Subjective Cognitive Decline May Be a Stronger Predictor of Incident Dementia in Women than in Men

Article type: Research Article

Authors: Heser, Kathrin^{a; *} | Kleineidam, Luca^a | Wiese, Birgitt^b | Oey, Anke^b | Roehr, Susanne^c | Pabst, Alexander^c | Kaduszkiewicz, Hanna^d | van den Bussche, Hendrik^e | Brettschneider, Christian^f | König, Hans-Helmut^f | Weyerer, Siegfried^g | Werle, Jochen^g | Fuchs, Angela^h | Pentzek, Michael^h | Mösch, Edelgardⁱ | Bickel, Horstⁱ | Maier, Wolfgang^a | Scherer, Martin^e | Riedel-Heller, Steffi G.^{c; 1} | Wagner, Michael^{a; j; 1}

Affiliations: [a] Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany | [b] Institute of General Practice, Working Group Medical Statistics and IT Infrastructure, Hannover Medical School, Hannover, Germany | [c] Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany | [d] Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany | [e] Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [f] Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | [g] Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany | [h] Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany | [i] Department of Psychiatry, Technical University Munich, Munich, Germany | [j] DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany

Correspondence: [*] Correspondence to: Dr. Kathrin Heser, Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Tel.: +49 228 287 19827; E-mail: [email protected]

Note: [1] These authors contributed equally to this work.

Abstract: Background/Objective:Subjective cognitive decline (SCD) has often been associated with an increased risk for subsequent dementia. However, sex-specific associations are understudied until now. Methods:Cross-sectional and longitudinal associations over a follow-up period of up to 13 years were investigated in a sample of participants without objective cognitive impairment at baseline (n = 2,422, mean age = 79.63 years). Logistic regression and Cox proportional hazards models were conducted. Results:Women less frequently reported SCD without worries (p < 0.001), but tended to report more often SCD with worries (p = 0.082) at baseline compared to men. In models adjusted for age, education, cognitive status, and depressive symptoms, SCD at baseline increased the risk for subsequent dementia (p < 0.001), and this effect was less pronounced in males (interaction sex×SCD: p = 0.022). Stratified analyses showed that SCD increased the risk for subsequent dementia in women (HR = 1.77, p < 0.001), but not in men (HR = 1.07, p = 0.682). Similar results were found in analyses with SCD without and with worries, except that SCD with worries also predicted subsequent Alzheimer’s disease (AD) in men (p = 0.037). Conclusion:At baseline, men reported more SCD without worries and women tended to report more SCD with worries. SCD in women was more strongly associated with subsequent dementia. SCD without and with worries was related to incident dementia and AD in women, whereas in men only SCD with worries increased the risk for AD, but not for all-cause dementia.

Keywords: Alzheimer’s disease, dementia, gender, sex, subjective cognitive decline, subjective memory decline, subjective memory impairment

DOI: 10.3233/JAD-180981

Journal: Journal of Alzheimer's Disease, vol. 68, no. 4, pp. 1469-1478, 2019