Public campaigns to encourage early detection of dementia in the developed world have led to identification of more people with mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Early dementia diagnosis enables earlier information and support, including symptomatic treatments where appropriate. In clinical trials, detection of those with “prodromal dementia,” identified from cognitive symptoms and stratified by biomarkers (Schneider, Reference Schneider2010), enables potential disease modifying treatments to be targeted early in the disease process, where success is more likely.

The paper by Roehr et al. (Reference Roehr2017) in this issue adds to our understanding of the experiences of older people who report SCD. The authors recruited 1,387 people aged 75 years and older from German primary care practices, and followed them for up to six years. Half of those without MCI or dementia reported SCD. Patients with SCD reported lower health-related quality of life compared to those without SCD, and this was more pronounced for those with SCD-associated concerns. The effect was partially but not wholly explained by the common association of SCD and lower quality of life with depression and greater functional impairment.

These findings from a longitudinal study in a large, generalizable older population support those from previous cross-sectional studies. The authors conclude that people with SCD, and especially those who are worried about their symptoms experience worse quality of life and their symptoms should be taken seriously in clinical practice. The challenge for clinicians is to do this without “pathologizing” their symptoms. There is a danger that MCI and SCD could be understood by patients as definitive diagnoses, as opposed to increased risk states that might herald dementia, or be explained by depression, anxiety, substance use, or by mild deficits that do not progress. A focus on cognitive well-being rather than disease and treatment of comorbid anxiety and depression may be helpful, alongside continued work to destigmatize dementia and to support those with dementia to live and age successfully within our communities.