Galvin James E, Almonte Katherine C, Buehler Andrea, Caicedo Yolene M, Galvin Conor B, Jimenez Willman, Joshi Mahesh S, Mendez Nicole, Riccio Mary Lou A, Walker Marcia I, Kleiman Michael J
Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, Florida, United States of America.
PLoS One. 2025 Jun 24;20(6):e0322351. doi: 10.1371/journal.pone.0322351. eCollection 2025.
Subjective cognitive decline (SCD) affects 10% of older adults and may be a risk factor for future mild cognitive impairment (MCI) and dementia. Some individuals with MCI have anosognosia, the denial or lack of awareness of their cognitive deficits. We developed and tested the Healthy Brain 9 (HB9), a self-reported assessment of cognitive performance and everyday functioning, in a diverse community-based cohort of older adults in South Florida.
Cross-sectional study.
Community-based longitudinal study of brain health.
A total of 344 participants (mean age of 68.5±9.3y, 70% were female, 62% with 16 or less years of education, 39% ethnoracial minorities) completed the study. The sample included 42% normal cognition, 27% SCD and 30% MCI. Within the MCI group, 62% demonstrated awareness of cognitive deficits and 38% had MCI with anosognosia.
The psychometric properties of the HB9 were examined and the performance of the HB9 was compared to Gold Standard comprehensive clinical-cognitive-functional-behavioral evaluations and biomarkers evaluations from the Healthy Brain Initiative at the University of Miami.
The HB9 had strong psychometric properties with a Cronbach α of 0.898 (95%CI: 0.882-0.913) and low floor and ceiling effects. The HB9 performed well across different sociodemographic groups. Lower HB9 scores were associated with greater resilience, better physical performance, and less physical frailty. Higher HB9 scores were associated with more comorbid medical conditions, more mood symptoms, lower resilience, and more functional impairment. A cut-off score of 4 on the HB9 provided a 15-fold ability to detect SCD in cognitively normal individuals, and a 14-fold ability to detect anosognosia in MCI.
The use of the HB9 as an assessment of subjective cognitive complaints may help identify SCD for potential interventions and enrollment into clinical trials. The HB9 may also identify anosognosia which could lead to worse outcomes in MCI.
主观认知下降（SCD）影响10%的老年人，可能是未来轻度认知障碍（MCI）和痴呆症的危险因素。一些MCI患者存在失认症，即否认或未意识到自己的认知缺陷。我们在南佛罗里达州一个多样化的社区老年人群体中开发并测试了健康大脑9项评估量表（HB9），这是一种对认知表现和日常功能的自我报告评估工具。
横断面研究。
基于社区的大脑健康纵向研究。
共有344名参与者（平均年龄68.5±9.3岁，70%为女性，62%接受过16年及以下教育，39%为少数族裔）完成了研究。样本包括42%认知正常者、27%主观认知下降者和30%轻度认知障碍者。在MCI组中，62%意识到认知缺陷，38%存在失认症的MCI。
对HB9的心理测量特性进行了检查，并将HB9的表现与迈阿密大学健康大脑计划的金标准综合临床 - 认知 - 功能 - 行为评估和生物标志物评估进行了比较。
HB9具有很强的心理测量特性，Cronbach α系数为0.898（95%置信区间：0.882 - 0.913），地板效应和天花板效应较低。HB9在不同社会人口统计学群体中表现良好。较低的HB9分数与更强的恢复力、更好的身体表现和更少的身体虚弱相关。较高的HB9分数与更多的合并症、更多的情绪症状、较低的恢复力和更多的功能障碍相关。HB9的临界值为4时，在认知正常个体中检测SCD的能力提高了15倍，在MCI中检测失认症的能力提高了14倍。
使用HB9评估主观认知主诉可能有助于识别SCD以便进行潜在干预并纳入临床试验。HB9还可能识别出失认症，这可能导致MCI出现更差的结果。
