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Trajectories of decline in cognition and daily functioning in preclinical dementia
Author(s) -
Verlinden Vincentius J.A.,
Geest Jos N.,
Bruijn Renée F.A.G.,
Hofman Albert,
Koudstaal Peter J.,
Ikram M. Arfan
Publication year - 2016
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.2015.08.001
Subject(s) - dementia , activities of daily living , cognition , cognitive decline , apolipoprotein e , psychology , cognitive skill , alzheimer's disease , vascular dementia , gerontology , disease , medicine , psychiatry
Although preclinical dementia is characterized by decline in cognition and daily functioning, little is known on their temporal sequence. We investigated trajectories of cognition and daily functioning in preclinical dementia, during 18 years of follow‐up. Methods In 856 dementia cases and 1712 controls, we repetitively assessed cognition and daily functioning with memory complaints, mini‐mental state examination (MMSE), instrumental activities of daily living (IADL), and basic activities of daily living (BADL). Results Dementia cases first reported memory complaints 16 years before diagnosis, followed by decline in MMSE, IADL, and finally BADL. Vascular dementia related to earlier decline in daily functioning but later in cognition, compared with Alzheimer's disease. Higher education related to larger preclinical cognitive decline, whereas apolipoprotein E ( APOE ) ε4 carriers declined less in daily functioning. Discussion These results emphasize the long hierarchical preclinical trajectory of functional decline in dementia. Furthermore, they show that various pathologic, environmental, and genetic factors may influence these trajectories of decline.