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P3‐045: Relevance of computerized cognitive assessment to functional disability in a mildly impaired elderly cohort
Author(s) -
Simon Ely S.,
Simon Deena R.,
Dwolatzky Tzvi,
Tanne David,
Goldstein Felicia C.,
Doniger Glen M.
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.04.1222
Subject(s) - activities of daily living , cognition , psychology , cohort , gerontology , medicine , psychiatry , pathology
it is usually greater in a particular cognitive domain, and whether it is predicted by MCI subtype. Methods: Sample characteristics: 126 persons with MCI (61 male; 56 ethnic minority; 54 amnestic MCI); median age 75; median education 14 years, range 0-20. Number of annual evaluations was 2-7, with 67% of participants having had at least 3. Three psychometrically matched scales with high reliability and sensitivity to change were used: verbal episodic memory (VEM), semantic memory (SM), and executive function (EF). Neither these scales nor their underlying tests were available to the diagnosticians. Results: Rates of change are stated in annualized standard deviation units. Whole sample mean rates of change were very similar across domains: -0.07, -0.09, and -0.12 for VEM, SM, and EF, respectively. Variability around these estimates was high. Amnestic and non-amnestic cases declined at virtually identical rates of change in every domain. Cases were grouped according to those who converted to dementia (MCI-D; 63 cases), stayed MCI (MCI-M, 46 cases), or ‘‘reverted’’ to normal (MCI-N, 17 cases). Converters declined much more rapidly in every domain than did the other groups. Rates of change according to group and cognitive scale are shown in the table. The presence of at least 1 apoe4 allele was associated selectively with more rapid decline in VEM, but this effect disappeared when baseline diagnosis was added to the model. Conclusions: Reliable and psychometrically matched cognitive scales help better characterize the patterns of cognitive decline in MCI. Over 3 to 6 years of follow-up, those who became demented (50% of cases) declined rapidly, losing a standard deviation unit of cognitive ability per 4 to 5 years. Those who remained MCI declined but much more slowly such that it would take 10 to 18 years to suffer the same loss. No domain stood out as changing especially fast, nor was domain of change predicted by MCI subtype. Heterogeneity of decline in MCI is a major clinical and research challenge.