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Longitudinal Standards for Mid-life Cognitive Performance: Identifying Abnormal Within-Person Changes in the Wisconsin Registry for Alzheimer’s Prevention

Published online by Cambridge University Press:  28 November 2018

Rebecca L. Koscik ,
Erin M. Jonaitis ,
Lindsay R. Clark ,
Kimberly D. Mueller ,
Samantha L. Allison ,
Carey E. Gleason ,
Richard J. Chappell ,
Bruce P. Hermann  and
Sterling C. Johnson
Rebecca L. Koscik*
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Erin M. Jonaitis
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Lindsay R. Clark
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Kimberly D. Mueller
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Samantha L. Allison
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Carey E. Gleason
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Richard J. Chappell
Affiliation:
Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin
Bruce P. Hermann
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Sterling C. Johnson
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
*
The first two authors contributed equally to this article. Correspondence and reprint requests to: Rebecca Koscik, 610 Walnut Street (9th Floor), Madison, WI, 53726. E-mail: rekoscik@wisc.edu
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Abstract

Objectives: A major challenge in cognitive aging is differentiating preclinical disease-related cognitive decline from changes associated with normal aging. Neuropsychological test authors typically publish single time-point norms, referred to here as unconditional reference values. However, detecting significant change requires longitudinal, or conditional reference values, created by modeling cognition as a function of prior performance. Our objectives were to create, depict, and examine preliminary validity of unconditional and conditional reference values for ages 40–75 years on neuropsychological tests. Method: We used quantile regression to create growth-curve–like models of performance on tests of memory and executive function using participants from the Wisconsin Registry for Alzheimer’s Prevention. Unconditional and conditional models accounted for age, sex, education, and verbal ability/literacy; conditional models also included past performance on and number of prior exposures to the test. Models were then used to estimate individuals’ unconditional and conditional percentile ranks for each test. We examined how low performance on each test (operationalized as <7th percentile) related to consensus-conference–determined cognitive statuses and subjective impairment. Results: Participants with low performance were more likely to receive an abnormal cognitive diagnosis at the current visit (but not later visits). Low performance was also linked to subjective and informant reports of worsening memory function. Conclusions: The percentile-based methods and single-test results described here show potential for detecting troublesome within-person cognitive change. Development of reference values for additional cognitive measures, investigation of alternative thresholds for abnormality (including multi-test criteria), and validation in samples with more clinical endpoints are needed. (JINS, 2019, 25, 1–14)

Keywords

MemoryExecutive functionCognitive agingPreclinical cognitive declineConditional standardsQuantile regression
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 1 , January 2019 , pp. 1 - 14
Copyright
Copyright © The International Neuropsychological Society 2018 

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