Predicting Alzheimer's Disease: Neuropsychological Tests, Self-Reports, and Informant Reports of Cognitive Difficulties

• Published in: Journal of the American Geriatrics Society (JAGS) 2012-06, Vol.60 (6), p.1128-1134
• Main Authors: Rabin, Laura A., Wang, Cuiling, Katz, Mindy J., Derby, Carol A., Buschke, Herman, Lipton, Richard B.
• Format: Article
• Language: English
• Subjects: AD prediction; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Alzheimer Disease - diagnosis; Alzheimer Disease - epidemiology; Alzheimer Disease - psychology; Alzheimer's disease; Biological and medical sciences; Cognitive ability; cognitive complaints; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disease Progression; Female; General aspects; Humans; Incidence; informant reports; Kaplan-Meier Estimate; Longitudinal Studies; Male; Medical sciences; Mood Disorders - diagnosis; Mood Disorders - epidemiology; Mood Disorders - psychology; Neurology; Neuropsychological Tests; Neuropsychology; New York City - epidemiology; Older people; Organic mental disorders. Neuropsychology; Predictive Value of Tests; Proportional Hazards Models; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Assessment; Risk factors; Self Report; subjective memory complaints; Time Factors
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2012.03956.x

Objectives To investigate the independent and combined contributions to the risk of Alzheimer's disease (AD) of three important domains of cognitive assessment: neuropsychological measurement, self‐reports, and informant reports. Design Longitudinal, community‐based sample. Setting Einstein Aging Study. Participants Six hundred twenty‐seven individuals without dementia aged 70 and older systematically recruited from the Bronx, New York. Measurements Comprehensive assessment included neurological examination, behavioral questions, and neuropsychological testing. AD diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria assigned at a multidisciplinary consensus case conference. The major statistical analyses used Cox proportional hazards models (with age as the time scale) adjusted for sex, education, and depressive symptoms. Results Forty‐eight participants developed incident AD during a median of 3.3 years of follow‐up. Self‐ and informant reports of cognitive status and baseline scores on tests of episodic memory and psychomotor speed predicted the onset of AD, but in models examining all the variables simultaneously, only the episodic memory tests and informant reports were associated with risk of AD. A likelihood ratio test confirmed the incremental effect of informant reports in addition to the neuropsychological test scores (P = .03). Conclusion Informant ratings improved the prediction of AD conversion in addition to objective memory impairment in older adults without dementia. Combining these cognitive measures may provide a useful, empirical method for identifying individuals at high risk of future AD.