Importance Investigation of the conversion rates from normal cognition (NC) to mild cognitive impairment (MCI) is important, as effective early intervention could potentially prevent or substantially delay the onset of dementia. However, reported conversion rates differ across studies and recruitment source. Objective Our study examined predictors of conversion from NC to MCI in a racially and ethnically diverse sample drawn both from community and clinic recruitment sources. Design Rates and predictors of conversion were assessed in an ongoing prospective longitudinal study at University of California, Davis, Alzheimer’s Disease Center from 2000 to 2015. Setting Participants were recruited through a clinic (5%) and community sample (95%). Participants Participants (n = 254) were clinically confirmed as cognitively normal at baseline and followed up to seven years. Exposures Recruitment source, demographic factors (age, gender, race/ethnicity, year of education, APOE ε4 positive), cognitive measures (SENAS test scores), functional assessments (CDR sum of boxes), and neuroimaging measures (total brain volume, total hippocampal volume, white hyperintensity volume). Main outcome measure Conversion from cognitively normal to mild cognitive impairment. Results Of 254 participants, 62 (11 clinic, 51 community) progressed to MCI. The clinic-based sample showed an annual conversion rate of 30% (95% CI 17–54%) per person-year, whereas the community-based sample showed a conversion rate of 5% (95% CI 3–6%) per person-year. Risk factors for conversion include clinic based recruitment, being older, lower executive function and worse functional assessment at baseline, and smaller total brain volume. Conclusion and Relevance Older adults who sought out a clinical evaluation, even when they are found to have normal cognition, have increased risk of subsequent development of MCI. Results are consistent with other studies showing subjective cognitive complaints are a risk for future cognitive impairment, but extend such findings to show that those who seek evaluation for their complaints are at particularly high risk. Moreover, these individuals have subtle, but significant differences in functional and cognitive abilities that, in the presence of concerns and evidence of atrophy on by brain imaging, warrant continued clinical follow-up. These risk factors could also be used as stratification variables for dementia prevention clinical trial design.

IMPORTANCE As the life expectancy of people with Down syndrome (DS) has markedly increased over the past decades, older adults with DS may be experiencing a higher incidence of aging conditions. In addition to longevity, the amyloid precursor protein gene located on chromosome 21 places individuals with DS at a high risk for developing Alzheimer disease. Yet, few studies have determined prevalence of dementia and comorbidities among older people with DS. OBJECTIVE To determine the prevalence of dementia and aging-related comorbidities in older adult individuals with DS. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of 2015 California Medicare claims data. We examined 1 year of cross-sectional Medicare claims data that included 100% of Californian Medicare beneficiaries enrolled in both Medicare Part A and B in 2015. Of these 3 001 977 Californian Medicare beneficiaries 45 years or older, 878 individuals were identified as having a diagnosis of DS. Data were analyzed between April 2017 and February 2018. MAIN OUTCOMES AND MEASURES The frequency of DS dementia was assessed across different age categories. The number and frequency of 27 comorbidities were compared among individuals with DS with and without dementia and by age and sex groups. RESULTS A total of 353 DS individuals (40%) were identified as having dementia diagnoses (mean, 58.7 years; 173 women [49%]) and 525 without dementia diagnoses (mean, 55.9 years; 250 women [48%]). The frequency of DS dementia among those 65 years or older rose to 49%. The mean number of comorbidities per individual increased with age in general. Comorbid conditions were more numerous among those with dementia compared with those with DS without dementia (mean, 3.4 vs 2.5, respectively), especially among those younger than 65 years. In particular, 4 treatable conditions, hypothyroidism, epilepsy, anemia, and weight loss, were much more frequent in DS dementia. CONCLUSIONS AND RELEVANCE Older Medicare beneficiaries in California with DS, especially those with dementia, have a high level of multimorbidity including several treatable conditions. While DS follow-up has long been confined to the pediatric sphere, we found that longevity in individuals with DS will necessitate complex adult and geriatric care. More evidenced-based and standardized follow-up could support better long-term comorbidity management and dementia care among aging adults with DS.

No abstract

For women with POR, the CLBR declined with increasing age. Women with advanced age (≥38 years) achieved a significantly lower CLBR than young poor responders (<35 years). Very low CLBR was associated with women aged >43 years old. Natural cycle IVF is of no benefit for these patients.