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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2022-0064 copy

Follow-up of participants with subjective cognitive decline from Tremembé epidemiologic study, Brazil

Seguimento dos participantes com declínio cognitivo subjetivo do estudo epidemiológico de Tremembé, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Subjective cognitive decline is defined as a self-perceived cognitive decline but with normal performance in neuropsychological assessments.

Objective:

To verify the evolution of patients diagnosed with subjective cognitive decline compared to the cognitively normal group without any concern.

Methods:

This is a follow-up study based on data analysis from the Tremembé epidemiologic study, in Brazil. The 211 individuals classified as cognitively normal and 174 diagnosed as having subjective cognitive decline at baseline were invited to participate.

Results:

After a median follow-up time of five years, 108 subjective cognitive decline participants (62.0%) were reassessed. Of these, 58 (53.7%) kept this diagnosis, whereas 14 individuals (12.9%) progressed to mild cognitive impairment and 5 (4.6%) to dementia. In the cognitively normal group, 107 (50.7%) were reassessed, of which 51 (47.7%) were still classified likewise, 6 (5.6%) evolved to mild cognitive impairment and 9 (8.4%) to dementia. The presence of cognitive decline had a significant association with increasing age and depression symptoms. Considering the total number of baseline participants in each group: the subjective cognitive decline group showed higher percentage of mild cognitive impairment (p=0.022) and no difference was found in progression to dementia (p=0.468) between the groups after follow-up assessment.

Conclusion:

Most subjective cognitive decline participants at baseline kept their cognitive complaint at follow-up and this group progressed more to mild cognitive impairment than the other group. No difference in the progression to dementia was found, despite the higher incidence of dementia in the cognitively normal group.

Keywords:
Incidence; Dementia; Epidemiology; Cognitive Dysfunction

Age (years), mean (SD)		Cognitively normal (n=211)	Subjective cognitive decline (n=174)	p-value
Age (years), mean (SD)				69.9 (7.3)	68.5 (6.6)	0.073^* * Notes: Mann-Whitney Test;
Female, n (%)		128 (60.7)	125 (71.8)	0.022^† † Pearson's Chi-square Test.
Race, n (%)	White	156 (73.9)	133 (76.4)	0.316^† † Pearson's Chi-square Test.
	Black	54 (25.6)	38 (21.8)
	Asian	1 (0.5)	3 (1.7)
Education (years), mean (SD)		5.2 (4.8)	6.1 (4.8)	0.011^* * Notes: Mann-Whitney Test;
Diabetes, n (%)		63 (29.9)	50 (28.7)	0.810^† † Pearson's Chi-square Test.
Hypertension, n (%)		149 (70.6)	121 (69.5)	0.818^† † Pearson's Chi-square Test.
Coronary artery disease, n (%)		15 (7.1)	22 (12.6)	0.067^† † Pearson's Chi-square Test.
Stroke, n (%)		3 (1.4)	8 (4.6)	0.063^† † Pearson's Chi-square Test.
Psychiatric disorder, n (%)		51 (24.2)	74 (42.5)	<0.001^† † Pearson's Chi-square Test.
Smoking, n (%)	Never	164 (77.7)	146 (83.9)	0.291^† † Pearson's Chi-square Test.
	Current	29 (13.7)	16 (9.2)
	Former	18 (8.5)	12 (6.9)
Alcohol use, n (%)	No use or light use	161 (76.3)	143 (82.2)	0.143^† † Pearson's Chi-square Test.
	Moderate use	37 (17.5)	23 (13.2)
	Current or previous abuse	13 (6.2)	8 (4.6)

Follow-up	Cognitively normal (%)	Subjective cognitive decline (%)	p-value^* * Note: Pearson's Chi-square Test. Bold numbers indicates statistical significance.
Deaths	26 (12.3)	13 (7.4)	0.116
Refusals	61 (28.9)	45 (25.9)	0.505
Not found	17 (8.0)	8 (4.6)	0.170
CN	51 (24.1)	25 (14.3)	0.016
SCD	28 (13.2)	58 (33.3)	<0.001
CIND	13 (6.1)	6 (3.4)	0.221
MCI	6 (2.8)	14 (8.0)	0.022
Dementia	9 (4.3)	5 (2.9)	0.468
Total	211	174

Variables	Cognitively normal (n=107)	Subjective cognitive decline (n=108)	p-value
Age (years)	69.36 (±6.64)	67.81(±5.85)	0.099^* * Notes: Mann-Whitney Test;
Education (years)	5.52 (±5.13)	6.23 (±4.97)	0.123^* * Notes: Mann-Whitney Test;
Cornell scale	5.64 (±4.69)	8.21(±5.83)	<0.001^* * Notes: Mann-Whitney Test;
Depression	29 (27.1%)	54 (50.0%)	0.001^† † Pearson's Chi-square Test.
Diabetes	29 (27.1%)	34 (31.5%)	0.481^† † Pearson's Chi-square Test.
Hypertension	77 (72.0%)	76 (70.4%)	0.797^† † Pearson's Chi-square Test.
Stroke	1 (0.9%)	7 (6.5%)	0.032^† † Pearson's Chi-square Test.

Variables	CN-CN (n=51)	CN-SCD (n=28)	CN-CIND (n=13)	CN-MCI (n=6)	CN-Dementia (n=9)	SCD-CN (n=25)	SCD-SCD (n=58)	SCD-CIND (n=6)	SCD-MCI (n=14)	SCD-Dementia (n=5)	p-value
Age	68.69 (±6.50)^a a differs from CN–Dementia;	67.29 (±4.81)	72.23 (±6.25)	69.17 (±8.54)	75.67 (±7.79)^b b differs from CN–CN; ,^c c differs from SCD–Dementia;	66.72 (±5.71)^d d differs from SCD–MCI;	67.14 (±5.17)	70.33 (±4.84)	69.36 (±6.06)	73.80 (±10.62)	0.009^* * Notes: Kruskal Wallis test:
Education	5.00 (±4.98)	7.86 (±5.92)	4.85 (±3.16)	5.00 (±5.18)	2.56 (±3.47)	7.36 (±6.29)	5.78 (±4.79)	4.50 (±3.27)	7.14 (±3.80)	5.40 (±3.85)	0.066^* * Notes: Kruskal Wallis test:
Cornell	5.06 (±4.32)^e e differs from SCD–SCD;	4.07 (±2.79)^e e differs from SCD–SCD;	7.31 (±4.84)	12.00 (±8.08)	7.11 (±4.91)	5.76 (±4.57)^e e differs from SCD–SCD;	9.36 (±5.94)^b b differs from CN–CN; ,^f f differs from CN–MCI;	9.17 (±2.56)	8.86 (±7.57)	4.20 (±2.78)	<0.001^* * Notes: Kruskal Wallis test:
Depression	12 (23.5%)	4 (14.3%)	4 (30.8%)	5 (83.3%)	4 (44.4%)	10 (40.0%)	35 (60.3%)	4 (66.7%)	5 (35.7%)	0	<0.001^† † Pearson's Chi-square Test.
Diabetes	11 (21.6%)	8 (28.6%)	5 (38.5%)	2 (33.3%)	3 (33.3%)	7 (28.0%)	18 (31.0%)	1 (16.7%)	6 (42.9%)	2 (40.0%)	0.897^† † Pearson's Chi-square Test.
Hypertension	32 (20.9%)	21 (75.0%)	11 (84.6%)	5 (83.3%)	8 (88.9%)	20 (80.0%)	40 (26.1%)	4 (66.7%)	10 (71.4%)	2 (40.0%)	0.491^† † Pearson's Chi-square Test.
Stroke	1 (2.0%)	0	0	0	0	1 (4.0%)	3 (5.2%)	0	3 (21.4%)	0	0.075^† † Pearson's Chi-square Test.

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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