Certain memory complaints may predict future dementia

Matt Woodley

14/05/2020 3:55:54 PM

New research reaffirms the importance of practitioners listening to older patients’ self-experience of cognitive decline.

Head jigsaw puzzle
The GP is the first port of call for approximately 85% of people living with dementia.

The study, led by Dr Katya Numbers from UNSW’s Centre for Healthy Brain Ageing (CHeBA), shows certain presentations of memory concerns by older adults are predictive of future dementia.
According to Dr Numbers, subjective cognitive complaints – an individual’s self-experience of cognitive decline – have the potential to capture everyday memory problems that are not always detected by clinical tests, and may be the earliest detectible stage of preclinical dementia. 
‘We found that when older adults go to their general practitioner with memory-specific subjective cognitive complaints it would be wise to take it seriously as they may predict future dementia,’ she said.
‘Subjective cognitive complaints can be self-reported or reported by someone close to the individual. 
‘They can refer to specific changes in memory ability or changes in other cognitive domains like language or processing speed.’
Dr Marita Long, a GP and co-author of the Demystifying Dementia online course, told newsGP it is vital GPs take all self-reported symptoms seriously and investigate appropriately.
‘Dementia is the second leading cause of death overall in Australia and the leading cause of death for women, so it is imperative that we as GPs are alert to the possibility of dementia as a diagnosis,’ she said.
‘We know that a timely diagnosis, albeit a difficult one, is very important as it is linked to better patient outcomes.
‘What this study is telling us is that if a patient or carer reports subjective cognitive complaints, take it seriously – it warrants further discussion.’
The longitudinal Sydney Memory and Ageing Study (MAS) began investigating rates and predictors of health and cognitive decline in older adults in 2005, and participants took part in 12-year follow-up assessments in 2018–19.
A major focus of the study is determining when and why normally functioning adults who show evidence of memory or cognitive decline either progress to dementia or improve.

Dr Marita Long believes it is vital GPs take all self-reported symptoms seriously and investigate appropriately.

Dr Long said while there is still no evidence for universal screening for dementia, the MAS provides some ‘good evidence’ for case finding.
‘We know that for approximately 85% of people living with dementia their GP is their first port of call, which is why it is imperative that GPs are educated in the areas of identifying, diagnosing and managing dementia – specifically Alzheimer’s, and vascular and mixed dementia,’ she said.
‘[Unfortunately], there are so many barriers to diagnosing dementia in general practice. Lack of knowledge – most GPs report minimal training in the area of dementia – lack of confidence, time, lack of access to the carers, the list goes on.’
As such, Dr Long believes the importance of carer or informant knowledge is a critical takeaway from the study.
‘From the work I have done in the area of dementia, people living with dementia and their carers often feel that their self-reported concerns are trivialised or normalised by health professionals,’ she said.
‘[But] evidence from other studies also suggests that carers make the most accurate assessment of the situation and needs of people living with dementia.
‘So take a history, examine, order investigations, etcetera. Just look at something like fatigue or post coital bleeding or palpitations – we would all as GPs use our clinical reasoning to establish a diagnosis and act as needed. Why should this be any different?’
The latest MAS paper, published in PLOS ONE, builds on previous work led by CHeBA that examined the relationship between self-reported memory or other cognitive concerns and those provided by family or friends, known as informants.
Over a six-year period, researchers tracked 873 older adults without dementia when first assessed and also surveyed 843 informants who knew participants well enough to comment on changes in participants’ cognitive abilities.
Neuropsychological assessments were carried out initially and second yearly for the duration of the study, while comprehensive assessments were also reviewed by a panel of expert clinicians who made a clinical diagnosis of dementia by consensus.
Professor Henry Brodaty, study lead and co-director of CHeBa, said participant and informant memory-specific cognitive complaints were associated with the rate of global cognitive decline.
‘If an informant noted that the person had poorer memory, six years later we found a decline in memory and executive function [planning, understanding, abstract thinking],’ he said.
‘The risk of dementia at follow-up was also greater if participants complained about poorer memory or if their informant noted changes in memory and non-memory types of cognition.’
According to Dr Numbers, the findings emphasise the importance of an older adult’s subjective presentations, as well as the relevance of the perceptions of informants in relation to predicting cognitive decline.
‘Many people with memory complaints will not develop dementia,’ she said.
‘[But], where possible, informants should be asked to report any changes [to] the individual’s memory and non-memory abilities, as such symptoms increase the risk of further decline.’
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Dr Jitendra Natverlal Parikh   15/05/2020 12:34:36 PM

Excellent eye catching
Am I right to presume that dementia has now become a disease and and not symptom
and please also tell when did that happenned

Dr Nell De Graaf   15/05/2020 1:20:35 PM

No surprises here at all.
The trouble is dementia is not treatable so diagnosing it earlier isnt really helpful