title: Identification of mild cognitive impairment in ACTIVE: algorithmic classification and stability.
abstract: Rates of mild cognitive impairment (MCI) have varied substantially, depending on the criteria used and the samples surveyed. The present investigation used a psychometric algorithm for identifying MCI and its stability to determine if low cognitive functioning was related to poorer longitudinal outcomes. The Advanced Cognitive Training of Independent and Vital Elders (ACTIVE) study is a multi-site longitudinal investigation of long-term effects of cognitive training with older adults. ACTIVE exclusion criteria eliminated participants at highest risk for dementia (i.e., Mini-Mental State Examination < 23). Using composite normative for sample- and training-corrected psychometric data, 8.07% of the sample had amnestic impairment, while 25.09% had a non-amnestic impairment at baseline. Poorer baseline functional scores were observed in those with impairment at the first visit, including a higher rate of attrition, depressive symptoms, and self-reported physical functioning. Participants were then classified based upon the stability of their classification. Those who were stably impaired over the 5-year interval had the worst functional outcomes (e.g., Instrumental Activities of Daily Living performance), and inconsistency in classification over time also appeared to be associated increased risk. These findings suggest that there is prognostic value in assessing and tracking cognition to assist in identifying the critical baseline features associated with poorer outcomes.
authors.affiliation: Department of Psychiatry, Duke University, Durham, North Carolina, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Cook
authors.forename: Michael
authors.initials: M
authors.lastname: Marsiske
authors.forename: Kelsey R
authors.initials: KR
authors.lastname: Thomas
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Unverzagt
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Wadley
authors.forename: Jessica B S
authors.initials: JB
authors.lastname: Langbaum
authors.forename: Michael
authors.initials: M
authors.lastname: Crowe
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000465:Algorithms; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy; D060825:Cognitive Dysfunction / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D011594:Psychometrics; D016037:Single-Blind Method