Population & Study Design

Overview

Population/Study Design

Primary Care Cohort

A.  Enrollment

We will consecutively recruit 800 patients seeking medical care due to mild cognitive symptoms in primary care units (Figure 1). They will be recruited at approximately 25 primary care facilities in Skåne. The patients will as usual first meet a general practitioner who performs a basic investigation of the patient to rule out other obvious causes causing the cognitive symptoms other than a dementia disorder, such as depression, sleep deprivation, etc. The patients, whose cognitive symptoms are not clearly explained by psychiatric or somatic conditions, will be assessed with cognitive tests by a dementia nurse or occupational therapist at the primary care unit.

INCLUSION CRITERIA

  • The patient seeks medical help because of cognitive symptoms experienced by the patient and/or informant

or

  • The general practitioner suspects a progressive neurodegenerative disorder including, but not limited to, AD, Lewy body disease, frontotemporal lobar degeneration or subcortical vascular cognitive impairment.
  •  The main symptom is usually memory complaints, but could also be executive, visuospatial, language, or attention complaints.
  • Age ≥40 years
  • Subjective cognitive decline, mild cognitive impairment or mild dementia as assessed in primary care

EXCLUSION CRITERIA

  • Already diagnosed dementia (only newly discovered patients are enrolled)
  • Significant unstable systemic illness or organ failure that makes it difficult to participate.
  • Current significant alcohol or substance misuse.
  • Refusing investigation at the Memory clinic
  • Cognitive impairment with acute onset due to stroke
  • The cognitive impairment can with certainty be explained by another condition or disease such as significant anemia, infection, severe sleep deprivation, psychotic disorder, moderate to severe depression, alcohol abuse etc.

B. FOLLOW-UP

All patients classified as having SCD or MCI are followed longitudinally with annual visits including cognitive testing and clinical evaluation by a dementia expert. The follow-up is performed to evaluation prognostic algorithms consisting of plasma biomarkers, cognitive tests and MRI imaging data.

Illustration of the follow-up process

C.  Enrollment in BioFINDER-2

After the baseline assessments, a subsample of participants is enrolled in BioFINDER-2 undergoing BioFINDER-2 baseline assessments and longitudinal follow-ups as described here.