Cognition and Incident Dementia Hospitalization: Results from the Atherosclerosis Risk in Communities Study

Overview

Journal Neuroepidemiology

Specialties Neurology
Public Health

Date 2012 Oct 26

PMID 23095770

Citations 18

Authors

Andrea L C Schneider

Rebecca F Gottesman

Thomas Mosley

Alvaro Alonso

David S Knopman

Josef Coresh

A Richey Sharrett

Elizabeth Selvin

Affiliations

Soon will be listed here.

Abstract

Background/aims: Cognitive decline is a defining feature of dementia. We sought to determine if a single baseline cognitive test score or change in test score over time is more strongly associated with risk of dementia hospitalization. We also sought to compare short- and long-term dementia risk.

Methods: Prospective cohort study of 9,399 individuals from the Atherosclerosis Risk in Communities Study (median 10 years of follow-up). Cognition was assessed at two time points (6 years apart) using three tests: Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test. Dementia hospitalizations were determined using ICD-9 codes.

Results: Baseline cognitive test scores were associated with both short-term and long-term risk of dementia. The association of 6-year change in cognitive test score with dementia risk was stronger than that of individual test scores at a single visit [change from highest to lowest tertile, DWRT: hazard ratio = 6.45 (95% confidence interval = 1.80-23.08); DSST: hazard ratio = 10.94 (95% confidence interval = 3.07-38.97)].

Conclusions: In this community-based population, 6-year changes in cognitive scores were more strongly associated with risk of incident dementia hospitalization than baseline scores, although single DWRT and DSST scores were predictive. Our findings support the contention that cognitive changes may precede clinical dementia by a decade or more.

Citing Articles

Patterns of cognitive domain abnormalities enhance discrimination of dementia risk prediction: The ARIC study.

Knopman D, Pike J, Gottesman R, Sharrett A, Windham B, Mosley Jr T Alzheimers Dement. 2024; 20(7):4559-4571.

PMID: 38877664 PMC: 11247695. DOI: 10.1002/alz.13876.

The magnitude and direction of the relationship between risk factor and cognition depends on age: a pooled analysis of 5 community-based studies.

Meirelles O, Arnette A, Gudnason V, Launer L Eur J Epidemiol. 2024; 39(2):161-169.

PMID: 38180594 PMC: 10904440. DOI: 10.1007/s10654-023-01087-0.

Timing of Cognitive Test Score Decline Prior to Incident Dementia Diagnosis in Blacks and Whites: The Atherosclerosis Risk in Communities Neurocognitive Study.

Wang Y, Sharrett A, Schneider A, Knopman D, Hu J, Gottesman R Neuroepidemiology. 2023; 58(1):23-30.

PMID: 37918374 PMC: 10910615. DOI: 10.1159/000533851.

Parity and Risk of Dementia in Women: The Atherosclerosis Risk in Communities Study.

DiBiase R, Gottesman R, Tom S, Walker K, Mosley T, Lutsey P J Womens Health (Larchmt). 2023; 32(10):1031-1040.

PMID: 37615600 PMC: 10541925. DOI: 10.1089/jwh.2023.0030.

Dementia occurring over a 32-year follow-up attributable to hypertension observed at different ages: Implications for dementia prevention.

Smith J, Sharrett A, Pike J, Gottesman R, Knopman D, Lee M Alzheimers Dement. 2023; 19(8):3435-3447.

PMID: 36808817 PMC: 10435664. DOI: 10.1002/alz.12984.

References

Plassman B, Langa K, McCammon R, Fisher G, Potter G, Burke J . Incidence of dementia and cognitive impairment, not dementia in the United States. Ann Neurol. 2011; 70(3):418-26. PMC: 3139807. DOI: 10.1002/ana.22362. View

Amieva H, Jacqmin-Gadda H, Orgogozo J, Le Carret N, Helmer C, Letenneur L . The 9 year cognitive decline before dementia of the Alzheimer type: a prospective population-based study. Brain. 2005; 128(Pt 5):1093-101. DOI: 10.1093/brain/awh451. View

Marshall P, WATSON D, Steinberg P, Cornblatt B, Peterson P, Callies A . An assessment of cognitive function and mood in chronic fatigue syndrome. Biol Psychiatry. 1996; 39(3):199-206. DOI: 10.1016/0006-3223(95)00131-X. View

Alonso A, Mosley Jr T, Gottesman R, Catellier D, Sharrett A, Coresh J . Risk of dementia hospitalisation associated with cardiovascular risk factors in midlife and older age: the Atherosclerosis Risk in Communities (ARIC) study. J Neurol Neurosurg Psychiatry. 2009; 80(11):1194-201. PMC: 2783764. DOI: 10.1136/jnnp.2009.176818. View

Song Y, Manson J, Buring J, Liu S . A prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women: the women's health study. Diabetes Care. 2004; 27(9):2108-15. DOI: 10.2337/diacare.27.9.2108. View

Geiss L, Rolka D, Engelgau M . Elevated blood pressure among U.S. adults with diabetes, 1988-1994. Am J Prev Med. 2002; 22(1):42-8. DOI: 10.1016/s0749-3797(01)00399-3. View

Riley K, Snowdon D, Desrosiers M, Markesbery W . Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study. Neurobiol Aging. 2005; 26(3):341-7. DOI: 10.1016/j.neurobiolaging.2004.06.019. View

Singh-Manoux A, Kivimaki M, Glymour M, Elbaz A, Berr C, Ebmeier K . Timing of onset of cognitive decline: results from Whitehall II prospective cohort study. BMJ. 2012; 344:d7622. PMC: 3281313. DOI: 10.1136/bmj.d7622. View

Elias M, Beiser A, Wolf P, Au R, White R, DAgostino R . The preclinical phase of alzheimer disease: A 22-year prospective study of the Framingham Cohort. Arch Neurol. 2000; 57(6):808-13. DOI: 10.1001/archneur.57.6.808. View

10.

Amieva H, Le Goff M, Millet X, Orgogozo J, Peres K, Barberger-Gateau P . Prodromal Alzheimer's disease: successive emergence of the clinical symptoms. Ann Neurol. 2008; 64(5):492-8. DOI: 10.1002/ana.21509. View

11.

. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol. 1989; 129(4):687-702. View

12.

Kuller L, Lopez O, Newman A, Beauchamp N, Burke G, Dulberg C . Risk factors for dementia in the cardiovascular health cognition study. Neuroepidemiology. 2003; 22(1):13-22. DOI: 10.1159/000067109. View

13.

Backman L, Small B, Fratiglioni L . Stability of the preclinical episodic memory deficit in Alzheimer's disease. Brain. 2001; 124(Pt 1):96-102. DOI: 10.1093/brain/124.1.96. View

14.

Albert M, Moss M, Tanzi R, Jones K . Preclinical prediction of AD using neuropsychological tests. J Int Neuropsychol Soc. 2001; 7(5):631-9. DOI: 10.1017/s1355617701755105. View

15.

Zhang Y, Han B, Verhaeghen P, Nilsson L . Executive functioning in older adults with mild cognitive impairment: MCI has effects on planning, but not on inhibition. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2007; 14(6):557-70. DOI: 10.1080/13825580600788118. View

16.

Fitzpatrick A, Kuller L, Ives D, Lopez O, Jagust W, Breitner J . Incidence and prevalence of dementia in the Cardiovascular Health Study. J Am Geriatr Soc. 2004; 52(2):195-204. DOI: 10.1111/j.1532-5415.2004.52058.x. View

17.

Chen P, Ratcliff G, Belle S, Cauley J, DeKosky S, Ganguli M . Patterns of cognitive decline in presymptomatic Alzheimer disease: a prospective community study. Arch Gen Psychiatry. 2001; 58(9):853-8. DOI: 10.1001/archpsyc.58.9.853. View

18.

Knopman D, Ryberg S . A verbal memory test with high predictive accuracy for dementia of the Alzheimer type. Arch Neurol. 1989; 46(2):141-5. DOI: 10.1001/archneur.1989.00520380041011. View

19.

Tang M, Cross P, Andrews H, Jacobs D, Small S, Bell K . Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology. 2001; 56(1):49-56. DOI: 10.1212/wnl.56.1.49. View

20.

Christman A, Matsushita K, Gottesman R, Mosley T, Alonso A, Coresh J . Glycated haemoglobin and cognitive decline: the Atherosclerosis Risk in Communities (ARIC) study. Diabetologia. 2011; 54(7):1645-52. PMC: 3326598. DOI: 10.1007/s00125-011-2095-7. View