Prevalence and Progression of Subjective Cognitive Decline Among Rural Chinese Older Adults: A Population-Based Study

Article type: Research Article

Authors: Xu, Shan^{a; b} | Ren, Yifei^a | Liu, Rui^a | Li, Yuanjing^c | Hou, Tingting^{a; d; e} | Wang, Yongxiang^{a; d; e} | Wang, Xiang^{a; d; e} | Wang, Lidan^a | Monastero, Roberto^f | Du, Yifeng^{a; d; e; *} | Cong, Lin^{a; d; e; *} | Qiu, Chengxuan^{c; d}

Affiliations: [a] Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P. R. China | [b] Department of Neurology, The First Hospital of Tsinghua University, Beijing, P. R. China | [c] Department of Neurobiology, Aging Research Center and Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden | [d] Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P. R. China | [e] Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China | [f] Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy

Correspondence: [*] Correspondence to: Prof. Yifeng Du, Department of Neurology, Shandong Provincial Hospital, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong 250021, P. R. China. E-mail: [email protected] or Dr. Lin Cong, [email protected].

Abstract: Background:Few community-based studies have examined occurrence and progression of subjective cognitive decline (SCD). Objective:To investigate prevalence and progression of SCD among rural-dwelling Chinese elderly people. Methods:This cohort study included 2,488 cognitively unimpaired adults (age≥65 years) who were examined at baseline (2014-2015) and followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected via in-person interviews and clinical examinations following a structured questionnaire. At baseline, SCD was assessed using the self-rated Ascertain Dementia 8-item Questionnaire. At follow-up, Alzheimer’s disease (AD) and vascular dementia (VaD) were clinically diagnosed following the international criteria. Data were analyzed using logistic regression models. Results:The prevalence of SCD was 40.07%. SCD at baseline was associated with the multivariable-adjusted odds ratio (OR) of 1.51 (95% confidence interval 1.10–2.07) for incident cognitive impairment, no dementia (CIND) and 3.11 (1.64–5.93) for incident AD. Among people with SCD at baseline, the multivariable-adjusted OR of incident CIND was 0.55(0.32–0.96) for hyperlipidemia; the multivariable-adjusted OR of incident AD was 1.21 (1.14–1.30) for older age, 0.32 (0.12–0.88) for high education, 2.60 (1.11–6.08) for carrying APOE ɛ4 allele, and 0.34 (0.13–0.86) for high social support, whereas the multivariable-adjusted OR of incident VaD was 6.30 (1.71–23.18) for obesity. Conclusion:SCD affects over 40% of rural-dwelling cognitively unimpaired older adults in China. SCD is associated with accelerated progression to CIND and AD. Older age, lack of school education, APOE ɛ4 allele, and low social support are associated with an increased risk of progression from SCD to AD, whereas obesity is related to accelerated progression to VaD.

Keywords: Alzheimer’s disease, dementia, population-based study, prevalence, risk factors, subjective cognitive decline

DOI: 10.3233/JAD-221280

Journal: Journal of Alzheimer's Disease, vol. 93, no. 4, pp. 1355-1368, 2023