Ling Han1, Thomas M Gill2, Bobby L Jones3, Heather G Allore4. 1. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. ling.han@yale.edu. 2. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut. 3. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 4. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
Abstract
BACKGROUND: The course of cognitive aging has demonstrated substantial heterogeneity. This study attempted to identify distinctive cognitive trajectories and examine their relationship with burdens of disability, hospitalization, and nursing home admission. METHODS: Seven hundred and fifty-four community-living persons aged 70 years or older in the Yale Precipitating Events Project were assessed with the Mini-Mental State Examination every 18 months for up to 108 months. A group-based trajectory model was used to determine cognitive aging trajectories while adjusting for age, sex, and education. Cumulative burden of disabilities, hospitalizations, and nursing home admissions over 141 months associated with the cognitive trajectories were evaluated using a generalized estimating equation Poisson model. RESULTS: Five distinct cognitive trajectories were identified, with about a third of participants starting with high baseline cognitive function and demonstrating No decline during the follow-up period. The remaining participants diverged with Minimal (prevalence 41%), Moderate (16%), Progressive (8%), and Rapid (3%) cognitive decline. Participants with No decline incurred the lowest incidence rates (per 1,000 person-months) of disability in activities of daily living (ADL; 75, 95% confidence intervals: 60-95) and instrumental ADL (492, 453-535), hospitalization (29, 26-33) and nursing home admission (18, 12-27), whereas participants on the Rapid trajectory experienced the greatest burden of ADL disability (612, 595-758) and those on the Progressive trajectory had the highest nursing home admission (363, 292-451). CONCLUSIONS: Community-living older persons follow distinct cognitive aging trajectories and experience increasing burdens of disability, hospitalization, and nursing home placement as they age, with greater burdens for those on a declining cognitive trajectory.
BACKGROUND: The course of cognitive aging has demonstrated substantial heterogeneity. This study attempted to identify distinctive cognitive trajectories and examine their relationship with burdens of disability, hospitalization, and nursing home admission. METHODS: Seven hundred and fifty-four community-living persons aged 70 years or older in the Yale Precipitating Events Project were assessed with the Mini-Mental State Examination every 18 months for up to 108 months. A group-based trajectory model was used to determine cognitive aging trajectories while adjusting for age, sex, and education. Cumulative burden of disabilities, hospitalizations, and nursing home admissions over 141 months associated with the cognitive trajectories were evaluated using a generalized estimating equation Poisson model. RESULTS: Five distinct cognitive trajectories were identified, with about a third of participants starting with high baseline cognitive function and demonstrating No decline during the follow-up period. The remaining participants diverged with Minimal (prevalence 41%), Moderate (16%), Progressive (8%), and Rapid (3%) cognitive decline. Participants with No decline incurred the lowest incidence rates (per 1,000 person-months) of disability in activities of daily living (ADL; 75, 95% confidence intervals: 60-95) and instrumental ADL (492, 453-535), hospitalization (29, 26-33) and nursing home admission (18, 12-27), whereas participants on the Rapid trajectory experienced the greatest burden of ADL disability (612, 595-758) and those on the Progressive trajectory had the highest nursing home admission (363, 292-451). CONCLUSIONS: Community-living older persons follow distinct cognitive aging trajectories and experience increasing burdens of disability, hospitalization, and nursing home placement as they age, with greater burdens for those on a declining cognitive trajectory.
Authors: Robert S Wilson; Kumar B Rajan; Lisa L Barnes; Liesi E Hebert; Carlos F Mendes de Leon; Denis A Evans Journal: J Gerontol A Biol Sci Med Sci Date: 2013-10-10 Impact factor: 6.053
Authors: Dan Mungas; Laurel Beckett; Danielle Harvey; Sarah Tomaszewski Farias; Bruce Reed; Owen Carmichael; John Olichney; Joshua Miller; Charles DeCarli Journal: Psychol Aging Date: 2010-09
Authors: Ira Driscoll; Susan M Resnick; Juan C Troncoso; Yang An; Richard O'Brien; Alan B Zonderman Journal: Ann Neurol Date: 2006-12 Impact factor: 10.422
Authors: Kristine Yaffe; Karla Lindquist; Eric Vittinghoff; Deborah Barnes; Eleanor M Simonsick; Anne Newman; Suzanne Satterfield; Caterina Rosano; Susan M Rubin; Hilsa N Ayonayon; Tamara Harris Journal: J Am Geriatr Soc Date: 2010-04-06 Impact factor: 5.562
Authors: Robert S Wilson; Laurel A Beckett; Lisa L Barnes; Julie A Schneider; Julie Bach; Denis A Evans; David A Bennett Journal: Psychol Aging Date: 2002-06
Authors: Zimu Wu; Robyn L Woods; Trevor T J Chong; Suzanne G Orchard; Raj C Shah; Rory Wolfe; Elsdon Storey; Kerry M Sheets; Anne M Murray; John J McNeil; Joanne Ryan Journal: Front Med (Lausanne) Date: 2022-06-27
Authors: Vicki A Freedman; Karen Bandeen-Roche; Jennifer C Cornman; Brenda C Spillman; Judith D Kasper; Jennifer L Wolff Journal: J Gerontol B Psychol Sci Soc Sci Date: 2022-05-20 Impact factor: 4.942