self- and informant-reported subjective complaints and … · 2016-05-10 ·...

香港大學秀圃老年研究中心 Sau Po Centre on Ageing

The University of Hong Kong

Self- and Informant-reported Subjective Complaints and suspected MCI and Dementia JQ Xu, JCP Choy, JYM Tang, GHY Wong, TY Liu, H Luo, TYS Lum

Ref. 177



Early and Timely

Detection of Dementia - It is estimated that nearly 28

million people with dementia has NO diagnosis.

- Nearly 90% of people with dementia in HK without diagnosis1

- Early detection and early therapeutic interventions can be effective in improving cognitive function and depressive symptoms and delaying institutionalization.

Prince M, et al. World Alzheimer Report 2011: The benefits of early diagnosis and intervention. London: Alzheimer’s Disease International; 2011.

1Department of Health, HKSAR Government. http://www.dh.gov.hk/english/press/2006/061013.html. Accessed 6 June 2014



SC and Objective Cognitive Impairment

Subjective Complaint

Current cognitive performance

(Reisberg et al., 2007) Depressive symptoms

(Singh-Manoux et al., 2014)

More amyloid depositions (Perrotin, et. al., 2012)

Brain changes (Stwart et al., 2012)



- cognitive declines may be observed by others contact with the individual (informant-reported complaints) (Jessen, et al., 2014)

- inconsistent findings

- Gifford (2014): self-reported complaints MCI; informant-reported complaints dementia.

- Carr et al. (2014): Self-reported complaints NOT correlated with objective cognitive performance while informant-reported complaints correlated with poorer cognitive performance, current diagnosis and later development of dementia.

Reisberg et al., 1985, 2008.

Self- and Informant-reported SC



Different types of Subjective (Cognitive) Complaints

memory

language

time and place orientation

anxiety

mental calculation

change in personality hallucination

delusion

planning

depression Jessen et al. (2014) in

Alzheimer’s & Dementia 10 844–

852

“… the development and elaboration of

questions on subjective change in other

cognitive domains (e.g., executive function,

attention, language, and visuospatial

function), and the association of these with

preclinical AD or other diseases are core

topics for current and future SCD research…”



Current Study

Objectives

1. to classify the narrative SC into

meaningful themes

2. to compare and contrast the self-

and informant-reported SCC

3. to examine the relationship

between SC domains and suspected

MCI/Dementia respectively

Method

Participants - Help-seekers (N=965) from a community-based

dementia early detection program. Subjective Complaint Assessment - an open-ended question upon SCs that lead them to

help-seeking - “why do you suspect you/your family member have cognitive impairment?”

Clinical Dementia Rating (CDR) - administered by a trained OT or a RSW suspected MCI (CDR=0.5) /Dementia (CDR=>1) 15-item Geriatric Depression Scale (GDS) depression Demographic features - age, gender, years of education



Current Study - Sample

Healthy (CDR=0)

N=71

MCI (CDR=0.5)

N=473

Dementia (CDR>1) N=421

Difference (F/χ²); Significant contrastsa

Total N=965

Age (mean, SD)

72.17 (9.09) 75.81 (7.82) 78.98 (7.14) F=34.05*** 1<2<3

76.92 (7.89)

Gender (M, %) 28, 39.44% 152, 32.07% 123, 29.22% χ²=3.18 303, 31.40% Education (yrs)

(mean, SD) 6.49 (4.77) 5.76 (4.49) 4.21 (4.44) F=16.85***

1=2<3 5.14 (4.56)

Depression (GDS score)

3.38 (3.41) 3.14 (2.72) 3.67 (2.97) F=3.75* 2<3, 1=2, 1=3

3.39 (2.90)

a. As measured by Bonferroni Post-hoc analysis. For simplification, numbers are used to denote the clinical groups: 1: Healthy, 2: MCI, 3: Dementia.

***p<0.001; **p<0.01; *p<0.05.



Current Study - SC themes - Seven themes were classified based on the contents of SCs - Tw0 raters decided whether the SC contained each theme

(No=0, Yes=1); Kappa score s> 0.8.



Percentages of positive response in the SC domains (N=965)

87

.7

4.1

33

4.6

7.8

1.2

0.4

95

.5

23

.2

21

.3

33

20

.2

4.7

6.3

MEMORY EF LA NGUA GE ORIENTA TION NEUROPSY MOOD A V OLIT ION

INFORMANT AND SELF SC (%)

Self Informant

*

**

*



Self- and Informant-reported SC

1.41 1.45 1.32

1.49

1.8

2.41

Healthy MCI Dementia

Self-reorted SC Informant-reported SC

***

***

(mean, SD)

Healthy (CDR=0)

N=71

MCI (CDR=0.5)

N=473

Dementia (CDR>1) N=421

Difference (F/χ²);

Significant contrastsa

Informant SC 1.49 (0.84)

1.80 (0.86) 2.41 (0.95) F=64.07***, 1<2<3

Self SC 1.41 (0.90)

1.45 (0.76) 1.32 (0.78) F=3.46*, 1=2<3

Informant vs. self

t=0.57 p=0.57

t=6.48*** p<0.001

t=17.30*** p<0.001

-



Self-reported SC

& suspected MCI and dementia

Variables Healthy and MCI

(N=574) OR (95% C.I.)

Healthy and Dementia (N=492)

OR (95% C.I.)

MCI and Dementia (N=894)

OR (95% C.I.) Age 1.05 (1.02, 1.09)** 1.10 (1.06, 1.14)*** 1.05 (1.03, 1.07)***

Gender 1.41 (0.80, 2.46) 1.11 (0.62, 1.98) 0.91 (0.67, 1.24) Education 1.00 (0.94, 1.06) 0.95 (0.89, 1.02) 0.94 (0.91, 0.97)**)

Depression 0.97 (0.89, 1.06) 1.02 (0.94, 1.12) 1.07 (1.02, 1.13)** Complaints of

Executive Function

0.84 (0.27, 2.61)

0.91 (0.26, 3.22)

0.93 (0.45, 1.91) Language 0.88 (0.50, 1.55) 0.77 (0.42, 1.41) 0.90 (0.66, 1.24)

Orientation 1.05 (0.35, 3.17) 0.68 (0.21, 2.28) 0.75 (0.38, 1.46) Neuropsychiatry 1.07 (0.41, 2.85) 0.79 (0.28, 2.21) 0.96 (0.56, 1.65)

Nagelkerke R2 4.7% 16.6% 9.1%

% Correct 86.9% 86% 52.9% Model Significance p=0.083 p<0.001 p<0.001

Logical Regression Models



Informant-reported SC

& suspected MCI and dementia

Variables Healthy and MCI

(N=574) OR (95% C.I.)

Healthy and Dementia (N=492)

OR (95% C.I.)

MCI and Dementia (N=894)

OR (95% C.I.) Age 1.05 (1.02, 1.09)** 1.10 (1.06, 1.14)*** 1.06 (1.03, 1.08)***

Gender 1.43 (0.81, 2.53) 1.08 (0.57, 2.06) 1.07 (0.77, 1.49)

Education 1.00 (0.94, 1.07) 0.92 (0.93, 1.11)* 0.93 (0.89, 0.96)***

Depression 0.96 (0.88, 1.05) 1.02 (0.93, 1.11) 1.06 (1.01, 1.12)*

Complaints of Executive Function

1.23 (0.62, 2.43)

1.79 (0.85, 3.75)

1.34 (0.95, 1.89)

Language 1.33 (0.65, 2.72) 3.20 (1.48, 6.95)** 2.45 (1.69, 3.56)*** Orientation 1.19 (0.61, 2.32) 4.54 (2.27, 9.09)*** 3.32 (2.43, 4.54)***

Neuropsychiatry 1.14 (0.55, 2.38) 1.77 (0.82, 3.86) 1.52 (1.06, 2.17)** Mood 3.78 (0.49, 29.09) 7.07 (0.82, 61.30 ) 1.26 (0.66, 2.42)

Avolition 0.65 (0.21, 2.06) 1.81 (0.56, 5.81) 2.99 (1.59, 5.63)** Nagelkerke R2 6% 29.7% 22.8% % Correct 86.9% 85.6% 65.7% Model Significance p=0.059 p<0.001 p<0.001

Logical Regression Models



Summary of the Findings

1. The current study took the initiative to classify the SCs into meaningful

themes: memory, executive function, language, orientation, neuropsychiatry,

mood and avolition complaints, with a good interrater reliability.

2. Informants reported significantly more executive functions, neuropsychiatric

and mood complaints then the older adults themselves.

3. Different domains of SCs identified are found to be clinically valuable to

detect suspected MCI and dementia respectively.

4. Motivational disturbances (i.e., avolition) was found to be independent from

depression in the symptom manifestation of dementia.



Limitations and Future Directions

1. The current study only recruits active help-seekers. Most of the

participants in the current study were suspected for MCI and dementia.

2. Severity measures (i.e., frequency of complaints) shall be incorporated in

to the SC assessment in the future studies.

3. Future studies shall aim to develop a theme-based self-rated tool to

screen the potential patients with cognitive impairment in the community.



SAU PO CENTRE ON AGEING, HKU 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research 5 Sassoon Road, Pokfulam

Tel: (852) 2831-5120

Fax: (852) 2540 1244

Email: [email protected]

Homepage: http://ageing.hku.hk

Acknowledgements David Dai Maggie Lee Claudia Lai Terry Lum Carmen Ng Vivian Lou Gloria Wong Dorothy Kwok Mandy Lau

mailto:[email protected]

http://ageing.hku.hk/

Subjective Cognitive Complaint

– SCC: a person’s complaints on cognitive functions that they feel is impaired

subjectively

– Subjective Cognitive Impairment/Subjective Memory Complaint (Impairment)

– Prevalence: 50-60% among older adults in the community (Holmen et al., 2013;

Singh-Manoux et al., 2014)

SCC and Objective Cognitive Impairment

– current cognitive performance (Caselli et al., 2014; Reisberg et al., 2007)

– subjective cognitive declines are associated with more depressive symptoms

(Singh-Manoux et al., 2014) and more psychological stress (Caselli et al.,

2014).

– subjective memory declines associated with more amyloid deposition in the

brain among cognitively normal subjects (Perrotin, Mormino, et al., 2012)

– Neuroimaging studies showed associations between SCI and brain changes

while not all the changes will develop into dementia (Stwart et al., 2012).

SCC and progression to dementia/MCI

– A meta analysis of subjective memory complaints (SMC) in 28 studies

suggested that (Mitchell et al., 2014):

– Older people with SMC but no objective complaints are TWICE as likely to develop

dementia as individuals without SMC.

– Approximately 2.3% and 6.6% of older people with SMC will progress to dementia

and MCI per year.

– SCC has been proposed as an early stage of cognitive impairment

– SCC (15 years) MCI (8.5 years) Dementia (Reisberg et al., 2007)

Understanding SCC in order to achieve early detection for MCI and Dementia

Existing Measurements of SCC

Gifford et al., 2015 Schmand et al., 1996

Singh-Manoux et. al., 2014

1. Memory loss that disrupts daily life 2. Challenges in planning or solving problems 3. Difficulty completing familiar tasks at home, at work or at

leisure 4. Confusion with time or place 5. Trouble understanding visual images and spatial relationships 6. New problems with words in speaking or writing 7. Misplacing things and losing the ability to retrace steps 8. Decreased or poor judgment 9. Withdrawal from work or social activities 10. Changes in mood and personality

- the variations of SCC are rarely investigated

- non-cognitive complaints: neuropsychiatric, mood, motivation etc.

- different SCs may help differentiate non-demented, MCI and dementia from one another

Informant-reported and Self-reported Cognitive Complaints and Early Detection

Self - Cognitive Complaints

MCI Dementia

Informant - Cognitive Complaints

Current Study - Results

Differences between informants’ and self complaints

self- and informant-reported subjective complaints and … · 2016-05-10 ·...

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