Relationship between psychiatric symptoms and bidirectional change in subjective cognitive decline

Abstract

AbstractBackgroundSubjective Cognitive Decline (SCD) is increasingly recognized as a prodromal risk state for Alzheimer’s disease. However, relatively little is known about trajectories of SCD within cognitively normal older adults, or the factors that associate with SCD change in this group. In this study, we examine the extent to which specific psychiatric symptoms including anxiety, depression, and apathy associate with an individual’s change in SCD over time.MethodParticipants were community dwelling cognitively normal older adults. SCD was measured using a 20‐item age‐anchored questionnaire that assessed complaints of cognitive functioning. Anxiety, depression, and apathy were assessed using the Beck Anxiety Inventory(BAI), Geriatric Depression Scale(GDS), and Apathy Evaluation Scale(AES), respectively. Measurements were conducted at two timepoints (T1 and T2). Average duration between visits was 35.62 months(SD = 13.28). High SCD change individuals(HC), as opposed to low SCD change individuals(LC), were defined as those who’s total SCD rating changed more than ±1 SD from the mean change score. Regression models were conducted to examine the association between SCD change group and psychiatric symptoms.ResultParticipants were 82 cognitively normal older adults (6.1% Hispanic, 93.9% Non‐Hispanic; 79.3% White, 15.9% Black; 67% female; mean age = 70.96(SD = 6.98); mean education = 16.38(SD = 2.26)). 22 participants were classified as HC(11 with increasing SCD; 11 with decreasing SCD). Anxiety symptoms were higher in the HC group than the LC group at T1(6.57 vs 3.53, p = 0.013) and T2(6.70 vs 2.91, p = 0.003). After adjusting for demographics(age, gender, and education), only T1 anxiety was associated with the HC group(B = 0.297, p = 0.017).ConclusionIndividuals with greater change in SCD over time had higher levels of anxiety at baseline than individuals with relatively stable SCD. This was true for individuals who had a large increase in SCD as well as a large decrease. Our results inform the factors that may contribute to variability in SCD among cognitively normal older adults and underscore the importance of assessing anxiety along with SCD. Importantly, as psychiatric symptoms may also confer risk for future dementia, current findings do not undercut the potential relevance of SCD for future cognitive decline and dementia. Ongoing longitudinal research is examining the interplay of SCD change, psychiatric symptoms, objective cognition, and diagnostic conversion.