A recent research study conducted by the Harvard Medical School suggests that brain changes leading up to what is ultimately an Alzheimer’s diagnosis occur many years before onset of symptoms. Another of many important notes on the science of cognitive decline, then, is when should analysis of decline begin for a will contest attorney involved in an inheritance dispute?
As we’ve discussed before, Alzheimer’s disease is often not diagnosed until the latter stages when significant cognitive decline is already prevalent. Previous to this study, doctors believed that symptoms of mild cognitive impairment (MCI) were the earliest markers of dementia and Alzheimer’s. However, this new research suggests there may be an even earlier clinical sign — subjective cognitive decline (SCD). An earlier diagnosis would enable scientists to better understand the process of cognitive decline and shed light on treatment and even prevention of Alzheimer’s disease and dementia.
What are the signs and symptoms of SCD?
When one is subjective, they possess self-awareness. In this instance, SCD means the individual is able to notice that their thinking abilities are worsening, even when a standard memory test can’t confirm a decline. Standard symptoms include forgetting things more often, losing train of thought and feeling overwhelmed in planning or decision-making tasks. Will contest attorneys sometimes see this when examining medical records and patient history. For example, the patient may ask a physician tell-tale questions indicating a concern about memory loss or other functional challenges.
We don’t have an exact number on how many adults exhibit SCD, but the early stages of research suggest that when recognized, SCD can predict who may develop MCI. According to the Harvard report, a 2014 meta-analysis study (meta-analysis is a statistical procedure combining research from a number of studies) of almost 30,000 people found that “25% of cognitively healthy adults who reported SCD symptoms developed MCI within the next four years.” This year, Holly Tuokko and Colette Smart published , “Neuropsychology of Cognitive Decline: A Developmental Approach to Assessment and Intervention,” which knowledgeably discussed the guidelines that can be used to evaluate normal aging, SCD, mild cognitive impairment and various kinds of dementia.
Currently, SCD is considered a research term rather than a clinical diagnosis, so the researchers are focusing on assessing how SCD symptoms correlate to future risk for dementia. “You don’t want to be overly concerned about any slight change in memory, but at the same time, you don’t want to brush aside possible warning signs,” Dr. Rebecca Amariglio, a clinical neuropsychologist with Harvard-affiliated Brigham and Women’s Hospital, said in the report. “It’s not just one kind of memory lapse that is necessarily a cause for concern, like misplacing your car keys or missing an appointment, but rather when there is a recent memory change that occurs on a persistent basis.”
In the seven stages of Alzheimer’s progression, which we will discuss in our next post, MCI is at stage 3, when a person and his friends and family begin to notice memory and cognitive problems. Examples of this are difficulty finding the right words and remembering names of new acquaintances. Stage 3 is the first time that doctors can identify impaired cognitive function through memory tests.
In contrast, elements of SCD can be observed in the earlier part of stage 2, when an individual may start to notice minor memory problems, but they do not yet disrupt everyday life. However, these minor issues cannot be easily distinguished from normal age-related memory loss. Historically, stage 2 of cognitive decline is the most challenging to detect because even with some memory issues, people still pass memory tests and the problems are not pronounced enough to be identified by their doctor, friends or family.
Self-Awareness Is Key
In the absence of a test to diagnose SCD, it’s up to the individual to increase awareness in memory changes. If you or someone in your life is starting to have concern about their memory, the first thing they can do is track memory lapses or struggles with recalling names or information. It’s important to write them down when they occur and see if a pattern develops with specific kinds of memory problems or with an increased frequency.
In addition, the individual can ask for people close to them to be on the lookout for any changes they might miss. And of course, if there are changes with memory, it’s important to talk to a doctor about it. Any changes, even if insignificant, are important to share with a doctor so they can make a full assessment of cognitive health. Plus, this will give doctors a baseline to work from should deterioration escalate.
Join a Memory Study
You can advance the understanding of SCD by enrolling in a prevention trial. Check out trialmatch.alz.org for more information.