What happens to the worried well? Follow‐up of subjective cognitive impairment

Abstract

AbstractBackgroundPerceived neurocognitive decline is becoming a more common concern, leading to an increased number of referrals to specialists for further investigation and increased stress and anxiety for patients. Subjective cognitive impairment (SCI) refers to the condition of having concerns about one’s memory but performing within the expected range on neurocognitive tests. People with SCI can also be referred to as the “worried well”. We aimed to explore how likely the “worried well” are to experience neurocognitive decline and develop a neurologic diagnosis.Method166 consecutive “worried well” patients who attended the Rural and Remote Memory Clinic (RRMC) in Saskatchewan, Canada between 2004 and 2019 were included. Demographic, health, social, and behavioural factors were recorded at the initial visit. Mini Mental Status Examination (MMSE) score, Center for Epidemiologic Studies Depression Scale (CESD) score, and Functional Assessment Questionnaire (FAQ) scores were measured and compared at initial assessment and at 1‐year follow‐up. MMSE scores overtime were assessed with a mean follow‐up of 2.95 years (SD 2.87). Case summaries were used to build the profile of 9 cases, which have been followed longer than one year and developed a neurologic diagnosis.ResultThere was no statistically significant difference in MMSE, CESD, or FAQ scores between clinic day and one‐year follow‐up, and no consistent pattern of MMSE score over time. Of the 166 patients with SCI on initial assessment, 5 were later diagnosed with AD at 8.5, 3.5, 5, 3, and 1.75 years; 2 were diagnosed with MCI at 1 and 2 years; 1 was diagnosed with vascular cognitive impairment at 5 years; and 1 was diagnosed with frontotemporal dementia (FTD) at 0.5 years.ConclusionThere is no pattern of neurologic decline observed in the “worried well”. Though the likelihood of a patient with SCI developing a neurological diagnosis is reassuringly low, (9/166), it is not irrelevant. The chance of an underlying neurological problem and subsequent neurologic diagnosis, along with the benefits of early diagnosis and treatment for dementia, leads us to believe that patients with SCI should still be seen in follow‐up at least at the one‐year mark.