Early-life educational quality and literacy in late life explain a substantial portion of race-related disparities in late-life cognitive function.

Background The Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-Cog) is widely used in AD, but may be less responsive to change when used in people with mild cognitive impairment (MCI). Methods Participants from the Alzheimer's Disease Neuroimaging Initiative were administered a neuropsychological battery and 1.5 T MRI scans over 2–3 years. Informants were queried regarding functional impairments. Some participants had lumbar punctures to obtain cerebrospinal fluid (CSF). We added executive functioning (EF) and functional ability (FA) items to the ADAS-Cog to generate candidate augmented measures. We calibrated these candidates using baseline data (n=811) and selected the best candidate that added EF items alone and that added EF and FA items. We selected candidates based on their responsiveness over three years in a training sample of participants with MCI (n=160). We compared traditional ADAS-Cog scores with the two candidates based on their responsiveness in a validation sample of participants with MCI (n=234), ability to predict conversion to dementia (n=394), strength of association with baseline MRI (n=394) and CSF biomarkers (n=193). Results The selected EF candidate added category fluency (ADAS Plus EF), and the selected EF and FA candidate added category fluency, Digit Symbol, Trail Making, and five items from the Functional Assessment Questionnaire (ADAS Plus EF&FA). The ADAS Plus EF& FA performed as well as or better than traditional ADAS-Cog scores. Conclusion Adding EF and FA items to the ADAS-Cog may improve responsiveness among people with MCI without impairing validity.

OBJECTIVES Diabetes may raise dementia risk. However, the pattern of cognitive change over time in non-demented older adults with diabetes, including the onset of cognitive decline, is unclear. We examined the association of diabetes and cognitive functioning at baseline and cognitive change over time in a large, ethnically diverse sample of older adults. DESIGN Prospective cohort study. SETTING Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based, prospective study of risk factors for dementia. PARTICIPANTS 1,493 met both inclusion and exclusion criteria for this study. MEASUREMENTS Participants underwent baseline and follow-up cognitive and health assessments approximately every 18 months. Generalized estimating equations were used to examine the longitudinal association between diabetes and cognition. RESULTS Diabetes was associated with poorer baseline cognitive performance in memory, language, processing speed/executive functioning, and visuospatial abilities. After adjusting for age, education, sex, race/ethnicity, and apolipoprotein-ε4, participants with diabetes performed significantly worse at baseline relative to those without diabetes in language and visuospatial abilities. There were no differences between those with and without diabetes in terms of rate of cognitive change over a mean follow-up time of six years. CONCLUSION The rate of cognitive change in elderly persons with and without diabetes is similar, although cognitive performance is lower in persons with diabetes. Our findings suggest that cognitive changes may occur early during the diabetes process and highlight the need for studies to follow participants beginning at least in midlife, prior to the typical later-life onset of dementia.