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SCD Progression Risk — MRCPsych Paper B MCQ

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HardOld Age PsychiatrySCD Progression RiskMRCPsych Paper B

A 70-year-old woman reports an 18-month decline in memory compared with her previous ability. Detailed age- and education-adjusted neuropsychological testing is normal, everyday functioning is preserved, and depression, delirium, sleep disorder, sensory impairment, medication effects and other reversible causes have been excluded. She therefore has subjective cognitive decline rather than mild cognitive impairment or dementia. Which statement best reflects longitudinal evidence about her prognosis compared with cognitively normal people without subjective cognitive decline?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Her risk of both future mild cognitive impairment and dementia is approximately doubled, although progression is not inevitable.

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

B is correct. Subjective cognitive decline denotes a self-perceived decline from previous ability despite normal objective cognition and preserved functioning. A large meta-analysis found increased risks of both MCI (HR 1.73; OR 1.83) and dementia (HR 1.90; OR 2.48), broadly an approximately twofold elevation. This is a risk state, not an inevitable prodrome, and individual absolute risk varies with setting and additional features. A is incorrect because normal testing does not eliminate the increased longitudinal risk. C is incorrect because the association extends to dementia as well as MCI. D and E confuse relative risk with absolute probability and greatly overstate the speed and frequency of progression.

Reference: Pike KE et al. Subjective Cognitive Decline: Level of Risk for Future Dementia and Mild Cognitive Impairment, a Meta-Analysis of Longitudinal Studies. Neuropsychology Review. 2022;32:703–735. https://pubmed.ncbi.nlm.nih.gov/34748154/