Subjective cognitive decline and anxious/depressive symptoms during the COVID-19 pandemic: what is the role of stress perception, stress resilience, and β-amyloid?

Abstract

Background The COVID-19 pandemic may worsen the mental health of people reporting subjective cognitive decline (SCD) and therefore their clinical prognosis. We aimed to investigate the association between the intensity of SCD and anxious/depressive symptoms during confinement and the underlying mechanisms. Methods Two hundred fifty cognitively unimpaired participants completed the Hospital Anxiety and Depression Scale (HADS) and SCD-Questionnaire (SCD-Q) and underwent amyloid-β positron emission tomography imaging with [18F] flutemetamol (N = 205) on average 2.4 (± 0.8) years before the COVID-19 confinement. During the confinement, participants completed the HADS, Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), and an ad hoc questionnaire on worries (access to primary products, self-protection materials, economic situation) and lifestyle changes (sleep duration, sleep quality, eating habits). We investigated stress-related measurements, worries, and lifestyle changes in relation to SCD. We then conducted an analysis of covariance to investigate the association of SCD-Q with HADS scores during the confinement while controlling for pre-confinement anxiety/depression scores and demographics. Furthermore, we introduced amyloid-β positivity, PSS, and BRS in the models and performed mediation analyses to explore the mechanisms explaining the association between SCD and anxiety/depression. Results In the whole sample, the average SCD-Q score was 4.1 (± 4.4); 70 (28%) participants were classified as SCD, and 26 (12.7%) were amyloid-β-positive. During the confinement, participants reporting SCD showed higher PSS (p = 0.035) but not BRS scores (p = 0.65) than those that did not report SCD. No differences in worries or lifestyle changes were observed. Higher SCD-Q scores showed an association with greater anxiety/depression scores irrespective of pre-confinement anxiety/depression levels (p = 0.002). This association was not significant after introducing amyloid-β positivity and stress-related variables in the model (p = 0.069). Amyloid-β positivity and PSS were associated with greater HADS irrespective of pre-confinement anxiety/depression scores (p = 0.023; p < 0.001). The association of SCD-Q with HADS was mediated by PSS (p = 0.01). Conclusions Higher intensity of SCD, amyloid-β positivity, and stress perception showed independent associations with anxious/depressive symptoms during the COVID-19 confinement irrespective of pre-confinement anxiety/depression levels. The association of SCD intensity with anxiety/depression was mediated by stress perception, suggesting stress regulation as a potential intervention to reduce affective symptomatology in the SCD population in the face of stressors.

Subjective Cognitive Decline in Community-Dwelling Older Adults With Objectively Normal Cognition: Mediation by Depression and Instrumental Activities of Daily Living

“…This finding is consistent with previous studies suggesting that depressive symptoms could serve as an early indicator of cognitive decline, especially in relation to memory impairment. 14,[34][35][36][37] The findings from this study highlight the importance of conducting a comprehensive assessment of SCD in conjunction with CDR-SB and the GDepS. Early intervention during the cognitive impairment stage may be more effective when modifiable risk factors are identified and managed promptly.…”

Symptom profiles and their influencing factors among people with subjective cognitive decline: a secondary analysis of cross-sectional data from the 2019 Korea Community Health Survey using latent class analysis

“…As stress can cause changes in the metabolism and thereby induce symptoms such as sleep deprivation, restlessness, depression and fatigue,62 the level of perceived stress is believed to affect the various symptoms and their clusters. Effective stress regulation has been suggested as a potential intervention to manage negative symptoms in people with subjective cognitive decline, as the severity of the symptoms may be differed by the level of perceived stress 63. Given that individuals with subjective cognitive decline experience substantial perceived stress,62 it is important to support them with the education and diverse resources they need to manage stress efficiently as well as regularly monitor their stress levels for effective self-management in their daily lives.…”

“…Effective stress regulation has been suggested as a potential intervention to manage negative symptoms in people with subjective cognitive decline, as the severity of the symptoms may be differed by the level of perceived stress. 63 Given that individuals with subjective cognitive decline experience substantial perceived stress, 62 it is important to support them with the education and diverse resources they need to manage stress efficiently as well as regularly monitor their stress levels for effective self-management in their daily lives. Our findings therefore would provide additional evidence to support the role of psychological factors related to the symptoms experienced by individuals with subjective cognitive decline in preventing the worsening of symptoms as well as maintaining health.…”

Awareness of episodic memory and meta-cognitive profiles: associations with cerebrospinal fluid biomarkers at the preclinical stage of the Alzheimer’s continuum

“…” for the participant, and “ Do you perceive he/she has cognitive or memory difficulties? ” for the study partner ( Sánchez-Benavides et al, 2018a , b , 2021 ; Akinci et al, 2022 ).…”