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SCD Progression Rate — MRCPsych Paper B MCQ

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HardOld Age PsychiatrySCD Progression RateMRCPsych Paper B

A 72-year-old reports a gradual decline in memory over 2 years and is worried about developing dementia. Activities of daily living remain intact, collateral history identifies no functional decline, and formal neuropsychological testing is within the expected range for age and education. Reversible causes have been excluded. In pooled longitudinal studies of older adults with subjective cognitive complaints but no objective cognitive impairment, approximately what proportion developed dementia during long-term follow-up of more than 4 years?

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Correct answer: B — Approximately 14%

This presentation is subjective cognitive decline: the person perceives deterioration, but objective cognition and everyday functioning remain preserved. In a meta-analysis of longitudinal cohorts, approximately 14.1% of older adults with subjective memory complaints developed dementia in studies lasting more than 4 years, making B the best answer. The risk is elevated relative to people without subjective complaints, but most do not progress to dementia. Option C is the principal distractor: approximately 26.6% developed mild cognitive impairment rather than dementia. The annual conversion rate to dementia was about 2.3%, which should not be confused with the cumulative long-term proportion. Estimates vary with the definition of SCD, clinical versus community recruitment and risk features such as informant confirmation, persistent concern, APOE ε4 and Alzheimer-type biomarkers.

Reference: Mitchell AJ, Beaumont H, Ferguson D, Yadegarfar M, Stubbs B. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis. Acta Psychiatrica Scandinavica. 2014;130(6):439–451. https://pubmed.ncbi.nlm.nih.gov/34748154/