Are We Ready? The Construct of Subjective Cognitive Impairment and its Utilization in Clinical Practice: A Preliminary UK-Based Service Evaluation

Extensive research on the concept of mild cognitive impairment (MCI) as a potential prodromal stage of dementia has highlighted the likelihood that abnormalities in information processing occur at even earlier stages in the disease process with research increasingly focused on the relatively new concept of subjective cognitive impairment (SCI). An individual with SCI will experience cognitive impairment solely on a subjective level, which is in contrast to an individual with MCI who will also experience cognitive impairment at an objective level. SCI is believed to be a risk factor for development of MCI. This qualitative service evaluation aimed to determine how much is known about SCI and how it is currently managed in specialist clinical practice in the UK. An email-based questionnaire containing a vignette of an individual presenting with SCI was distributed to 112 memory clinics requesting information on their most likely approach to such an individual. The 21% response rate evinces potential time pressure within clinical services that may preclude research participation and/or a lack of issue salience at present. However, the data from those who responded provide an important insight into 'where we are now' in relation to this issue. Analysis revealed main themes associated with SCI, namely the factors that influence what action is taken when an individual presents and what further investigations are performed, the multiplicity of potential outcomes experienced, and the barriers clinicians may face. The findings highlight the need for a coherent and consistent framework in relation to the management of SCI.