Skip to main content Accessibility help
×
Home
Hostname: page-component-5c569c448b-q9r9l Total loading time: 0.282 Render date: 2022-07-02T21:30:26.448Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Subjective Cognitive Complaints Contribute to Misdiagnosis of Mild Cognitive Impairment

Published online by Cambridge University Press:  22 August 2014

Emily C. Edmonds
Affiliation:
Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California
Lisa Delano-Wood
Affiliation:
Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California Veterans Affairs San Diego Healthcare System, San Diego, California
Douglas R. Galasko
Affiliation:
Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California Veterans Affairs San Diego Healthcare System, San Diego, California Department of Neurosciences, University of California San Diego, School of Medicine, La Jolla, California
David P. Salmon
Affiliation:
Department of Neurosciences, University of California San Diego, School of Medicine, La Jolla, California
Mark W. Bondi*
Affiliation:
Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California Veterans Affairs San Diego Healthcare System, San Diego, California
*
Correspondence and reprint requests to: Mark W. Bondi, PhD, Psychology Service (116B), VA San Diego, Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail: mbondi@ucsd.edu

Abstract

Subjective cognitive complaints are a criterion for the diagnosis of mild cognitive impairment (MCI), despite their uncertain relationship to objective memory performance in MCI. We aimed to examine self-reported cognitive complaints in subgroups of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI cohort to determine whether they are a valuable inclusion in the diagnosis of MCI or, alternatively, if they contribute to misdiagnosis. Subgroups of MCI were derived using cluster analysis of baseline neuropsychological test data from 448 ADNI MCI participants. Cognitive complaints were assessed via the Everyday Cognition (ECog) questionnaire, and discrepancy scores were calculated between self- and informant-report. Cluster analysis revealed Amnestic and Mixed cognitive phenotypes as well as a third Cluster-Derived Normal subgroup (41.3%), whose neuropsychological and cerebrospinal fluid (CSF) Alzheimer’s disease (AD) biomarker profiles did not differ from a “robust” normal control group. This cognitively intact phenotype of MCI participants overestimated their cognitive problems relative to their informant, whereas Amnestic MCI participants with objective memory impairment underestimated their cognitive problems. Underestimation of cognitive problems was associated with positive CSF AD biomarkers and progression to dementia. Overall, there was no relationship between self-reported cognitive complaints and objective cognitive functioning, but significant correlations were observed with depressive symptoms. The inclusion of self-reported complaints in MCI diagnostic criteria may cloud rather than clarify diagnosis and result in high rates of misclassification of MCI. Discrepancies between self- and informant-report demonstrate that overestimation of cognitive problems is characteristic of normal aging while underestimation may reflect greater risk for cognitive decline. (JINS, 2014, 20, 1–12)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (http://adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of the ADNI and/or provided data but did not participate in analysis or writing of this article. A complete listing of ADNI investigators can be found at http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf.

References

Albert, M. S., DeKosky, S. T., Dickson, D., Dubous, B., Feldman, H. H., Fox, N. C., & Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7, 270279.CrossRefGoogle Scholar
Anastasi, A., & Urbina, S. (1997). Psychological testing (7th ed). Upper Saddle River, NJ: Prentice Hall.Google ScholarPubMed
Bondi, M. W., Edmonds, E. C., Jak, A. J., Clark, L. R., Delano-Wood, L., McDonald, C. R., & Salmon, D. P. (2014). Neuropsychological criteria for mild cognitive impairment improves diagnostic precision, biomarker associations, and prediction of progression. Journal of Alzheimer’s Disease [Epub ahead of print].Google Scholar
Bondi, M. W., Salmon, D. P., Galasko, D., Thomas, R. G., & Thal, L. J. (1999). Neuropsychological function and apolipoprotein E genotype in the preclinical detection of Alzheimer’s disease. Psychology and Aging, 14, 295303.CrossRefGoogle ScholarPubMed
Brooks, B. L., Iverson, G. L., & White, T. (2007). Substantial risk of “accidental MCI” in healthy older adults: Base rates of low memory scores in neuropsychological assessment. Journal of the International Neuropsychological Society, 13, 490500.CrossRefGoogle ScholarPubMed
Buckley, R., Saling, M. M., Ames, D., Rowe, C. C., Lautenschlager, N. T., Macaulay, S. L., & Ellis, K. A. (2013). Factors affecting subjective memory complaints in the AIBL aging study: Biomarkers, memory, affect, and age. International Psychogeriatrics, 25, 13071315.CrossRefGoogle Scholar
Clark, L. R., Delano-Wood, L., Libon, D. J., McDonald, C. R., Nation, D. A., Bangen, K. J., & Bondi, M. W. (2013). Are empirically derived subtypes of mild cognitive impairment consistent with conventional subtypes? Journal of the International Neuropsychological Society, 19(6), 111.CrossRefGoogle ScholarPubMed
de Jager, C. A., Hogervorst, E., Combrinck, M., & Budge, M. M. (2003). Sensitivity and specificity of neuropsychological tests for mild cognitive impairment, vascular cognitive impairment and Alzheimer’s disease. Psychological Medicine, 33, 10391050.CrossRefGoogle ScholarPubMed
Delano-Wood, L., Abeles, N., Sacco, J. M., Wierenga, C. E., Horne, N. R., & Bozoki, A. (2008). Regional white matter pathology in mild cognitive impairment: Differential influence of lesion type of neurocognitive functioning. Stroke, 39, 794799.CrossRefGoogle Scholar
Delano-Wood, L., Bondi, M. W., Sacco, J., Abeles, N., Jak, A. J., Libon, D. J., Bozoki, A. (2009). Heterogeneity in mild cognitive impairment: Differences in neuropsychological profile and associated white matter lesion pathology. Journal of the International Neuropsychological Society, 15, 906914.CrossRefGoogle ScholarPubMed
Edmonds, E. C., Delano-Wood, L., Clark, L. R., Jak, A. J., Nation, D. A., McDonald, C. R., & Bondi, M. W. (2014). Susceptibility of the conventional criteria for mild cognitive impairment to false positive diagnostic errors. Alzheimer’s & Dementia [Epub ahead of print].Google ScholarPubMed
Farias, S. T., Mungas, D., & Jagust, W. (2005). Degree of discrepancy between self and other- reported everyday functioning by cognitive status: Dementia, mild cognitive impairment, and healthy elders. International Journal of Geriatric Psychiatry, 20, 827834.CrossRefGoogle Scholar
Farias, S. T., Mungas, D., Reed, B. R., Cahn-Weiner, D., Jagust, W., Baynes, K., Decarli, C. (2008). The measurement of everyday cognition (ECog): Scale development and psychometric properties. Neuropsychology, 22, 531544.CrossRefGoogle Scholar
Farias, S. T., Park, L. Q., Harvey, D. J., Simon, C., Reed, B. R., Carmichael, O., Mungas, D. (2013). Everyday cognition in older adults: Associations with neuropsychological performance and structural brain imaging. Journal of the International Neuropsychological Society, 19, 430441.CrossRefGoogle ScholarPubMed
Ganguli, M., Snitz, B. E., Saxton, J. A., Chang, C. C., Lee, C. W., Vander Bilt, J., & Petersen, R. C. (2011). Outcomes of mild cognitive impairment by definition: A population study. Archives of Neurology, 68, 761767.CrossRefGoogle ScholarPubMed
Gifford, K. A., Liu, D., Lu, Z., Tripodis, Y., Cantwell, N. G., Palmisano, J., & Jefferson, A. L. (2014). The source of cognitive complaints predicts diagnostic conversion differentially among nondemented older adults. Alzheimer’s & Dementia, 10, 319327.CrossRefGoogle ScholarPubMed
Koepsell, T. D., & Monsell, S. E. (2012). Reversion from mild cognitive impairment to normal or near-normal cognition. Neurology, 79, 15911598.CrossRefGoogle ScholarPubMed
Landau, S. M., Harvey, D., Madison, C. M., Reiman, E. M., Foster, N. L., Aisen, P. S., & Jagust, W. J. (2010). Comparing predictors of conversion and decline in mild cognitive impairment. Neurology, 75, 230238.CrossRefGoogle ScholarPubMed
Lenehan, M. E., Klekociuk, S. Z., & Summers, M. J. (2012). Absence of a relationship between subjective memory complaint and objective memory impairment in mild cognitive impairment (MCI): Is it time to abandon subjective memory complaint as an MCI diagnostic criterion? International Psychogeriatrics, 24, 15051514.CrossRefGoogle ScholarPubMed
Libon, D. J., Xie, S. X., Eppig, J., Wicas, G., Lamar, M., Lippa, C., & Wambach, D. M. (2010). The heterogeneity of mild cognitive impairment: A neuropsychological analysis. Journal of the International Neuropsychological Society, 16, 8493.CrossRefGoogle ScholarPubMed
Lineweaver, T. T., Bondi, M. W., Galasko, D., & Salmon, D. P. (2014). Effect of knowledge of APOE genotype on subjective and objective memory performance in healthy older adults. American Journal of Psychiatry, 171, 201208.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The clinical dementia rating (CDR): Current version and scoring rules. Neurology, 43, 24122414.CrossRefGoogle ScholarPubMed
Palmer, B. W., Boone, K. B., Lesser, I. M., & Wohl, M. A. (1998). Base rates of “impaired” neuropsychological test performance among healthy older adults. Archives of Clinical Neuropsychology, 13, 503511.Google ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.CrossRefGoogle ScholarPubMed
Petersen, R. C., Aisen, P. S., Beckett, L. A., Donohue, M. C., Gamst, A. C., Harvey, D. J., & Weiner, M. W. (2010). Alzheimer’s Disease Neuroimaging Initiative (ADNI): Clinical characterization. Neurology, 74, 201209.CrossRefGoogle Scholar
Petersen, R. C., Aisen, P., Boeve, B. F., Geda, Y. E., Ivnik, R. J., Knopman, D. S., & Jack, C. R. Jr. (2013). Criteria for mild cognitive impairment due to Alzheimer’s disease in the community. Annals of Neurology, 74, 199208.Google Scholar
Petersen, R. C., & Morris, J. C. (2005). Mild cognitive impairment as a clinical entity and treatment target. Archives of Neurology, 62, 11601163.CrossRefGoogle ScholarPubMed
Rabin, L. A., Pare, N., Saykin, A. J., Brown, M. J., Wishart, H. A., Flashman, L. A., Santulli, R. B. (2009). Differential memory test sensitivity for diagnosing amnestic mild cognitive impairment and predicting conversion to Alzheimer’s disease. Aging, Neuropsychology, and Cognition, 16, 357376.CrossRefGoogle ScholarPubMed
Reid, L. M., & MacLullich, A. M. (2006). Subjective memory complaints and cognitive impairment in older people. Dementia and Geriatric Cognitive Disorders, 22, 471485.CrossRefGoogle ScholarPubMed
Roberts, J. L., Clare, L., & Woods, R. T. (2009). Subjective memory complaints and awareness of memory functioning in mild cognitive impairment: A systematic review. Dementia and Geriatric Cognitive Disorders, 28, 95109.CrossRefGoogle ScholarPubMed
Saxton, J., Snitz, B. E., Lopez, O. L., Ives, D. G., Dunn, L. O., Fitzpatrick, A., & DeKosky, S. T. (2009). Functional and cognitive criteria produce different rates of MCI and conversion to dementia. Journal of Neurology, Neurosurgery, and Psychiatry, 80, 737743.CrossRefGoogle Scholar
Shaw, L. M., Vanderstichele, H., Knapik-Czajka, M., Clark, C. M., Aisen, P. S., Petersen, R. C., & Trojanowski, J. Q. (2009). Cerebrospinal fluid biomarker signature in Alzheimer's disease neuroimaging initiative subjects. Annals of Neurology, 65, 403413.CrossRefGoogle ScholarPubMed
Sliwinski, M., Lipton, R. B., Buschke, H., & Stewart, W. (1996). The effects of preclinical dementia on estimates of normal cognitive functioning in aging. Journal of Gerontology: Psychological Sciences, 51, P217P225.CrossRefGoogle Scholar
Sperling, R. A., Aisen, P. S., Beckett, L. A., Bennett, D. A., Craft, S., Fagan, A. M., & Phelps, C. H. (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. Alzheimer’s & Dementia, 7, 280292.CrossRefGoogle ScholarPubMed
Studer, J., Donati, A., Popp, J., & von Gunten, A. (2013). Subjective cognitive decline in patients with mild cognitive impairment and healthy older adults: Association with personality traits. Geriatrics Gerontology International [Epub ahead of print].Google ScholarPubMed
Summers, M. J., & Saunders, N. L. (2012). Neuropsychological measures predict decline to Alzheimer’s dementia from mild cognitive impairment. Neuropsychology, 26, 498508.CrossRefGoogle ScholarPubMed
Tabert, M. H., Albert, S. M., Borukhova-Milov, L., Camacho, Y., Pelton, G., Liu, X., & Devanand, D. P. (2002). Functional deficits in patients with mild cognitive impairment: Prediction of AD. Neurology, 58, 758764.CrossRefGoogle ScholarPubMed
Tierney, M. C., Yao, C., Kiss, A., & McDowell, I. (2005). Neuropsychological tests accurately predict incident Alzheimer disease after 5 and 10 years. Neurology, 64, 18531859.CrossRefGoogle ScholarPubMed
Vogel, A., Stokholm, J., Gade, A., Andersen, B. B., Hejl, A. M., & Waldemar, G. (2004). Awareness of deficits in mild cognitive impairment and Alzheimer’s disease: Do MCI patients have impaired insight? Dementia and Geriatric Cognitive Disorders, 17, 181187.CrossRefGoogle ScholarPubMed
Wechsler, D. (1987). Wechsler memory scale-revised. New York: The Psychological Corporation.Google Scholar
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L. O., & Petersen, R. C. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240246.CrossRefGoogle Scholar
129
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Subjective Cognitive Complaints Contribute to Misdiagnosis of Mild Cognitive Impairment
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Subjective Cognitive Complaints Contribute to Misdiagnosis of Mild Cognitive Impairment
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Subjective Cognitive Complaints Contribute to Misdiagnosis of Mild Cognitive Impairment
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *