Subjective vs informant-reported cognitive complaints have differential clinical significance in covert cerebral small vessel disease

Anne Arola; Hanna M Laakso; Heidi Heinonen; Johanna Pitkänen; Matti Ahlström; Juha Lempiäinen; Teemu Paajanen; Jussi Virkkala; Juha Koikkalainen; Jyrki Lötjönen; Antti Korvenoja; Susanna Melkas; Hanna Jokinen

doi:10.1016/j.cccb.2023.100182

Subjective vs informant-reported cognitive complaints have differential clinical significance in covert cerebral small vessel disease

Cereb Circ Cogn Behav. 2023 Sep 9:5:100182. doi: 10.1016/j.cccb.2023.100182. eCollection 2023.

Authors

Anne Arola^{1

2}, Hanna M Laakso^{1

2}, Heidi Heinonen¹, Johanna Pitkänen³, Matti Ahlström³, Juha Lempiäinen³, Teemu Paajanen⁴, Jussi Virkkala⁵, Juha Koikkalainen^{6

7}, Jyrki Lötjönen^{6

8}, Antti Korvenoja⁹, Susanna Melkas³, Hanna Jokinen^{1

2}

Affiliations

¹ Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
² Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
³ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴ Work ability and working careers, Finnish Institute of Occupational Health, Helsinki, Finland.
⁵ Department of Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶ Combinostics Ltd, Tampere, Finland.
⁷ Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
⁸ Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland.
⁹ Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Abstract

Objective: Subjective cognitive complaints are common in patients with cerebral small vessel disease (cSVD), yet their relationship with informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports with findings from comprehensive neuropsychological assessment and brain MRI.

Method: In the Helsinki SVD Study, 152 older adults with varying degrees of white matter hyperintensities (WMH) but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on neuropsychological criteria. The measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective and informant versions of the Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX); functional abilities with the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL); and depressive symptoms with the Geriatric Depression Scale (GDS-15).

Results: Subjective cognitive complaints correlated significantly with informant reports (r=0.40-0.50, p<0.001). After controlling for demographics, subjective and informant DEX and PRMQ were not related to MCI, memory or executive functions. Instead, subjective DEX and PRMQ significantly associated with GDS-15 and informant DEX and PRMQ with WMH volume and A-IADL.

Conclusions: Neither subjective nor informant-reported cognitive complaints associated with objective cognitive performance. Informant-evaluations were related to functional impairment and more severe WMH, whereas subjective complaints only associated with mild depressive symptoms. These findings suggest that awareness of cognitive impairment may be limited in early-stage cSVD and highlight the value of informant assessments in the identification of patients with functional impairment.

Keywords: Awareness of cognitive impairment; Cerebral small vessel disease; Cognition; Mild cognitive impairment; Subjective cognitive complaints; White matter hyperintensities.