Cognitive Discrepancies Versus APOE Genotype as Predictors of Cognitive Decline in Normal-Functioning Elderly Individuals: A Longitudinal Study

Objectives Cognitive-discrepancy analysis has been shown to be a useful technique for detecting subtle cognitive deficits in normal-functioning elderly individuals who are genetically at-risk for Alzheimer disease (AD). However, studies that have used cognitive-discrepancy measures to date have used...

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Bibliographic Details
Published in:The American journal of geriatric psychiatry 2008-05, Vol.16 (5), p.366-374
Main Authors: Fine, Eric M., Ph.D, Delis, Dean C., Ph.D, Wetter, Spencer R., Ph.D, Jacobson, Mark W., Ph.D, Jak, Amy J., Ph.D, McDonald, Carrie R., Ph.D, Braga, Jodessa C., B.A, Thal, Leon J., M.D, Salmon, David P., Ph.D, Bondi, Mark W., Ph.D
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
aging
Alzheimer disease
Alzheimer Disease - classification
Alzheimer Disease - epidemiology
Apolipoproteins - genetics
Cognition
Cognition Disorders - epidemiology
Cognition Disorders - genetics
Cognitive discrepancies
Educational Status
executive functioning
Female
Genotype
Geriatric Assessment
Humans
Internal Medicine
Longitudinal Studies
Male
Psychiatric Status Rating Scales
Wechsler Scales
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Summary:Objectives Cognitive-discrepancy analysis has been shown to be a useful technique for detecting subtle cognitive deficits in normal-functioning elderly individuals who are genetically at-risk for Alzheimer disease (AD). However, studies that have used cognitive-discrepancy measures to date have used retrospective or cross-sectional designs, and the utility of this approach to predict cognitive decline has not been examined in a prospective investigation. Design Longitudinal study. Setting San Diego, CA, Veterans Administration Hospital. Participants Twenty-four normal-functioning elderly individuals participated in the study, with 16 subjects exhibiting no change in their Dementia Rating Scale (DRS) scores over an 1-year period (Stable Group), and 8 subjects exhibiting a decline in DRS scores over the 1-year period (Decline group). Measurements A cognitive-discrepancy measure isolating cognitive switching was computed that contrasted performance on a new higher-level task of executive functioning (a Stroop/Switching measure) relative to a composite measure of lower-level Stroop conditions. Results a) In the year before their cognitive changes, the Decline group exhibited a significantly larger cognitive-discrepancy (Stroop/Switching versus lower-level Stroop conditions) score compared with a control (Stable) group; and b ) the cognitive-discrepancy measure was superior to APOE genotype in predicting DRS decline. Conclusion Cognitive-discrepancy analysis isolating a component executive function ability not only seems to be a useful tool for identifying individuals at risk for cognitive deficits, but also shows promise in predicting individuals who may show subtle cognitive decline over time.
ISSN:1064-7481
1545-7214
DOI:10.1097/JGP.0b013e3181629957