title: Patterns of Cognitive Decline Prior to Dementia in Persons with Mild Cognitive Impairment.
abstract: Only a limited number of studies have investigated the decline of discrete cognitive domains as individuals progress from mild cognitive impairment (MCI) to dementia. Thus, the goal of this longitudinal study was to evaluate the cognitive changes underway during the years preceding a diagnosis of probable Alzheimer's disease (AD), and to compare these changes to those found in MCI participants who do not progress to dementia. Participants were compared as a function of whether they later converted to AD (n = 47) or not (n = 74). Cognitive change was assessed prior to the conversion year, using that year as a starting point. A combination of polynomial regression analyses and mixed ANOVAs assessed 1) the trajectory of cognitive decline for each domain and 2) the differences between non-progressors and those who had converted to AD. The different cognitive domains demonstrated very different patterns of decline in the group of MCI progressors. A quadratic function, i.e., many years of stable performance followed by a rapid decline just prior to diagnosis, was observed for delayed recall, working memory, and spatial memory. In contrast, a gradual linear decline was observed for immediate recall, executive function, and visuo-spatial abilities. Finally, language in progressors was impaired on all time periods relative to non-progressors, but there was no further change between the first assessments and conversion to AD. Individuals with MCI who progress to AD show abnormal cognition at least two years prior to their dementia diagnosis. The pattern of symptom change observed appears to depend upon the cognitive domain and thus, clinical studies should not assume similar rate of decline across domains. In contrast and, apart from verbal memory, the non-progressors present a performance similar to that of healthy older adults.
authors.affiliation: Institut universitaire de gériatrie de Montréal, QC, Canada.|Department of Psychology, Université de Montréal, QC, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Cloutier
authors.affiliation: Lady Davis Institute, McGill University, QC, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Chertkow
authors.affiliation: Institut universitaire de gériatrie de Montréal, QC, Canada.|Department of Medicine, Université de Montréal, QC, Canada.
authors.forename: Marie-Jeanne
authors.initials: MJ
authors.lastname: Kergoat
authors.affiliation: Alzheimer Disease Research Unit, McGill Center for Studies in Aging, McGill University, QC, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Gauthier
authors.affiliation: Institut universitaire de gériatrie de Montréal, QC, Canada.|Department of Psychology, Université de Montréal, QC, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Belleville
mesh_terms: D000368:Aged; D000493:Allopurinol; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000523:psychology*; D018450:Disease Progression; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007802:Language; D008137:Longitudinal Studies; D008297:Male; D008570:Memory, Short-Term; D011939:Mental Recall; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D065852:Spatial Memory
chemical_list: D000493:Allopurinol
keywords: Alzheimer’s disease; cognitive trajectory; mild cognitive impairment; natural history; retrospective study