title: Cognitive declines precede and predict functional declines in aging and Alzheimer's disease.
abstract: OBJECTIVE
  To investigate the temporal ordering of cognitive and functional declines separately in older adults with or without Alzheimer's disease (AD).
  
  
  METHODS
  A community-based longitudinal study of aging and dementia in Northern Manhattan (Washington Heights/Hamilton Heights Inwood Columbia Aging Project) and a multicenter, clinic-based longitudinal study of prevalent AD at Columbia University Medical Center, Johns Hopkins School of Medicine, Massachusetts General Hospital, and the Hôpital de la Salpêtrière in Paris, France (the Predictors Study).
  
  
  METHODS
  3,443 initially non-demented older adults (612 with eventual incident dementia) and 517 patients with AD.
  
  
  METHODS
  Cognitive measures included the modified Mini-Mental State Exam and composite scores of memory and language derived from a standardized neuropsychological battery. Function was measured with the Blessed Dementia Rating Scale, completed by the participant (in the sample of non-demented older adults) or an informant (in the sample of prevalent AD patients). Data were analyzed with autoregressive cross-lagged panel analysis.
  
  
  RESULTS
  Cognitive scores more consistently predicted subsequent functional abilities than vice versa in non-demented older adults, participants with eventual incident dementia, and patients with prevalent AD.
  
  
  CONCLUSIONS
  Cognitive declines appear to precede and cause functional declines prior to and following dementia diagnosis. Standardized neuropsychological tests are valid predictors of later functional changes in both non-demented and demented older adults.
authors.affiliation: Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, United States of America.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Zahodne
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Manly
authors.forename: Anna
authors.initials: A
authors.lastname: MacKay-Brandt
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
mesh_terms: D000328:Adult; D000375:Aging / Q000502:physiology*; D000544:Alzheimer Disease / Q000175:diagnosis / Q000503:physiopathology*; D003071:Cognition; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male
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