Dataset Information

A Cognitive Turning Point in Development of Clinical Alzheimer's Disease Dementia and Mild Cognitive Impairment: A Biracial Population Study.

ABSTRACT:

Background

Cognitive changes during the preclinical phase of Alzheimer's disease (AD) dementia have been characterized among European Americans (EAs), but studies of preclinical changes among African Americans (AAs) are notably absent.

Methods

Preclinical changes in cognition before the development of AD dementia and mild cognitive impairment over a period of 18 years were examined using change points in a biracial sample of 2,125 older adults.

Results

Of 2,125 participants, 442 (21%) developed AD dementia and 661 (31%) developed mild cognitive impairment. A cognitive change point occurred between 4 and 5 years before the clinical diagnosis of AD dementia. Differences between AAs and EAs were observed: EAs had a higher starting level of composite cognitive function, and a change point occurred 4.3 years before AD dementia among AAs and 4.7 years among EAs. The slope of cognitive decline after the change point among those developing clinical AD dementia was significantly greater among EAs (0.233 units/y) than among AAs (0.171 units/y; p < .001). This difference in slope of cognitive decline persisted after diagnosis of AD dementia so that at the conclusion of observation the difference in average cognitive level was reversed. AAs without cognitive impairment had a lower average baseline of cognition than EAs, but the slopes of cognitive decline were similar.

Conclusions

A prominent change to a steeper slope of cognitive decline occurs between 4 and 5 years prior to the diagnosis of AD dementia. The slope of cognitive decline after the change point is steeper among EAs than AAs.

SUBMITTER: Rajan KB

PROVIDER: S-EPMC5965301 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A Cognitive Turning Point in Development of Clinical Alzheimer's Disease Dementia and Mild Cognitive Impairment: A Biracial Population Study.

Rajan Kumar B KB Wilson Robert S RS Barnes Lisa L LL Aggarwal Neelum T NT Weuve Jennifer J Evans Denis A DA

The journals of gerontology. Series A, Biological sciences and medical sciences 20170301 3

<h4>Background</h4>Cognitive changes during the preclinical phase of Alzheimer's disease (AD) dementia have been characterized among European Americans (EAs), but studies of preclinical changes among African Americans (AAs) are notably absent.<h4>Methods</h4>Preclinical changes in cognition before the development of AD dementia and mild cognitive impairment over a period of 18 years were examined using change points in a biracial sample of 2,125 older adults.<h4>Results</h4>Of 2,125 participants ...[more]

PMID: 28043942

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Project description:BackgroundMild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia in elderly people. Controversy surrounds their characterization, definition and application in clinical practice. In this article, we provide physicians with practical guidance on the definition, diagnosis and treatment of mild cognitive impairment and cognitive impairment, no dementia, based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006.MethodsWe developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that had mild cognitive impairment or cognitive impairment, no dementia, as the outcome. Subsequent to the conference, we searched for additional articles published between January 2006 and January 2008. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care.ResultsWe identified 2483 articles, of which 314 were considered to be relevant and of good or fair quality. From a synthesis of the evidence in these studies, we made 16 recommendations. In brief, family physicians should be aware that most types of dementia are preceded by a recognizable phase of mild cognitive decline. They should be familiar with the concepts of mild cognitive impairment and of cognitive impairment, no dementia. Patients with these conditions should be closely monitored because of their increased risk for dementia. Leisure activities, cognitive stimulation and physical activity could be promoted as part of a healthy lifestyle in elderly people and those with mild cognitive impairment. Vascular risk factors should be treated optimally. No other specific therapies can yet be recommended.InterpretationPhysicians will increasingly see elderly patients with mild memory loss, and learning an approach to diagnosing states such as mild cognitive impairment is now warranted. Close monitoring for progression to dementia, promotion of a healthy lifestyle and treatment of vascular risk factors are recommended for the management of patients with mild cognitive impairment.

Project description:This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless, they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is an understanding of how to develop an intervention for people with mild cognitive impairment and dementia to promote their independence, stability, and physical activity.IntroductionOlder adults with dementia are at a high risk of falls. Standard interventions have not been shown to be effective in this patient population potentially due to poor consideration of dementia-specific risk factors. An intervention is required that addresses the particular needs of older people with dementia in a community setting.MethodsWe followed guidelines for the development of an intervention, which recommend a structured approach considering theory, evidence and practical issues. The process used 15 information sources. Data from literature reviews, clinician workshops, expert opinion meetings, patient-relative interviews, focus groups with people with dementia and clinicians, a cross-sectional survey of risk factors, a pre-post intervention study and case studies were included. Data were synthesized using triangulation to produce an intervention suitable for feasibility testing. Practical consideration of how an intervention could be delivered and implemented were considered from the outset.ResultsElements of the intervention included individually tailored, dementia-appropriate, balance, strength and dual-task exercises, functional training, and activities aimed at improving environmental access, delivered using a motivational approach to support adherence and long-term continuation of activity. We focussed on promoting safe activity rather than risk or prevention of falls.ConclusionWe used a systematic process to develop a dementia-specific intervention to promote activity and independence while reducing falls risk in older adults with mild dementia.

Dataset Information

A Cognitive Turning Point in Development of Clinical Alzheimer's Disease Dementia and Mild Cognitive Impairment: A Biracial Population Study.

Background

Methods

Results

Conclusions

Publications

A Cognitive Turning Point in Development of Clinical Alzheimer's Disease Dementia and Mild Cognitive Impairment: A Biracial Population Study.

Similar Datasets

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