Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS)
Objectives To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation i...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-10-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/10/e073205.full |
| _version_ | 1797628855816552448 |
|---|---|
| author | Yoav Ben-Shlomo Mark Fish John Gallacher Antony Bayer Harriet A Ball Elizabeth Coulthard |
| author_facet | Yoav Ben-Shlomo Mark Fish John Gallacher Antony Bayer Harriet A Ball Elizabeth Coulthard |
| author_sort | Yoav Ben-Shlomo |
| collection | DOAJ |
| description | Objectives To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation is poor meta-cognition, the extreme of which is seen in functional cognitive disorder (FCD).Design Prospective cohort (Caerphilly Prospective Study).Setting Population-based, South Wales, UK.Participants This men-only study began in 1979; 1225 men participated at an average age of 73 in 2002–2004, including assessments of simple subjective cognitive decline (sSCD, defined as a subjective report of worsening memory or concentration). Dementia outcomes were followed up to 2012–2014. Data on non-completers was additionally obtained from death certificates and local health records.Primary and secondary outcome measures The primary outcome measure was incident dementia over 10 years. Secondary outcome measures included prospective change in objective cognition and cross-sectional cognitive internal inconsistency (the existence of a cognitive ability at some times, and its absence at other times, with no intervening explanatory factors except for focus of attention).Results sSCD was common (30%) and only weakly associated with prior objective cognitive decline (sensitivity 36% (95% CI 30 to 42) and specificity 72% (95% CI 68 to 75)). Independent predictors of sSCD were older age, poor sleep quality and higher trait anxiety. Those with sSCD did not have excess cognitive internal inconsistency, but results suggested a mild attentional deficit. sSCD did not predict objective cognitive change (linear regression coefficient −0.01 (95% CI −0.13 to 0.15)) nor dementia (odds ratio 1.35 (0.61 to 2.99)) 10 years later.Conclusions sSCD is weakly associated with prior objective cognitive decline and does not predict future cognition. Prior sleep difficulties and anxiety were the most robust predictors of sSCD. sSCD in the absence of objective decline appears to be a highly prevalent example of poor meta-cognition (ie, poor self-awareness of cognitive performance), which could be a driver for later FCD. |
| first_indexed | 2024-03-11T10:45:05Z |
| format | Article |
| id | doaj.art-8918ed7be8ed417dbd54c8d4eef9f3bf |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T10:45:05Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-8918ed7be8ed417dbd54c8d4eef9f3bf2023-11-14T07:10:08ZengBMJ Publishing GroupBMJ Open2044-60552023-10-01131010.1136/bmjopen-2023-073205Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS)Yoav Ben-Shlomo0Mark Fish1John Gallacher2Antony Bayer3Harriet A Ball4Elizabeth Coulthard5Population Health Sciences, University of Bristol, Bristol, UKRoyal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UKDepartment of Psychiatry, University of Oxford, Oxford, UKInstitute of Primary Care and Public Health, Cardiff University, Cardiff, Wales, UKPopulation Health Sciences, University of Bristol, Bristol, UKTranslational Health Sciences, University of Bristol Medical School, Bristol, UKObjectives To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation is poor meta-cognition, the extreme of which is seen in functional cognitive disorder (FCD).Design Prospective cohort (Caerphilly Prospective Study).Setting Population-based, South Wales, UK.Participants This men-only study began in 1979; 1225 men participated at an average age of 73 in 2002–2004, including assessments of simple subjective cognitive decline (sSCD, defined as a subjective report of worsening memory or concentration). Dementia outcomes were followed up to 2012–2014. Data on non-completers was additionally obtained from death certificates and local health records.Primary and secondary outcome measures The primary outcome measure was incident dementia over 10 years. Secondary outcome measures included prospective change in objective cognition and cross-sectional cognitive internal inconsistency (the existence of a cognitive ability at some times, and its absence at other times, with no intervening explanatory factors except for focus of attention).Results sSCD was common (30%) and only weakly associated with prior objective cognitive decline (sensitivity 36% (95% CI 30 to 42) and specificity 72% (95% CI 68 to 75)). Independent predictors of sSCD were older age, poor sleep quality and higher trait anxiety. Those with sSCD did not have excess cognitive internal inconsistency, but results suggested a mild attentional deficit. sSCD did not predict objective cognitive change (linear regression coefficient −0.01 (95% CI −0.13 to 0.15)) nor dementia (odds ratio 1.35 (0.61 to 2.99)) 10 years later.Conclusions sSCD is weakly associated with prior objective cognitive decline and does not predict future cognition. Prior sleep difficulties and anxiety were the most robust predictors of sSCD. sSCD in the absence of objective decline appears to be a highly prevalent example of poor meta-cognition (ie, poor self-awareness of cognitive performance), which could be a driver for later FCD.https://bmjopen.bmj.com/content/13/10/e073205.full |
| spellingShingle | Yoav Ben-Shlomo Mark Fish John Gallacher Antony Bayer Harriet A Ball Elizabeth Coulthard Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS) BMJ Open |
| title | Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS) |
| title_full | Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS) |
| title_fullStr | Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS) |
| title_full_unstemmed | Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS) |
| title_short | Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS) |
| title_sort | predictors and prognosis of population based subjective cognitive decline longitudinal evidence from the caerphilly prospective study caps |
| url | https://bmjopen.bmj.com/content/13/10/e073205.full |
| work_keys_str_mv | AT yoavbenshlomo predictorsandprognosisofpopulationbasedsubjectivecognitivedeclinelongitudinalevidencefromthecaerphillyprospectivestudycaps AT markfish predictorsandprognosisofpopulationbasedsubjectivecognitivedeclinelongitudinalevidencefromthecaerphillyprospectivestudycaps AT johngallacher predictorsandprognosisofpopulationbasedsubjectivecognitivedeclinelongitudinalevidencefromthecaerphillyprospectivestudycaps AT antonybayer predictorsandprognosisofpopulationbasedsubjectivecognitivedeclinelongitudinalevidencefromthecaerphillyprospectivestudycaps AT harrietaball predictorsandprognosisofpopulationbasedsubjectivecognitivedeclinelongitudinalevidencefromthecaerphillyprospectivestudycaps AT elizabethcoulthard predictorsandprognosisofpopulationbasedsubjectivecognitivedeclinelongitudinalevidencefromthecaerphillyprospectivestudycaps |