Memory decline reported by patients and partners may signal early changes in Alzheimer’s disease

A new study adds further evidence that when a patient or family member notices signs of persistent memory loss, it’s important to talk to a doctor. While there are many reasons why someone’s memory might change, researchers at Mass General Brigham studying patients before a diagnosis of Alzheimer’s disease found changes in the brain when the patients and their study partners—those who could to answer questions about their daily cognitive functioning – ;reported a decline in cognitive functioning. Using imaging, the researchers found that reports of cognitive decline were related to the accumulation of tau tangles – a hallmark of Alzheimer’s disease. The results are published in Neurology, the medical journal of the American Academy of Neurology.

“Something as simple as asking about memory complaints can monitor disease severity in the preclinical stage of Alzheimer’s disease.”

Rebecca E. Amariglio, PhD, senior author of the Department of Neurology at Brigham and Women’s Hospital

Amariglio is a clinical neuropsychologist at Brigham and Women’s Hospital and Massachusetts General Hospital, the founding members of Mass General Brigham. “We now understand that brain changes due to Alzheimer’s disease begin long before patients show clinical symptoms that are detectable by a doctor. There is increasing evidence that individuals themselves or a close family member may notice changes in memory, even before a clinical measure shows evidence of cognitive impairment.”

The new study, led by first author Michalina F. Jadick, included researchers from across Brigham and Mass General. The research team designed their study to include participants from anti-amyloid treatment in Asymptomatic AD/Longitudinal Assessment of Amyloid Risk (A4/LEARN) and Neurodegeneration studies and the Harvard Aging Brain Study and related studies. Participants were people without cognitive impairment who were at risk but had not yet been diagnosed with Alzheimer’s disease. Each participant and their respective study partner completed assessments of cognitive function for the participant. Each participant also underwent PET imaging to detect levels of tau and amyloid beta.

In 675 participants, the team found that both amyloid and tau were associated with greater self-reported decline in cognitive function. The team also found that subjective reports from patients and their partners complemented objective tests of cognitive performance.

The authors note that the study was limited by the fact that most participants were white and highly educated. Future studies that include more diverse participants and follow participants long-term are needed.

Amariglio cautions that observing a change in cognitive function does not mean we should conclude that a person has Alzheimer’s disease. However, a patient’s or family member’s concerns should not be dismissed if they are concerned about cognitive function.