Subjective Cognitive Impairment: Should You Worry About Memory Loss?

Definition and Risks of Subjective Cognitive Impairment

Worried about Subjective Cognitive Impairment and Memory Loss
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Subjective Cognitive Impairment (SCI) is a self-observed decline in your thinking processes, most often noted in memory functioning. It's subjective because others may not have observed any difficulty and you may score very well on cognitive tests designed to screen for dementia; however, you feel that there is a decline. For example, you may notice that your memory is not as good as it used to be, or that it's more difficult to recall the right word you want to use to describe something.

Subjective cognitive impairment is also called subjective memory loss, subjective memory disorder, self-reported memory loss, and subjective cognitive decline.

Should You Worry If You Have SCI?

Yes and no. On one hand, there have been several research studies that demonstrate that SCI may be one of the earliest symptoms of Alzheimer's disease and dementia.

For example, one study involved more than 500 people who underwent annual cognitive assessments. The researchers found that participants who reported SCI on their regular follow-up appointments were almost three times as likely to be later diagnosed with mild cognitive impairment or dementia. Interestingly, the first complaints of memory decline occurred on an average of six years before mild cognitive impairment (a condition that sometimes, but not always, progresses to dementia) was diagnosed, and about nine years before dementia was diagnosed.

In another study, those who reported SCI were also more likely to show changes in their brains on imaging scans, specifically demonstrating higher levels of beta-amyloid protein. The concerns identified by individuals whose brains showed higher amounts of beta-amyloid protein included feeling that their memories were worse than their peers' memories and that organizing and prioritizing tasks (which utilizes executive functioning) was harder than it used to be.

A third study evaluated more than 2000 adults with an average age of 80 and asked them if they felt their memory was getting worse. They were also asked if they were concerned about this memory decline. Those who answered yes to both questions were significantly more likely to demonstrate an impairment in episodic memory (the memory of specific event) on follow up testing eight years later than those who did not express a concern about their memory.

SCI has also been correlated with brain changes such as hippocampal atrophy (shrinkage due to cell death in this area of the brain).

On the other hand, some research refutes the idea of SCI progressing to MCI and dementia, with one study concluding that SCI is "predominantly a benign condition." In this study, researchers followed some individuals with SCI and others with normal cognition for six years. They saw very little difference in the cognitive functioning of both groups by the end of the study.

Another study found that SCI was significantly associated with mood, specifically depression and anxiety. The authors suggested that SCI should perhaps not be considered indicative of any true cognitive decline but rather felt that it pointed sharply to a mood issue.

Additionally, people who have been diagnosed with Alzheimer's disease might not be very aware of their memory loss. The fact that you're able to identify your memory functioning as a concern indicates cognitive functioning that is fairly well intact, despite your identification of a problem.

What Else Might SCI Be Indicating?

While SCI might be the precursor of more significant memory loss later, it also has been connected to other conditions that may make cognitive functioning more difficult but are not actual impairments in cognition. These conditions include depression and anxiety, as well as other health problems and chronic diseases.

Why the Focus on SCI?

SCI, while sometimes unrelated to dementia, is in other cases considered an early indicator of Alzheimer's or another type of dementia. Researchers feel that it may develop first, then progress to mild cognitive impairment, and finally to Alzheimer's or a related dementia.

The foremost reason to study SCI is to aid in the ability to detect any cognitive changes early in the disease process. Early detection of Alzheimer's and other dementias is critical for optimal treatment since some of the treatments are most effective before cognitive abilities significantly decline. Early detection also allows you to participate in more clinical trials.

What Should You Do If You Have SCI?

First, don't panic. While it's understandable that you might be worried about your mild memory loss, especially after reading that it may be a sign that dementia may be developing, remember that many cases of SCI do not develop into dementia.

It's important to understand that as you age, your overall speed of processing information may become slower, and that this is a normal change which is not related to the development of dementia.

Additionally, some research suggests that people with SCI who have a lower risk of cardiovascular issues and show less brain atrophy were less likely to develop Alzheimer's over time. Thus, living in a healthy manner to reduce cardiovascular risk factors may potentially be able to reduce risk of SCI progressing to greater cognitive impairment.

Finally, keep in mind the association discussed earlier between SCI and mood. If you feel you have SCI, consider getting screened for depression and anxiety. Addressing these mental health concerns could potentially ease your symptoms of SCI and improve your quality of life.

Cognitive Training for SCI

A study outlined in the Journal of Alzheimer's Disease essentially focused on this question: "Can anything be done?" This study involved persons with memory concerns who participated in two months of cognitive training designed to target their episodic memory functioning. Following this training, the participants' memory functioning had improved and their brains' gray matter volume had increased at a rate comparable to control subjects (other participants without memory concerns who also received the cognitive training). Of note, greater brain volume has been shown to be correlated with higher cognitive functioning.

Other research has identified the MEND approach as somewhat effective in helping reverse symptoms of SCI and MCI. The MEND approach is a multi-pronged treatment strategy that works to address several areas that could impact cognition, such as diet, vitamin supplementation, physical activity, adequate sleep and more.

A Word From Verywell

Simply because you notice some decline in word-finding ability or memory doesn't mean you have Alzheimer's disease, or that you're going to develop the disease. Some people are far more likely to be aware of these changes or become concerned about them due to basic personality differences. There are also many different causes of memory loss, and some are as benign as being too busy or not getting enough sleep. Others, such as vitamin B12 deficiency, may be reversible.

Memory loss is, however, something you should pay attention to and report to your physician. You can also do your part to maintain an active brain by eating healthy foods, exercising physically as well as mentally, all of which have been associated with improved cognition.

Sources:

Alzheimer's Association. In Brief for Healthcare Professionals. Research Highlights: Subjective Cognitive Concerns May Be an Early Clinical Indicator of Alzheimer’s Disease..http://www.alz.org/documents_custom/inbrief_issue4_final.pdf

Alzheimer’s Association International Conference (AAIC) 2013.  Abstracts F5-01-04,  P4-178, and  P4-206.

Cheng, Y., Chen, T. and Chiu, M. (2017). From mild cognitive impairment to subjective cognitive decline: conceptual and methodological evolution. Neuropsychiatric Disease and Treatment, Volume 13, pp.491-498.  doi: 10.2147/NDT.S123428.

Hessen, E., Eckerström, M., Nordlund, et al. (2017). Subjective Cognitive Impairment Is a Predominantly Benign Condition in Memory Clinic Patients Followed for 6 Years: The Gothenburg-Oslo MCI Study. Dementia and Geriatric Cognitive Disorders Extra, 7(1), pp.1-14.

Journal of Alzheimer's Disease. 2014 Jan 1;41(3):779-91. Effects of cognitive training on gray matter volumes in memory clinic patients with subjective memory impairment. http://www.ncbi.nlm.nih.gov/pubmed/24685630

Yates, J., Clare, L. and Woods, R. (2015). Subjective memory complaints, mood and MCI: a follow-up study. Aging & Mental Health, 21(3), pp.313-321.

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