LAUSR

Improved understanding of the first signs of cognitive decline in aging is needed in order to describe trajectories of diseases, to design prevention studies, and to counsel individual patients. A reported symptom of feeling that cognition is worsening, together with normal performance on an objective level, is referred to as subjective cognitive decline (SCD).1 This is distinct from mild cognitive impairment (MCI), in which cognition is already below what is expected for age.2 While a subjective report of cognitive decline in an unimpaired individual was formerly considered of little relevance (patients were referred to as the “worried well”), SCD has recently gained increasing attention as a risk condition for dementia.3 In the presence of Alzheimer disease (AD) pathology, SCD is now considered its first symptomatic manifestation (stage 2).4