Subjective, but very much real, cognitive decline in older adults

By Dr. Shlomit Rotenberg

Older adults may experience changes in their memory, such as misplacing items or having difficulty retrieving words. In our research recently published in OTJR, we explored  how this experience manifests in the everyday lives of older adults with subjective cognitive decline, defined as self-reported decline in cognitive functions with no evidence of impairment on cognitive tests held in a clinic or research lab. People with subjective cognitive decline are twice more likely to develop dementia compared to those who do not experience cognitive decline. A better understanding of their early, subtle, functional decline will support dementia prevention efforts, because dementia is characterized by decline in both cognitive abilities and everyday functioning.

In this study, we investigated cognitive problems as they manifest in everyday life by 135 older adults with subjective cognitive decline (mean age: 71; age range: 60-85). We explored not only memory, but also executive functions, which are cognitive functions related to goal directed behaviors, such as planning, organization, and problem solving, and behavioural regulation.

1.       Self-report questionnaires of cognition in everyday life

Participants were asked to fill out questionnaires about the frequency of memory and executive functions problem in everyday life. We compared their report to that of a normative sample of people of a similar age, who did not experience cognitive decline.

·       Memory: Our participants reported similar frequency of memory mistakes (e.g., forgetting an appointment, forgetting to take medication, having difficulty coming up with a specific word) as the normative group. However, they were much less satisfied with their memory, more often feeling concerned about their memory and about developing Alzheimer’s disease.

·       Executive functions: The participants reported executive functioning problems in daily life, significantly more that the normative sample. This includes issues that may be perceives as “memory problems” such as walking into a room and forgetting what for; forgetting to take an important document to an appointment; picking up only nine of a ten-item grocery list; or not knowing where the umbrella is on a rainy day.

2.       Direct observation of performance of daily life tasks

Our participants performed a simulated shopping task that took place in a large Toronto hospital complex (pre COVID), to explore the role of executive functions in real-life situations. They were asked to complete several real-world tasks, such as purchase a Coke or find out opening hours of the hospital library; they were required to do so while following a set of rules, such as spending as little money as possible or not going into a place they had already been to. This is a highly complex task, requiring much planning, monitoring, and problem solving. Based on previous studies, healthy adults are expected to complete approximately eight of the 12 tasks. Older adults with subjective cognitive decline completed only six of the tasks, on average, and broke many more rules than healthy adults. In fact, their performance was more like that of adults post stroke.

What did we learn?

·       Real-life questionnaires and observations of people’s performance capture challenges in cognition that may be too subtle to be identified by lab-based cognitive tests, that are detached from everyday life contexts. We advocate for incorporating more functional assessments of cognitive problems in health assessments.

·       Cognitive training and compensatory strategy training offered to older adults with subjective cognitive decline should address executive functioning, such as to improve planning, problem solving or self-monitoring of task progress.  

·       Seeing that memory concerns, more than memory mistakes, characterize people with subjective cognitive decline, we suggest that health professional include explicit training to alleviate memory concerns and establish positive memory related beliefs.

Conclusion

Although older adults with subjective cognitive decline are generally healthy and independent, early attention to their experience and its implication on everyday life can support their continued independence. This is an important step towards slowing future functional and cognitive decline that may lead to dementia.

Article Details
Characterizing Cognition in Everyday Life of Older Adults With Subjective Cognitive Decline
Shlomit Rotenberg, Deirdre R. Dawson
First Published May 2, 2022
DOI: 15394492221093310

Author Details