Abstract
BackgroundSubjective cognitive decline (SCD) and anxiety symptoms both predict neurocognitive disorders, but the two correlate strongly with each other. It is unclear whether they reflect two independent disease processes in the development of neurocognitive disorders and hence deserve separate attention. This cohort study examined whether SCD and anxiety symptoms demonstrate independent risks of mild cognitive disorder and dementia (MCI/dementia).MethodsThe study included 14,066 participants aged ≥ 50 years and diagnosed with normal cognition at baseline, recruited from Alzheimer’s Disease Centers across the USA. The participants were evaluated for SCD and anxiety symptoms at baseline and followed up almost annually for incident MCI/dementia (median follow-up 4.5 years; interquartile range 2.2–7.7 years). SCD and anxiety symptoms were included in Cox regression to investigate their independent risks of MCI/dementia.ResultsSCD and anxiety symptoms demonstrated independent risks of MCI/dementia, with HR 1.9 (95% CI 1.7–2.1) and 1.3 (95% CI 1.2–1.5), respectively. Co-occurring SCD and anxiety symptoms demonstrated the highest risk (HR 2.4, 95% CI 1.9–2.9)—participants in this group had a 25% probability of developing MCI/dementia by 3.1 years (95% 2.4–3.7), compared to 8.2 years among those without SCD or anxiety (95% CI 7.9–8.6). The results remained robust even in the sensitivity analyses that took into account symptom severity and consistency of symptoms in the first 2 annual visits.ConclusionsThe findings suggest that clinicians should not dismiss one over the other when patients present with both SCD and anxiety and that both constructs may potentially be useful to identify high-risk populations for preventive interventions and trials. The findings also point to the need for further research to clarify on the neurobiological distinctions between SCD and anxiety symptoms, which may potentially enrich our understanding on the pathogenesis of neurocognitive disorders.
Highlights
Subjective cognitive decline (SCD) refers to the subjective perception of a decline in cognition among individuals with normal cognition [1,2,3]
If SCD and anxiety are both independent predictors of neurocognitive disorders (Fig. 1c), it behooves the researchers to delineate the distinct neurodegenerative processes between SCD and anxiety, as well as the clinicians to not dismiss one over the other when patients present with both SCD and anxiety
1270 (9.0%) participants reported the presence of anxiety symptoms and 3809 (27.1%) reported the presence of SCD
Summary
Subjective cognitive decline (SCD) refers to the subjective perception of a decline in cognition (typically in the memory domain) among individuals with normal cognition (that is, in the absence of objective cognitive deficits) [1,2,3]. Anxiety could be an early manifestation of neurocognitive disorders, with worries about one’s cognitive function (SCD) as one of the many symptoms of anxiety (Fig. 1b) Both SCD and anxiety could be independent predictors of neurocognitive disorders and reflect two independent disease processes that deserve separate attention (Fig. 1c). Subjective cognitive decline (SCD) and anxiety symptoms both predict neurocognitive disorders, but the two correlate strongly with each other It is unclear whether they reflect two independent disease processes in the development of neurocognitive disorders and deserve separate attention. This cohort study examined whether SCD and anxiety symptoms demonstrate independent risks of mild cognitive disorder and dementia (MCI/ dementia)
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