Subjective cognitive decline (SCD) is the self-perception of cognitive decline in the absence of clinical impairment on formal testing. SCD has been posited to be a risk state for Alzheimer’s disease and related dementias. However, SCD is a multifaceted construct related not only to cognition, but to demographic factors (e.g., education) and psychological factors (e.g., depression). Moreover, previous work has documented an association between subjective cognition and subjective physical health, suggesting that SCD could in part reflect perceived declines in health more broadly. To date, research has not examined the simultaneous contributions of cognitive, demographic, psychological, and perceived health variables on SCD to develop a more comprehensive model of this complex construct. The current study investigated the unique and combined contribution of these variables to promote a more nuanced understanding of SCD.

The current sample consisted of 121 healthy older adults (71% female, 29% male), aged 51 to 96 (M= 75.32, SD=7.74) with a mean education of 17 years (SD= 2.21) who performed > -1.5 SD on objective cognitive testing. Of the sample, 23% self-reported as African American, Asian, or Other race) and 6.6% as Hispanic. Participants completed a 20-item SCD questionnaire assessing perceived cognitive difficulties across memory and non-memory domains in comparison to same aged peers, an objective measure of  semantic interference and learning sensitive to preclinical AD, and questionnaires assessing mood and subjective physical health (e.g., Compared with others your age, would you say your physical health is…”). Generalized linear regressions were used to examine the contribution of objective cognition, education, depression, and perceived physical health on SCD.

In the first generalized linear regression, objective cognition was related to SCD (B=-2.41, SE=0.96, p<0.01). In a second model entering depressive symptoms as a predictor of SCD, both cognition (B=-2.41, SE=0.96, p<0.01) and depression (B=2.09, SE=0.79,<0.01) were both independently related to SCD. Neither level of education nor gender were significant predictors when added in a third and fourth model. Subjective physical health was added as a predictor in a final model, and was significantly associated with SCD (B=-6.15, SE=2.20, p<0.01). Objective cognition remained associated with SCD (B=-1.87, SE=0.91, p<0.05), whereas depression was no longer significant (p=0.13).

Overall study findings indicated that endorsed depressive symptoms and objective cognition are associated with SCD, such that lower memory scores and greater depressive symptoms are related to increased SCD.  However, once subjective physical health is considered, depression is no longer independently related to SCD. Current study findings highlight the value of viewing SCD as a multidimensional construct, reflecting subtle cognitive impairments not evident on traditional neuropsychological testing as well as perceptions about health more broadly. Findings underscore the utility of addressing cognition, mental health and perceived physical health in inter-professional and patient-provider communication regarding SCD. Importantly, communication with patients endorsing SCD may benefit from including psychoeducation on how such factors are modifiable, to help build patient agency and generate prevention strategies to optimize cognitive function.