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Clinical Manifestations.

Tau Ming Liew1

  • 1Singapore General Hospital, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 24, 2025
PubMed
Summary

Subjective cognitive decline (SCD) has different patterns in individuals who develop neurocognitive disorders (NCD) versus those who do not. Understanding these distinct SCD trajectories can aid early NCD risk assessment and intervention.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Cognitive Psychology

Background:

  • Subjective cognitive decline (SCD) predicts neurocognitive disorders (NCD) but its nature is debated.
  • Many individuals with SCD do not progress to NCD, leading to the concept of functional cognitive disorders.
  • This study differentiates SCD trajectories in those who do and do not develop NCD.

Purpose of the Study:

  • To examine distinct differences in subjective cognitive decline (SCD) trajectories.
  • To compare SCD progression in individuals who develop neurocognitive disorders (NCD) versus those who remain cognitively normal.
  • To inform early NCD risk identification and public health strategies.

Main Methods:

  • A case-control study of 5,167 participants aged ≥50 years with a median follow-up of 8.1 years.
  • Cases developed incident NCD; controls had normal cognition throughout ≥10 years of follow-up.
  • Mixed-effect logistic regression modeled SCD trajectories using a backward timescale.

Main Results:

  • Individuals who developed NCD showed new-onset SCD within 20 years, becoming prominent 13-14 years pre-diagnosis.
  • Individuals who did not develop NCD reported SCD from a younger age with constant probability over time.
  • These distinct SCD trajectories were consistent across Alzheimer's and non-Alzheimer's diseases and in those with psychiatric conditions.

Conclusions:

  • Subjective cognitive decline (SCD) exhibits distinct trajectories differentiating progression to neurocognitive disorders (NCD).
  • These trajectories can enhance early NCD risk assessment and guide public health messaging.
  • Future SCD assessments may require a 20-year perspective to capture new-onset symptoms effectively.