Clinical factors contributing to functional change over time in individuals with subjective cognitive concerns and mild cognitive impairment

Abstract

AbstractBackgroundAccumulating research suggests individuals with subjective cognitive concerns (SCC) and Mild Cognitive Impairment (MCI) experience subtle but noticeable functional changes, despite diagnostic criteria emphasising predominantly intact daily functioning to differentiate them from more severe stages of decline, i.e. dementia. This study investigates how factors associated with cognition, general health, and psychosocial wellbeing relate to functional change longitudinally in older adults with early‐stage cognitive change.MethodOne hundred and thirty‐seven participants with SCC or MCI (mean age=70.4 years, SD=8.0) completed standardised neuropsychological, medical and psychosocial assessments, and the self‐report Healthy Brain Ageing ‐ Functional Assessment Questionnaire (HBA‐FAQ) at baseline and again at follow‐up at least one year later (mean time to follow‐up= 25.5 months, SD=8.0). Correlational and linear regression analyses were used to explore relationships between subjective functional change over time and cognition, general health, and psychosocial wellbeing, where p was set at .05.ResultOlder people with SCC and MCI reported a similar amount of functional change (p = .13) and were therefore analysed as one ‘at risk’ group. Overall, greater subjective functional change over time was significantly and most markedly correlated with poorer baseline cognitive performance on tests of new learning (r = ‐.23), memory (r = ‐.25), processing speed (r = ‐.25), and cognitive flexibility (r = ‐.21), as well as poorer baseline psychosocial wellbeing including subjective disability (r = .56), quality of life (r = ‐.54), sleep quality (r = .29), mood disturbance (r = .51) and subjective memory complaints (r = .51). Of these factors, greater subjective memory complaints and greater mood disturbance at baseline significantly predicted increased functional change at follow‐up, accounting for 9.7% and 3.3% respectively of the unique variance in the model.ConclusionThese results suggest that functional change over time is evident in older adults with early‐stage cognitive change and is associated with poorer cognition and psychosocial wellbeing. This has important implications for early intervention, as this research highlights key clinical factors predictive of functional decline that clinicians can look out for when assessing older adults in primary practice. Targeted early intervention and management strategies may then help to maximise and maintain day‐to‐day functioning.