Indicator Definitions – Cognitive Health and Caregiving

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Alzheimer’s disease is one of the leading causes of death in the United States. It involves parts of the brain that control thought, memory, and language. It begins with mild memory loss and can lead to losing the ability to carry on a conversation and respond to the environment. Memory problems are one of the first warning signs of Alzheimer’s disease and related dementias (ADRD). Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent memory loss within the previous 12 months and an early indicator of possible future ADRD. 

Given the anticipated growth of the older adult population, it is important to decrease the burden of dementia using various public health strategies. For example, a growing body of evidence has identified potential modifiable risk factors for ADRD, and addressing these factors can help delay onset or slow the progression of ADRD. Early detection of dementia can also facilitate early intervention, including building a care team, participating in support services and counseling, addressing other chronic conditions, and better managing medications. In addition, supporting dementia caregivers is critical. Although caregiving provides numerous benefits to caregivers and recipients, it can also negatively impact caregivers’ mental and physical health. 

Visit Alzheimer’s Disease and Healthy Aging | CDC for more information about this condition.  

Definition Details

Subjective cognitive decline (SCD) among adults aged 45 years and older
Population: Adults aged 45 years and older
Numerator: Adults aged 45 years and older with SCD. Adults who reported confusion or memory loss that is happening more often or is getting worse in the past 12 months were classified as having SCD.
Denominator: All adults aged 45 years and older.
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: Past 12 months
Summary: Alzheimer’s disease is one of the leading causes of death in the United States.1 SCD, which involves confusion or memory loss, is an early symptom of possible future Alzheimer’s disease and related dementias (ADRD).2 Not all people with these symptoms develop dementia, but many do.2 Public health strategies addressing dementia risk reduction, early detection and diagnosis, and support for dementia caregivers are needed to comprehensively address ADRD at the population level.3,4
Notes: Data are obtained from the Cognitive Decline optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: None
Related CDI Topic Area: None
Reference 1: National Center for Health Statistics. Leading causes of death. Centers for Disease Control and Prevention. Updated January 18, 2023. Accessed April 5, 2023. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Reference 2: Subjective cognitive decline — a public health issue. Centers for Disease Control and Prevention. Updated February 27, 2019. Accessed April 5, 2023. https://www.cdc.gov/aging/data/subjective-cognitive-decline-brief.html
Reference 3: Alzheimer’s Disease and Healthy Aging. Centers for Disease Control and Prevention. Updated May 2, 2022. Accessed April 5, 2023. https://www.cdc.gov/aging/index.html
Reference 4: Healthy Brain Initiative: State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map. Centers for Disease Control and Prevention, Alzheimer’s Association; 2018. https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf

Discussed symptoms of subjective cognitive decline (SCD) with a health care professional among adults aged 45 years and older with subjective cognitive decline
Population: Adults aged 45 years and older with SCD
Numerator: Adults aged 45 years and older with SCD who have discussed their confusion or memory loss with a health care professional
Denominator: Adults aged 45 years and older with SCD
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: Past 12 months
Summary: Alzheimer’s disease is one of the leading causes of death in the United States.1 SCD, which involves confusion or memory loss, is an early symptom of possible future Alzheimer’s disease and related dementias (ADRD).2 Not all people with these symptoms develop dementia, but many do.2 If people with SCD talk to a health care provider about their symptoms, it may lead to early diagnosis and treatment.3,4 The earlier dementia is diagnosed, the sooner care can be provided, including building a care team, participating in support services and counseling, addressing other chronic conditions, and better managing medications.5
Notes: Data are obtained from the Cognitive Decline optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: Healthy People 2030 objective: DIA-03. Increase the proportion of adults with subjective cognitive decline who have discussed their symptoms with a provider
Related CDI Topic Area: None
Reference 1: National Center for Health Statistics. Leading causes of death. Centers for Disease Control and Prevention. Updated January 18, 2023. Accessed April 5, 2023. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Reference 2: Alzheimer’s disease and healthy aging: subjective cognitive decline — a public health issue. Centers for Disease Control and Prevention. Updated February 27, 2019. Accessed April 5, 2023. https://www.cdc.gov/aging/data/subjective-cognitive-decline-brief.html
Reference 3: Olivari BS, Baumgart M, Lock SL, et al. CDC Grand Rounds: promoting well-being and independence in older adults. MMWR Morb Mortal Wkly Rep. 2018;67(37):1036–1039. doi:10.15585/mmwr.mm6737a4
Reference 4: Olivari BS, Baumgart M, Taylor CA, McGuire LC. Population measures of subjective cognitive decline: a means of advancing public health policy to address cognitive health. Alzheimers Dement. 2021;7(1). doi: 10.1002/trc2.12142
Reference 5: Healthy Brain Initiative: State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map. Centers for Disease Control and Prevention, Alzheimer’s Association; 2018. https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf

Provided care for someone with dementia or other cognitive impairment in the past month among adults
Population: All adults
Numerator: Adults who provided regular care to a friend or family member with Alzheimer’s disease, dementia, or other cognitive impairment in the past 30 days
Denominator: All adults
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: Past 30 days
Summary: Although caregiving provides numerous benefits to both caregivers and recipients, it can also negatively impact caregivers’ mental and physical health.1 In addition, caring for a person with Alzheimer’s disease or related dementias can present unique challenges.2 For example, people with dementias may stop recognizing the person who is caring for them, can have trouble sharing their desires and feelings, and may become completely dependent on their caregiver for daily activities such as eating, using the bathroom, and bathing.2 Developing effective public health and clinical interventions to support caregivers for people with dementia can promote their health and improve the care they provide. The 2022 National Strategy to Support Family Caregivers (National Strategy) provides a national vision for recognizing, assisting, including, supporting, and engaging caregivers and includes a goal to “expand data, research, and evidence-based practices to support caregivers.”3
Notes: Data are obtained from the Caregiver optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: None
Related CDI Topic Area: None
Reference 1: Alzheimer’s disease and healthy aging: caregiving for family and friends — a public health issue. Centers for Disease Control and Prevention. Updated July 30, 2019. Accessed April 5, 2023. https://www.cdc.gov/aging/caregiving/caregiver-brief.html
Reference 2: Alzheimer’s disease and healthy aging: helping Alzheimer’s caregivers. Centers for Disease Control and Prevention. Updated November 1, 2018. Accessed April 5, 2023. https://www.cdc.gov/aging/publications/features/alzheimers_caregivers.html
Reference 3: Recognize, Assist, Include, Support, and Engage (RAISE) Act Family Caregiving Advisory Council, Advisory Council to Support Grandparents Raising Grandchildren. 2022 National Strategy to Support Family Caregivers. Administration for Community Living, US Dept of Health and Human Services; 2022. https://acl.gov/sites/default/files/RAISE_SGRG/NatlStrategyToSupportFamilyCaregivers.pdf

Provided care for a friend or family member in the past month among adults
Population: All adults
Numerator: Adults who provided regular care to a friend or family member with a health condition or disability in the past 30 days.
Denominator: All adults
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: Past 30 days
Summary: Although caregiving provides numerous benefits to both caregivers and recipients, it can also negatively impact caregivers’ mental and physical health.1 Developing effective public health and clinical interventions to support caregivers can promote their health and improve the care they provide. The 2022 National Strategy to Support Family Caregivers (National Strategy) provides a national vision for recognizing, assisting, including, supporting, and engaging caregivers and includes a goal to “expand data, research, and evidence-based practices to support caregivers.”.2
Notes: Data are obtained from the Caregiver optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: None
Related CDI Topic Area: None
Reference 1: Alzheimer’s disease and healthy aging: caregiving for family and friends — a public health issue. Centers for Disease Control and Prevention. Updated July 30, 2019. Accessed April 5, 2023. https://www.cdc.gov/aging/caregiving/caregiver-brief.html
Reference 2: Recognize, Assist, Include, Support, and Engage (RAISE) Act Family Caregiving Advisory Council, Advisory Council to Support Grandparents Raising Grandchildren. 2022 National Strategy to Support Family Caregivers. Administration for Community Living; 2022. https://acl.gov/sites/default/files/RAISE_SGRG/NatlStrategyToSupportFamilyCaregivers.pdf

Additional Data Sources

Adolescent and School Health Data and Statistics

Data and Statistics | Alzheimer’s Disease and Healthy Aging | CDC 

YRBS Explorer

Alzheimer’s Disease and Healthy Aging Data Portal | CDC 

Youth Online High School Youth Risk Behavior Surveillance System

BRFSS FAQs Modules | Healthy Brain Initiative | Surveillance | Alzheimer’s Disease and Healthy Aging | CDC 

The National Survey of Children's Health

Healthy People 2030 | health.gov