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P4‐567: PUBLIC ATTITUDES TO EARLY DETECTION AND DIAGNOSIS OF ALZHEIMER'S DISEASE
Author(s) -
Mitchell Susan,
Mauricio Rui,
Evans Alison
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.08.114
Subject(s) - disease , context (archaeology) , dementia , alzheimer's disease , medicine , perception , intervention (counseling) , psychology , focus group , psychiatry , pathology , neuroscience , paleontology , marketing , business , biology
Background: Subjective cognitive decline (SCD)refers to perceived decline in cognition, in the absence of objective deficits. SCD is associated with an increased risk of progression toMCI and dementia and may be one of the first cognitive symptoms of AD. However, SCD may also be associated with psychiatric symptoms including depression and anxiety, which confound its assessment. Mild Behavioral Impairment (MBI) is a validated neurobehavioral syndrome that explicitly describes later life changes in mood, behavior and personality, as an at-risk state for incident cognitive decline and dementia. While SCD andMBI overlap, to our knowledge there are no comparative studies that determine the risk for incident cognitive decline for SCD and MBI, together and alone.Methods: Participants were volunteers at Alzheimer’s Disease Centers, with a baseline Clinical Dementia Rating Scale (CDR) of 0. Outcome was change in cognitive category to CDR>0 at 3 years. SCD was abstracted from the baseline dataset using Jessen criteria. MBI was derived using a published algorithm, mapping neuropsychiatric inventory questionnaire items onto MBI domains, with positive NPS at 2 consecutive time points including baseline. Odds ratios for cognitive decline at 3 years were calculated for those with: neither SCD nor MBI (SCD-MBI-); SCD without MBI (SCD+MBI-); MBI without SCD (SCD-MBI+); and both SCD and MBI (SCD+MBI+). Patients with psychiatric conditions were excluded from analysis. Results: Of 2769 participants (mean age 1⁄476, 63% females), 1536 were SCD-MBI-, 254 SCD+MBI-, 743 SCD-MBI+, 236 SCD+MBI+. Compared to SCD-MBI-, ORs for incident cognitive decline at 3 years were 3.61 [2.42-5.38] for SCD+MBI-, 4.76 [3.57-6.34] for SCD-MBI+, and 8.15 [5.7111.64] for SCD+MBI+ (p<0.0001). Conclusions: MBI alone had higher odds of cognitive decline than SCD alone, but the combination of the two described a specific group with a great risk for progression. The systematic incorporation of MBI and SCD into risk stratification is an area with public health significance. Used in conjunction, SCD + MBI could be an inexpensive and scalable method to case select those at higher risk for cognitive decline, who may be biomarker enriched, for inclusion into dementia prevention trials increasing their efficiency, and decreasing their cost.