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Increasing Inaccuracy of Self-Reported Subjective Cognitive Complaints Over 24 Months in Empirically Derived Subtypes of Mild Cognitive Impairment

  • Emily C. Edmonds (a1) (a2), Alexandra J. Weigand (a1) (a2), Kelsey R. Thomas (a1) (a2), Joel Eppig (a3), Lisa Delano-Wood (a1) (a2), Douglas R. Galasko (a1) (a2) (a4), David P. Salmon (a4) and Mark W. Bondi (a1) (a2)...

Abstract

Objectives: Although subjective cognitive complaints (SCC) are an integral component of the diagnostic criteria for mild cognitive impairment (MCI), previous findings indicate they may not accurately reflect cognitive ability. Within the Alzheimer’s Disease Neuroimaging Initiative, we investigated longitudinal change in the discrepancy between self- and informant-reported SCC across empirically derived subtypes of MCI and normal control (NC) participants. Methods: Data were obtained for 353 MCI participants and 122 “robust” NC participants. Participants were classified into three subtypes at baseline via cluster analysis: amnestic MCI, mixed MCI, and cluster-derived normal (CDN), a presumptive false-positive group who performed within normal limits on neuropsychological testing. SCC at baseline and two annual follow-up visits were assessed via the Everyday Cognition Questionnaire (ECog), and discrepancy scores between self- and informant-report were calculated. Analysis of change was conducted using analysis of covariance. Results: The amnestic and mixed MCI subtypes demonstrated increasing ECog discrepancy scores over time. This was driven by an increase in informant-reported SCC, which corresponded to participants’ objective cognitive decline, despite stable self-reported SCC. Increasing unawareness was associated with cerebrospinal fluid Alzheimer’s disease biomarker positivity and progression to Alzheimer’s disease. In contrast, CDN and NC groups over-reported cognitive difficulty and demonstrated normal cognition at all time points. Conclusions: MCI participants’ discrepancy scores indicate progressive underappreciation of their evolving cognitive deficits. Consistent over-reporting in the CDN and NC groups despite normal objective cognition suggests that self-reported SCC do not predict impending cognitive decline. Results demonstrate that self-reported SCC become increasingly misleading as objective cognitive impairment becomes more pronounced. (JINS, 2018, 24, 842–853)

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Corresponding author

Correspondence and reprint requests to: Emily C. Edmonds, 3350 La Jolla Village Drive #151B, San Diego, CA 92161. E-mail: ecedmonds@ucsd.edu

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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. Conflict of Interest Disclosures: Dr. Bondi is a consulting editor for the Journal of the International Neuropsychological Society, serves as a consultant for Eisai, Novartis, and Roche, and receives royalties from Oxford University Press. Dr. Galasko serves as editor for Alzheimer’s Research and Therapy, and as a paid consultant on Data Safety Monitoring Boards for Pfizer, Inc., Elan, Inc., and Balance Pharmaceuticals, Inc. Dr. Salmon serves as a paid consultant for Takeda Pharmaceuticals. The other authors report no disclosures.

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References

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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.
Bangen, K.J., Clark, A.L., Werhane, M., Edmonds, E.C., Nation, D.A., Evangelista, N., & Delano-Wood, L. (2016). Cortical amyloid burden differences across empirically-derived mild cognitive impairment subtypes and interaction with APOE ε4 genotype. Journal of Alzheimer’s Disease, 52, 849861.
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, 42, 275289.
Brooks, B.L., Iverson, G.L., Holdnack, J.A., & Feldman, H.H. (2008). Potential for misclassification of mild cognitive impairment: A study of memory scores on the Wechsler Memory Scale-III in healthy older adults. Journal of the International Neuropsychological Society, 14, 463478.
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.
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.
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), 635645.
de Rotrou, J., Wenisch, E., Chausson, C., Dray, F., Faucounau, V., & Rigaud, A.S. (2005). Accidental MCI in healthy subjects: A prospective longitudinal study. European Journal of Neurology, 12, 879885.
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.
Edmonds, E.C., Ard, M.C., Edland, S.D., Galasko, D.R., Salmon, D.P., & Bondi, M.W. (2018). Unmasking the benefits of donepezil via psychometrically precise identification of mild cognitive impairment: A secondary analysis of the ADCS vitamin E and donepezil in MCI study. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 4, 1118.
Edmonds, E.C., Delano-Wood, L., Clark, L.R., Jak, A.J., Nation, D.A., McDonald, C.R., & Bondi, M.W. (2015). Susceptibility of the conventional criteria for mild cognitive impairment to false positive diagnostic errors. Alzheimer’s & Dementia, 11, 415424.
Edmonds, E.C., Delano-Wood, L., Galasko, D.R., Salmon, D.P., & Bondi, M.W. (2014). Subjective cognitive complaints contribute to misdiagnosis of mild cognitive impairment. Journal of the International Neuropsychological Society, 20, 836847.
Edmonds, E.C., Eppig, J., Bondi, M.W., Leyden, K.M., Goodwin, B., Delano-Wood, L., & McDonald, C.R. (2016). Heterogeneous cortical atrophy patterns in MCI not captured by conventional diagnostic criteria. Neurology, 87, 21082116.
Eppig, J., Edmonds, E.C., Campbell, L., Sanderson, M., Delano-Wood, L., & Bondi, M.W. (2017). Statistically-derived subtypes and associations with cerebrospinal fluid and genetic biomarkers in mild cognitive impairment: A latent profile analysis. Journal of the International Neuropsychological Society, 23, 113.
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.
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.
Fyock, C.A., & Hampstead, B.M. (2015). Comparing the relationship between subjective memory complaints, objective memory performance, and medial temporal lobe volumes in patients with mild cognitive impairment. Alzheimer’s & Dementia, 1, 242248.
Galeone, F., Pappalardo, S., Chieffi, S., Iavarone, A., & Carlomagno, S. (2011). Anosognosia for memory deficits in amnestic mild cognitive impairment and Alzheimer’s disease. International Journal of Geriatric Psychiatry, 26, 695701.
Gerretsen, P., Chung, J.K., Shah, P., Plitman, E., Iwata, Y., Caravaggio, F., & Graff-Guerrero, A. (2017). Anosognosia is an independent predictor of conversion from mild cognitive impairment to Alzheimer’s disease and is associated with reduced brain metabolism. Journal of Clinical Psychiatry, 78, e1187e1196.
Goerlich, K.S., Votinov, M., Dicks, E., Ellendt, S., Csukly, G., & Habel, U. (2017). Neuroanatomical and neuropsychological markers of amnestic MCI: A three-year longitudinal study in individuals unaware of cognitive decline. Frontiers in Aging Neuroscience, 99, 34.
Hansson, O., Seibyl, J., Stomrud, E., Zetterberg, H., Trojanowski, J.Q., Bittner, T., & Shaw, L.M. (2018). CSF biomarkers of Alzheimer’s disease concord with amyloid-β PET and predict clinical progression: A study of fully automated immunoassays in BioFINDER and ADNI cohorts. Alzheimer’s & Dementia. doi: 10.1016/j.jalz.2018.01.010
Hill, N.L., Mogle, J., Wion, R., Munoz, E., DePasquale, N., Yevchak, A.M., & Parisi, J.M. (2016). Subjective cognitive impairment and affective symptoms: A systematic review. The Gerontologist, 56, e109e127.
Hollands, S., Lim, Y.Y., Buckley, R., Pietzak, R.H., Snyder, P.J., Ames, D., & Maruff, P. (2015). Amyloid-β related memory decline is not associated with subjective or informant rated cognitive impairment in healthy adults. Journal of Alzheimer’s Disease, 43, 677686.
Jak, A.J., Preis, S.R., Beiser, A.S., Seshadri, S., Wolf, P.A., Bondi, M.W., & Au, R. (2016). Neuropsychological criteria for mild cognitive impairment and dementia risk in the Framingham Heart Study. Journal of the International Neuropsychological Society, 22, 937943.
Jansen, W.J., Ossenkoppele, R., Knol, D.L., Tijms, D.L., Scheltens, P., Verhey, F.R., & Zetterberg, H. (2015). Prevalence of cerebral amyloid pathology in persons without dementia: A meta-analysis. Journal of the American Medical Association, 313, 19241938.
Klekociuk, S.Z., Summers, J.J., Vickers, J.C., & Summers, M.J. (2014). Reducing false positive diagnoses in mild cognitive impairment: The importance of comprehensive neuropsychological assessment. European Journal of Neurology, 21, 13301336.
Kryscio, R.J., Abner, E.L., Cooper, G.E., Fardo, D.W., Jicha, G.A., Nelson, P.T., & Schmitt, F.A. (2014). Self-reported memory complaints: Implications from a longitudinal cohort with autopsies. Neurology, 83, 13591365.
Lehrner, J., Kogler, S., Lamm, C., Moser, D., Klug, S., Pusswald, G., & Auff, E. (2015). Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease. International Psychogeriatrics, 27, 357366.
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, 150511014.
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.
Mendonca, M.D., Alves, L., & Bugalho, P. (2016). From subjective cognitive complaints to dementia: Who is at risk?: A systematic review. American Journal of Alzheimer’s Disease and Other Dementias, 31, 105114.
Mitchell, A.J., Beaumont, H., Ferguson, D., Yadegarfar, M., & Stubbs, B. (2014). Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: Meta-analysis. Acta Psychiatrica Scandinavica, 130, 439451.
Nettiksimmons, J., DeCarli, C., Landau, S., & Beckett, L. (2014). Biological heterogeneity in ADNI amnestic mild cognitive impairment. Alzheimer’s & Dementia, 10, 511521.
Petersen, R.C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.
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.
Petersen, R.C., Smith, G.E., Waring, S.C., Ivnik, R.J., Tangalos, E.G., & Kokmen, E. (1999). Mild cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 56, 303308.
Piras, F., Piras, F., Orfei, M.D., Caltagirone, C., & Spalletta, G. (2016). Self-awareness in mild cognitive impairment: Quantitative evidence from systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 61, 90107.
Rattanabannakit, C., Risacher, S.L., Gao, S., Lane, K.A., Brown, S.A., McDonald, B.C., & Farlow, M.R. (2016). The cognitive change index as a measure of self and informant perception of cognitive decline: Relation to neuropsychological tests. Journal of Alzheimer’s Disease, 51, 11451155.
Reid, L.M., & MacLullich, A.M. (2006). Subjective memory complaints and cognitive impairment in older people. Dementia and Geriatric Cognitive Disorders, 22, 471485.
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.
Ryu, S.Y., Lee, S.B., Kim, T.W., & Lee, T.J. (2016). Subjective memory complaints, depressive symptoms and instrumental activities of daily living in mild cognitive impairment. International Psychogeriatrics, 28, 487494.
Silva, M.R., Moser, D., Pfluger, M., Pusswald, G., Stogmann, E., Dal-Bianco, P., & Lehrner, J. (2016). Self-reported and informant-reported memory functioning and awareness in patients with mild cognitive impairment and Alzheimer’s disease. Neuropsychiatrie, 30, 103112.
Slavin, M.J., Brodaty, H., Kochan, N.A., Crawford, J.D., Trollor, J.N., Draper, B., & Sachdev, P.S. (2010). Prevalence and predictors of “subjective cognitive complaints” in the Sydney Memory and Ageing Study. American Journal of Geriatric Psychiatry, 18, 701710.
Starkstein, S.E. (2014). Anosognosia in Alzheimer’s disease: Diagnosis, frequency, mechanism and clinical correlates. Cortex, 61, 6473.
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, 14, 589595.
Thomas, K.R., Edmonds, E.C., Delano-Wood, L., & Bondi, M.W. (2017). Longitudinal trajectories of informant-reported daily functioning in empirically-defined subtypes of mild cognitive impairment. Journal of the International Neuropsychological Society, 23, 521527.
Vannini, P., Amariglio, R., Hanseeuw, B., Johnson, K.A., McLaren, D.G., Chhatwal, J., & Sperling, R.A. (2017). Memory self-awareness in the preclinical and prodromal stages of Alzheimer’s disease. Neuropsychologia, 99, 343349.
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.
Wechsler, D. (1987). Wechsler Memory Scale-Revised. New York: The Psychological Corporation.
Wilson, R.S., Boyle, P.A., Yu, L., Barnes, L.L., Sytsma, J., Buchman, A.S., & Schneider, J.A. (2015). Temporal course and pathologic basis of unawareness of memory loss in dementia. Neurology, 85, 984991.
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.
Wolfsgruber, S., Wagner, M., Schmidtke, K., Frolich, L., Kurz, A., Schulz, S., & Jessen, F. (2014). Memory concerns, memory performance and risk of dementia in patients with mild cognitive impairment. PLos One, 9, e100812. doi: 10.1371/journal.pone.0100812
Yates, J.A., Clare, L., & Woods, R.T. (2017). Subjective memory complaints, mood and MCI: A follow-up study. Aging & Mental Health, 21, 313321.

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