18 Which cognitive complaints among older adults are more concerning than others? Analysis of items in a Subjective Cognitive Decline Questionnaire

Abstract

Objective:

Subjective Cognitive Decline (SCD) is the self-reported experience of one’s own declining cognition prior to objective impairment on clinical neuropsychological testing. While SCD is a promising marker of preclinical Alzheimer’s disease (AD), information is needed to determine which cognitive complaints reflect typical aging versus prodromal degenerative disease. The objective of the current study was to examine the extent to which specific cognitive complaints were associated with two clinical outcomes including: 1) lower performance on cognitive tasks sensitive to preclinical AD; and 2) seeking help (i.e., medical attention) for cognitive difficulties.

Participants and Methods:

The current sample consisted of 175 healthy older adults (56 Male, 119 Female), aged 51 to 90 (M=72.67, SD=7.12) with a mean education of 16 years (SD=2.3 years) who performed > -1.5 SD on clinical neuropsychological testing. 26.8% of the sample self-reported as race/ethnic minorities (e.g., Hispanic or Non-Hispanic, Black, Asian, Other.) Participants completed a 20-item SCD questionnaire assessing perceived cognitive difficulties in comparison to same aged peers, and tests shown to be sensitive to preclinical AD including the Face Name Associative Learning Test and the Loewenstein-Acevedo Scales for Semantic Interference and Learning. Participants were coded as having sought help for SCD (39%) if they entered the current study from a clinical referral source, OR if they entered through a non-clinical referral stream but indicated that they had previously seen a doctor specifically for memory concerns or spoken to their doctor about memory concerns. Chi square tests were used to examine relationships between SCD item endorsement and help-seeking; ANOVAs were used to the extent to which item endorsement was associated with performance on cognitive tests. Results were considered significant at p < .05.

Results:

Three SCD items were associated with both lower cognitive test scores and having sought help for SCD (p values ranged from < .001 to .02). Items included difficulty remembering the date or day of the week and remembering a few shopping items without a list. One non-memory item was also associated with both outcomes including difficulty thinking ahead. In contrast, six items were not related to either outcome of interest. Such items included difficulty remembering appointments, remembering where you put things like keys, following a map to a new location, doing two things at once, understanding what you read, or understanding what people say to you. The remaining eleven items explore the extent to which selective associations exist with either help-seeking or cognitive performance.

Conclusions:

Patients and clinicians alike are often unsure about which cognitive difficulties are typical for aging and which may be the cause for further workup. Current results suggest that certain complaints among cognitively healthy older adults may be cause for more thorough evaluation or monitoring. These complaints include specific memory and nonmemory concerns. Future work is needed to determine if these complaints predict future cognitive decline or conversion to Mild Cognitive Impairment.