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)
Restricted accessResearch articleFirst published online January 22, 2019
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)
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.
SperlingR, AisenPS, BeckettLA, BennettDA, CraftS, FaganAM, IwatsuboT, JackCRJr, KayeJ, MontineTJ, ParkDC, ReimanEM, RoweCC, SiemersE, SternY, YaffeK, CarrilloMC, ThiesB, Morrison-BogoradM, WagsterMV, PhelpsCH (2011) Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement7, 280–292.
2.
JessenF, AmariglioRE, van BoxtelM, BretelerM, CeccaldiM, ChételatG, DuboisB, DufouilC, EllisKA, van der FlierWM, GlodzikL, van HartenAC, de LeonMJ, McHughP, MielkeMM, MolinuevoJL, MosconiL, OsorioRS, PerrotinA, PetersenRC, RabinLA, RamiL, ReisbergB, RentzDM, SachdevPS, de la SayetteV, SaykinAJ, ScheltensP, ShulmanMB, SlavinMJ, SperlingRA, StewartR, UspenskayaO, VellasB, VisserPJ, WagnerM, Subjective Cognitive Decline Initiative (SCD-I) Working Group (2014) A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimers Dement10, 844–852.
3.
MolinuevoJL, RabinLA, AmariglioR, BuckleyR, DuboisB, EllisKA, EwersM, HampelH, KlöppelS, RamiL, ReisbergB, SaykinAJ, SikkesS, SmartCM, SnitzBE, SperlingR, van der FlierWM, WagnerM, JessenF, for the Subjective Cognitive Decline Initiative (SCD-I) Working Group (2017) Implementation of subjective cognitive decline criteria in research studies. Alzheimers Dement13, 296–311.
ReisbergB, FerrisSH, de LeonMJ, CrookT (1982) The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry139, 1136–1139.
6.
La JoieR, PerrotinA, EgretS, PasquierF, TomadessoC, MézengeF, DesgrangesB, de La SayetteV, ChételatG (2016) Qualitative and quantitative assessment of self-reported cognitive difficulties in nondemented elders: Association with medical help seeking, cognitive deficits, and β-amyloid imaging. Alzheimers Dement5, 23–34.
7.
PerrotinA, La JoieR, de La SayetteV, BarréL, MézengeF, MutluJ, GuilloteauD, EgretS, EustacheF, ChételatG (2017) Subjective cognitive decline in cognitively normal elders from the community or from a memory clinic: Differential affective and imaging correlates. Alzheimers Dement13, 550–560.
8.
OssenkoppeleR, JagustWJ (2017) The complexity of cognitive decline. JAMA Neurol74, 1400–1402.
9.
ReisbergB, SchneckMK, FerrisSH, SchwartzGE, de LeonMJ (1983) The Brief Cognitive Rating Scale (BCRS): Findings in primary degenerative dementia (PDD). Psychopharmacol Bull19, 47–50.
10.
ReisbergB (1986) Dementia: A systematic approach to identifying reversible causes. Geriatrics41, 30–46.
11.
FolsteinMF, FolsteinSE, McHughPR (1975) “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res12, 189–198.
12.
BlessedG, TomlinsonBE, RothM (1968) The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry114, 797–811.
13.
ReisbergB, FerrisSH, de LeonMJ, SinaikoE, FranssenE, KlugerA, MirP, BorensteinJ, GeorgeAE, ShulmanE, SteinbergG, CohenJ (1988) Stage-specific behavioral, cognitive, and in vivo changes in community residing subjects with age-associated memory impairment and primary degenerative dementia of the Alzheimer type. Drug Dev Res15, 101–114.
14.
GilbertJG, LeveeRF (1971) Patterns of declining memory. J Gerontol26, 70–75.
15.
WechslerDA (1958) The Measurement and Appraisal of Adult Intelligence4th ed. Williams & Wilkins, Baltimore, MD.
16.
McCarthyM, FerrisSH, ClarkE, CrookT (1981) Acquisition and retention of categorized material in normal aging and senile dementia. Exp Aging Res7, 127–135.
17.
BuschkeH, FuldPA (1974) Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology11, 1019–1025.
18.
LehmannHE, BanTA (1970) Psychometric tests in evaluation of brain pathology, response to drugs. Geriatrics25, 142–147.
ReisbergB, FranssenE, SclanSG, KlugerA, FerrisSH (1989) Stage specific incidence of potentially remediable behavioral symptoms in aging and Alzheimer’s disease: A study of 120 patients using the BEHAVE-AD. Bull Clin Neurosci54, 95–112.
21.
FranssenEH, ReisbergB, KlugerA, SinaikoE, BojaC (1991) Cognition-independent neurologic symptoms in normal aging and probable Alzheimer’s disease. Arch Neurol48, 148–154.
22.
PrichepLS, JohnER, FerrisSH, ReisbergB, AlmasM, AlperK, CancroR (1994) Quantitative EEG correlates of cognitive deterioration in the elderly. Neurobiol Aging15, 85–90.
23.
SclanSG, ReisbergB (1992) Functional assessment staging (FAST) in Alzheimer’s disease: Reliability, validity and ordinality. Int Pscyhogeriatr4(Supp 1), 55–69.
24.
U.S. government Center for Medicare and Medicaid Services (CMS) mandates the Functional Assessment Staging (FAST) scale for hospice care determination for dementia patients (1998 to present). Approximately one million Medicare beneficiaries are receiving hospice care. Initial reference: “Hospice-Determining Terminal Status in Non-Cancer Diagnoses – Dementia, Policy Number (YPF #163) (Y Med # 20),” The Medicare News Brief (A Publication for all Medicare Part B Providers Issue No. MNB-98-7, September, 1998.
25.
The United States Veterans Administration (VA) Healthcare System requires the usage of the Functional Assessment Staging (FAST) measure for determination of prescribing practice for all approved Alzheimer’s disease medications (2008). See http://www.pbn.va.gov to access the United States Department of Veterans Affairs Pharmacy Benefits Management Services. For further details click “31 July 08, Functional Assessment Staging (FAST), Drug Monitoring,” or “31, July 08, Mementine, Criteria for use,” or “31 July 08, Cholinesterase Inhibitors, Criteria for Use.” The US VA consists of more than 1,000 facilities in all US states serving more than 5 million unique treated patients annually.
26.
ReisbergB, DoodyR, StöfflerA, SchmittF, FerrisS, MöbiusHJ, for the Memantine Study Group (2003) Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med348, 1333–1341.
27.
TariotPN, FarlowMR, GrossbergGT, GrahamSM, McDonaldS, GergelI,for the Memantine Study Group (2004) Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: A randomized controlled trial. JAMA291, 317–324.
28.
FeldmanH, GauthierS, HeckerJ, VellasB, SubbiahP, WhalenE (2001) A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology57, 613–620.
29.
WinbladB, KilanderL, ErikssonS, MinthonL, BatsmanS, WetterholmAL, Jansson-BlixtC, HaglundA (2006) Donepezil in patients with severe Alzheimer’s disease: Double-blind, parallel-group, placebo-controlled study. Lancet367, 1057–1065.
30.
BlackSE, DoodyR, LiH, McRaeT, JamborKM, XuY, SunY, PerdomoCA, RichardsonS (2007) Donepezil preserves cognition and global function in patients with severe Alzheimer’s disease. Neurology69, 459–469.
31.
HommaA, ImaiY, TagoH, AsadaT, ShigetaM, IwamotoT, TakitaM, ArimotoI, KomaH, OhbayashiT (2008) Donepezil treatment of patients with severe Alzheimer’s disease in a Japanese population: Results from a 24-week, double-blind, placebo-controlled, randomized trial. Dement Geriatr Cogn Disord25, 399–407.
32.
CummingsJ, JonesR, WilkinsonD, LopezO, GauthierS, WaldemarG, ZhangR, XuY, SunY, RichardsonS, MackellJ (2010) Effect of donepezil on cognition in severe Alzheimer’s disease: A pooled data analysis. J Alzheimers Dis21, 843–851.
33.
KlugerA, GianutsosJG, GolombJ, FerrisSH, GeorgeAE, FranssenE, ReisbergB (1997) Patterns of motor impairment in normal aging, mild cognitive decline, and early Alzheimer’s disease. J Gerontol B Psychol Sci Soc Sci52B, 28–39.
34.
FranssenEH, SourenLEM, TorossianCL, ReisbergB (1999) Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer’s disease. J Am Geriatr Soc4, 463–469.
35.
ReisbergB, FinkelS, OverallJ, Schmidt-GollasN, KanowskiS, LehfeldH, HullaF, SclanSG, WilmsH-U, HeiningerK, HindmarchI, StemmlerM, PoonL, KlugerA, CoolerC, BergenerM, Hugenot-DienerL, RobertPH, ErzigkeitH (2001) The Alzheimer’s Disease Activities of Daily Living International Scale (ADL-IS). Int Psychogeriatr13, 163–181.
PetersenRC, StevensJC, GanguliM, TangalosEG, CummingsJL, DeKoskyST (2001) Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology56, 1133–1142.
38.
PetersenRC (2004) Mild cognitive impairment as a diagnostic entity. J Intern Med256, 183–194.
39.
ReisbergB, FerrisSH, KlugerA, FranssenE, WegielJ, de LeonMJ (2008) Mild cognitive impairment (MCI): A historical perspective. Int Psychogeriatr20, 18–31.
PrichepLS, JohnER, FerrisSH, RauschL, FangZ, CancroR, TorossianC, ReisbergB (2006) Prediction of longitudinal cognitive decline in normal elderly with subjective complaints using electrophysiological imaging. Neurobiol Aging27, 471–481.
42.
ReisbergB, GauthierS (2008) Current evidence for subjective cognitive impairment (SCI) as the pre-mild cognitive impairment (MCI) stage of subsequently manifest Alzheimer’s disease. Int Psychogeriatr20, 1–16.
43.
RosenWG, TerryRD, FuldPA, KatzmanR, PeckA (1980) Pathological verification of ischemic score in differentiation of dementias. Ann Neurol7, 486–488.
44.
HamiltonM (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry23, 56–62.
45.
FlickerC, FerrisSH, ReisbergB (1991) Mild cognitive impairment in the elderly: Predictors of dementia. Neurology41, 1006–1009.
46.
BruscoliM, LovestoneS (2004) Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr16, 129–140.
47.
MosconiL, De SantiS, BrysM, TsuiWH, PirragliaE, Glodzik-SobanskaL, RichKE, SwitalskiR, MehtaPD, PraticoD, ZinkowskiR, BlennowK, de LeonMJ (2008) Hypometabolism and altered cerebrospinal fluid markers in normal apolipoprotein E E4 carriers with subjective memory complaints. Biol Psychiatry63, 609–18.
48.
FerrisSH, de Leon MJ, WolfAP, FarkasT, ChristmanDR, ReisbergB, FowlerJS, MacgregorR, GoldmanA, GeorgeAE, RampalS (1980) Positron emission tomography in the study of aging and senile dementia. Neurobiol Aging1, 127–131.
49.
ReisbergB, ShulmanMB, TorossianC, LengL, ZhuW (2010) Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimers Dement6, 11–24.
50.
VisserPJ, VerheyF, KnolDL, ScheltensP, WahlundLO, Freund-LeviY, TsolakiM, MinthonL, WallinAK, HampelH, BürgerK, PirttilaT, SoininenH, RikkertMO, VerbeekMM, SpiruL, BlennowK (2009) Prevalence and prognostic value of CSF markers of Alzheimer’s disease pathology in patients with subjective cognitive impairment or mild cognitive impairment in the DESCRIPA study: A prospective cohort study. Lancet Neurol8, 619–627.
51.
PerrotinA, MorminoEC, MadisonCM, HayengaAO, JagustWJ (2012) Subjective cognition and amyloid deposition imaging: A Pittsburgh Compound B positron emission tomography study in normal elderly individuals. Arch Neurol69, 223–229.
ReisbergB, FerrisSH, TorossianC, KlugerA, MonteiroI (1992) Pharmacologic treatment of Alzheimer’s disease: A methodologic critique based upon current knowledge of symptomatology and relevance for drug trials. Int Psychogeriatr4, 9–42.
54.
ReisbergB, FranssenE, BobinskiM, AuerS, MonteiroI, BoksayI, WegielJ, ShulmanE, SteinbergG, SourenL, KlugerA, TorossianC, SinaikoE, WisniewskiHM, FerrisSH (1996) Overview of methodologic issues for pharmacologic trials in mild, moderate, and severe Alzheimer’s disease. Int Psychogeriatr8, 291–311.
55.
McKhannG, DrachmanD, FolsteinM, KatzmanR, PriceD, StadlanEM (1984) Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS – ADRDA workgroup under the auspices of the Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology34, 939–944.
56.
RabinLA, SmartCM, CranePK, AmariglioRE, BermanLM, BoadaM, BuckleyRF, ChételatG, DuboisB, EllisKA, GiffordKA, JeffersonAL, JessenF, KatzMJ, LiptonRB, LuckT, MaruffP, MielkeMM, MolinuevoJL, NaeemF, PerrotinA, PetersenRC, RamiL, ReisbergB, RentzDM, Riedel-HellerSG, RisacherSL, RodriguezO, SachdevPS, SaykinAJ, SlavinMJ, SnitzBE, SperlingRA, TandetnikC, van der FlierWM, WagnerM, WolfsgruberS, SikkesSA (2015) Subjective cognitive decline in older adults: An overview of self-report measures across 19 international studies. J Alzheimers Dis48, S63–86.
57.
MitchellAJ, BeaumontH, FergusonD, YadegarfarM, StubbsB (2014) Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: Meta-analysis. Acta Psychiatr Scand130, 439–451.
58.
GironellA, García-SánchezC, Estévez-GonzálezA, BoltesA, KulisevskyJ (2005) Usefulness of P300 in subjective memory complaints: A prospective study. J Clin Neurophysiol22, 279–284.
59.
NunesT, FragataI, RibeiroF, PalmaT, MarocoJ, CannasJ, SeccaM, MenezesC, CarmoI, CunhaG, Castelo BrancoM, GuerreiroM, de MendoncaA (2010) The outcome of elderly patients with cognitive complaints but normal neuropsychological tests. J Alzheimers Dis19, 137–145.
60.
GallasiR, OppiF, PodaR, ScortichiniS, Stanzani MaseratiM, MaranoG, SambatiL (2010) Are subjective cognitive complaints a risk factor for dementia?Neurol Sci31, 327–336.
61.
van Harten AC, VisserPJ, PijnenburgYA, TeunissenCE, BlankensteinMA, ScheltensP, van der FlierWM (2013) Cerebrospinal fluid Aβ42 is the best predictor of clinical progression in patients with subjective complaints. Alzheimers Dement9, 481–487.
62.
ElfgrenC, GustafsonL, VestbergS, PassantU (2010) Subjective memory complaints, neuropsychological performance and psychiatric variables in memory clinic attendees: A 3-year follow-up study. Arch Gerontol Geriatr51, e110–e114.
63.
JohanssonB, Allen-BurgeR, ZaritSH (1997) Self reports on memory functioning in a longitudinal study of the oldest old: Relation to current, prospective, and retrospective performance. J Gerontol B Psychol Sci Soc Sci52, 139–146.
64.
LuckT, Riedel-HellerSG, LuppaM, WieseB, WollnyA, WagnerM, BickelH, WeyererS, PentzekM, HallerF, MoeschE, WerleJ, EiseleM, MaierW, van den BusscheH, KaduszkiewiczH, AgeCoDe Study Group (2010) Risk factors for incident mild cognitive impairment – results from the German study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Acta Psychiatr Scand121, 260–272.
65.
ReisbergB, GordonB, McCarthyM, FerrisSH, de LeonMJ (1985) Insight and denial accompanying progressive cognitive decline in normal aging and Alzheimer’s disease. In Geriatric Psychiatry: Ethical and Legal Issues, StanleyB, ed. American Psychiatric Press, Washington, DC, pp. 37–79.
66.
Corey-BloomJ, AnandR, VeachJ, for the ENA 713 B352 Study Group (1998) A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer’s disease. Int J Geriatr Psychopharmacol1, 55–65.
67.
RöslerM, AnandR, Cicin-SainA, GauthierS, AgidY, Dal-BiancoP, StähelinHB, HartmanR, GharabawiM (1999) Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: International randomized controlled trial. BMJ318, 633–640.
68.
WinbladB, PoritisN (1999) Memantine in severe dementia: Results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine). Int J Geriatr Psychiatry14, 135–146.
69.
ReisbergB (2007) Global measures: Utility in defining and measuring treatment response in dementia. Int Psychogeriatr19, 421–456.
MonteiroIM, BoksayI, AuerSR, TorossianC, FerrisSH, ReisbergB (2001) Addition of a frequency-weighted score to the Behavioral Pathology in Alzheimer’s Disease Rating Scale: The BEHAVE-AD-FW: Methodology and reliability. Eur Psychiatry16 (Suppl 1), 5s–24s.
72.
JenkinsA, TalesA, TreeJ, BayerA (2015) Are we ready? The construct of subjective cognitive impairment and its utilization in clinical practice: A preliminary UK-based service evaluation. J Alzheimers Dis48, S25–S31.
