Prevalence Of Subjective Cognitive Decline Research Articles

RACIAL/ETHNIC DIFFERENCES IN SUBJECTIVE COGNITIVE DECLINE AMONG US ADULTS AGED ≥45 YEARS, 2015–2020

Abstract Recent studies report that older minorities have a higher prevalence of subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, than older non-Hispanic Whites. This study describes the prevalence of SCD by race/ethnicity and select demographic and social characteristics among U.S. adults aged ≥45 years and whether those reporting symptoms of SCD talked with a health care professional about them. Data collected from 215,406 respondents by the Behavioral Risk Factor Surveillance System (BRFSS) in 2015-2020 were used in the analyses. Statistical comparisons were made using chi-square tests and p value of < 0.05. SCD was reported by nearly 10% of the study population. Asian/Pacific Islanders (5.0%) were least likely to report experiences of SCD and American Indian/Alaska Natives (16.7%) were most likely to report the experience compared to other racial/ethnic groups. Among adults with SCD, Asian/Pacific Islander (34.5%) and Hispanic (40.5%) adults were less likely to talk with a health care professional about their SCD symptoms compared to non-Hispanic White (48.5), non-Hispanic Black (49.5%), and American Indian/Alaska Native (50.5%) adults. Early detection of SCD symptoms can be important to identify early signs of dementia or other potentially treatable conditions and establish a care plan to help people remain as healthy and independent for as long as possible. Health care professionals, especially those working with groups with increased prevalence of SCD, could consider initiating discussions with adults as young as 45 years of age to identify early signs of dementia-like symptoms.

Exploring Cognitive Impairment in a Community‐Based Sample of LGBTQ+ Older Adults

AbstractBackgroundOver three million adults aged 60+ in the U.S. identify as lesbian, gay, bisexual, transgender, queer, or another sexual and/or gender minority identity (LGBTQ+). Population‐based studies have found a higher prevalence of subjective cognitive decline among LGBTQ+ adults compared to non‐LGBTQ+ adults. Less is known about objective cognitive impairment in LGBTQ+ older adults.MethodWe recruited a community‐based sample of LGBTQ+ older adults (n = 61) from low‐income housing registries. The Telephone Interview for Cognitive Status (TICS; Brandt et al., 1988), an 11‐item screening test of global cognition. Descriptive statistics were used to summarize demographic characteristics, TICS scores, and the prevalence of cognitive impairment. We also examined associations between TICS score (adjusted for age and education) and self‐reported physical and mental health limitations.ResultMean age was 70.8 (SD = 5.8, range = 58‐84). Most reported their sex assigned at birth as male (67%), and 5% identified their gender as transgender or non‐binary. Most participants identified as lesbian or gay (85%), with 7% identifying as bisexual, and 8% queer or another sexual orientation. The majority (90%) identified as White, 7% Black, and 3% Latino. Over 62% of participants had a four‐year college degree or higher. Nearly 80% reported an annual income ≤$30,000. Common chronic health conditions included depression (57%), anxiety (48%), hypertension (46%), post‐traumatic stress disorder (26%), and human immunodeficiency virus infection (21%). About 40% (n = 24) reported problems with their memory. TICS median score was 33.0 (SD = 3.55, range = 21‐39). Nearly 43% (n = 26) may have cognitive impairment (i.e., TICS score of ≤32). A lower TICS score was associated with reporting limitations in daily activities (p = 0.02) and social activities with family and friends (p = 0.04) over the past four weeks.ConclusionOver 40% of LGBTQ+ older adults scored in the impaired range on a screening measure of global cognition. Clinically, more comprehensive evaluations would clarify the extent of decline present among the current sample. Follow‐up studies are needed to better understand the cognitive functioning of LGBTQ+ older adults as some subgroups report more memory problems relative to non‐LGBTQ+ groups. Moreover, inclusive recruitment and outreach efforts are essential so the voices of all LGBTQ+ subgroups can be accurately portrayed in clinical research.

Prevalence and affective correlates of subjective cognitive decline in patients with de novo Parkinson's disease.

ObjectivesThe novel concept of subjective cognitive decline (SCD) in Parkinson's disease (PD) refers to subjective cognitive impairment without concurrent objective cognitive deficits. This study aimed to determine the prevalence and affective correlates of SCD in de novo PD patients.Materials and MethodsA total of 139 de novo PD patients underwent comprehensive neuropsychological evaluation. PD patients with SCD (PD‐SCD) did not meet the diagnostic criteria for mild cognitive impairment in PD (PD‐MCI) based on the Movement Disorder Society Level II Criteria and were defined by a Domain‐5 Score ≥1 on the Non‐Motor Symptoms Questionnaire. Affective symptoms were measured using the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA).ResultsIn de novo PD cohort, the prevalence of SCD was 28.1%. PD‐SCD patients performed significantly better than PD‐MCI patients on tests of five cognitive domains. The more commonly affected domains in PD‐SCD patients were memory (28.2%) and attention/working memory (25.6%). Multivariable linear regression analysis revealed that PD‐SCD was significantly associated with both HAMD (β = 4.518, 95% CI = 0.754–8.281, p = .019) and HAMA scores (β = 4.259, 95% CI = 1.054–7.464, p = .010). Furthermore, binary logistic regression analysis revealed that higher HAMD (OR = 1.128, 95% CI = 1.019–1.249, p = .020) and HAMA scores (OR = 1.176, 95% CI = 1.030–1.343, p = .017) increased the risk of PD‐SCD.ConclusionsOur findings suggest that SCD is highly prevalent in de novo PD patients. The presence of PD‐SCD is suggestive of an underlying affective disorder.

Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years - United States, 2019.

Alzheimer disease,* the most common cause of dementia, affects an estimated 6.5 million persons aged ≥65 years in the United States (1). A growing body of evidence has identified potential modifiable risk factors for Alzheimer disease and related dementias (ADRD) (1-3). In 2021, the National Plan to Address Alzheimer's Disease (National Plan) introduced a new goal to "accelerate action to promote healthy aging and reduce risk factors for Alzheimer's disease and related dementias" to help delay onset or slow the progression of ADRD (3). To assess the status of eight potential modifiable risk factors (i.e., high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking), investigators analyzed data from the cognitive decline module that was administered to adults aged ≥45 years in 31 states and the District of Columbia (DC)† in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the risk factors, prevalence was highest for high blood pressure (49.9%) and lowest for binge drinking (10.3%) and varied by selected demographic characteristics. Adults with subjective cognitive decline (SCD),§ an early indicator of possible future ADRD (4), were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). Prevalence of SCD was 11.3% overall and increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors. Implementing evidence-based strategies to address modifiable risk factors can help achieve the National Plan's new goal to reduce risk for ADRD while promoting health aging.¶,*.

Overall and sex-specific risk factors for subjective cognitive decline: findings from the 2015\u20132018 Behavioral Risk Factor Surveillance System Survey

BackgroundPrior research indicates that at least 35% of Alzheimer’s disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent Alzheimer’s disease in such individuals being greater in women than men. We wished to understand how modifiable factors are associated with subjective cognitive decline, and whether differences exist by sex.MethodsData were collected from men and women (45 years and older) who completed the U.S. Behavioral Risk Factor Surveillance System Cognitive Decline Module (2015–2018), n = 216,838. We calculated population-attributable fractions for subjective cognitive decline, stratified by sex, of the following factors: limited education, deafness, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes. Our models were adjusted for age, race, income, employment, marital and Veteran status, and accounted for communality among risk factors.ResultsThe final study sample included more women (53.7%) than men, but both had a similar prevalence of subjective cognitive decline (10.6% of women versus 11.2% of men). Women and men had nearly equivalent overall population-attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors were social isolation, depression, and hypertension, which explained three-quarters of the overall population-attributable fraction.ConclusionsWhile we did not identify any differences in modifiable factors between men and women contributing to subjective cognitive decline, other factors including reproductive or endocrinological health history or biological factors that interact with sex to modify risk warrant further research.

Subjective cognitive decline in Brazil: Prevalence and association with dementia modifiable risk factors in a population-based study.

Subjective cognitive decline (SCD) may be an early symptom of Alzheimer's disease. We aimed to estimate the prevalence of SCD in Brazil and its association with dementia modifiable risk factors. We used data of 8138 participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based study that included clinical and demographic variables of individuals across the country. We calculated the prevalence of SCD and its association with dementia modifiable risk factors. We found that the prevalence of SCD in Brazil was 29.21% (28.22%-30.21%), varying according to region, sex, and age. SCD was strongly associated with hearing loss, low education, psychological distress, Brown/Pardo and Black races. The prevalence of SCD in Brazil is higher than in high-income countries. Brown/Black races and dementia modifiable risk factors were associated with SCD. Public strategies that target SCD may help mitigate the incidence of dementia.

Prevalence and Characteristics of Subjective Cognitive Decline Among Caregivers, 2015-2019

Approximately 20% of U.S. adults provide unpaid care to family members and friends with a health condition or disability, and 20% of caregivers reported being in fair or poor health themselves. Much of the assistance caregivers provide have cognitive components, such as medication or financial management, yet little is known about caregivers’ cognitive functioning. Subjective cognitive decline (SCD), or self-reported worsening of memory over the past year, among caregivers could impact the quality of care they provide. This study assessed prevalence of SCD by caregiving status and, among caregivers, the distribution of sociodemographic and other characteristics by SCD status. The study included 93,851 community-dwelling adults aged ≥45 years in 22 states who completed both the Behavioral Risk Factor Surveillance System Cognitive Decline and Caregiving modules during 2015-2019. All data were weighted; comparisons are based on modified Rao-Scott chi-square tests (α=0.05). Among caregivers (n=21,238), 12.6% (95%CI:11.7-13.5) reported SCD, compared with 10.2% (95%CI:9.7-10.7) of non-caregivers (p<0.0001). Caregivers with SCD had more chronic health conditions, lower educational attainment, and were less likely to be married or employed than caregivers without SCD, despite a similar age distribution. Caregivers with SCD were also more likely than caregivers without SCD to report fair or poor health, frequent mental distress, a history of depression, and frequent activity limitations. SCD may negatively impact caregivers’ health, function, and ability to provide care. With the anticipated increases in the need for caregiving, it is critical to understand the cognitive health of caregivers to better support caregivers and care recipients.

Gender minority BIPOC adults in the U.S. report greater subjective cognitive decline

AbstractBackgroundThere is limited research investigating risk of cognitive impairment and Alzheimer’s disease and related dementia (ADRD) among gender minority (GM) adults (i.e. transgender, non‐binary). To‐date, no study has examined these cognitive challenges among GM who identify as Black, Indigenous, or People of Color (BIPOC). The health and social inequities experienced by GM BIPOC are linked to an increased risk of cognitive impairment in cisgender (CG) adults. Subjective cognitive decline (SCD), a self‐reported experience of worsening memory or thinking, may be one of the first clinical manifestations of ADRD.Method2015‐2019 Behavioral Risk Factor Surveillance System data, representing 33 states that assessed SCD and gender identity, were used to create a 1:4 matched analytic sample (1GM matched to 2CG males and 2CG females on U.S. state, age, race) to examine SCD among GM BIPOC (N=129), GM White (N=324), CG BIPOC (N=513), and CG White (N=1296) adults aged 45‐65. Logistic regression and adjusted odds ratios were used to determine SCD and SCD‐associated functional limitations prevalences and test for differences in prevalence and demographic characteristics.ResultSCD prevalence was highest among GM BIPOC (26.36%) and GM White (17.90%), followed by CG BIPOC (12.28%) and CG White (9.72%). The odds of SCD were 1.64‐3.32 times higher in GM BIPOC relative to the other groups. There were no differences in prevalence of SCD‐associated limitations. After accounting for demographic characteristics, GM BIPOC adults were nearly twice as likely to report SCD when compared to both CG BIPOC (CL: 1.06–3.02, P=0.0283) and CG White adults (95% CL: 1.22–3.20, P=0.0059).ConclusionPast research highlights that BIPOC adults suffer from ADRD at higher rates than Whites. When considering the intersection of GM status and identifying as BIPOC, we found that SCD prevalence was highest among GM BIPOC and GM BIPOC had higher odds of SCD when compared to CG BIPOC. Additional studies are needed to understand correlates and modifiable risk factors of cognitive impairment among GM BIPOC adults. This understanding is necessary for identifying GM adults at higher risk for cognitive impairment, reducing ADRD risk, and improving care and quality of life for this understudied population.

Risk factors for subjective cognitive decline: the CABLE study

Increasing evidences supported that subjective cognitive decline (SCD) might be a potential first symptomatic manifestation of Alzheimer’s disease (AD). The rapidly growing number of SCD individuals who seek medical help and advice also makes it urgent to develop more precise strategy for SCD. Therefore, this study aimed to explore the risk factors for SCD. Logistics and linear regression models were performed to investigate 41 factors for SCD in 1165 participants without objective cognitive impairment. Cochran-Armitage trend test was used to confirm the constant trend toward higher prevalence of SCD with an increasing number of risk factors. A high overall prevalence of SCD was found in total participants (42%). Eight factors were eventually identified as risk factors for SCD, including four stable factors associated with both SCD statues and severity (older age, thyroid diseases, minimal anxiety symptoms, and day time dysfunction; odds ratio (OR) ranging from 1.74 to 2.29) as well as four suggestive factors associated with either SCD statues or severity (female sex, anemia, lack of physical exercises, and living alone; OR ranging from 1.30 to 2.29). The prevalence of SCD gradually increased with the number of risk factors clustering increased in individuals (p for trend <0.001). Five of these eight factors were further proved among individuals with SCD-plus features. These findings revealed several risk factors for SCD, providing some new clues for formulating priority strategies for early prevention of SCD.

Disparities of Subjective Cognitive Decline Among Native Hawaiians/Other Pacific Islanders, Asian Americans, and White Americans in Hawai'i: Behavioral Risk Factor Surveillance System 2015 and 2017.

Existing research on subjective cognitive decline (SCD) among Native Hawaiians/Other Pacific Islanders (NHOPIs) is limited even though NHOPI adults have the highest prevalence of cardiovascular risk factors. In this study, we investigated SCD disparities among NHOPIs, Asian Americans, and White Americans and its contributing factors utilizing the 2015 and 2017 survey year data from the Behavioral Risk Factor Surveillance System (BRFSS) for Hawai'i State in the United States. The SCD prevalence was 11.9%, 8.97%, and 7.86% among NHOPIs, Whites, and Asians, respectively. Adjusting for sociodemographic and health behavioral variables, the prevalence ratios (PRs) of SCD were 1.37 (95% confidence interval [CI] = 1.05-1.78) for NHOPI versus Asian and 1.15 (95% CI = 0.89-1.50) for NHOPI versus Whites. The associations were weakened after adjusting for health conditions. Depressive disorders, coronary heart disease or myocardial infarction, stroke, and diabetes were associated with cognitive decline in the multivariate-adjusted model. NHOPIs experienced more SCD-related functional difficulties than other races.

Predictors of Subjective Cognitive Decline Among People With Diabetes: Data From the Behavioral Risk Factor Surveillance System.

The purpose of this study was to examine the prevalence of subjective cognitive decline (SCD) and SCD-related functional limitations among people with diabetes and to identify socioeconomic and comorbidity risk factors associated with SCD. This study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) with background variables (race, gender, education, and age), health-related factors (self-rated health, BMI, insurance, and comorbid conditions), and health behaviors (smoking, exercise, alcohol consumption) entered simultaneously to estimate logistic regression models of SCD. Within the sample (n = 5263 adults with diabetes), 48% were age ≥65 years; 50% were male; 55% were non-Hispanic White; and of the 15% who reported having SCD, 57% had functional limitations. Increased odds of reporting SCD were observed among individuals who were Hispanic (odds ratio [OR] = 2.21, P < .001), male (OR = 1.47, P < .01), depressed (OR = 3.85, P < .001), or had arthritis (OR = 1.43, P < .03). Participants with better self-rated health had a reduced likelihood of SCD (OR = 0.51, P < .001). Health care providers should assess high-risk patients for self-rated cognitive dysfunction and offer early interventions.

Perceived environmental pollution and subjective cognitive decline (SCD) or SCD-related functional difficulties among the general population.

This study aimed to determine whether perceived environmental pollution is associated with subjective cognitive decline (SCD) or SCD-related functional difficulties. We conducted a cross-sectional study using data from a nationwide sample of 191,054 individuals aged ≥19 years from the 2018 Korea Community Health Survey. Perceived air, water, soil, noise, and green space pollution was assessed. To investigate the dose-response effect of the amount of perceived environmental pollution, we determined whether an increasing number of types of perceived environmental pollution also increased the odds of having SCD or SCD-related functional difficulties. Among the 191,054 individuals, the prevalence of SCD and SCD-related functional difficulties was 17.7% (N = 33,853) and 2.2% (N = 4139), respectively. Perception of air, soil, or noise pollution was significantly associated with SCD. However, the perception of any type of environmental pollution was not significantly associated with SCD-related functional difficulties. With regard to a dose-response effect, individuals perceiving a greater number of types of environmental pollution had significantly higher odds of SCD or SCD-related functional difficulties. This association was notably more evident in the younger age group.

Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015-2018.

IntroductionSubjective cognitive decline (SCD) represents self‐reported problems with memory, a possible early sign of dementia. Little is known about SCD among sexual and gender minority (SGM) adults who identify as lesbian, gay, bisexual, and/or transgender or gender non‐binary.MethodsData were weighted to represent population estimates from 25 states’ 2015–2018 Behavioral Risk Factor Surveillance System to describe SCD in adults ≥45 years by SGM status. Logistic regression tested associations between demographic and health conditions.ResultsSCD prevalence was higher in SGM (15.7%; 95% confidence interval [CI]:13.1–18.2) than in non‐SGM adults (10.5%; 95% CI:10.1–10.9; P < .0001). SGM adults with SCD were also more likely to report functional limitations due to SCD than non‐SGM adults with SCD, 60.8% versus 47.8%, P = .0048. Differences in SCD by SGM status were attenuated after accounting for depression.DiscussionHigher prevalence of SCD in SGM adults highlights the importance of ensuring inclusive screenings, interventions, care services, and resources for SGM adults.

A Fay-Herriot Model for Estimating Subjective Cognitive Decline among Military Veterans.

Although studies have examined the geographic distribution of dementia among the general population in order to develop geographically targeted interventions, no studies have examined the geographic distribution of subjective cognitive decline (SCD) among military veterans specifically. To map the geographic distribution of subjective cognitive decline from 2011-2019 in the United States among military veterans. Cross-sectional. United States. Individuals reporting previous service in the United States Armed Forces. Using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data, which is last year for which geocoded SCD data is publicly available, we estimated the survey-weighted county-level prevalence of veteran SCD for counties with >30 veterans (43 counties in 7 states). We then developed a Fay-Herriot small area estimation linear model using auxiliary data from the Census, with county-level veteran-specific covariates including % >65 years old, % female, % college educated, and median income. Following model validation, we created beta-weighted predictions of veteran SCD for all USA counties for 2011-2019 using relevant time-specific Census auxiliary data. We provide choropleth maps of our predictions. Results of our model on 43 counties showed that county-level rates of SCD were significantly associated with all auxiliary variables except annual income (F = 1.49, df = 4, 38). Direct survey-weighted rates were correlated with model-predicted rates in 43 counties (Pearson r = 0.32). Regarding predicted rates for the entire USA, the average county-level prevalence rate of veteran SCD in 2011 was 13.83% (SD = 7.35), but 29.13% in 2019 (SD = 14.71) - although variation in these rates were evident across counties. SCD has increased since 2011 among veterans. Veterans Affairs hospitals should implement plans that include cognitive assessments, referral to resources, and monitoring patient progress, especially in rural areas.

U.S. state correlations between oral health metrics and Alzheimer\u2019s disease mortality, prevalence and subjective cognitive decline prevalence

Given the association between periodontal disease (PdD) and Alzheimer’s disease (AD), we examined correlations between states’ age-adjusted AD mortality rates, AD prevalence, subjective cognitive decline (SCD) prevalence, and oral health data. Data sources include the Centers for Disease Control and Prevention, scientific literature, and oral health rankings formulated by WalletHub.com and Toothbrush.org. Pearson (r) or Spearman (rs) correlation coefficients were generated and evaluated. AD mortality rates correlate with dental visits (r = − 0.50, p = 0.0003), partial (r = 0.39, p = 0.005) or total (r = 0.44, p = 0.001) edentulism, WalletHub.com (rs = 0.30, p = 0.03) and Toothbrush.org (rs = 0.35, p = 0.01) rankings. AD prevalence correlates with dental visits (r = − 0.30, p = 0.03), partial (r = 0.55, p = 0.00003) or total (r = 0.46, p = 0.0009) edentulism, prevalence of any (r = 0.38, p = 0.006) or severe-stage (r = 0.46, p = 0.0009) PdD, and WalletHub.com (rs = 0.38, p = 0.006) rankings. SCD prevalence in adults aged ≥ 45 years correlates with dental visits (r = − 0.69, p < 0.00001), partial (r = 0.33, p = 0.02) or total (r = 0.37, p = 0.008) edentulism, prevalence of any (r = 0.53, p = 0.0001) or severe-stage (r = 0.57, p = 0.00002) PdD, WalletHub.com (rs = 0.53, p = 0.00008) and Toothbrush.org (rs = 0.60, p < 0.00001) rankings. State metrics indicative of compromised oral health correlate with AD mortality rates, AD prevalence and SCD prevalence.

Estimating prevalence of subjective cognitive decline in and across international cohort studies of aging: a COSMIC study

BackgroundSubjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer’s disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts.MethodsWe combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence.ResultsThe sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3–24.4%) and IRT (25.6%, 95%CI = 25.1–26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1–7.0%, to 52.7%, 95%CI = 47.4–58.0%; IRT: 7.8%, 95%CI = 6.8–8.9%, to 52.7%, 95%CI = 47.4–58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades.ConclusionsSCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field.

Minor hallucinations reflect early gray matter loss and predict subjective cognitive decline in Parkinson's disease.

Well-structured hallucinations in Parkinson's disease (PD) are associated with poor prognosis and dementia. However, the predictive value of minor psychotic phenomena in cognitive deterioration is not well known. Cross-sectional studies have shown that PD patients with minor hallucinations have more severe cortical atrophy than non-hallucinators, but baseline and longitudinal studies addressing the evolution of these brain differences are lacking. The impact of developing minor hallucinations on cognitive impairment and cortical atrophy progression in early PD was explored. One hundred and thirty-one de novo PD patients from the Parkinson's Progression Marker Initiative for whom brain magnetic resonance imaging scans were available were included. Cognitive outcome at 5years was compared between patients with and without minor hallucinations during follow-up. Additionally, using gray matter volume (GMV) voxel-based morphometry, cross-sectional (at baseline) and longitudinal (1- and 2-year GMV loss) structural brain differences between groups were studied. During follow-up, 35.1% of patients developed minor hallucinations. At 5years, these patients showed an increased prevalence of subjective cognitive decline compared to non-hallucinators (44.1% vs. 13.9%; p<0.001), but not formal cognitive impairment. Additionally, compared to non-hallucinators, they exhibited reduced GMV at baseline in visuoperceptive areas and increased GMV loss in left temporal areas (p<0.05 corrected). Minor hallucinations seem to be an early clinical marker of increased neurodegeneration and are associated with mid-term subjective cognitive decline. Longer follow-up analyses would be needed to further define if these findings could reflect a higher risk of future cognitive deterioration.

Associations between Chewing Difficulty, Subjective Cognitive Decline, and Related Functional Difficulties among Older People without Dementia: Focus on Body Mass Index.

This study aimed to determine whether chewing difficulty is associated with subjective cognitive decline (SCD) and related functional difficulties by body mass index. A population-based cross-sectional study. A nationwide sample of 54,004 individuals aged ≥65 years from the 2018 Korea Community Health Survey. SCD and SCD-related functional difficulties were measured using the cognitive decline module of the Behavioral Risk Factor Surveillance System. Chewing difficulty was assessed based on a self-report questionnaire from an oral health-related behaviors interview survey. BMI was calculated from objective values by measuring height and weight through a physical meter. Among the 54,004 individuals, the prevalence of SCD in underweight, overweight, and obesity group was 33.6% (n = 806), 30.3% (n = 9,691), and 28.7% (n=5,632) respectively. Chewing difficulty was associated with SCD and SCD-related functional difficulties. This association was more pronounced in underweight (BMI: <18.5 kg/m2) people [underweight: (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.48-1.92); normal weight: OR = 1.13, 95% CI 1.04-1.22; obese: OR = 1.15, 95% CI 1.05-1.27]. Similar trends were demonstrated for SCD-related functional difficulties (underweight: OR = 1.53, 95% CI 1.17-2.01; normal weight: OR = 1.36, 95% CI 1.15-1.63; obese: OR = 1.50, 95% CI 1.22-1.86). Chewing difficulty was associated with SCD and SCD-related functional difficulties in older people. Our results suggest that underweight status may play roles in the associations between chewing difficulty and SCD and SCD-related functional difficulties.

Slow Gait, Subjective Cognitive Decline and Motoric Cognitive RISK Syndrome: Prevalence and Associated Factors in Community Dwelling Older Adults.

Motoric Cognitive Risk Syndrome (MCR), slow gait speed (SG) and subjective cognitive decline (SCD) are known to be harbingers of dementia. MCR is known to be associated with a 3-fold increased risk of future dementia, while SG can precede cognitive impairment. We aim to determine the prevalence and demographics of MCR, slow gait alone (SG-A) and subjective cognitive decline alone (SCD-A) in community-dwelling older adults and association with physical, functional, cognition and psychosocial factors. A total of 509 participants were classified into four groups according to presence of SG and/or SCD. Multinomial logistic regression was used to identify the factors associated with SG-A, SCD-A and MCR. The prevalence of MCR was 13.6%, SG-A 13.0% and SCD-A 35.0%. Prevalence of MCR doubled every decade in females with 27.7% of female ≥ 80 years old had MCR. Almost 4 in 10 had no SG or SCD (SG+SCD negative). MCR and SG-A groups were significantly older, had higher body mass index (BMI), lower education, lower global cognition scores especially in non-memory domains, higher prevalence of low grip strength and lower short physical performance battery scores than those with SCD-A and SG+SCD negative. In addition, the SG-A group had significantly higher prevalence of multi-morbidity and diabetes. The prevalence of pain, depression, frailty, social isolation and activity of daily living impairment were significantly higher in MCR. The global cognitive and functional scores for those with SCD-A were comparable to the SG+SCD negative group. The Malay ethnic group had the lowest prevalence of SCD but highest prevalence of SG. After adjusting for confounding factors, age, BMI, frailty status, instrumental activity of daily living, depression and pain remained significantly associated with MCR. For SG-A, age, BMI, education and number of chronic diseases remained significant. Both MCR and SG-A are associated with global cognitive decline especially in the non-memory domains and lower functional scores. Gait speed is a good predictor of negative outcomes and should be considered as the 'sixth' vital sign. Long term prospective studies are needed to evaluate: i) the conversion to dementia in different ethnic groups and ii) effect of targeted physical and / or dual task exercise on delaying the conversion to dementia and / or improvement in physical measures and reduction of disability.

Cross-sectional association between physical activity level and subjective cognitive decline among US adults aged ≥45 years, 2015

Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months and can be one of the earliest symptoms of Alzheimer's disease. Regular physical activity can contribute to the primary, secondary, and tertiary prevention of cognitive decline. At the national level, prevalence estimates of SCD by physical activity level in the United States are currently unknown. The purpose of this study is to examine the prevalence of SCD and resulting functional limitations by physical activity level among US adults aged ≥45 years. Data from 33 states and the District of Columbia participating in the 2015 Behavioral Risk Factor Surveillance System (N = 128,925) were analyzed. We estimated the prevalence of SCD (a positive response to a question about worsening or more frequent confusion or memory loss within the previous 12 months) and resulting functional limitations overall and by self-reported physical activity level based on current guidelines (i.e., active, insufficiently active, and inactive). Odds ratios were estimated using logistic regression models adjusting for respondent characteristics. Overall, 11.3% of US adults aged ≥45 years reported SCD. Prevalence of SCD increased as physical activity level decreased (active: 8.8%; insufficiently active: 11.4%; inactive: 15.7%). Among those with SCD, the prevalence of functional limitations also increased as physical activity level decreased (active: 40.5%; insufficiently active: 50.0%; inactive: 57.4%). These differences largely remained after adjusting for respondent characteristics. Findings highlight the potential public health impact nationally of efforts to promote physical activity for cognitive health.