The source of cognitive complaints predicts diagnostic conversion differentially among nondemented older adults

Abstract

Objective The objective of this study was to compare whether different sources of cognitive complaint (i.e., subjective and informant) predict diagnostic conversion in nondemented older adults. Methods Participants from the National Alzheimer’s Coordinating Center had a baseline diagnosis of normal cognition (NC; n=4414, 73±8 years, 69% female) or mild cognitive impairment (MCI; n=1843, 74±8 years, 52% female). Multinomial logistic regression related baseline cognitive complaint (no-complaint, self only, informant only, or both self-and informant) to diagnostic outcome (reversion, stable or conversion). Results At follow-up, 14% of NC participants converted to MCI/dementia (3.5±1.8 years), and 41% of MCI participants converted to dementia (3.0±1.6 years). Among NC participants, self-complaint only (OR=2.1; 99%CI=1.5–2.9, p<0.001), informant-complaint only (OR=2.2; 99%CI=1.2–3.9, p<0.001), and both self-and informant-complaint (OR=4.2; 99%CI=2.9–6.0, p<0.001) were associated with diagnostic conversion, compared to no-complaint. Among participants with MCI—compared with no-complaint, informant-complaint only (OR, 2.2; 99% CI, 1.2–4.3, P = .002), and both self- and informant-complaint (OR, 2.9; 99% CI, 1.8–4.8; P < .001)—were associated with conversion. Conclusions Cognitive complaints are related to conversion among non-demented older adults. Complaint from both (i.e. mutual complaint) sources was most predictive of diagnostic outcome, followed by informant complaint, highlighting the need for obtaining informant corroboration to enhance prognosis and distinguish underlying pathological processes from normal cognitive aging. Self-complaint was inconsistently related to diagnostic outcome.

P1‐340: Subjective Cognitive Complaints Contribute to Misdiagnosis of Mild Cognitive Impairment

“…This finding extends prior work showing that reduced awareness of functional deficits in patients with MCI predicts development of AD (Tabert et al, 2002). Our results are also consistent with another recent study which found that self-reported cognitive problems in non-demented older adults were not consistently predictive of a future diagnostic outcome of dementia, although informantreported cognitive complaints were predictive, particularly when combined with self-report (i.e., when there was a "mutual complaint"; Gifford et al, 2014).…”

Patients Who Attend Alone at a First Memory Consultation: Are They a Specific Population,or Is It an Instance of Confounding Bias?

“…One could speculate as to whether the complaint of the individual would itself be a sufficient variable to explain an increased risk of progression to dementia, as memory complaints are very prevalent in the elderly (and therefore can be nonspecific) [29]. In one study [30], the authors report that cognitive complaints by the individual and an informant are the most accurately predictive of cognitive decline.…”

Demonstrating the Role of Anticholinergic Activity in a Mood Disorder

“…In fact, despite assessments by our team and another two clinics she persistently refused to accept that her symptoms were not caused by dementia. Nevertheless, some reports have argued that subjective memory complaints are predictive of conversion from normal cognitive function to MCI, and from MCI to AD [10], so we considered early dementia a possibility. Third, there were objective reports of mistakes at work that had caused her significant employment problems.…”