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      Estimating prevalence of subjective cognitive decline in and across international cohort studies of aging: a COSMIC study

      research-article
      1 , 2 , , 1 , 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 9 , 10 , 11 , 12 , 10 , 11 , 13 , 14 , 15 , 13 , 14 , 16 , 13 , 14 , 17 , 18 , 19 , 18 , 18 , 20 , 20 , 20 , 21 , 22 , 23 , 21 , 22 , 24 , 25 , 26 , 27 , 27 , 28 , 29 , 30 , 28 , 29 , 31 , 32 , 33 , 33 , 34 , 35 , 36 , 37 , 37 , 37 , 38 , 39 , 38 , 38 , 40 , 41 , 42 , 41 , 43 , 41 , 44 , 38 , 38 , 38 , 39 , for Cohort Studies of Memory in an International Consortium (COSMIC)
      Alzheimer's Research & Therapy
      BioMed Central
      Subjective cognitive decline, Prevalence, Epidemiology, Individual participant data, Data harmonization, Cohort study

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          Abstract

          Background

          Subjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer’s disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts.

          Methods

          We combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence.

          Results

          The sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3–24.4%) and IRT (25.6%, 95%CI = 25.1–26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1–7.0%, to 52.7%, 95%CI = 47.4–58.0%; IRT: 7.8%, 95%CI = 6.8–8.9%, to 52.7%, 95%CI = 47.4–58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades.

          Conclusions

          SCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field.

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          Most cited references46

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease

            In 2011, the National Institute on Aging and Alzheimer’s Association created separate diagnostic recommendations for the preclinical, mild cognitive impairment, and dementia stages of Alzheimer’s disease. Scientific progress in the interim led to an initiative by the National Institute on Aging and Alzheimer’s Association to update and unify the 2011 guidelines. This unifying update is labeled a “research framework” because its intended use is for observational and interventional research, not routine clinical care. In the National Institute on Aging and Alzheimer’s Association Research Framework, Alzheimer’s disease (AD) is defined by its underlying pathologic processes that can be documented by postmortem examination or in vivo by biomarkers. The diagnosis is not based on the clinical consequences of the disease (i.e., symptoms/signs) in this research framework, which shifts the definition of AD in living people from a syndromal to a biological construct. The research framework focuses on the diagnosis of AD with biomarkers in living persons. Biomarkers are grouped into those of β amyloid deposition, pathologic tau, and neurodegeneration [AT(N)]. This ATN classification system groups different biomarkers (imaging and biofluids) by the pathologic process each measures. The AT(N) system is flexible in that new biomarkers can be added to the three existing AT(N) groups, and new biomarker groups beyond AT(N) can be added when they become available. We focus on AD as a continuum, and cognitive staging may be accomplished using continuous measures. However, we also outline two different categorical cognitive schemes for staging the severity of cognitive impairment: a scheme using three traditional syndromal categories and a six-stage numeric scheme. It is important to stress that this framework seeks to create a common language with which investigators can generate and test hypotheses about the interactions among different pathologic processes (denoted by biomarkers) and cognitive symptoms. We appreciate the concern that this biomarker-based research framework has the potential to be misused. Therefore, we emphasize, first, it is premature and inappropriate to use this research framework in general medical practice. Second, this research framework should not be used to restrict alternative approaches to hypothesis testing that do not use biomarkers. There will be situations where biomarkers are not available or requiring them would be counterproductive to the specific research goals (discussed in more detail later in the document). Thus, biomarker-based research should not be considered a template for all research into age-related cognitive impairment and dementia; rather, it should be applied when it is fit for the purpose of the specific research goals of a study. Importantly, this framework should be examined in diverse populations. Although it is possible that β-amyloid plaques and neurofibrillary tau deposits are not causal in AD pathogenesis, it is these abnormal protein deposits that define AD as a unique neurodegenerative disease among different disorders that can lead to dementia. We envision that defining AD as a biological construct will enable a more accurate characterization and understanding of the sequence of events that lead to cognitive impairment that is associated with AD, as well as the multifactorial etiology of dementia. This approach also will enable a more precise approach to interventional trials where specific pathways can be targeted in the disease process and in the appropriate people.
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              Dementia prevention, intervention, and care

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                Author and article information

                Contributors
                susanne.roehr@medizin.uni-leipzig.de
                Journal
                Alzheimers Res Ther
                Alzheimers Res Ther
                Alzheimer's Research & Therapy
                BioMed Central (London )
                1758-9193
                18 December 2020
                18 December 2020
                2020
                : 12
                : 167
                Affiliations
                [1 ]GRID grid.9647.c, ISNI 0000 0004 7669 9786, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, , University of Leipzig, ; Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
                [2 ]GRID grid.8217.c, ISNI 0000 0004 1936 9705, Global Brain Health Institute (GBHI), , Trinity College Dublin, ; Dublin, Ireland
                [3 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Department of Psychiatry, , University of Cologne, Medical Faculty, ; Cologne, Germany
                [4 ]GRID grid.424247.3, ISNI 0000 0004 0438 0426, German Center for Neurodegenerative Diseases (DZNE), ; Bonn, Germany
                [5 ]GRID grid.443450.2, ISNI 0000 0001 2288 786X, Department of Neurology, School of Medicine, , Atma Jaya Catholic University of Indonesia, ; Jakarta, Indonesia
                [6 ]GRID grid.443450.2, ISNI 0000 0001 2288 786X, Center for Health Research, School of Medicine, , Atma Jaya Catholic University of Indonesia, ; Jakarta, Indonesia
                [7 ]GRID grid.5335.0, ISNI 0000000121885934, Cambridge Public Health, , Cambridge University, ; Cambridge, UK
                [8 ]GRID grid.5335.0, ISNI 0000000121885934, MRC Biostatistics Unit, Institute of Public Health, , Cambridge University, ; Cambridge, UK
                [9 ]GRID grid.1006.7, ISNI 0000 0001 0462 7212, Institute of Health and Society, , Newcastle University, ; Newcastle upon Tyne, UK
                [10 ]GRID grid.268433.8, ISNI 0000 0004 1936 7638, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, , Yeshiva University, ; New York, NY USA
                [11 ]GRID grid.268433.8, ISNI 0000 0004 1936 7638, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, , Yeshiva University, ; New York, NY USA
                [12 ]GRID grid.268433.8, ISNI 0000 0004 1936 7638, Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, , Yeshiva University, ; New York, NY USA
                [13 ]GRID grid.497275.a, INSERM, U1094, Tropical Neuroepidemiology, ; Limoges, France
                [14 ]GRID grid.9966.0, ISNI 0000 0001 2165 4861, Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, , GEIST, ; Limoges, France
                [15 ]IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France
                [16 ]GRID grid.411178.a, ISNI 0000 0001 1486 4131, CHU, Department of Medical Information & Evaluation, , Clinical Research and Biostatistic Unit, ; Limoges, France
                [17 ]Department of Neurology, Amitié Hospital, Bangui, Central African Republic
                [18 ]GRID grid.121334.6, ISNI 0000 0001 2097 0141, INSERM U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, , Université de Montpellier, ; Montpellier, France
                [19 ]GRID grid.4305.2, ISNI 0000 0004 1936 7988, Centre for Clinical Brain Sciences, , University of Edinburgh, ; Edinburgh, UK
                [20 ]GRID grid.428690.1, ISNI 0000 0004 7473 8040, Golgi Cenci Foundation, ; Corso San Martino 10, 20081 Abbiategrasso, Italy
                [21 ]GRID grid.412480.b, ISNI 0000 0004 0647 3378, Department of Neuropsychiatry, , Seoul National University Bundang Hospital, ; Seongnam, Republic of Korea
                [22 ]GRID grid.31501.36, ISNI 0000 0004 0470 5905, Department of Psychiatry, , Seoul National University College of Medicine, ; Seoul, Republic of Korea
                [23 ]GRID grid.31501.36, ISNI 0000 0004 0470 5905, Department of Brain and Cognitive Science, , Seoul National University College of Natural Sciences, ; Seoul, Republic of Korea
                [24 ]GRID grid.412113.4, ISNI 0000 0004 1937 1557, Centre of Healthy Aging and Wellness, Faculty of Health Sciences, , Universiti Kebangsaan Malaysia, ; Kuala Lumpur, Malaysia
                [25 ]GRID grid.412113.4, ISNI 0000 0004 1937 1557, Centre for Rehabilitation Science and Special Needs, Faculty of Health Science, , Universiti Kebangsaan Malaysia, ; Kuala Lumpur, Malaysia
                [26 ]GRID grid.11875.3a, ISNI 0000 0001 2294 3534, School of Health Science, , Universiti Sains Malaysia, ; Kota Bharu, Kelantan Malaysia
                [27 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), , Maastricht University Medical Center (MUMC), ; Maastricht, The Netherlands
                [28 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Department of Psychiatry, , University of Pittsburgh School of Medicine, ; Pittsburgh, PA USA
                [29 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Department of Neurology, , University of Pittsburgh School of Medicine, ; Pittsburgh, PA USA
                [30 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Department of Epidemiology, , University of Pittsburgh Graduate School of Public Health, ; Pittsburgh, PA USA
                [31 ]GRID grid.1005.4, ISNI 0000 0004 4902 0432, Ageing Futures Institute, , University of New South Wales, ; Sydney, NSW Australia
                [32 ]GRID grid.250407.4, ISNI 0000 0000 8900 8842, Neuroscience Research Australia, ; Sydney, NSW Australia
                [33 ]GRID grid.1001.0, ISNI 0000 0001 2180 7477, Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, , Australian National University, ; Canberra, ACT Australia
                [34 ]GRID grid.177174.3, ISNI 0000 0001 2242 4849, Center for Health Science and Counseling, , Kyushu University, ; 744 Motooka, Nishi-ku, Fukuoka, 819-0395 Japan
                [35 ]GRID grid.177174.3, ISNI 0000 0001 2242 4849, Department of Epidemiology and Public Health, Graduate School of Medical Sciences, , Kyushu University, ; 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
                [36 ]GRID grid.418051.9, ISNI 0000 0000 8774 3245, Faculty of Socio-Environmental Studies, Department of Socio-Environmental Studies, , Fukuoka Institute of Technology, ; 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295 Japan
                [37 ]GRID grid.4280.e, ISNI 0000 0001 2180 6431, Department of Psychological Medicine, Yong Loo Lin School of Medicine, , National University of Singapore, ; Singapore, Singapore
                [38 ]GRID grid.1005.4, ISNI 0000 0004 4902 0432, Centre for Healthy Brain Ageing, School of Psychiatry, , University of New South Wales Sydney, ; Sydney, Australia
                [39 ]GRID grid.1005.4, ISNI 0000 0004 4902 0432, Dementia Collaborative Research Centre, School of Psychiatry, , University of New South Wales Sydney, ; Sydney, Australia
                [40 ]GRID grid.1005.4, ISNI 0000 0004 4902 0432, Department of Developmental Disability Neuropsychiatry, , University of New South Wales Sydney, ; Sydney, Australia
                [41 ]GRID grid.451322.3, ISNI 0000 0004 1770 9462, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), , Ministry of Science and Innovation, ; Madrid, Spain
                [42 ]GRID grid.488737.7, ISNI 0000000463436020, Department of Medicine and Psychiatry, , Universidad de Zaragoza and Instituto de Investigación Sanitaria Aragón, ; Zaragoza, Spain
                [43 ]GRID grid.11205.37, ISNI 0000 0001 2152 8769, Department of Psychology and Sociology, , Universidad de Zaragoza, ; Zaragoza, Spain
                [44 ]GRID grid.11205.37, ISNI 0000 0001 2152 8769, Department of Microbiology, Preventive Medicine and Public Health, , University of Zaragoza, ; Zaragoza, Spain
                Author information
                http://orcid.org/0000-0001-9385-0669
                Article
                734
                10.1186/s13195-020-00734-y
                7749505
                33339532
                526fff57-3bd2-419a-8d2e-ed362b089e78
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 July 2020
                : 26 November 2020
                Funding
                Funded by: National Health and Medical Research Council of Australia
                Award ID: 1093083
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000049, National Institute on Aging;
                Award ID: RF1AG057531
                Award Recipient :
                Funded by: The Dementia Momentum Fund
                Award ID: PS38235
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100004895, European Social Fund;
                Award ID: LIFE-103 P1
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Neurology
                subjective cognitive decline,prevalence,epidemiology,individual participant data,data harmonization,cohort study

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