Are You Worried About Your Memory? It Could Be Subjective Cognitive Decline (SCD).

 In General

Dr. van der FlierARPF recently had the opportunity to interview Dr. van der Flier after her presentation at the International Alzheimer’s Conference in Copenhagen, Denmark, July 2014.

 Dr. van der Flier is the Head Researcher at the Alzheimer Center, Department of Neurology at the VU University Medical Center in Amsterdam, Netherlands.

 ARPF: What is your present research?

 Dr. Van der Flier:I am particularly interested in the early diagnosis of Alzheimer’s disease and earliest brain changes that ultimately lead to Alzheimer’s disease and dementia. The focus of our research now are patients with Subjective Cognitive Decline (SCD).

 ARPF: You talked about Subjective Cognitive Decline, how does SCD relate to what is called Age Associated Memory Impairment?

 Dr. Van der Flier:  Age-Associated Memory Impairment is a term that stems from approximately 20 years ago. I believe it encompasses both Subjective Cognitive Decline and objective cognitive decline. Since then, MCI (Mild Cognitive Impairment) was introduced, and we now move forward to the SCD for better diagnose the disease.

 ARPF: How would you define SCD for laypeople?

 Dr. Van der Flier:The definition of SCD is: a person who perceives cognitive decline, but they have normal cognitive tests and there is no MCI or dementia or any neurological or psychiatric disorder.

 ARPF:  Does SCD progress?

 Dr. Van der Flier:SCD definitely does not always progress. There is a lot of research presently going on to answer the question of which patients with SCD will progress to MCI and eventually to dementia.  We have some start of an answer, but that is really in a research setting now, so we cannot translate that yet to the clinical setting. 

 ARPF: Have you studied interventions to slow the progression?

 Dr. Van der Flier:No, we did not yet, because actually this group is only now attracting attention, but I do think this is an excellent population to study interventions such as lifestyle modifications. This is because these patients are worried and they are very likely to be highly motivated to do something about their memory, so I do think that this would be an excellent population to study.

 ARPF: In your study, where and how did you recruit patients?

 Dr. Van der Flier:We perform our own studies and they are all memory clinic based. The patients come from the Amsterdam Dementia Cohort, University Medical Center in Amsterdam. Most of them come to our clinic because they are worried about their memory. We do a full diagnostic evaluation and we say you are normal, there is no neurodegenerative disease, normal cognition; actually we reassure them and send them home, but we follow many of these patients on a yearly basis and some of them do progress to Alzheimer’s disease, in some cases the patient themselves were more sensitive to the change than our cognitive tests and these are really the patients that we need to know how to identify them earlier and better.

 Because we also know, from a clinical perspective to be even more important, that when the biomarkers, concentration of Amyloid Beta and Tau in cerebrospinal fluid are normal in these patients, the chances of showing clinical progression are really very low, so they are very unlikely to develop dementia.  From a clinical point of view, that is more important now because that is really reassuring.

 ARPF:  Tell us about your future research.

 Dr. Van der Flier:We just started the SCIENCe cohort, Subjective Cognitive Impairment cohort in Amsterdam. We intend to include 300 patients with Subjective Cognitive Decline, perform extensive baseline phenotyping, investigations, measure their memory and cognition in every way we can, perform an MRI and also amyloid scans and hopefully also Tau scanning. Then we hope to follow them for as long as possible; preferably 20 years, because this is how long it takes for preclinical AD to develop to full blown dementia.

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