Published on: August 20, 2018
by Harvard Health:
Recent research suggests that the brain changes leading to Alzheimer’s disease begin many years before the onset of symptoms.
Most often the disease is not diagnosed until it exists in full force, so finding earlier changes in thinking or behavior may help scientists better understand this process.
In the past, doctors found that symptoms of mild cognitive impairment (MCI) were the earliest marker of dementia and Alzheimer’s. But new research has suggested there may be an even earlier clinical sign – subjective cognitive decline (SCD).
Signs and symptoms
SCD refers to a situation in which a person notices his thinking abilities are worsening, but standard memory tests can’t verify a decline. Common symptoms include forgetting things more often, losing one’s train of thought, and feeling overwhelmed about making decisions or planning.
It’s not clear how many older adults have SCD, but initial research has shown that when recognized, SCD can predict who may get MCI. A 2014 meta-analysis of almost 30,000 people found that 25% of cognitively healthy adults who reported SCD symptoms developed MCI within the next four years.
Right now, SCD is more of a research term than a clinical diagnosis, so the focus is on determining how SCD symptoms relate to future risk for dementia. “You don’t want to be overly concerned about any slight change in memory, but at the same time, you don’t want to brush aside possible warning signs,” says Dr. Rebecca Amariglio, a clinical neuropsychologist with Harvard-affiliated Brigham and Women’s Hospital. “It’s not just one kind of memory lapse that is necessarily a cause for concern, like misplacing your car keys or missing an appointment, but rather when there is a recent memory change that occurs on a persistent basis.”
There are seven stages of Alzheimer’s progression, according to new criteria put out by the National Institute on Aging and the American Alzheimer’s Association. They track the disease’s progression from stage 1 (no memory problems or other symptoms) to stage 7 (severe dementia).
MCI is at stage 3, when a person and his friends and family begin to notice memory and cognitive problems, such as difficulty finding the right words and remembering names of new acquaintances. At stage 3, doctors can often detect impaired cognitive function through performance on memory tests.
In comparison, features of SCD can be observed in the earlier stage 2, when a person may notice minor memory problems, although not to the point where it interferes with daily life. Nor can this be easily distinguished from normal age-related memory loss. Stage 2 is the most difficult stage to detect because even with these memory issues, people can still do well on memory tests, and any problems are unlikely to be detected by them or their physician, friends, or loved ones.
Since there is no test to diagnose SCD, the key is to increase self-awareness of changes in memory.
What can you do? Try to track memory lapses or struggles with recalling names or information. Write them down when they occur, and see if any pattern develops, like specific kinds of memory problems or greater frequency.
Also, ask your spouse, family, and friends to look for any changes that you may miss. If you or anyone else notices anything different about your memory, speak with your doctor.
“Don’t be afraid to share any changes, even if you feel they may be insignificant, as it can help your doctor paint a clearer picture of your current cognitive health,” says Dr. Amariglio. “Even if you are okay right now, monitoring your mind on an ongoing basis is the best way to detect early problems if and when they occur.”
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