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Available for Download Cdc-pdf[PDF – 2 MB] Subjective Cognitive Decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss.1,2 It is a form of cognitive impairment and one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias.2,3 SCD can have implications for living with and managing chronic disease, or performing everyday activities like cooking or cleaning.2 Because SCD is self-reported, it does not imply a diagnosis of cognitive decline by a health care professional.1,2 Cognition is a combination of processes in the brain that includes the ability to learn, remember, and make judgments.1 When cognition is impaired, it can have a profound impact on an individual’s overall health and well-being.1 Cognitive decline can range from mild cognitive impairment to dementia, a form of decline in abilities severe enough to interfere with daily life.1 Alzheimer’s disease is the most common form of dementia.1-3 Some cognitive decline can occur as adults age, but frequently forgetting how to perform routine tasks, for example, is not a normal part of aging and can affect a person’s ability to live and function independently. Some people with cognitive decline may be unable to care for themselves or perform activities of daily living, such as meal preparation, managing medical appointments, or managing their personal finances. Limitations in cognitive ability may impact a person’s ability to effectively manage medication regimens which can result in poor health outcomes of comorbid chronic diseases like heart disease or diabetes. By educating people about modifiable risk factors, encouraging early assessment and intervention, and understanding its impact on adults and their families, the health and well-being of many older adults may be improved.1,2 Subjective Cognitive Decline is self-reported confusion or memory problems that have been happening more often or getting worse in the past 12 months.4 Subjective Cognitive Decline is a Growing Public Health IssueWith the growing older adult population and the related increase in the need for health and social
services, the public health community is challenged to be proactive. By acting quickly This brief examines the following questions:
SCD data presented in this brief were collected from communitydwelling adults aged 45 years and older in 2015-2017 through the Behavioral Risk Factor Surveillance System (BRFSS).4 Questions related to SCD were administered as part of the BRFSS in 49 states, the District of Columbia and Puerto Rico. For states administering the module during multiple years, and the most recent data were used for this brief. Additional results for these data were previously published.5 Additional data reports can be generated and viewed through the CDC Healthy Aging Data Portal https://www.cdc.gov/aging/agingdata/index.html). These data were examined in two age groups, adults 45-64 years and 65 years of age and older, as well as by sex, race, Hispanic ethnicity, chronic disease status, and other demographic characteristics. By acting quickly and strategically to stimulate needed changes to systems and environments, public health professionals can work to mitigate future impacts of SCD as well as Alzheimer’s disease and related dementias on the health and wellness of the public. During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?
How many adults aged 18 and older live in your household? How many children less than 18 years of age live in your household? Older adults who live alone can be at risk for poor health outcomes, are less likely to use health services, and are more vulnerable to self-neglect and fall-related injuries than those living with others.6,7 Older adults who live alone report more unmet needs such as managing money, medications, mobility, and some activities of daily living.6,7
Have you or anyone else discussed your confusion or memory loss with a health care professional? Researchers have found that few adults with SCD discussed their confusion or memory loss with a health care professional.7-9 In fact, the prevalence of cognitive decline identified in community surveys is over twice that reported in medical records of general practitioners.8,9 Opportunities for improvement exist for increased screening, diagnosis, and identification of treatable cause(s).9
Has a doctor, nurse or other health professional ever told you that you had one of the following: Coronary heart disease (including angina and/or myocardial infarction)? Has a doctor, nurse or other health professional ever told you that you a stroke? Coronary heart disease can lead to decreased cognitive function that can impact effective chronic disease self-management.10-13 Cognitive impairment in areas of learning, memory, and decision-making can increase the need for assistance in self-management, such as help with medication management or scheduling medical appointments.10-13
** Respondents were classified as having coronary heart disease if they reported experiencing a heart attack (i.e., myocardial infarction) or angina Has a doctor, nurse or other health professional ever told you that you had one of the following: Coronary heart disease (including angina and/or myocardial infarction), stroke, asthma (still have), cancer (skin, other types of cancer), COPD, arthritis, depressive disorder, kidney disease, diabetes? Multiple chronic diseases (two or more) have been found to be associated with increased cognitive decline.12-14 As the number of chronic diseases increases, the management of these conditions becomes increasingly complex, which may lead to a greater need for assistance. The presence of chronic diseases includes the report of at least one of the following: heart attack, coronary heart disease, stroke, asthma, cancer, arthritis, or diabetes.
Subjective Cognitive Decline and Frequent Mental DistressMental distress includes stress, depression and problems with emotions.15 Frequent mental distress (FMD) is defined as experiencing mental distress or having mentally unhealthy days for at least 14 days in a 30 day period.15 About how many days during the past 30 days was your mental health not good? (14 or more days = frequent mental distress)
Subjective Cognitive Decline—related Functional DifficultiesSCD can impact people’s lives in ways that extend beyond thinking and remembering. It may interfere with a person’s ability to engage in activities they typically perform, like chores, socializing, taking medications, or working outside the home. An SCD-related functional difficulty is defined as always, usually, or sometimes giving up day-to-day household activities or chores and/or experiencing interference in engaging in activities outside the home.16 During the past 12 months, as a result of confusion or memory loss, how often have you given up day-to-day household activities or chores you used to do, such as cooking, cleaning, taking medications, driving, or paying bills? During the past 12 months, how often has confusion or memory loss interfered with your ability to work, volunteer, or engage in social activities outside the home.
Call to ActionSubjective Cognitive Decline (SCD) is a public health issue and public health has a role in alleviating its impact. Below are some of the actions that can be taken to improve the health and well-being of persons with SCD. For additional actions, refer to The Healthy Brain Initiative: State and Local Public Health Partnerships to Address Dementias, The 2018-2023 Road Map.17
Technical InformationThe Behavioral Risk Factor Surveillance System (BRFSS) is the nation’s premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District of Columbia and three U.S. territories. BRFSS completes more than 450,000 adult interviews each year, making it the largest and longest continuously conducted health survey system in the world. CDC’s Behavioral Risk Factor Surveillance System (BRFSS) helps states survey U.S. adults regarding a wide range of health issues and behaviors that affect their health. The crucial information gathered through this state-based telephone surveillance system is used by national, state, and local public health agencies to identify populations that might be most at risk and to monitor the need for and the effectiveness of various public health interventions. Although the BRFSS is a useful tool for assessing cognitive decline in the older adult population, it has some limitations: it excludes people who do not have telephones or are in institutions such as nursing homes; it may under-represent people who are severely impaired because of the functional capacity required to participate in the survey; and responses to BRFSS are self-reported and therefore have not been confirmed by a healthcare provider. Despite these limitations, the BRFSS is a uniquely powerful tool to provide the prevalence of cognitive decline and related health issues among older community-dwelling U.S. adults, due to its large sample size and proven reliability and validity. The BRFSS is administered and supported by the Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. For more information, please visit https://www.cdc.gov/brfss. Footnotes
What cognitive changes occur in late adulthood?Older adults retain semantic memory or the ability to remember vocabulary. Younger adults rely more on mental rehearsal strategies to store and retrieve information. Older adults focus rely more on external cues such as familiarity and context to recall information (Berk, 2007).
What factors contribute to declines in cognitive abilities in old age?These factors include damage to the brain due to cerebral ischemia, head trauma, toxins such as alcohol, excess stress hormones, or the development of a degenerative dementia such as AD. Degenerative dementias are the most common cause of significant late-life cognitive decline, but a combination of factors is common.
Which cognitive ability is most affected by aging?The basic cognitive functions most affected by age are attention and memory. Neither of these are unitary functions, however, and evidence suggests that some aspects of attention and memory hold up well with age while others show significant declines.
What are the 3 most common cognitive changes during the aging process?In general, however, the symptoms of cognitive decline that are associated with aging include: Slower inductive reasoning / slower problem solving. Diminished spatial orientation. Declines in perceptual speed.
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