Mark A Espeland1, Jiu-Chiuan Chen2, Julie Weitlauf3,4, Kathleen M Hayden5, Stephen R Rapp5,6, Susan M Resnick7, Lorena Garcia8, Brad Cannell9, Laura D Baker10, Bonnie C Sachs10,11, Hilary A Tindle12, Robert Wallace13, Ramon Casanova1. 1. Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina. 2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California. 3. Department of Veterans Affairs, Palo Alto Health Care System, Stanford, California. 4. Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California. 5. Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, North Carolina. 6. Department of Psychiatry and Behavioral Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina. 7. Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland. 8. Department of Public Health Sciences, University of California at Davis, Davis, California. 9. Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, Texas. 10. Division of Geriatrics Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina. 11. Department of Neurology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina. 12. Department of Medicine, Vanderbilt University, Nashville, Tennessee. 13. School of Public Health, University of Iowa, Iowa City, Iowa.
Abstract
OBJECTIVES: To examine whether trajectories of global cognitive function over time in studies that change assessment protocols may be modeled based on an individual's performance relative to others in the study cohort. DESIGN: Extended follow-up of a cohort originally enrolled in a clinical trial of postmenopausal hormone therapy. SETTING: The Women's Health Initiative Memory Study switched from an in-person interview with the Modified Mini-Mental State Examination to a telephone-based interview with the modified Telephone Interview for Cognitive Status to assess global cognitive function over long-term follow-up. PARTICIPANTS: Women aged 75 to 92 (N=2,561). MEASUREMENTS: Annual cognitive assessments from participants, ranked according to age-, race- and ethnicity-adjusted performance levels, were used to identify distinct trajectories. Participants assigned to the resulting trajectories were compared for selected risk factor profiles. RESULTS: Our approach grouped participants into five trajectories according to relative cognitive performance over time. These groups differed significantly according to 3 known risk factors for cognitive decline-education level, apolipoprotein E-ϵ4 genotype, and type 2 diabetes mellitus-and a biomarker based on brain structure that has been linked to cognitive decline and Alzheimer's disease. Participants with consistently low relative levels of cognitive function over time and those whose relative performance over time declined to these levels tended to have poorer risk factor profiles. CONCLUSION: Longitudinal measures of an individual's relative performance on different assessment protocols for global cognitive function can be used to identify trajectories of change over time that appear to have internal validity with respect to known risk factors.
OBJECTIVES: To examine whether trajectories of global cognitive function over time in studies that change assessment protocols may be modeled based on an individual's performance relative to others in the study cohort. DESIGN: Extended follow-up of a cohort originally enrolled in a clinical trial of postmenopausal hormone therapy. SETTING: The Women's Health Initiative Memory Study switched from an in-person interview with the Modified Mini-Mental State Examination to a telephone-based interview with the modified Telephone Interview for Cognitive Status to assess global cognitive function over long-term follow-up. PARTICIPANTS: Women aged 75 to 92 (N=2,561). MEASUREMENTS: Annual cognitive assessments from participants, ranked according to age-, race- and ethnicity-adjusted performance levels, were used to identify distinct trajectories. Participants assigned to the resulting trajectories were compared for selected risk factor profiles. RESULTS: Our approach grouped participants into five trajectories according to relative cognitive performance over time. These groups differed significantly according to 3 known risk factors for cognitive decline-education level, apolipoprotein E-ϵ4 genotype, and type 2 diabetes mellitus-and a biomarker based on brain structure that has been linked to cognitive decline and Alzheimer's disease. Participants with consistently low relative levels of cognitive function over time and those whose relative performance over time declined to these levels tended to have poorer risk factor profiles. CONCLUSION: Longitudinal measures of an individual's relative performance on different assessment protocols for global cognitive function can be used to identify trajectories of change over time that appear to have internal validity with respect to known risk factors.
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