Frederick A.Schmitt, Professor, University of Kentuckyfascom@uky.edu
Erin Abner, Lexington,KY; Richard Kryscio, Lexington, KY
Submitted March 13, 2015
We appreciate our UK colleagues' comments on our manuscript. There has been widespread discussion regarding screening for dementia [1] and subjective memory complaint (SMC) has been a known dementia risk for decades [2] yet data regarding underlying SMC pathophysiology are limited. We agree that a major component of physicians' consideration of SMC is an issue of time and resources. However, the significance of SMC as highlighted in our analyses shows the underlying Alzheimer disease (AD) neuropathology. This is consistent with the view regarding onset of AD pathology, years before clinical symptoms are detected. These findings would suggest a need to inform physicians about SMC as a dementia risk. When combined with other risks such as dementia family history and age of the patient as shown in our data, SMC could prompt consideration for at least referral for neurocognitive examination. The average 'holding time' data suggest a window ranging from 5 to 10+ years for options including lifestyle modifications [3] or clinical trials focused on dementia risk reduction. [4] Until the data accumulate regarding SMC as a dementia risk and effective interventions become available, it is our opinion that physicians will continue to struggle with issues regarding resources and workloads.
1. Borson S, Frank L, Bayley PJ, et al. Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimers Dement 2013;9:151-159.
2. Jorm AF, Masaki KH, Davis DG, et al. Memory complaints in nondemented men predict future pathologic diagnosis of Alzheimer disease. Neurology 2004;63:1960-1961.
3. Cummings JL, Isaacson RS, Schmitt FA, et al. A practical algorithm for managing Alzheimer's disease: what, when, and why? Ann Clin Transl Neurol 2015;2:307-323.
4. Sperling RA, Rentz DM, Johnson KA, et al. The A4 Study: Stopping AD before Symptoms Begin? Sci Transl Med 2014;6:228fs13.
For disclosures, please contact the editorial office at journal@neurology.org.
We appreciate our UK colleagues' comments on our manuscript. There has been widespread discussion regarding screening for dementia [1] and subjective memory complaint (SMC) has been a known dementia risk for decades [2] yet data regarding underlying SMC pathophysiology are limited. We agree that a major component of physicians' consideration of SMC is an issue of time and resources. However, the significance of SMC as highlighted in our analyses shows the underlying Alzheimer disease (AD) neuropathology. This is consistent with the view regarding onset of AD pathology, years before clinical symptoms are detected. These findings would suggest a need to inform physicians about SMC as a dementia risk. When combined with other risks such as dementia family history and age of the patient as shown in our data, SMC could prompt consideration for at least referral for neurocognitive examination. The average 'holding time' data suggest a window ranging from 5 to 10+ years for options including lifestyle modifications [3] or clinical trials focused on dementia risk reduction. [4] Until the data accumulate regarding SMC as a dementia risk and effective interventions become available, it is our opinion that physicians will continue to struggle with issues regarding resources and workloads.
1. Borson S, Frank L, Bayley PJ, et al. Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimers Dement 2013;9:151-159.
2. Jorm AF, Masaki KH, Davis DG, et al. Memory complaints in nondemented men predict future pathologic diagnosis of Alzheimer disease. Neurology 2004;63:1960-1961.
3. Cummings JL, Isaacson RS, Schmitt FA, et al. A practical algorithm for managing Alzheimer's disease: what, when, and why? Ann Clin Transl Neurol 2015;2:307-323.
4. Sperling RA, Rentz DM, Johnson KA, et al. The A4 Study: Stopping AD before Symptoms Begin? Sci Transl Med 2014;6:228fs13.
For disclosures, please contact the editorial office at journal@neurology.org.