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Clinical meaningfulness of subtle cognitive decline on longitudinal testing in preclinical AD
Author(s) -
Papp Kathryn V.,
Buckley Rachel,
Mormino Elizabeth,
Maruff Paul,
Villemagne Victor L.,
Masters Colin L.,
Johnson Keith A.,
Rentz Dorene M.,
Sperling Reisa A.,
Amariglio Rebecca E.
Publication year - 2020
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.2019.09.074
Subject(s) - cognitive decline , dementia , clinical dementia rating , cognition , neuroimaging , hazard ratio , disease , medicine , alzheimer's disease neuroimaging initiative , psychology , proportional hazards model , alzheimer's disease , effects of sleep deprivation on cognitive performance , gerontology , psychiatry , confidence interval
Demonstrating the “clinical meaningfulness” of slowing early cognitive decline in clinically normal (CN) older adults with elevated amyloid‐β (Aβ+) is critical for Alzheimer's disease secondary prevention trials and for understanding early cognitive progression. Methods Cox regression analyses were used to determine whether 3‐year slopes on the preclinical Alzheimer's cognitive composite predicted MCI diagnosis and global Clinical Dementia Rating>0 in 267 Aβ+ CN individuals participating in the Harvard Aging Brain Study, Australian Imaging, Biomarker and Lifestyle Study, and Alzheimer's Disease Neuroimaging Initiative. Results Steeper preclinical Alzheimer's cognitive composite decline over 3 years was associated with increased risk for MCI diagnosis and global Clinical Dementia Rating>0 in the following years across all cohorts. Hazard ratios using meta‐analytic estimates were 5.47 (95% CI: 3.25–9.18) for MCI diagnosis and 4.49 (95% CI: 2.84–7.09) for Clinical Dementia Rating>0 in those with subtle decline (>−.14 to −.26 preclinical Alzheimer's cognitive composite standard deviations/year) on longitudinal cognitive testing. Discussion Early “subtle cognitive decline” among Aβ+ CN on a sensitive cognitive composite demonstrably increases risk for imminent clinical disease progression and functional impairment.