Subjective Cognitive Complaints Given in Questionnaire: Relationship With Brain Structure, Cognitive Performance and Self-Reported Depressive Symptoms in a 25-Year Retrospective Cohort Study

Background: Subjective cognitive complaints are common but it is unclear whether they indicate an underlying pathological process or reflect affective symptoms. Method: 800 community-dwelling older adults were drawn from the Whitehall II cohort. Subjective cognitive complaint inquiry for memory and concentration, a range of neuropsychological tests and multimodal MRI were performed in 2012-2016. Subjective complaints were again elicited after 1 year. Group differences in grey and white matter, between those with and without subjective complaints, were assessed using voxel-based morphometry and tract-based spatial statistics, respectively. Mixed effects models assessed whether cognitive decline or depressive symptoms (over a 25-year period) were associated with later subjective complaints. Analyses were controlled for potential confounders and multiple comparisons. Results: Mean age of the sample at scanning was 69.8 years (+/- 5.1, range: 60.3-84.6). Subjective memory complaints were common (41%) and predicted further similar complaints later (mean 1.4 +/- 1.4 years). There were no group differences in grey matter density or white matter integrity. Subjective complaints were not cross-sectionally or longitudinally associated with objectively assessed cognition. However, those with subjective complaints reported higher depressive symptoms (poor concentration: odds ratio = 1.12, 95% CI 1.07-1.18; poor memory: odds ratio = 1.18, 1.12-1.24). Conclusions: In our sample subjective complaints were consistent over time and reflected depressive symptoms but not markers of neurodegenerative brain damage or concurrent or future objective cognitive impairment. Clinicians assessing patients presenting with memory complaints should be vigilant for affective disorders. These results question the rationale for including subjective complaints in a spectrum with Mild Cognitive Impairment diagnostic criteria.

Automated summary

The study found that subjective cognitive complaints in older adults can predict similar complaints in the future and often reflect depressive symptoms rather than neurodegenerative brain damage. Additionally, subjective complaints were not associated with objectively assessed cognition. Clinicians should be careful to consider depressive symptoms when evaluating patients presenting with memory complaints.