Brain MRI shows that memory complaints in the elderly can indicate higher risk of cognitive decline -- especially among those with larger white-matter hyperintensity volumes, according to a study published April 15 in JAMA Network Open.
"[Our] findings may suggest that subjective memory complaints could originate from different neural mechanisms, but when they coexist with larger white-matter hyperintensity volumes, [they] are an important sign that may indicate cognitive impairment in older adults," wrote a team led by Dr. Anisa Dhana of Rush University Medical Center in Chicago.
Research has suggested that people who don't show cognitive impairment but who are concerned about their everyday memory are at higher risk of faster cognitive decline and developing dementia, the team noted. But whether this phenomenon is actually connected to brain structure differences such as the volume of white-matter hyperintensities has remained unclear.
"Determining whether subjective memory complaints are in part a consequence of brain structure abnormalities, such as white-matter hyperintensity, is an essential step toward understanding the origin of [these complaints] and ultimately developing tailored preventive strategies for these high-risk populations," the authors explained.
Dhana's group sought to explore if any connection between memory complaints and brain structure via a study that included 900 adults aged 65 and older from the Chicago Health and Aging Project who voiced concern about the quality of their memory through a questionnaire and who underwent volumetric MRI assessment of white-matter hyperintensities as well as neuropsychological testing. Of the patient cohort, 59.9% were Black (a population that tends to have higher prevalence of vascular risk factors associated with larger white-matter hyperintensity volumes compared with other racial groups).
The investigators categorized study participants into three cohorts -- those with no concerns about the quality of their memory, those with moderate concerns, and those with strong concerns -- and adjusted MRI findings for age, sex, race, ethnicity, education, APOE4 gene status (a common risk factor for Alzheimer's), and total brain volume.
The group found that having larger white-matter hyperintensity volume was connected to the level of concern about memory patients had.
| Association of memory complaints with white-matter hyperintensity volume on MRI | |
| Complaint severity | White-matter hyperintensity volume |
| No concerns | 0 (reference) |
| Moderate concerns | 0.262 |
| Very concerned | 0.833 |
The team also found that people who were very worried about their memory had 174% faster cognitive decline compared with individuals with no concerns, and those with white-matter hyperintensities volumes in the fourth quartile who were very concerned about their memory showed 428% faster cognitive decline compared with their unconcerned counterparts.
The study results indicate that the level of concern patients express about their memory could help clinicians assess their risk of cognitive decline, according to the authors.
"This cohort study suggests that subjective memory complaints, which are frequently reported by elderly individuals, are an important sign of cognitive impairment, especially among [those] with abnormalities in brain structure, such as large white-matter hyperintensity volumes," they concluded. "Obtaining information about subjective memory complaints from older adults may provide essential information about their future risk of cognitive impairment."
