Arola Anne, Laakso Hanna M, Heinonen Heidi, Pitkänen Johanna, Ahlström Matti, Lempiäinen Juha, Paajanen Teemu, Virkkala Jussi, Koikkalainen Juha, Lötjönen Jyrki, Korvenoja Antti, Melkas Susanna, Jokinen Hanna
Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Cereb Circ Cogn Behav. 2023 Sep 9;5:100182. doi: 10.1016/j.cccb.2023.100182. eCollection 2023.
Subjective cognitive complaints are common in patients with cerebral small vessel disease (cSVD), yet their relationship with informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports with findings from comprehensive neuropsychological assessment and brain MRI.
In the Helsinki SVD Study, 152 older adults with varying degrees of white matter hyperintensities (WMH) but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on neuropsychological criteria. The measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective and informant versions of the Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX); functional abilities with the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL); and depressive symptoms with the Geriatric Depression Scale (GDS-15).
Subjective cognitive complaints correlated significantly with informant reports (=0.40-0.50, p<0.001). After controlling for demographics, subjective and informant DEX and PRMQ were not related to MCI, memory or executive functions. Instead, subjective DEX and PRMQ significantly associated with GDS-15 and informant DEX and PRMQ with WMH volume and A-IADL.
Neither subjective nor informant-reported cognitive complaints associated with objective cognitive performance. Informant-evaluations were related to functional impairment and more severe WMH, whereas subjective complaints only associated with mild depressive symptoms. These findings suggest that awareness of cognitive impairment may be limited in early-stage cSVD and highlight the value of informant assessments in the identification of patients with functional impairment.
主观认知主诉在脑小血管病（cSVD）患者中很常见，但它们与知情者评估、客观认知功能及脑改变严重程度之间的关系却鲜为人知。我们研究了主观和知情者报告与全面神经心理学评估及脑磁共振成像（MRI）结果之间的关联。
在赫尔辛基SVD研究中，152名有不同程度白质高信号（WMH）但无中风或痴呆的老年人，根据神经心理学标准被分类为认知正常或轻度认知障碍（MCI）。测量指标还包括记忆和执行功能的连续领域得分。使用前瞻性和回顾性记忆问卷（PRMQ）及执行功能障碍问卷（DEX）的主观版和知情者版评估认知主诉；使用阿姆斯特丹日常生活工具性活动问卷（A-IADL）评估功能能力；使用老年抑郁量表（GDS-15）评估抑郁症状。
主观认知主诉与知情者报告显著相关（=0.40 - 0.50，p<0.001）。在控制人口统计学因素后，主观和知情者的DEX及PRMQ与MCI、记忆或执行功能无关。相反，主观DEX和PRMQ与GDS-15显著相关，知情者DEX和PRMQ与WMH体积及A-IADL相关。
无论是主观还是知情者报告的认知主诉均与客观认知表现无关。知情者评估与功能损害及更严重的WMH相关，而主观主诉仅与轻度抑郁症状相关。这些发现表明，在早期cSVD中对认知损害的认知可能有限，并突出了知情者评估在识别有功能损害患者中的价值。
