Two Year Outcomes, Cognitive and Behavioral Markers of Decline in Healthy, Cognitively Normal Older Persons with Global Deterioration Scale Stage 2 (Subjective Cognitive Decline with Impairment)

Article type: Research Article

Authors: Reisberg, Barry^{a; f; n; o; *} | Torossian, Carol^a | Shulman, Melanie B.^{a; b} | Monteiro, Isabel^a | Boksay, Istvan^a | Golomb, James^{a; b} | Guillo Benarous, Francoise^{a; b} | Ulysse, Anaztasia^b | Oo, Thet^b | Vedvyas, Alok^b | Rao, Julia A.^b | Marsh, Karyn^b | Kluger, Alan^{a; g} | Sangha, Jaspreet^a | Hassan, Mudasar^a | Alshalabi, Munther^a | Arain, Fauzia^a | Shaikh, Naveed^h | Buj, Maja^a | Kenowsky, Sunnie^a | Masurkar, Arjun V.^b | Rabin, Laura^{i; o} | Noroozian, Maryam^{j; n} | Sánchez-Saudinós, Mar&a Belén^{k; l} | Blesa, Rafael^{k; l; n} | Auer, Stefanie^m | Zhang, Yian^e | de Leon, Mony^a | Sadowski, Martin^{a; b; c} | Wisniewski, Thomas^{a; b; d} | Gauthier, Serge^{f; n} | Shao, Yongzhao^e

Affiliations: [a] Department of Psychiatry, New York University Langone Health, New York, NY, USA | [b] Department of Neurology, New York University Langone Health, New York, NY, USA | [c] Departments of Biochemistry and Molecular Pharmacology, New York University Langone Health, New York, NY, USA | [d] Department of Pathology, New York University Langone Health, New York, NY, USA | [e] Division of Biostatistics, Department of Population Health and Department of Environmental Medicine, New York University Langone Health, New York, NY, USA | [f] Departments of Neurology & Neurosurgery, Psychiatry, and Medicine, McGill University Research Centre for Studies in Aging, Québec, Canada | [g] Department of Psychology, Lehman College, City University of New York, New York, NY, USA | [h] Kings County Hospital Center, New York, NY, USA | [i] Department of Psychology, Brooklyn College and The Graduate Center, City University of New York, New York, NY, USA | [j] Memory and Behavioral Neurology Division, Roozbeh Hospital, Department of Psychiatry, Tehran University Medical Sciences, Tehran, Iran | [k] Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain | [l] Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain | [m] Department for Clinical Neurosciences and Preventive Medicine, Faculty of Health and Medicine, Danube University, Krems, Austria | [n] Subjective Cognitive Impairment Working Group, Alzheimer’s Disease International (ADI) | [o] Subjective Cognitive Decline Initiative (SCD-I) Professional Interest Area (PIA), Alzheimer’s Association

Correspondence: [*] Correspondence to: Barry Reisberg, MD, Professor, Department of Psychiatry, Aging & Dementia Clinical Research Center, NYU Alzheimer’s Disease Center, New York University Langone Health, 145 East 32nd Street, Room 508, New York, NY 10016, USA. Tel.: +1 212 263 8550; Fax: +1 212 263 6991; E-mail: barry.reisberg@nyulangone.org.

Abstract: Background:Little is known with respect to behavioral markers of subjective cognitive decline (SCD), a condition initially described in association with Global Deterioration Scale (GDS) stage 2. Objective:Two-year interval behavioral markers were investigated herein. Methods:Subjects from a published 7-year outcome study of GDS stage 2 subjects were selected. This study had demonstrated a hazard ratio of 4.5 for progression of GDS stage 2, in comparison with GDS stage 1 (no subjective or objective cognitive decline) subjects, after controlling for demographic and temporal variables. Because GDS 2 subjects have previously demonstrated impairment in comparison with healthy persons free of complaints, we herein suggest the terminology “SCD(I)” for these persons. 98 SCD(I) persons, 63 women and 35 men, mean baseline age, 67.12±8.75 years, with a mean educational background of 15.55±2.60 years, and mean baseline MMSE scores of 28.9±1.24 were followed for 2.13±0.30 years. Results:Observed annual decline on the GDS was 6.701% per annum, very close to a 1986 published estimate. At follow up, the MMSE, and 7 of 8 psychometric tests did not decline significantly. Of 21 Hamilton Depression Scale items, 2 improved and the remainder were unchanged. Anxieties declined from multiple perspectives. The Brief Cognitive Rating Scale (BCRS) declined significantly (p < 0.001), with component declines in Remote memory (p < 0.01), and Functioning/self-care (p = 0.01). Conclusion:SCD(I) persons decline at an annual rate of approximately 6.7% /year from several recent studies. The BCRS assessments and the Digit Symbol Substitution Test can be sensitive measures for future studies of progression mitigation.

Keywords: Aging, behavioral disturbances, cognition, cognitive decline, cognitive impairments, longitudinal studies,, memory, prognosis, psychometric testing, remote memory

DOI: 10.3233/JAD-180341

Journal: Journal of Alzheimer's Disease, vol. 67, no. 2, pp. 685-705, 2019