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Cognitive test performance predicts change in functional status at the population level: The MYHAT Project

Published online by Cambridge University Press:  08 July 2010

MARY GANGULI ,
JONI VANDER BILT ,
CHING-WEN LEE ,
BETH E. SNITZ ,
CHUNG-CHOU H. CHANG ,
DAVID A. LOEWENSTEIN  and
JUDITH A. SAXTON
MARY GANGULI*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
JONI VANDER BILT
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
CHING-WEN LEE
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
BETH E. SNITZ
Affiliation:
Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
CHUNG-CHOU H. CHANG
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
DAVID A. LOEWENSTEIN
Affiliation:
Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida
JUDITH A. SAXTON
Affiliation:
Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
*Correspondence and reprint requests to: Mary Ganguli, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA, 15213. E-mail: [email protected]
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Abstract

In the community at large, many older adults with minimal cognitive and functional impairment remain stable or improve over time, unlike patients in clinical research settings, who typically progress to dementia. Within a prospective population-based study, we identified neuropsychological tests predicting improvement or worsening over 1 year in cognitively driven everyday functioning as measured by Clinical Dementia Rating (CDR). Participants were 1682 adults aged 65+ and dementia-free at baseline. CDR change was modeled as a function of baseline test scores, adjusting for demographics. Among those with baseline CDR = 0.5, 29.8% improved to CDR = 0; they had significantly better baseline scores on most tests. In a stepwise multiple logistic regression model, tests which remained independently associated with subsequent CDR improvement were Category Fluency, a modified Token Test, and the sum of learning trials on Object Memory Evaluation. In contrast, only 7.1% with baseline CDR = 0 worsened to CDR = 0.5. They had significantly lower baseline scores on most tests. In multiple regression analyses, only the Mini-Mental State Examination, delayed memory for visual reproduction, and recall susceptible to proactive interference, were independently associated with CDR worsening. At the population level, changes in both directions are observable in functional status, with different neuropsychological measures predicting the direction of change. (JINS, 2010, 16, 761–770.)

Keywords

EpidemiologyCommunityAgingClinical dementia ratingCognitionPrediction
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 5 , September 2010 , pp. 761 - 770
Copyright
Copyright © The International Neuropsychological Society 2010

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