title: Mini-Mental State Examination score trajectories and incident disabling dementia among community-dwelling older Japanese adults.
abstract: OBJECTIVE
  The present prospective study used repeated measures analysis to identify potential Mini-Mental State Examination (MMSE) score trajectories and determine whether MMSE trajectory was associated with incident disabling dementia among community-dwelling older Japanese adults.
  
  
  METHODS
  A total of 1724 non-demented adults (mean age 71.4 years [SD 5.7]; 56.7% women) aged 65-90 years participated in annual geriatric health assessments during the period from June 2002 through July 2014. The total number of observations was 6755, and the average number of follow-up assessments was 3.9. A review of municipal databases in the Japanese public long-term care insurance system showed that 205 (11.9%) participants developed disabling dementia through December 2014.
  
  
  RESULTS
  We identified three distinct MMSE score trajectory patterns (high, middle and low) in adults aged 65-90 years. After adjusting for important confounders, participants with middle (42.8%) and low (5.1%) MMSE trajectories had hazard ratios of 2.46 (95% confidence interval 1.64-3.68) and 10.73 (95% confidence interval 4.91-23.45), respectively, for incident disabling dementia, as compared with those in the high (52.1%) trajectory group.
  
  
  CONCLUSIONS
  Approximately half of the participants were classified as having a high MMSE trajectory, whereas 43% and 5% had middle and low MMSE trajectories, respectively, in this population. Individuals with middle and low MMSE trajectories had a higher risk for incident disabling dementia, which suggests that a high-risk approach to dementia prevention should target people with mild and more rapid cognitive decline. Geriatr Gerontol Int 2017; 17: 1928-1935.
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Institute of Gerontology, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Murayama
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Amano
authors.affiliation: Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.affiliation: Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Yokota
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Seino
authors.affiliation: Institute of Community Medical Practice, Health Promotion Research Center, Tokyo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Nofuji
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Nishi
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Shinkai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D015994:Incidence; D057187:Independent Living; D007564:Japan / Q000453:epidemiology; D008297:Male; D000073216:Mental Status and Dementia Tests; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Mini-Mental State Examination; aging; cognitive function; dementia; trajectories