BarryAD - Outcome over seven years of healthy adults with...

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Outcome over seven years of healthy adults with and without subjective cognitive impairment Barry Reisberg 1 , M.D., Melanie B. Shulman 1 , M.D., Carol Torossian 1 , Psy.D., Ling Leng 2 , Ph.D. and Wei Zhu 1,2 , Ph.D. 1 Silberstein Aging and Dementia Research Center New York University School of Medicine New York, New York 10016 2 Department of Applied Mathematics and Statistics State University of New York at Stony Brook Stony Brook, NY 11794-3600 1
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1. Introduction Subjective cognitive impairment (SCI) is a common condition in older persons. A review found three studies of prevalence in community residing persons ≥ 65 years [1-4]. SCI prevalence ranged from 25% to 56%. Over the past three decades, ~ 1/3 of persons coming to our out-patient, brain aging and dementia, university hospital based, clinical research center have presented with these subjective deficits in the absence of subtle or overtly manifest cognitive decline. The prognosis of SCI is a personal concern for many older persons and a public health concern for the medical community. The prognostic import of these symptoms may also have scientific relevance in terms of the evolution of cognitive impairment in aging. SCI can occur in apparently healthy persons in the absence of objective evidence of cognitive impairment or psychopathology. Subjective cognitive complaints can also occur in association with mild cognitive impairment (MCI) [5-7], dementia [5], depression [8-10], anxiety [11], numerous medical illnesses and various medications. Hence, there is a need for studies of the prognosis of persons with SCI who are otherwise healthy. Results from present studies of SCI prognosis, which have generally used dementia as an outcome criterion, are varied. One recent study [12] queried subjects at baseline with the question, “Do you have memory complaints?” Subjects, aged 55 or greater at baseline, were followed for a mean of 9 years. A 3 times greater risk of 2
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Alzheimer’s disease (AD) was observed in the highly educated subject group without cognitive impairment at baseline who had memory complaints, in comparison with subjects who denied complaints. The increase in risk of AD associated with subjective memory complaints was much lower in the subject group with low education (specifically, limited to primary education). In these less educated persons, the presence of subjective complaints of memory problems was associated with 1.5 times greater risk of subsequent AD than in persons who did not report complaints. However, a limitation of this study is that there was no baseline assessment of the presence of depression or of affective symptomatology. This is a potentially serious limitation since, as noted above, depression is associated both with subjective complaints of memory and cognitive impairment and also with an increased risk of subsequent AD. Another study queried cognitively normal, community residing persons aged 65
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BarryAD - Outcome over seven years of healthy adults with...

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