Heterogeneity of cognitive trajectories in diverse older persons

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline.

Original languageEnglish (US)
JournalPsychology and Aging
Volume25
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Episodic Memory
Dementia
Executive Function
Semantics
Cognition
Differential Diagnosis
Genotype
Research
Cognitive Dysfunction

Keywords

  • Aging
  • Cognitive change
  • Dementia
  • Mild cognitive impairment
  • Normal cognition

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology
  • Social Psychology

Cite this

@article{f6635fad55c44a64b974232710262b7a,
title = "Heterogeneity of cognitive trajectories in diverse older persons",
abstract = "This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline.",
keywords = "Aging, Cognitive change, Dementia, Mild cognitive impairment, Normal cognition",
author = "Mungas, {Dan M} and Beckett, {Laurel A} and Harvey, {Danielle J} and {Tomaszewski Farias}, {Sarah E} and Reed, {Bruce R} and Owen Carmichael and Olichney, {John M} and Joshua Miller and Charles DeCarli",
year = "2010",
month = "9",
doi = "10.1037/a0019502",
language = "English (US)",
volume = "25",
journal = "Psychology and Aging",
issn = "0882-7974",
publisher = "American Psychological Association Inc.",
number = "3",

}

TY - JOUR

T1 - Heterogeneity of cognitive trajectories in diverse older persons

AU - Mungas, Dan M

AU - Beckett, Laurel A

AU - Harvey, Danielle J

AU - Tomaszewski Farias, Sarah E

AU - Reed, Bruce R

AU - Carmichael, Owen

AU - Olichney, John M

AU - Miller, Joshua

AU - DeCarli, Charles

PY - 2010/9

Y1 - 2010/9

N2 - This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline.

AB - This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline.

KW - Aging

KW - Cognitive change

KW - Dementia

KW - Mild cognitive impairment

KW - Normal cognition

UR - http://www.scopus.com/inward/record.url?scp=77957276652&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957276652&partnerID=8YFLogxK

U2 - 10.1037/a0019502

DO - 10.1037/a0019502

M3 - Article

C2 - 20677882

AN - SCOPUS:77957276652

VL - 25

JO - Psychology and Aging

JF - Psychology and Aging

SN - 0882-7974

IS - 3

ER -