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J Am Geriatr Soc. 2017 Dec;65(12):2627-2633. doi: 10.1111/jgs.15077. Epub 2017 Sep 21.

Cognitive Trajectory Changes Over 20 Years Before Dementia Diagnosis: A Large Cohort Study.

Author information

1
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
2
Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington.
3
Department of General Internal Medicine, University of Washington, Seattle, Washington.
4
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
5
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington.
6
Department of Biostatistics, University of Washington, Seattle, Washington.

Abstract

BACKGROUND/OBJECTIVES:

Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to "normal" aging, in the trajectory of scores on a global cognitive function test-the Cognitive Abilities Screening Instrument (CASI).

DESIGN:

A prospective cohort study.

SETTING:

Community-dwelling members of a U.S. health maintenance organization.

PARTICIPANTS:

Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315).

MEASUREMENTS:

Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed with dementia, were estimated for CASI item response theory (IRT) scores. The impact of sex, education level, and APOE genotype on cognitive trajectories was assessed.

RESULTS:

Increased cognitive decline relative to "normal" aging was evident in CASI IRT at least 10 years before clinical diagnosis. Male gender, lower education, and presence of ≥1 APOE ε4 alleles were associated with lower average IRT scores. In those who would be diagnosed with dementia, a trajectory change point was estimated at an average of 3.1 years (95% confidence interval 3.0-3.2) before clinical diagnosis, after which cognitive decline appeared to accelerate. The change point did not differ by sex, education level, or APOE ε4 genotype. There were subtle differences in trajectory slopes by sex and APOE ε4 genotype, but not by education.

CONCLUSION:

Decline in average global cognitive function was evident at least 10 years before clinical diagnosis of dementia. The decline accelerated about 3 years before clinical diagnosis.

KEYWORDS:

change point; cognitive function; dementia; trajectory changes

PMID:
28940184
PMCID:
PMC5729097
DOI:
10.1111/jgs.15077
[Indexed for MEDLINE]
Free PMC Article

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