Evans Sarah A, Paitel Elizabeth R, Bhasin Riya, Nielson Kristy A
Department of Psychology, Marquette University, Milwaukee, WI, USA.
J Alzheimers Dis Rep. 2024 Feb 16;8(1):267-279. doi: 10.3233/ADR-230166. eCollection 2024.
Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. However, findings comparing SCC and objective cognitive performance have varied, particularly in the memory domain. Even less well established is the relationship between subjective and objective complaints in non-amnestic domains, such as in executive functioning, despite evidence indicating very early changes in these domains. Moreover, particularly early changes in both amnestic and non-amnestic domains are apparent in those carrying the Apolipoprotein-E ɛ4 allele, a primary genetic risk for Alzheimer's disease (AD).
This study investigated the role of the ɛ4 allele in the consistency between subjective and objective executive functioning in 54 healthy, cognitively intact, middle-aged and older adults.
Participants ( = 64.07, = 9.27, range = 48-84; ɛ4+ = 18) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure subjective executive functioning (SEF) and multiple executive functioning tasks, which were condensed into a single factor.
After accounting for age, depression, and anxiety, objective executive functioning performance significantly predicted SEF. Importantly, ɛ4 moderated this effect. Specifically, those carrying the ɛ4 allele had significantly less accurate self-awareness of their executive functioning compared to ɛ4 non-carriers.
Utilizing an approach that integrates self-evaluation of executive functioning with objective neurocognitive assessment may help identify the earliest signs of impending cognitive decline, particularly in those with genetic risk for AD. Such an approach could sensitively determine those most prone to future cognitive decline prior to symptom onset, when interventions could be most effective.
主观认知主诉（SCC）可能是未来认知衰退的早期指标。然而，比较SCC与客观认知表现的研究结果各不相同，尤其是在记忆领域。在非遗忘领域，如执行功能方面，主观与客观主诉之间的关系更是鲜为人知，尽管有证据表明这些领域会出现非常早期的变化。此外，携带载脂蛋白Eε4等位基因（阿尔茨海默病（AD）的主要遗传风险因素）的人群在遗忘和非遗忘领域都有特别明显的早期变化。
本研究调查了ε4等位基因在54名健康、认知功能正常的中老年人主观与客观执行功能一致性中的作用。
参与者（年龄均值=64.07，标准差=9.27，范围=48 - 84岁；ε4携带者=18人）完成了额叶系统行为量表（FrSBe）执行功能障碍量表（EXECDYS）以测量主观执行功能（SEF），并完成了多项执行功能任务，这些任务被浓缩为一个单一因素。
在考虑年龄、抑郁和焦虑因素后，客观执行功能表现显著预测了SEF。重要的是，ε4调节了这种效应。具体而言，与非ε4携带者相比，携带ε4等位基因的个体对其执行功能的自我认知准确性明显更低。
采用将执行功能的自我评估与客观神经认知评估相结合的方法，可能有助于识别即将出现的认知衰退的最早迹象，特别是在有AD遗传风险的人群中。这种方法可以在症状出现前敏感地确定那些最容易出现未来认知衰退的人，此时干预可能最为有效。
