Validation and Clinical Usability of a New Screening Tool: MASCoD - Multidimensional Assessment of Subjective Cognitive Decline

Subjective cognitive decline (SCD) is a subclinical cognitive impairment, which is complained by the individual without being objectively supported at diagnostic and neuropsychological levels. It can negatively influence outpatient's frailty and quality of life, as well as caregiver's burden. It may be associated with anxious and/or depressive symptoms too. Moreover, it can be prodromal to Mild Cognitive Impairment or dementia. Concerning this issue, to date, imaging biomarkers (e.g. positron emission tomography - brain 18F-FDG-PET), can be considered a promising method to predict the development of different forms of future cognitive decline. However, this examination is very expensive for the healthcare system.

Although the clinical manifestations of SCD can differ along several cognitive domains (e.g. memory problems, mental slowness and concentration difficulties, self-perceived deterioration in usual cognitive performance), as far as the investigators know, there are currently only screening tools to investigate subjective memory complaints.

Rehabilitation can play a pivotal role in this condition and non-pharmacological interventions on SCD, as cognitive training, could maintain on existing cognitive resources and slow the rate of possible increasing cognitive decline. To date, lower-functioning individuals seem to benefit more from cognitive training, in particular concerning working memory and executive functions (i.e. inhibition).

Thus, a screening tool assessing all possible subclinical manifestations of SCD and risk factors is needed to support professionals in making differential diagnosis and to predict the risk of developing severe cognitive impairment over time, proposing a personalized care path. From a clinical and research standpoint, a useful screening tool is expected to be brief for usual clinical assessment and research protocol, as well as administrable by different professionals and in various healthcare settings. Moreover, it should suggest targeted interventions to maximize the psychophysical outcome. The development of such a screening tool would address the current shortage of rapid, economic and validated instruments globally assessing over time cognition affected by this condition.

In light of the above issues, the investigators propose a brief, not expensive, multidimensional screening tool called MASCoD (Multidimensional Assessment of Subjective Cognitive Decline) developed on the basis of literature and the clinical experience provided by an experts' panelist (i.e. psychologists, neuropsychologists, neurologists) employed at the Institute for Research, Hospitalization and Healthcare (IRCCS) - Istituti Clinici Scientifici (ICS) Maugeri - Institute of Montescano and Pavia, Italy. It is composed of a general form for socio-demographic data and the following sections: a) risk factors for SCD; b) memory and executive symptoms; c) anxious/depressive or distressing symptoms. There are four increasing risk levels (i.e. low, medium with emotional complaints, medium without emotional complaints, high risk) of developing a severe cognitive impairment. Two versions of MASCoD have been proposed: one for the first baseline screening and one for the follow up assessments.