], academic and clinical/third-sector professional representatives) will use the Behaviour Change Wheel theoretical framework to develop it. We will recruit and randomly allocate 704 participants, 1:1 to the intervention: informational control group. This sample size is sufficient to detect a between-group difference at 2 years of 0.15 on the primary outcome (cognition: modified neuropsychological test battery; 90% power, 5% significance, effect size 0.25, SD 0.6).

DISSEMINATION

We will work with Public Health England and third-sector partners to produce an effective national implementation approach, so that if our intervention works, it is used in practice.

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

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

Exploring the prevalence of substance-induced neurocognitive disorder among polysubstance users, adding subjective and objective evidence of cognitive impairment

The objective of this study was to explore the prevalence of substance-induced neurocognitive disorder (NCD) in a sample of polysubstance users, adding both objective- and subjective cognitive impairment.

METHOD

We collected cross-sectional data from 33 community-based residential facilities in Mexico City. Montreal Cognitive Assessment was used for measurement of objective cognitive impairment, and a DSM-5-based interview for subjective impairment. Years and days of recent use of alcohol, marijuana, cocaine and inhalants were collected for regression analyses.

RESULTS

753 participants were analyzed; from these, 50.5% show objective impairment, 71% and 58.5% self-reported any cognitive deficit and cognitive decline, respectively. Between 21.8%-36.5% would qualify for NCD when integrating both objective- and subjective impairment (deficit or decline). Significant weak associations were found between objective impairment and subjective deficits in all cognitive domains except social cognition. Regression models adding both objective- and subjective measures explained more variation in the years of alcohol, inhalant and cocaine use, and in recent marijuana use, than the objective measure alone, but associations were inconsistent.

CONCLUSION

Though significant in proportion, the prevalence of NCD in this population can only be partially related to substance use. Further integrative approaches are needed to refine the epidemiology of this disorder.

Subjective Cognitive Impairment in 55-65-Year-Old Adults Is Associated with Negative Affective Symptoms, Neuroticism, and Poor Quality of Life

Although subjective cognitive impairment (SCI) is increasingly recognized clinically and in research as a risk factor for mild cognitive impairment and dementia (particularly Alzheimer’s disease), it is etiologically heterogeneous and potentially treatable. Compared to mild cognitive impairment and Alzheimer’s disease, SCI however remains poorly characterized with debate continuing regarding its clinical relevance. The primary aim of this study was to improve the characterization of SCI within the general public by investigating functions sometimes omitted clinically or in research, namely visual attention-related information processing speed (RT) and its intra-individual variability (IIV_RT), general cognition, depression, anxiety, memory, quality of life (QOL), and neuroticism. Compared to individuals without SCI, those with SCI were more likely to reveal higher scores of anxiety, depression, and neuroticism and poorer perceived physical, psychological, and environmental QOL. Within-group analysis identified no significant relationships between any of the above variables for the non-SCI group whereas for the SCI group, poorer Cognitive Change Index scores were significantly correlated with slower RT, raised IIV_RT, poorer memory, negative affective symptoms, higher neuroticism scores, and poorer QOL. This indicates that reports of perceived memory changes in SCI can also be associated with other characteristics, namely objectively measured detrimental change in other aspects of brain function and behavior. This outcome emphasizes the importance of a multi-function approach to characterizing and understanding SCI. Thus, although the effect of RT and IIV_RT is not strong enough to differentiate SCI from non-SCI at group level, slowing and raised IIV_RT do appear to characterize some people with SCI.

Subjective Cognitive Decline and Related Cognitive Deficits

Since late stage dementia, including Alzheimer's disease (AD), cannot be reversed by any available drugs, there is increasing research interest in the preclinical stage of AD, i.e., subjective cognitive decline (SCD). SCD is characterized by self-perceptive cognitive decline but is difficult to detect using objective tests. At SCD stage, the cognitive deficits can be more easily reversed compared to that of mild cognitive impairment (MCI) and AD only if accurate diagnosis of SCD and early intervention can be developed. In this paper, we review the recent progress of SCD research including current assessment tools, biomarkers, neuroimaging, intervention and expected prognosis, and the potential relevance to traumatic brain injury (TBI)-induced cognitive deficits.

The utility of simple questions to evaluate cognitive impairment

Objectives

As the population of patients with cognitive decline grows, physicians and caregivers need brief screening tools. Comprehensive neurocognitive batteries require special training and time for evaluation. We focused on accessibility and compared the diagnostic power of several easy questions.

Design

“Attended With” (AW) and “Head-Turning Sign” (HTS) factors and participants’ replies to following questions were recorded: “Do you feel that you have more difficulties in your daily life than you used to?”, [no consciousness (C-) or consciousness+ (C+)], “Could you tell me about your daily pleasures or pastimes?” [no pleasure (P-) or pleasure + (P+)], “What are notable current/recent news/topics?” [no news (N-) or news+ (N+)].

Setting

This took place in our Memory Clinic between May 2016 and July 2019.

Participants

We enrolled 162 consecutive cases (44 cognitive normal (CN), 55 amnestic mild cognitive impairment (aMCI), and 48 Alzheimer’s disease (AD)).

Measurements

The sensitivity and specificity of each battery were calculated, and on account of those numbers, the population attributable risk percent % (PAR%) of (AW and HTS+), (C- and P-), (C- and N-), (P- and N-) as analysis of combination of questions, respectively, were calculated.

Results

AW had high sensitivity, 87.4, 95.8% (CN vs aMCI + AD, CN + aMCI vs AD) but the sensitivity of HTS was only 46.4, 57.7%, and HTS showed high specificity, 100.0, 71.8%. C- had high sensitivity, 80.6, 87.5%, whereas P- and N- had high specificity, both 83.9% in CN vs aMCI + AD, 88.1% and 75.9% in CN + aMCI vs AD, respectively. In combination analysis, the PAR% of (C- and N-) were as high as (AW and HTS+).

Conclusions

The combination of (C- and N-) is as powerful as (AW and HTS+) in screening AD. Our findings provide novel insights for screening utility of brief questions “Consciousness of Impairment” and “Recent News.”