P4‐101: Anxiety mediates endorsement of subjective cognitive decline questions in non‐demented older adults

Subjective cognitive decline (SCD) may predict future cognitive decline and diagnostic progression to Alzheimer's disease. Alternatively, the presence of SCD may be influenced by non-cognitive factors, such as anxiety. Thus current SCD assessment methods may lack specificity. The current study examined specific SCD questions and their associations with general anxiety in non-demented older adults. Participants included 1120 cognitively normal (NC; 69±8 years, 56% female) and 250 MCI individuals (76±10 years, 52% female) from the Vanderbilt Memory & Alzheimer's Center participant registry. All completed a telephone-based cognitive screener, medical history, and 196-item SCD survey. Anxiety was defined as endorsing recent or past feelings of anxiety (n=427). SCD status included the upper tertile of the total SCD score (n=397, 70±9 years; 57% female). Binary logistic regression adjusting for age, sex, and education related each SCD item to anxiety status with SCD non-endorsement and no-anxiety as referents. NC anxious participants had higher SCD total scores than NC-non-anxious participants (p<0.001) but not MCI-non-anxious participants (n=115, p>0.05). SCD-positive participants endorsing “I have trouble manipulating buttons, fasteners, scissors, or bottle caps,” (b=0.71, p<0.001), “Worry about my memory or ability to pay attention” (b=0.68, p<0.001), “Memory problems make it harder to complete tasks that used to be easy,” (b=0.64, p<0.001) and “Need to check or double-check whether I locked the door, turned off the stove, etc.” (b=0.57, p<0.001) were more likely to report anxiety. Endorsing “I have trouble recalling frequently used phone numbers” (b=-0.54, p=0.003), “Mistakes in writing, typing, or operating a calculator” (b=-0.52 p=0.01), and “Compared to 10 years ago, there has been change in the ability to anticipate weather changes and plan accordingly” (b=-1.70 p<0.001) were less likely to report anxiety. Endorsement of specific SCD questions, such as items related to distractibility, worry, and checking behavior items may be more sensitive to anxiety symptoms. Results are an important first step to refining SCD assessment to differentiate elders with pathological SCD from merely anxious individuals. Further research is needed to relate SCD items to markers of Alzheimer's disease and longitudinal decline. K12-HD043483, NIRG-13-283276, K24-AG046373, UL1-TR000445; Vanderbilt Memory & Alzheimer's Center.