Do you worry that your memory is getting worse?  Have you misplaced your car keys (again!), and think that maybe you are in the early throes of Alzheimer’s?  If so, you are not alone. There are so many reports about the increasing number of people with Alzheimer’s, it is only natural to worry. However, it is also known that as people grow older, cognitive and physical functioning slow down. So when should you worry?

Normal Aging

Dr. Robert Stern, Professor of Neurology and Neurosurgery at the Boston University Alzheimer’s Disease Center, provides some excellent guidance on this topic. As people age, it is normal for people to take longer to find the right word, or remember someone’s name. And people who are distracted can find themselves in front of their refrigerators, wondering  what it was that they were looking for. These are examples of normal aging according to Dr. Stern, and though they may be frustrating, they are generally not something to be worried about.

Abnormal Aging

Signs that you are experiencing something more serious than normal aging include:

• Not being able to remember information that you just heard, such as the time of a movie 
• Not being able to retrieve the right word or name even when given hints or more information to help find the word
•  Getting lost while driving in a familiar area
• Having trouble with organization and planning
•  Having difficulty executing tasks that one used to perform easily, such as balancing a check book
• Not remember what common tools or devices are used for

These basic guidelines have been very helpful to many people, especially the “worried well”.

Introducing Subjective Cognitive Decline

The Alzheimer’s Association International Conference in Boston this summer introduced a new concept: “Subjective Cognitive Decline”, or SCD. This concept builds off of five different research studies that linked people with self-reported concerns about cognitive decline but who tested normally with a later diagnosis of cognitive impairment. The five studies did not use standard measures to gauge cognitive decline, nor did they report the same forms of impairment.

One found a link between SCD and the gene known to be a risk factor for Alzheimer’s.  Another study found a link between SCD and a decline in episodic memory, but not overall cognitive status. A third study found an association with the following array of factors: gender, estrogen use, family history of cognitive decline, and being overweight.

A working group created by the Alzheimer’s Association has developed a standard framework for assessing those who report concerns about memory loss, including the development of a standard definition of SCD:

A subjectively experienced persistent continuous cognitive decline or decline in cognitive capacity compared with a previously normal state, which is not related to an acute event. Performance on standard tests used to define cognitive impairment is normal.  

The researchers think that those who self report cognitive issues but who test normally have a higher likelihood of developing Alzheimer’s, and therefore, are ideal candidates for clinical trials.

Does this New Concept have Merit?

The response from the public and some physicians to the concept of SCD has been mixed. There has been a front article discussion in The New York Times. There are concerns that this idea will only create more worried well, as most people will experience some decline in their mental prowess as they age. There are concerns about  unnecessary anxiety. There are questions about the ability of people to know what is “normal” and whether anyone can be objective about their cognitive abilities.

Some speak about the “dementia industry” and think in its efforts to obtain more funding, it is fear mongering. Last, there are those who question the ethics of trying to identify people who are currently normal, but who may have a higher risk of developing a disease for which there is no effective treatment.

Over the course of the next years, researchers will try to refine the concept of SCD and develop objective measurements. At the moment, the concept seems too loosely tied to functional impairment to be of much use to those outside the research field.