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October 07, 2014; 83 (15) Article

Self-reported memory complaints

Implications from a longitudinal cohort with autopsies

Richard J. Kryscio, Erin L. Abner, Gregory E. Cooper, David W. Fardo, Gregory A. Jicha, Peter T. Nelson, Charles D. Smith, Linda J. Van Eldik, Lijie Wan, Frederick A. Schmitt
First published September 24, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000856
Richard J. Kryscio
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Erin L. Abner
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Gregory E. Cooper
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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David W. Fardo
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Gregory A. Jicha
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Peter T. Nelson
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Charles D. Smith
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Linda J. Van Eldik
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Lijie Wan
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Frederick A. Schmitt
From the Sanders-Brown Center on Aging (R.J.K., E.L.A., G.E.C., G.A.J., P.T.N., C.D.S., L.J.V.E., L.W., F.A.S.), Alzheimer's Disease Center (R.J.K., E.L.A., G.E.C., D.W.F., G.A.J., P.T.N., C.D.S., L.J.V.E., F.A.S.), Departments of Biostatistics (R.J.K., D.W.F.), Statistics (R.J.K., L.W.), Epidemiology (E.L.A.), and Pathology (P.T.N.), Department of Anatomy and Neurobiology, College of Medicine (L.J.V.E.), and Department of Neurology, College of Medicine (G.A.J., C.D.S., F.A.S.), University of Kentucky, Lexington; and Baptist Neurology Center (G.E.C.), Lexington, KY.
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Citation
Self-reported memory complaints
Implications from a longitudinal cohort with autopsies
Richard J. Kryscio, Erin L. Abner, Gregory E. Cooper, David W. Fardo, Gregory A. Jicha, Peter T. Nelson, Charles D. Smith, Linda J. Van Eldik, Lijie Wan, Frederick A. Schmitt
Neurology Oct 2014, 83 (15) 1359-1365; DOI: 10.1212/WNL.0000000000000856

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Abstract

Objective: We assessed salience of subjective memory complaints (SMCs) by older individuals as a predictor of subsequent cognitive impairment while accounting for risk factors and eventual neuropathologies.

Methods: Subjects (n = 531) enrolled while cognitively intact at the University of Kentucky were asked annually if they perceived changes in memory since their last visit. A multistate model estimated when transition to impairment occurred while adjusting for intervening death. Risk factors affecting the timing and probability of an impairment were identified. The association between SMCs and Alzheimer-type neuropathology was assessed from autopsies (n = 243).

Results: SMCs were reported by more than half (55.7%) of the cohort, and were associated with increased risk of impairment (unadjusted odds ratio = 2.8, p < 0.0001). Mild cognitive impairment (dementia) occurred 9.2 (12.1) years after SMC. Multistate modeling showed that SMC reporters with an APOE ε4 allele had double the odds of impairment (adjusted odds ratio = 2.2, p = 0.036). SMC smokers took less time to transition to mild cognitive impairment, while SMC hormone-replaced women took longer to transition directly to dementia. Among participants (n = 176) who died without a diagnosed clinical impairment, SMCs were associated with elevated neuritic amyloid plaques in the neocortex and medial temporal lobe.

Conclusion: SMC reporters are at a higher risk of future cognitive impairment and have higher levels of Alzheimer-type brain pathology even when impairment does not occur. As potential harbingers of future cognitive decline, physicians should query and monitor SMCs from their older patients.

GLOSSARY

AD=
Alzheimer disease;
BRAiNS=
Biologically Resilient Adults in Neurological Studies;
CERAD=
Consortium to Establish a Registry for Alzheimer's Disease;
HRT=
hormone replacement therapy;
MCI=
mild cognitive impairment;
MTL=
medial temporal lobe;
NFT=
neurofibrillary tangle;
NP=
neuritic plaque;
NSI=
no serious impairment;
OR=
odds ratio;
SMC=
subjective memory complaint

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received December 19, 2013.
  • Accepted in final form July 12, 2014.
  • © 2014 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Subjective Memory Complaint and Clinical Impact
    • Frederick A. Schmitt, Professor, University of Kentuckyfascom@uky.edu
    • Erin Abner, Lexington,KY; Richard Kryscio, Lexington, KY
    Submitted March 13, 2015
  • Response to "Self-reported memory complaints: Implications from a longitudinal cohort with autopsies"
    • Amy Jenkins, PhD Researcher, Swansea University643775@swansea.ac.uk
    • Anthony Bayer, Cardiff, UK; Jeremy Tree, Swansea, UK; Andrea Tales, Swansea, UK
    Submitted November 18, 2014
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