Spectrum of cognition short of dementia: Framingham Heart Study and Mayo Clinic Study of Aging

David S Knopman, Alexa Beiser, Mary Margaret Machulda, Julie A Fields, Rosebud O Roberts, V. Shane Pankratz, Jeremiah Aakre, Ruth H. Cha, Walter A Rocca, Michelle M Mielke, Bradley F Boeve, Sherral Devine, Robert J. Ivnik, Rhoda Au, Sanford Auerbach, Philip A. Wolf, Sudha Seshadri, Ronald Carl Petersen

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: To understand the neuropsychological basis of dementia risk among persons in the spectrum including cognitive normality and mild cognitive impairment. Methods: We quantitated risk of progression to dementia in elderly persons without dementia from 2 population-based studies, the Framingham Heart Study (FHS) and Mayo Clinic Study of Aging (MCSA), aged 70 to 89 years at enrollment. Baseline cognitive status was defined by performance in 4 domains derived from batteries of neuropsychological tests (that were similar but not identical for FHS and MCSA) at cut scores corresponding to SDs of ≤-0.5, -1, -1.5, and -2 from normative means. Participants were characterized as having no cognitive impairment (reference group), or single or multiple amnestic or nonamnestic profiles at each cut score. Incident dementia over the following 6 years was determined by consensus committee at each study separately. Results: The pattern of hazard ratios for incident dementia, rates of incident dementia and positive predictive values across cognitive test cut scores, and number of affected domains was similar although not identical across the FHS and MCSA. Dementia risks were higher for amnestic profiles than for nonamnestic profiles, and for multidomain compared with single-domain profiles. Conclusions: Cognitive domain subtypes, defined by neuropsychologically derived cut scores and number of low-performing domains, differ substantially in prognosis in a conceptually logical manner that was consistent between FHS and MCSA. Neuropsychological characterization of elderly persons without dementia provides valuable information about prognosis. The heterogeneity of risk of dementia cannot be captured concisely with one test or a single definition or cutpoint.

Original languageEnglish (US)
Pages (from-to)1712-1721
Number of pages10
JournalNeurology
Volume85
Issue number19
DOIs
StatePublished - Nov 10 2015

Fingerprint

Cognition
Dementia
Neuropsychological Tests
Consensus
Population

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Spectrum of cognition short of dementia : Framingham Heart Study and Mayo Clinic Study of Aging. / Knopman, David S; Beiser, Alexa; Machulda, Mary Margaret; Fields, Julie A; Roberts, Rosebud O; Pankratz, V. Shane; Aakre, Jeremiah; Cha, Ruth H.; Rocca, Walter A; Mielke, Michelle M; Boeve, Bradley F; Devine, Sherral; Ivnik, Robert J.; Au, Rhoda; Auerbach, Sanford; Wolf, Philip A.; Seshadri, Sudha; Petersen, Ronald Carl.

In: Neurology, Vol. 85, No. 19, 10.11.2015, p. 1712-1721.

Research output: Contribution to journalArticle

Knopman, DS, Beiser, A, Machulda, MM, Fields, JA, Roberts, RO, Pankratz, VS, Aakre, J, Cha, RH, Rocca, WA, Mielke, MM, Boeve, BF, Devine, S, Ivnik, RJ, Au, R, Auerbach, S, Wolf, PA, Seshadri, S & Petersen, RC 2015, 'Spectrum of cognition short of dementia: Framingham Heart Study and Mayo Clinic Study of Aging', Neurology, vol. 85, no. 19, pp. 1712-1721. https://doi.org/10.1212/WNL.0000000000002100
Knopman, David S ; Beiser, Alexa ; Machulda, Mary Margaret ; Fields, Julie A ; Roberts, Rosebud O ; Pankratz, V. Shane ; Aakre, Jeremiah ; Cha, Ruth H. ; Rocca, Walter A ; Mielke, Michelle M ; Boeve, Bradley F ; Devine, Sherral ; Ivnik, Robert J. ; Au, Rhoda ; Auerbach, Sanford ; Wolf, Philip A. ; Seshadri, Sudha ; Petersen, Ronald Carl. / Spectrum of cognition short of dementia : Framingham Heart Study and Mayo Clinic Study of Aging. In: Neurology. 2015 ; Vol. 85, No. 19. pp. 1712-1721.
@article{423995b870d34e41bd09a3fd02cad479,
title = "Spectrum of cognition short of dementia: Framingham Heart Study and Mayo Clinic Study of Aging",
abstract = "Objective: To understand the neuropsychological basis of dementia risk among persons in the spectrum including cognitive normality and mild cognitive impairment. Methods: We quantitated risk of progression to dementia in elderly persons without dementia from 2 population-based studies, the Framingham Heart Study (FHS) and Mayo Clinic Study of Aging (MCSA), aged 70 to 89 years at enrollment. Baseline cognitive status was defined by performance in 4 domains derived from batteries of neuropsychological tests (that were similar but not identical for FHS and MCSA) at cut scores corresponding to SDs of ≤-0.5, -1, -1.5, and -2 from normative means. Participants were characterized as having no cognitive impairment (reference group), or single or multiple amnestic or nonamnestic profiles at each cut score. Incident dementia over the following 6 years was determined by consensus committee at each study separately. Results: The pattern of hazard ratios for incident dementia, rates of incident dementia and positive predictive values across cognitive test cut scores, and number of affected domains was similar although not identical across the FHS and MCSA. Dementia risks were higher for amnestic profiles than for nonamnestic profiles, and for multidomain compared with single-domain profiles. Conclusions: Cognitive domain subtypes, defined by neuropsychologically derived cut scores and number of low-performing domains, differ substantially in prognosis in a conceptually logical manner that was consistent between FHS and MCSA. Neuropsychological characterization of elderly persons without dementia provides valuable information about prognosis. The heterogeneity of risk of dementia cannot be captured concisely with one test or a single definition or cutpoint.",
author = "Knopman, {David S} and Alexa Beiser and Machulda, {Mary Margaret} and Fields, {Julie A} and Roberts, {Rosebud O} and Pankratz, {V. Shane} and Jeremiah Aakre and Cha, {Ruth H.} and Rocca, {Walter A} and Mielke, {Michelle M} and Boeve, {Bradley F} and Sherral Devine and Ivnik, {Robert J.} and Rhoda Au and Sanford Auerbach and Wolf, {Philip A.} and Sudha Seshadri and Petersen, {Ronald Carl}",
year = "2015",
month = "11",
day = "10",
doi = "10.1212/WNL.0000000000002100",
language = "English (US)",
volume = "85",
pages = "1712--1721",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "19",

}

TY - JOUR

T1 - Spectrum of cognition short of dementia

T2 - Framingham Heart Study and Mayo Clinic Study of Aging

AU - Knopman, David S

AU - Beiser, Alexa

AU - Machulda, Mary Margaret

AU - Fields, Julie A

AU - Roberts, Rosebud O

AU - Pankratz, V. Shane

AU - Aakre, Jeremiah

AU - Cha, Ruth H.

AU - Rocca, Walter A

AU - Mielke, Michelle M

AU - Boeve, Bradley F

AU - Devine, Sherral

AU - Ivnik, Robert J.

AU - Au, Rhoda

AU - Auerbach, Sanford

AU - Wolf, Philip A.

AU - Seshadri, Sudha

AU - Petersen, Ronald Carl

PY - 2015/11/10

Y1 - 2015/11/10

N2 - Objective: To understand the neuropsychological basis of dementia risk among persons in the spectrum including cognitive normality and mild cognitive impairment. Methods: We quantitated risk of progression to dementia in elderly persons without dementia from 2 population-based studies, the Framingham Heart Study (FHS) and Mayo Clinic Study of Aging (MCSA), aged 70 to 89 years at enrollment. Baseline cognitive status was defined by performance in 4 domains derived from batteries of neuropsychological tests (that were similar but not identical for FHS and MCSA) at cut scores corresponding to SDs of ≤-0.5, -1, -1.5, and -2 from normative means. Participants were characterized as having no cognitive impairment (reference group), or single or multiple amnestic or nonamnestic profiles at each cut score. Incident dementia over the following 6 years was determined by consensus committee at each study separately. Results: The pattern of hazard ratios for incident dementia, rates of incident dementia and positive predictive values across cognitive test cut scores, and number of affected domains was similar although not identical across the FHS and MCSA. Dementia risks were higher for amnestic profiles than for nonamnestic profiles, and for multidomain compared with single-domain profiles. Conclusions: Cognitive domain subtypes, defined by neuropsychologically derived cut scores and number of low-performing domains, differ substantially in prognosis in a conceptually logical manner that was consistent between FHS and MCSA. Neuropsychological characterization of elderly persons without dementia provides valuable information about prognosis. The heterogeneity of risk of dementia cannot be captured concisely with one test or a single definition or cutpoint.

AB - Objective: To understand the neuropsychological basis of dementia risk among persons in the spectrum including cognitive normality and mild cognitive impairment. Methods: We quantitated risk of progression to dementia in elderly persons without dementia from 2 population-based studies, the Framingham Heart Study (FHS) and Mayo Clinic Study of Aging (MCSA), aged 70 to 89 years at enrollment. Baseline cognitive status was defined by performance in 4 domains derived from batteries of neuropsychological tests (that were similar but not identical for FHS and MCSA) at cut scores corresponding to SDs of ≤-0.5, -1, -1.5, and -2 from normative means. Participants were characterized as having no cognitive impairment (reference group), or single or multiple amnestic or nonamnestic profiles at each cut score. Incident dementia over the following 6 years was determined by consensus committee at each study separately. Results: The pattern of hazard ratios for incident dementia, rates of incident dementia and positive predictive values across cognitive test cut scores, and number of affected domains was similar although not identical across the FHS and MCSA. Dementia risks were higher for amnestic profiles than for nonamnestic profiles, and for multidomain compared with single-domain profiles. Conclusions: Cognitive domain subtypes, defined by neuropsychologically derived cut scores and number of low-performing domains, differ substantially in prognosis in a conceptually logical manner that was consistent between FHS and MCSA. Neuropsychological characterization of elderly persons without dementia provides valuable information about prognosis. The heterogeneity of risk of dementia cannot be captured concisely with one test or a single definition or cutpoint.

UR - http://www.scopus.com/inward/record.url?scp=84946908451&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84946908451&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000002100

DO - 10.1212/WNL.0000000000002100

M3 - Article

C2 - 26453643

AN - SCOPUS:84946908451

VL - 85

SP - 1712

EP - 1721

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 19

ER -