title: Trajectories of decline in cognition and daily functioning in preclinical dementia.
abstract: BACKGROUND
  Although preclinical dementia is characterized by decline in cognition and daily functioning, little is known on their temporal sequence. We investigated trajectories of cognition and daily functioning in preclinical dementia, during 18 years of follow-up.
  
  
  METHODS
  In 856 dementia cases and 1712 controls, we repetitively assessed cognition and daily functioning with memory complaints, mini-mental state examination (MMSE), instrumental activities of daily living (IADL), and basic activities of daily living (BADL).
  
  
  RESULTS
  Dementia cases first reported memory complaints 16 years before diagnosis, followed by decline in MMSE, IADL, and finally BADL. Vascular dementia related to earlier decline in daily functioning but later in cognition, compared with Alzheimer's disease. Higher education related to larger preclinical cognitive decline, whereas apolipoprotein E (APOE) ε4 carriers declined less in daily functioning.
  
  
  CONCLUSIONS
  These results emphasize the long hierarchical preclinical trajectory of functional decline in dementia. Furthermore, they show that various pathologic, environmental, and genetic factors may influence these trajectories of decline.
authors.affiliation: Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Vincentius J A
authors.initials: VJA
authors.lastname: Verlinden
authors.affiliation: Department of Neuroscience, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jos N
authors.initials: JN
authors.lastname: van der Geest
authors.affiliation: Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Renée F A G
authors.initials: RFAG
authors.lastname: de Bruijn
authors.affiliation: Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: m.a.ikram@erasmusmc.nl.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D053327:Apolipoprotein E4 / Q000235:genetics; D003071:Cognition / Q000502:physiology*; D015140:Dementia, Vascular / Q000175:diagnosis / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data
chemical_list: D053327:Apolipoprotein E4
keywords: Activities of daily living; Alzheimer's disease; Apolipoproteins E; Cognition; Dementia; Preclinical; Vascular dementia