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Subjective Cognitive Impairment and Affective Symptoms: A Systematic Review
Open accessAbstract
PURPOSE OF STUDY: Subjective cognitive impairment (SCI) has been argued to reflect affective symptoms (i.e., depression and anxiety) rather than actual cognitive issues. Although a number of studies exist that look at the associations between SCI and affective symptoms, no review is available to aggregate this disparate literature. We addressed this gap by conducting a systematic review to better understand the relationships among SCI and affective symptoms among older adults in both community and clinical settings. DESIGN AND METHODS: We reviewed available literature per the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Weight of evidence (WoE) ratings and narrative synthesis were completed for 58 articles. RESULTS: A majority of studies focused on community-based samples (n = 40). Approximately half (53%) of the articles reviewed met high WoE criteria for the current review. Cross-sectional findings consistently identified a positive relationship among SCI and affective symptoms. Findings from available longitudinal studies (n = 9) were mixed but suggested a possible reciprocal relationship among SCI and depression. The relationship between SCI and anxiety appeared to be driven by fears over loss of function. Following consultation with health professionals, the association between SCI and anxiety was diminished or eliminated. IMPLICATIONS: Although SCI is consistently related to affective symptoms in older adults cross-sectionally, more longitudinal work is needed to understand their temporal relationship. Improved measurement of SCI would support a deeper understanding of the impact of SCI on psychological well-being.
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“A systematic review by Hill et al. (2016) recognized the need for additional longitudinal assessment to better understand the temporality of the kinds of associations we have just described.”
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“Moreover, in a recent systematic review Hill et al concluded that subjective memory complaint was consistently related to depressive symptomatology.(63) The findings of our study are only”
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“Furthermore, a link has been found between SCD, impaired mental health (Hill et al., 2016), and worse quality of life (Hill et al., 2017).”
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“The subjective cognitive decline has been shown to strongly correlate with anxiety symptoms among older persons [38], which is similar to the findings of the present study.”
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“For example, older adults with a first-degree relative with dementia maybe more likely to report memory decline, even when they have no objective cognitive deficits (Hill et al., 2016).”
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“In particular, affective symptoms in this population have been associated with AD biomarkers and cognitive changes over time (Pavisic et al., 2021; Ahn et al., 2021), and depressive symptoms specifically may underlie and interact with SCD (Hill et al., 2016; Z ¨ ollinger et al., 2023).”
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A Longitudinal Study on Attenuated Structural Covariance in Patients With Somatic Symptom Disorder
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“To address the frequent occurrence of depressive and anxiety symptoms in people with SCD [40,41], all participants were assessed with the 30 item Geriatric Depression Scale (GDS-30) [42] and the Geriatric Anxiety Inventory (GAI) [43].”
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“However, caution should be exercised because self-perceived cognition can be influenced by several factors, including emotional status (Hill et al., 2016) and poor self-awareness of cognitive ability (Fragkiadaki et al., 2016).”
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“They are also an obstacle to healthy aging as a factor related to worse quality of life (Hill et al., 2017), poorer physical health (Hill et al., 2021), and poorer mental health (Hill et al., 2016).”
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“Better subjective cognitive functioning was associated with lower anxiety levels, similar to findings on subjective cognition in older adults (Hill et al., 2016; Liew, 2020).”
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“Excluding these individuals minimizes the confounding effects of affective symptoms on subjective cognition [17].”
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“Due to the potential confounding effects of self-rated health, depression, and cognitive performance (Hill et al., 2017, 2016; Rabin et al., 2017), our analyses also controlled for the influence of these variables.”
BackgroundInfluentialSelf-citationConcomitants of Depressive Symptoms in Memory Clinic Patients
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“For example, if perception of memory is poorer than actual memory ability then older adults might leave the workforce earlier than necessary or avoid cognitively challenging activities (Hill et al., 2016; Trouton, Stewart, & Prince, 2006).”
BackgroundWeissberger, G. H., Núñez, R. A., Tureson, K., Gold, A. I., & Thames, A. D. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000929 · Cited by 4
“Thus, subjective ratings of SES may influence subjective ratings of cognition more than objective measures of cognition (79), possibly via stress levels.”
BackgroundMogle, J. A., Hill, N. L., Bhang, I., Bhargava, S., Bratlee‐Whitaker, E., & Kitt-Lewis, E. A. (2019) · Aging & Mental Health · doi:10.1080/13607863.2018.1523882 · Cited by 4
“…lives are often negatively impacted by memory complaints, including decreased quality of life (e.g. life satisfaction; Hill et al., 2017), well-being (Hill et al., 2016), and functional abilities (e.g. instrumental activities of daily living; Montejo, Montenegro, Fern andez, & Maest u, 2012).”
BackgroundSelf-citationActive information sampling in health and disease
Attaallah, B., Petitet, P., & Husain, M. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106197 · Cited by 3
Frantzi, N., Μoraitou, D., Emmanouilidou, E., Poptsi, E., Tsardoulias, E., Symeonidis, A. L., Παπαντωνίου, Γ., Sofologi, M., Masoura, E. V., Tsentidou, G., et al. (2025) · Journal of Intelligence · doi:10.3390/jintelligence13090118 · Cited by 3
“Nevertheless, SCD is a heterogeneous construct, and its interpretation remains debated, as psychological factors and personality traits may also contribute to subjective complaints, especially in the absence of neuropathology (Hill et al. 2016; Jenkins et al. 2021; Schlosser et al. 2020).”
Tieri, G., da Costa, A. L. C., Zabberoni, S., Tenaglia, E., & Simone, M. S. D. (2025) · Brain Sciences · doi:10.3390/brainsci15121289 · Cited by 4
“Moreover, these individuals often present with subclinical symptoms, such as anxiety and depression, which further contribute to their vulnerability [23].”
Executive Functions and Subjective Cognitive Decline: The Moderating Role of Depressive Symptoms
Maffoni, M., Magnani, A., Pierobon, A., Mafferra, A., Pasotti, F., Dallocchio, C., Torlaschi, V., Mancini, D., & Fundarò, C. (2025) · Diagnostics · doi:10.3390/diagnostics15243164 · Cited by 3
Dean, O. R., Anjum, S. H., Scott, T. L., Ham, L., Traino, K. A., Wang, J., Hunsberger, S., Powers, J. H., Marr, K. A., Snow, J., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-83176-2 · Cited by 3
Gupta, S. K. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000579 · Cited by 3
Neuropsychological Correlates of Clinical Progression in Subjective Cognitive Decline
Ryoo, N., Suh, J., Son, E. J., Park, Y. H., & Kim, S.-Y. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-231042 · Cited by 3
Associations between neuropsychiatric symptoms and motoric cognitive risk syndrome
Jia, F., Liu, C.-X., Cheng, S.-M., Qian, X.-Y., & Wang, C. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06770-y · Cited by 3
Elkana, O., Levy, M., Bicovsky, Y. T., Tal, N., Oren, N., & Ash, E. L. (2025) · Journal of dementia and Alzheimer's disease · doi:10.3390/jdad2020018 · Cited by 3
Bell, T. R., Felix, C., Gider, N., Rebok, G. W., Crowe, M., Ball, K., Wallace, G., Black, S., Thomas, K. R., Wheeler, K. M., et al. (2025) · Experimental Gerontology · doi:10.1016/j.exger.2025.112891 · Cited by 3
“Baseline associations are consistent with prior research (Hill et al., 2020; Hill et al., 2016).”
Self-citationBorelli, W. V., Labrea, V. N., Leal‐Conceição, E., Portuguez, M. W., & da Costa, J. C. (2021) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x-anp-2020-0153 · Cited by 3
Vintimilla, R., Mathew, E., Hall, J. R., Johnson, L. A., & O’Bryant, S. E. (2022) · Cerebral Circulation - Cognition and Behavior · doi:10.1016/j.cccb.2022.100126 · Cited by 3
“Literature about the relationship of diabetes, hypertension, and other chronic conditions with SCC have reported inconsistent and mixed results [14].”
ResultInfluentialCésar‐Freitas, K. G., Berardis, A. C. P., Pretto, T. V. M., Viagi, A. M., Neto, V. L., Zanini, L. Y., Barbosa, I. C. C., Machado, R. P., Cunha, N. G. M., Watanabe, M. J. L., et al. (2023) · Dementia & Neuropsychologia · doi:10.1590/1980-5764-dn-2022-0064 · Cited by 3
Hama, T., & Koeda, M. (2023) · BMC Psychology · doi:10.1186/s40359-023-01281-5 · Cited by 3
Impaired lexical access for unique entities in individuals with subjective cognitive decline
Macoir, J., Tremblay, P., Beaudoin, S., Parent, M., & Hudon, C. (2024) · Applied Neuropsychology Adult · doi:10.1080/23279095.2024.2344636 · Cited by 3
“To account for the frequent occurrence of depressive and anxiety symptoms in individuals with SCD (Hill et al., 2016; John et al., 2019), all participants were assessed with the 30-item Geriatric Depression Scale (GDS −30) and the Geriatric Anxiety Inventory (GAI).”
Age moderates associations between dementia worry and subjective cognition
Spalding, D. M., Hart, R., Henderson, R., & Brown, L. A. (2024) · Cognition & Emotion · doi:10.1080/02699931.2024.2371095 · Cited by 3
“Indeed, the relationship between anxiety and subjective cognition in older adults has been suggested to be driven by worries about cognitive decline (for a review, see Hill et al., 2016).”
Just as expected? Older adults’ aging expectations are associated with subjective cognition
Hill, N. L., Bhargava, S., Do, J., Bratlee‐Whitaker, E., Brown, M. J., Komalasari, R., Wu, R., & Mogle, J. A. (2024) · Aging & Mental Health · doi:10.1080/13607863.2024.2399080 · Cited by 3
“Furthermore, many aspects of subjective cognition are associated with a variety of negative outcomes in aging including depressive symptoms and poorer quality of life (Hill et al., 2016, 2017).”
Self-citationRao, A., Rao, A. R., Painkra, B., Kiruthika, S., Kumar, S., Thakral, M., Bajpai, S., Aithal, S., Dey, A. B., & Chatterjee, P. (2025) · Archives of Gerontology and Geriatrics Plus · doi:10.1016/j.aggp.2025.100133 · Cited by 3
Phillips, M. S., Kent, G. W., Ismail, H. A., Piszczor, J., Galindo, B. N., Shapiro, G., Gonzalez, L., Cerny, B. M., & Soble, J. R. (2025) · Psychological Medicine · doi:10.1017/s0033291725001084 · Cited by 3
“Hill et al. (2016) even made a specific call for longitudinal research.”
Quaade, A. S., Davidsen, A. S., Siersma, V., Waldemar, G., & Waldorff, F. B. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.08.008 · Cited by 3
“In a recent review from 2016 on subjective cognitive impairment and affective symptoms the authors found that in the majority of the identified literature SMCs at baseline were associated with the development of depression over time [23].”
BackgroundAllam, A. K., Allam, V., Reddy, S., Patel, A., Froudarakis, E., ROHREN, E. M., Sheth, S. A., & Papageorgiou, T. D. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.03.03.582390 · Cited by 3
“…to Alzheimer’s disease, is a state of cognitive decline without objective cognitive deficits on neuropsychological testing or of any other neurological or psychiatric diagnosis (Cheng et al., 2017; Hill et al., 2016; Killeen et al., 2023; Pedro et al., 2016; Wang et al., 2020; Zheng et al., 2018).”
BackgroundEffect of hormonal therapies for prostate cancer on cognition: The ongoing search for clarity
Fat, G. L., & Alibhai, S. M. H. (2024) · Cancer · doi:10.1002/cncr.35283 · Cited by 3
Cruz, L. N., Walker, N. C., Rehman, S. S., McNerney, M. W., & Madore, M. R. (2024) · Behavioral Sciences · doi:10.3390/bs14100932 · Cited by 2
Herrera-Imbroda, J., Carbonell-Aranda, V., Guerrero-Pertiñez, G., Barnestein‐Fonseca, P., Anderberg, P., Moreno, E. V., Cuesta‐Vargas, A., Garolera, M., Lemmens, E., Berglund, J. S., et al. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15070132 · Cited by 2
“However, the causal and temporal relationship between cognitive impairment and depression is complex and not clearly understood (Hill et al., 2016; Jorm, 2000), leading to mixed findings (Bassuk et al., 1998; Baune et al., 2007; Chodosh et al., 2007; Ganguli et al., 2006; Geerlings et al., 2000;…”
Cannabidiol (CBD) and cognitive function in older adults: a mini review
Binkowska, A. A., Mateja, A., & Jakubowska, N. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1646151 · Cited by 4
“Although the extent and trajectory of cognitive aging vary signi fi cantly across individuals (4), even modest declines can adversely affect mental health, independence, and overall quality of life in older adults (5).”
Boulais, B. M., Finley, J. A., Cichocki, A. C., Gonzalez, C., Dykins, M. M., Sedgwick, T. A., Pliskin, N. H., Jennette, K. J., Tsai, P., Maniar, N., et al. (2025) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2025.2566649 · Cited by 2
“It has long been proposed that depression and anxiety are associated with a negativity bias, wherein individuals become overly vigilant of typical fluctuations in cognition, perceiving them as pathological (Beck, 2002; Hill et al., 2016).”
Uncovering pathology, subjective cognitive complaints, and sex in early Alzheimer's disease
Boutin, S., Houzé, B., Binette, A. P., Brambati, S. M., & Initiative, A. D. N. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251393268 · Cited by 2
“Considering the possible impact of depression and anxiety symptoms on the subjective experience of cognitive changes, 68 the results at the Geriatric Depression Scale 69 and Neuropsychiatric Inventory 70 (anxiety subscore) were extracted to include as covariates in our analyses alongside age and…”
Zhang, Z., Li, G., Song, Z., Han, Y., & Tang, X. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.978611 · Cited by 2
“However, arguments can be made that depressive symptoms exacerbate SCD and, vice versa, that SCD contributes to the development of affective symptomatology (Hill et al., 2016).”
BackgroundLee, Y., Nicholas, M. L., & Connor, L. T. (2024) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492241238949 · Cited by 2
“…was further supported by a previous study indicating that subjective cognitive deficits, mental health symptoms (e.g., depression and anxiety), and participation in important aspects of daily life influence each other in older adults in both community and clinical settings (Hill et al., 2016).”
Troyer, A. K., Shaikh, K. T., Baptist-Mohseni, N., Singh, A., Duncan-Kofman, J., Vandermorris, S., & Rich, J. B. (2024) · Clinical Gerontologist · doi:10.1080/07317115.2024.2421876 · Cited by 2
“Self-identified memory concerns also reflect the impact, distress, or worries that older adults experience about their memory, as is evidenced in associations with quality of life and affective symptoms (Hill et al., 2016; Rabin et al., 2017; Rotenberg Shpigelman et al., 2019).”
Simone, M. S. D., Zabberoni, S., da Costa, A. L. C., Tenaglia, E., & Tieri, G. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1591239 · Cited by 2
“For instance, it has been demonstrated that concern about loss of cognitive function contributes to elevated anxiety observed in individuals with SCD, and anxiety in turn increases alertness for cognitive failures (Hill et al., 2016).”
Yates, J. (2020) · International Psychogeriatrics · doi:10.1017/s104161021900187x · Cited by 2
“A key factor that may explain the association between subjective reports of memory changes and later development of dementia is depression, but this relationship is complicated (Hill et al., 2016).”
BackgroundThe Cognitive Function at Work Questionnaire in memory clinic setting: a validation study
Heikkinen, A.-L., Paajanen, T. I., Hublin, C., Valtonen, T., Krüger, J., Tikkanen, V., Saari, T. T., Koivisto, A. M., Hänninen, T., & Remes, A. M. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2239508 · Cited by 2
“However, cognitive symptoms can also be benign or result from a great number of other conditions, such as mental health issues (Comijs et al., 2002; Hill et al., 2016), sleep disturbances (Eskildsen et al., 2017; Vaessen, Overeem, & Sitskoorn, 2015), substance abuse (Hunt et al., 2015) or physical…”
BackgroundShould cognition be the fifth vital sign in nursing?
Pang, S., Chen, N. Y. C., & Dong, Y. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105101 · Cited by 2
Metadata
- Authors
- Hill, N. L., Mogle, J., Wion, R., Munoz, E., DePasquale, N., Yevchak, A. M., & Parisi, J. M.
- Affiliations
- Pennsylvania State University (US)
- Johns Hopkins University (US)
- Corresponding author
- Hill, Nikki L.
- Venue
- The Gerontologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-06-23
- Volume
- 56
- Issue
- 6
- Pages
- e109-e127
- ISSN
- 0016-9013 (ISSN-L)
- 1758-5341
- PMC
- PMC5181393
- OpenAlex
- W2461875054
- Cited by
- 277
- References
- 103
- Citations by year
- 2026: 28 · 2025: 44 · 2024: 37 · 2023: 22 · 2022: 40 · 2021: 33 · 2020: 27 · 2019: 21 · 2018: 15 · 2017: 8
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Gerontologist (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (F31AG050385)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Aging and Gerontology Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- subjective cognitive impairment, affective symptoms, depression, anxiety, older adults, bidirectional relationship, psychological well-being
- MeSH terms
- Affective Symptoms, Aged, Aged, 80 and over, Anxiety, Depression, Humans, Independent Living, Diagnostic Self Evaluation, Cognitive Dysfunction
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