Predictors of cognitive stability or decline during aging: A longitudinal study in primary care

Abstract

We aimed to identify the early predictors of cognitive decline, and primary care physicians' (PCP) ability to diagnose cognitively impaired subjects, in a cohort of individuals recruited in primary care centers. Independent adults, aged ≥50 years at inception, with an overall low level of education, undertook a prospective clinical and cognitive evaluation targeting memory, attention and executive functions. At follow-up subjects were classified as cognitively normal (CN) or impaired (CI). Of 275 subjects (70.4 ± 8.3 years old, 176 females, 7.5 ± 4.4 education, 162 with MRI), 31 (11.2%) presented CI 4.9 years later, the majority (64.5%) presenting subjective cognitive complaints. PCP could correctly identify 40% of CI individuals, particularly if they presented current cognitive complaints. Male sex (OR = 3.117; CI95%: 1.007-9.645), age (OR = 1.063; CI95%: 1.004-1.126) and baseline scores on TMT-B (OR = 0.225; CI95%: 0.073-0.688) and Vocabulary (OR = 0.940; 95% CI: 0.894-0.986) predicted CI. This study shows that measures indicating poor cognitive reserve and low executive performance (as shown by low vocabulary and executive test scores, respectively) can be early indicators of the risk of decline, stressing the role of cognitive assessment as part of prevention/early intervention programs. The results also underline the need to help PCP to improve the detection of subjects with cognitive decline.

May Subjective Language Complaints Predict Future Language Decline in Community-Dwelling Subjects?

“…The first is the high attrition rate. As previously reported (Martins et al, 2018), individuals that were lost to follow-up were older and had lower baseline MMSE than those who remained in the study. The results presented may therefore underscore the risk of a 5-year decline.…”

“…A total of 127 subjects previously enrolled in the baseline evaluation were lost to follow-up due to several reasons (unknown current contact/mailing address; absence of updated clinical information obtained from the local health center; and currently living outside Lisbon Metropolitan region) (Martins et al, 2018). This has led to a final cohort of 275 subjects that participated in the follow-up part of the study 4.9 (±0.6) years later on average.…”

“…The diagnosis of cognitive impairment (MCI/dementia) was done in accordance to published criteria (APA, 1994; Petersen, 2004) and has already been described in previous work (Martins et al, 2018). Briefly, it was obtained by consensus and involved information from the results obtained in memory and executive tests contributing to the composite indexes, the review of all available clinical, neuropsychological, and imaging data by a panel of two neurologists and two neuropsychologists, and an independent clinical evaluation performed in a research center (not presented in study data) with a minimum interval of 6 months after study testing.…”

Cognitive aging in migraine sufferers is associated with more subjective complaints but similar age-related decline: a 5-year longitudinal study

“…The participants of this study came from a cohort taking part in a prospective cross-sectional study composed by 479 subjects that performed a baseline assessment [32]. However, 77 of those were excluded from the longitudinal follow up because they could not be reached due to both unknown contact/mailing address and insufficient updated clinical information (N = 53), or currently living outside the Lisbon Metropolitan region (N = 24).…”

“…These two diagnoses were further confirmed by an interview with their family. The diagnosis of cognitive impairment/dementia was done in accordance to published criteria [49,50] and has already been described in previous work [32]. The diagnosis was reached by consensus after consulting and analyzing the results obtained on memory and executive tests (memory or executive composite scores should be below -1.5 SD), and the review of all available clinical, neuropsychological, and imaging data by a panel of two neurologists and two neuropsychologists.…”