Relation of modifiable lifestyle and mood factors to subjective cognitive concerns among participants and their study partners in the A4 screen data

Abstract

AbstractBackgroundSubjective cognitive decline (SCD) is associated with future cognitive decline, elevated amyloid levels, and non‐specific variables, including mood. Participants often endorse higher cognitive concerns than their study partners (SPs), raising the possibility that participant complaints reflect multiple factors, including mood, lifestyle variables, and amyloid status. To determine the predictive value of modifiable factors, we examined the relation between SCD, lifestyle habits, amyloid, and mood among cognitively unimpaired older adults from a multi‐site secondary prevention trial (A4 screen data).MethodParticipants were 6943 individuals from A4 assessed pre‐randomization [mean(SD): age = 71.6(4.9), education = 16.4(3.0); 58% women, 95% non‐Hispanic or Latino, 90% white)]. Using descriptive analyses and linear regression models, we examined whether amyloid status (amyloid+: n = 1329/4492) and self‐reported mood (Geriatric Depression Scale [GDS]) or lifestyle habits (exercise, sleep) predicted subjective cognitive concerns (CFI; participant‐ and SP‐reported).ResultParticipants endorsed healthy lifestyle habits (mean hours of aerobic exercise/week = 2.9; mean hours of sleep/night = 7.1), minimal mood symptoms (mean GDS = 1.1), and higher cognitive concerns than SPs (t(5996) = ‐25.08, p<.001). Lower mood (t = 29.49, p<.001), older age (t = 5.75, p<.001), and lower education (t = ‐3.92, p<.001) predicted participant concerns on the CFI, with additive predictive value of lower self‐reported exercise (t = ‐2.90, p = .004) and sleep duration (t = ‐2.12, p = .035); however, only lower participant‐reported mood (t = 12.90, p<.001) and older participant age (t = 6.54, p<.001) predicted SP concerns. Adding amyloid to the model in a subset, all predictors for participant concerns remained except sleep, while only amyloid status (t = 4.59, p<.001), lower mood (t = 11.53, p<.001), and older age (t = 4.72, p<.001) predicted SP concerns.ConclusionCognitively unimpaired participants endorsed higher cognitive concerns on the CFI compared to their SPs. Participant concerns were associated with multiple predictors (age, education, mood, amyloid status, exercise, sleep), while SP concerns were only associated with age, mood, and amyloid status. Participants may be more aware of early changes and endorse concerns reflecting various factors, including personal lifestyle habits, while SP report may be more specific to cognitive changes due to age and amyloid burden. These findings expand understanding of how various factors (e.g., biomarkers, mood, lifestyle habits) may contribute differently to participant and SP cognitive concerns, which may inform research recruitment and clinical care.