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Relevance of Minor Neuropsychological Deficits in Patients With Subjective Cognitive Decline.

Neurology

Authors: Melina Stark, Steffen Wolfsgruber, Luca Kleineidam, Ingo Frommann, Slawek Altenstein, Claudia Bartels, Frederic Brosseron, Katharina Buerger, Lena Burow, Michaela Butryn, Michael Ewers, Klaus Fliessbach, Tatjana Gabelin, Wenzel Glanz, Doreen Goerss, Daria Gref, Niels Hansen, Michael T Heneka, Petra Hinderer, Enise I Incesoy, Daniel Janowitz, Ingo Kilimann, Okka Kimmich, Christoph Laske, Matthias H Munk, Robert Perneczky, Oliver Peters, Lukas Preis, Josef Priller, Boris-Stephan Rauchmann, Ayda Rostamzadeh, Nina Roy-Kluth, Carolin Sanzenbacher, Anja Schneider, Björn H Schott, Annika Spottke, Eike Jakob Spruth, Stefan Teipel, Ina R Vogt, Jens Wiltfang, Emrah Duzel, Frank Jessen, Michael Wagner

BACKGROUND AND OBJECTIVES: To determine the relevance of minor neuropsychological deficits (MNPD) in patients with subjective cognitive decline (SCD) with regard to CSF levels of Alzheimer's disease (AD) biomarkers, cognitive decline and clinical progression to mild cognitive impairment (MCI).

METHODS: This study included clinical SCD patients and SCD free, healthy control (HC) participants with available baseline CSF and/or longitudinal cognitive data from the observational (DELCODE) study. We defined MNPD as a performance of at least 0.5SD below the mean on a demographically adjusted total score derived from the Neuropsychological Assessment Battery. We compared SCD patients with MNPD and those without MNPD with regard to CSF amyloid-β (Aβ)42/Aβ40, phosphorylated tau (p-tau) total tau and Aβ42/p-tau levels, longitudinal cognitive composite trajectories and risk of clinical progression to incident MCI (follow-up ±: 40.6±23.7 months). Additionally, we explored group differences between SCD and HC in those without MNPD.

RESULTS: In our sample (N = 672, mean age: 70.7±5.9 years, 50% female), SCD patients with MNPD (n = 55, 12.5% of SCD group) showed significantly more abnormal CSF biomarker levels, increased cognitive decline and a higher risk of progression to incident MCI (HR: 4.07, 95%CI: 2.46-6.74) compared to SCD patients without MNPD (n = 384). MNPD had a positive predictive value of 57.0% (95%CI: 38.5-75.4) and a negative predictive value of 86.0% (95%CI: 81.9-90.1) for the progression of SCD to MCI within three years. SCD patients without MNPD showed increased cognitive decline and a higher risk of incident MCI compared to HC participants without MNPD (n = 215; HR: 4.09, 95%CI: 2.07-8.09), while AD biomarker levels did not differ significantly between these groups.

DISCUSSION: Our results suggest that MNPD are a risk factor for AD related clinical progression in cognitively normal patients seeking medical counseling due to SCD. As such, the assessment of MNPD could be useful for individual clinical prediction and for AD risk stratification in clinical trials. However, SCD remains a risk factor for future cognitive decline even in the absence of MNPD.

© 2023 American Academy of Neurology.

PMID: 37821235

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