High frequency of functional cognitive decline among patients with low education

Abstract

AbstractBackgroundFunctional cognitive decline (FCD) has been increasingly described as a blind spot of dementia care. Psychological distress, affective symptoms and disturbed self‐perception comprehend the most common causes of FCD. Herein, we aim to identify the frequency of FCD in a tertiary memory clinic from a very low education setting.MethodA retrospective analysis was conducted to identify new referrals to our tertiary memory clinic (Porto Alegre, southern Brazil) over a 6‐year period (2014 ‐ 2020). All individuals referred from the primary care setting of the public health system in this time period were included in this analysis. Patients underwent a diagnostic protocol including neurologic evaluation, cognitive screening, neuroimaging (CT or MRI) and laboratory testing. FCD was defined as patients with cognitive complaints/objective cognitive decline associated with psychological distress and affective symptoms, without evidence of underlying neurodegenerative disease. Data is shown in median [interquartile range].ResultA total of 474 patients (287 females, median age 72 [65‐78]) with a median of 5 [0‐10] years of education were referred to our memory clinic within the period from 2014 to 2020. FCD was the second more frequent final diagnosis (95, 19.8%), only behind of dementia due to Alzheimer's disease (106, 22.4%); other diagnosis were less frequent: Mild Cognitive Impairment (49, 10.3%), Subjective Cognitive Decline (35, 7.4%), Vascular dementia (34, 7.2%), Mixed‐type dementia (24, 5.1%), behavioral variant Frontotemporal Dementia (5, 1.1%), and other types (36, 7.6%). Patients with FCD were younger (69 [63‐75] vs. 74 [67‐78], p<0.001), and showed higher Geriatric Depression Scale (GDS‐15) than non‐FCD individuals (9 [5‐12] vs. 5 [2‐8], p<0.001). The education level did not differ (p>0.05).ConclusionFunctional Cognitive Decline was the second most frequent diagnosis among patients with very low education in a tertiary memory clinic. FCD individuals were younger, showed increased depressive symptoms than non‐FCD patients. Taken altogether with Subjective Cognitive Decline, functional disorders account for the majority of consultations referred to this tertiary setting. Public health strategies including the primary care setting may greatly improve early diagnosis and treatment to these patients.