Suggestions for the decision making in subjective cognitive complaints

Abstract

In recent years, the increasing life expectancy has underscored the importance of cognitive health alongside physical well-being, particularly because healthy adults may report subjective cognitive complaints (SCC), often related to memory. These complaints may or may not align with objective cognitive impairments, fueling ongoing debates about whether SCC could serve as an early indicator of dementia. While some studies suggest SCC as a potential precursor to dementia, others propose that these complaints may merely co-occur with cognitive decline. Despite the lack of consensus, addressing SCC remains crucial for early intervention, especially as emerging treatments for dementia show promise when applied at early stages. Risk factors associated with dementia, such as age, education, family history, and comorbid conditions like depression and diabetes, have been incorporated into predictive models. However, clinical practice continues to rely heavily on neuropsychological assessments to bridge subjective complaints with objective cognitive performance and may often require additional investigations, such as neuroimaging. Factors such as cognitive reserve, depression, stress, sleep disturbances, and personality traits also play significant roles in the interpretation of SCC. Some of these conditions may potentially mask underlying cognitive decline. A comprehensive clinical evaluation, integrating neuropsychological testing with a thorough anamnesis, can help distinguish between cognitive disorders and other contributing factors. Here, we propose a flowchart to guide clinicians in the management of SCC, integrating key factors to enhance diagnostic accuracy and inform treatment decisions. Despite the challenges involved, a careful and holistic approach remains essential for effective patient care.