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Subjective Cognitive Decline — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatrySubjective Cognitive DeclineMRCPsych Paper B

A 70-year-old man reports a persistent decline in his memory compared with his previous ability. He remains independent in all instrumental activities of daily living, and collateral history identifies no functional decline. His ACE-III score is 92/100, and age- and education-adjusted neuropsychological assessment shows no objective cognitive impairment. Delirium, depression, medication effects and other medical or neurological explanations have been excluded. He is concerned because his father had Alzheimer's disease. Which term best describes his current cognitive state?

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Correct answer: B — Subjective cognitive decline

The best answer is subjective cognitive decline: a persistent self-experienced decline from previous cognitive ability without objective impairment on appropriately interpreted cognitive assessment. It is a descriptive clinical state, not a diagnosis of Alzheimer's disease. Preserved instrumental functioning and normal neuropsychological performance argue against mild cognitive impairment, which requires objective cognitive impairment, and against dementia, where cognitive decline interferes with independent functioning. There are no features supporting vascular dementia. Normal ageing without subjective decline does not capture his persistent perceived deterioration. His concern and family history warrant a careful, individualised assessment, but they do not establish an underlying neurodegenerative disorder. NICE also cautions that a normal screening score alone cannot exclude dementia; the additional normal assessment and preserved function make the distinction secure here.

Reference: Jessen F, et al. The characterisation of subjective cognitive decline. Lancet Neurology. 2020;19(3):271–278. https://pubmed.ncbi.nlm.nih.gov/31958406/