Emergence of Mild Cognitive Impairment in Late-Middle-Aged Adults in the Wisconsin Registry for Alzheimer’s Prevention Study


Koscik RL, LaRue A, Jonaitis EM, Okonkwo OC, Johnson SC, Bendlin BB, Hermann BP, Sager MA.

Dementia and Geriatric Cognitive Disorders. 2014;38(1-2):16-30. Epub 2014 Feb 20.

Abstract

AIM: It is difficult to reliably detect the earliest signs of Alzheimer's disease (AD)-associated cognitive impairment. Our aim was to compare 3 psychometric methods of identifying amnestic mild cognitive impairment (aMCI) in a middle-aged longitudinal cohort enriched for AD risk. METHODS: Wisconsin Registry for Alzheimer's Prevention (WRAP) participants with 3 waves of cognitive assessment over approximately 6 years were coded as meeting each of 3 psychometric aMCI definitions: (a) 'aMCI standard-baseline' used published norms to establish cutoffs for baseline performance; (b) 'aMCI robust-baseline' applied WRAP-specific robust norms to baseline, and (c) 'aMCI robust-multiwave' applied these robust norms across 3 waves of assessment. Each group was compared to a cognitively healthy subset. RESULTS: Half the aMCI standard-baseline and one third of the aMCI robust-baseline group reverted to normal ranges at follow-up. Only the aMCI robust-multiwave method had an aMCI x age interaction showing significantly worse age-related memory declines in the aMCI group compared to the cognitively healthy group over 6 years of follow-up. CONCLUSION: Both cross-sectional methods showed instability over time, with many reverting to normal performance after baseline. The multiwave approach identified a group who showed progressive memory declines over 3 visits. Being able to detect progressive decline in late middle age is a critical step in improving prevention efforts.

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