CDC: Subjective cognitive decline more prevalent in underrepresented populations

Key takeaways

• Some underrepresented racial and ethnic populations were more likely to face subjective cognitive decline than their white counterparts.
• American Indian or Alaskan Native people saw the highest prevalence rates at 16.7%.
• Fewer than half of those who reported worsening memory talked to a health care professional about their concerns.

In the United States, some underrepresented racial and ethnic populations were more likely to face subjective cognitive decline, according to researchers, and fewer than half discussed their symptoms with a health care provider.

Karen G. Wooten, MA, a health scientist at the CDC, and colleagues wrote that, in the U.S., approximately 6.5 million people aged 65 years and older live with the most common dementia: Alzheimer’s disease. Experts anticipate that number will double by 2060, and that Black and Hispanic adults will face the largest increase.

The researchers conducted a study to evaluate differences in the prevalence of subjective cognitive decline (SCD) — self-reported confusion or memory loss that happens more frequently and a possible symptom of early-stage dementia. They used data from the Behavioral Risk Factor Surveillance System to examine differences in SCD prevalence by select demographics and the prevalence of reporting symptoms to a health care professional.

“Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible,” the researchers wrote.

Wooten and colleagues found that, from 2015 to 2020, the prevalence of SCD was 9.6% overall, but there were higher rates in underrepresented racial and ethnic populations. The prevalence rates were:

• 16.7% in American Indian or Alaskan Native people;
• 11.4% in Hispanic people;
• 10.1% in Black people;
• 9.3% in white people; and
• 5% in Asian or Pacific Islander people.

Across all racial and ethnic groups, the researchers noted that college education was linked to a lower prevalence of SCD, which “suggests that education might be protective against SCD.” SCD prevalence was also reduced for those with health insurance.

“More research is needed to better understand the roles that education and related systemic factors play in sustaining cognitive health, particularly across diverse racial and ethnic populations,” they wrote. “For example, modifiable risk factors for Alzheimer disease or a related dementia are less prevalent among adults with higher education, differ among racial and ethnic groups, and are associated with high prevalence of SCD.”

Wooten and colleagues found that SCD prevalence increased with successive age groups. The highest overall percentages of SCD, they found, were among adults aged 75 years or older, at 13.3%; those who had been married but were not currently married, at 13.6%; and those who did not have a high school diploma, at 16.4%.

Notably, 47.3% of those who reported worsening memory had talked to a health care professional about their concerns, but women were more likely than men to do so: 50.7% versus 43.3%, respectively.

Similar to overall prevalence rates, people with SCD symptoms who were less likely to talk to a health care professional about their symptoms typically had less of an education, no health insurance, no personal physician and were aged 75 years or older.

“Health care providers could consider asking patients as young as age 45 years about experiences of worsening memory loss or confusion during visits to initiate discussions about early signs of dementia and strategies to reduce risk and sustain cognitive health,” the researchers wrote.

Wooten and colleagues added that their findings could help providers “identify groups of patients who would benefit from risk reduction behaviors and further cognitive assessment.”

“Public health strategies are needed to support access to health care for persons who lack access to routine health care or to have a designated preventive health care professional,” they wrote.