Contrasting cognitive trajectories of impending death and preclinical dementia in the very old

Laukka, E. J.; MacDonald, Stuart W. S.; Bäckman, Lars

doi:10.1212/01.wnl.0000203112.12554.f4

Cited by 44 publications

(60 citation statements)

References 24 publications

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“…A corresponding group of nondemented controls were identified from the same population [21]. The controls (n = 249) participated in all 3 follow-ups and remained nondemented during the entire assessment period.…”

Section: Participants and Methodsmentioning

confidence: 99%

Trajectories of Cognitive Decline following Dementia Onset: What Accounts for Variation in Progression?

MacDonald

Karlsson

Fratiglioni

et al. 2011

Dement Geriatr Cogn Disord

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Background: Delineating the natural history of dementia progression has important clinical implications, including reducing caregiver burden and targeting effective drug trials. We examined whether trajectories of cognitive change differed reliably after diagnosis, and whether diverse predictors of such differences (demographic, psychological, biological, genetic, social) could be identified. Methods: Cognitive change was examined for incident dementia cases (mild: n = 156; moderate: n = 77; severe: n = 73) and controls (n = 249) from the Kungsholmen Project, a community-based study of adults 75 years and older. Results: For those with dementia, total variance attributed to between-person differences in cognitive decline was modest and linked to but a single predictor (history of cardiovascular disease). Although less variance in cognitive decline was observed for the similarly aged controls, numerous significant predictors of these differences were identified. Conclusion: The neurodegenerative process underlying dementia overshadows formerly significant predictors of cognitive change.

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Section: Participants and Methodsmentioning

confidence: 99%

Trajectories of Cognitive Decline following Dementia Onset: What Accounts for Variation in Progression?

MacDonald

Karlsson

Fratiglioni

et al. 2011

Dement Geriatr Cogn Disord

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“…Laukka et al [11] examined trajectories of cognitive change in 1,200 participants of the Kungsholmen Project, a community-based sample of individuals at least 75 years old and free of dementia at baseline and residing in the Kungsholmen parish of Stockholm, Sweden. Longitudinal assessments of global cognition measured with the Mini-Mental State Examination (MMSE) [14] were obtained over 11 years at 3-year intervals.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

et al. 2018

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Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument – Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.

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“…In cognitively unimpaired persons, the amount of [20] ). In contrast, an accelerated cognitive decline was concordantly shown in people with incident dementia prior to dementia diagnosis in several population-based or community-based studiesthe Kungsholmen Project [2,3] , the Paquid study [21] , the longitudinal and geriatric population studies in Gothenburg [1] , the Framingham cohort [22] and the MoVies [23,24] . Although one might conclude from earlier findings that a change in total MMSE score can support the early diagnosis of dementia (albeit with presumably limited accuracy), only few population-based studies have explicitly examined the diagnostic accuracy of a decline in MMSE total score over time for dementia prediction.…”

Section: Discussionmentioning

confidence: 99%

“…1 Twenty-four participants were lost to the second follow-up (time 3) and did not receive a final diagnosis. 2 Comparison between the two final diagnoses groups (no dementia vs. dementia).…”

Section: Definition Of Casesmentioning

confidence: 99%

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Does a Reliable Decline in Mini Mental State Examination Total Score Predict Dementia?

Hensel

Luck

Luppa

et al. 2009

Dement Geriatr Cogn Disord

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Background/Aim: Norms for change in Mini Mental State Examination (MMSE) total score suggest that only a decline of at least 2–4 points indicates a reliable change. However, it is unknown whether change norms (Reliable Change Indices, RCIs) of the MMSE total score are suitable to predict future dementia. Methods: 554 elderly individuals aged 75 and over without dementia at the first 2 visits were tested with the MMSE at a maximum of 6 visits with 1.5-year intervals. Two different RCIs for change in MMSE score (first to second visit) were computed – one RCI which corrects for practice and one RCI which corrects for regression to the mean. The main outcome measure was the diagnosis of dementia. Results: During the study, 88 persons developed dementia. RCIs were significantly associated with future dementia diagnosis. The best cutoff for raw change in MMSE total score to predict dementia was –1 point (sensitivity = 48%, specificity = 67%, relative risk = 1.6). With the RCI + regression to the mean, the diagnostic accuracy was moderate (sensitivity = 61%, specificity = 72%, relative risk = 3.2). Conclusion: A change in MMSE total score is significantly associated with future dementia, but the diagnostic accuracy for dementia prediction is rather low.

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Contrasting cognitive trajectories of impending death and preclinical dementia in the very old

Cited by 44 publications

References 24 publications

Trajectories of Cognitive Decline following Dementia Onset: What Accounts for Variation in Progression?

Trajectories of Cognitive Decline following Dementia Onset: What Accounts for Variation in Progression?

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

Does a Reliable Decline in Mini Mental State Examination Total Score Predict Dementia?

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