title: Trajectories of cognitive decline following dementia onset: what accounts for variation in progression?
abstract: 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.
  
  
  CONCLUSIONS
  The neurodegenerative process underlying dementia overshadows formerly significant predictors of cognitive change.
authors: Aging Research Center, Karolinska Institutet, Stockholm, Sweden. smacd@uvic.ca
authors: Stuart W S
authors: SW
authors: MacDonald
authors: Sari
authors: S
authors: Karlsson
authors: Laura
authors: L
authors: Fratiglioni
authors: Lars
authors: L
authors: Bäckman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D003704:Dementia / Q000150:complications*; D018450:Disease Progression; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008960:Models, Psychological; D011237:Predictive Value of Tests; D012016:Reference Values; D012720:Severity of Illness Index