Assessing subjective cognitive decline in older adults attending primary health care centers: what question should be asked?

ABSTRACT

Introduction

Subjective Cognitive Decline (SCD) refers to a self-perceived experience of decreased cognitive function without objective signs of cognitive impairment in neuropsychological tests or daily living activities. Despite the abundance of instruments addressing SCD, there is no consensus on the methods to be used. Our study is founded on 11 questions selected due to their recurrence in most instruments. The objective was to determine which one of these questions could be used as a simple screening tool.

Methods

189 participants aged 65 and over selected from Primary Care centers in Santiago de Chile responded to these 11 questions and were evaluated with the MiniMental State Examination (MMSE), the Free and Cued Selective Reminding Test (FCSRT), the Pfeffer functional scale, and the Geriatric Depression Scale (GDS). An Item ResponseTheory (IRT) method was performed to assess the contribution of each of the 11 questions to the SCD latent trait and its discrimination ability.

Results

Based on the results of the exploratory factor analysis showing very high/low saturation of several questions on the factors, and the high residual correlation between some questions, the IRT methods led to select one question (“Do you feel like your memory has become worse?”) which revealed to be the most contributive and discriminant. Participants who answered yes had a higher GDS score. There was no association with MMSE, FCSRT, and Pfeffer scores.

Conclusion

The question “Do you feel like your memory has become worse?” may be a good proxy of SCD and could be included in routine medical checkups.

KEYWORDS:

• Subjective cognitive decline
• item response theory (IRT)
• older adults
• neurocognitive disorders
• mild cognitive impairment

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by ANID/FONDAP/15150012. AI is supported by Takeda Grant CW2680521; CONICET; FONCYT-PICT (2017-1818, 2017-1820); ANID/FONDECYT Regular (1210195, 1210176, 1220995); ANID/FONDAP (15150012); ANID/PIA/ANILLOS ACT210096; and the Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat), funded by the Fogarty International Center (FIC), and the National Institutes of Aging of the National Institutes of Health under award number R01AG057234, an Alzheimer’s Association grant (SG-20-725707-ReDLat), the Rainwater Foundation, the Bluefield Project to Cure FTD, and the Global Brain Health Institute. AS is partially supported by ANID/ FONDECYT Regular (1231839, 1210176 & 1210195), Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat), funded by the National Institutes of Aging of the National Institutes of Health under award number R01AG057234, an Alzheimer’s Association grant (SG-20-725707-ReDLat), the Rainwater Foundation, the Global Brain Health-Institute and ANID/PIA/ANILLOS ACT210096. The content is solely the responsibility of the authors and does not represent the official views of these institutions.