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

Abstract

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.

Amyloid Plaques and Symptoms of Depression Links to Medical Help-Seeking due to Subjective Cognitive Decline

“…Indeed, worried individuals with SCD have increased risk of developing objective cognitive decline [6,28,29]. However, patients who report SCD to their general practitioner (GP) may not be referred to a memory clinic for assessment [30]. In a previous study, we found no significant cognitive differences between SCD cases recruited from memory clinics as compared to SCD cases recruited from a community sample [24].…”

Hippocampal Resting-State Functional Connectivity Patterns are More Closely Associated with Severity of Subjective Memory Decline than Whole Hippocampal and Subfield Volumes

“…2014 ). The ease with which SMD data can be collected and evidence supporting that those who endorse it are at greater risk for dementia have resulted in an increased focus on research into SMD and how reports of this state are managed in clinical practice ( Jenkins et al. 2015 ; Rabin et al.…”

Subjective Cognitive Decline

“…Moving on to audits, Pennington and colleagues [ 2 ] highlight and discuss the fact that functional memory disorders are common in neurology memory services; that patients with functional symptoms are not only the worried well or just suffering from anxiety and depression, and that there can be significant social and occupational impairment. Of particular relevance to memory clinics and services is the qualitative service evaluation performed by Jenkins and colleagues [ 3 ] to determine the state of knowledge of SCD and what actions are taken for its management in specialist clinical practice in the UK at the present time.…”