Independent Predictors of Cognitive Decline in Healthy Elderly Persons | Dementia and Cognitive Impairment | JAMA Neurology | JAMA Network
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Original Contribution
April 2002

Independent Predictors of Cognitive Decline in Healthy Elderly Persons

Author Affiliations

From the Department of Neurology, Oregon Health Sciences University (Drs Howieson, Sexton, Payami, and Kaye, Mr Marquis, and Ms Moore), and the Portland Veterans Affairs Medical Center (Dr Kaye), Portland, Ore; and the Department of Medicine, University of Alberta, Edmonton (Dr Camicioli).

Arch Neurol. 2002;59(4):601-606. doi:10.1001/archneur.59.4.601

Background  Several studies have shown that individually memory, hippocampal volume, and motor measures presage the onset of dementia. It is unclear if these independently contribute to the prediction of mild cognitive impairment.

Objective  To determine the ability of memory, hippocampal volume, and a gait speed to independently predict cognitive decline in healthy elderly persons.

Design  A prospective, longitudinal, observational cohort study with a mean follow-up of 6 years.

Participants  One hundred eight optimally healthy elderly cognitively intact subjects.

Main Outcome Measures  Any cognitive impairment noted on the Clinical Dementia Rating Scale (score = 0.5) or persistent or progressive cognitive impairment. Cox modeling determined if time to onset of cognitive impairment was associated with baseline logical memory II test score (a measure of delayed recall), hippocampal volume (magnetic resonance imaging), or gait speed (time to walk 30 ft [9 m]) independent of age, sex, depression, or the allele producing the ϵ4 type of apolipoprotein E (APOE ϵ4).

Results  Questionable dementia occurred in 48 participants in a mean (SD) of 3.7 (2.4) years. This progressed to persistent cognitive impairment in 38 of these participants in a mean (SD) of 4.4 (2.4) years. Logical memory II test performance and hippocampal volume each predicted onset of questionable dementia, independent of age and sex. Time to walk 30 ft additionally contributed independently to the prediction of time to onset of persistent cognitive impairment. Possessing the APOE ϵ4 allele and depression did not enter either model significantly.

Conclusions  Models combining multiple risk factors should refine the prediction of questionable dementia and persistent cognitive impairment, harbingers of dementia. Individuals at risk for cognitive impairment may represent a high-risk group for intervention.