Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York, United States of America.
PLoS One. 2013 Sep 2;8(9):e73645. doi: 10.1371/journal.pone.0073645. eCollection 2013.
To investigate the temporal ordering of cognitive and functional declines separately in older adults with or without Alzheimer's disease (AD).
A community-based longitudinal study of aging and dementia in Northern Manhattan (Washington Heights/Hamilton Heights Inwood Columbia Aging Project) and a multicenter, clinic-based longitudinal study of prevalent AD at Columbia University Medical Center, Johns Hopkins School of Medicine, Massachusetts General Hospital, and the Hôpital de la Salpêtrière in Paris, France (the Predictors Study).
3,443 initially non-demented older adults (612 with eventual incident dementia) and 517 patients with AD.
Cognitive measures included the modified Mini-Mental State Exam and composite scores of memory and language derived from a standardized neuropsychological battery. Function was measured with the Blessed Dementia Rating Scale, completed by the participant (in the sample of non-demented older adults) or an informant (in the sample of prevalent AD patients). Data were analyzed with autoregressive cross-lagged panel analysis.
Cognitive scores more consistently predicted subsequent functional abilities than vice versa in non-demented older adults, participants with eventual incident dementia, and patients with prevalent AD.
Cognitive declines appear to precede and cause functional declines prior to and following dementia diagnosis. Standardized neuropsychological tests are valid predictors of later functional changes in both non-demented and demented older adults.
分别研究认知和功能衰退在患有阿尔茨海默病（AD）或不患有 AD 的老年人中的时间顺序。
一项在北曼哈顿（华盛顿高地/汉密尔顿高地因伍德哥伦比亚老龄化项目）进行的基于社区的老龄化和痴呆纵向研究，以及一项在哥伦比亚大学医学中心、约翰霍普金斯医学院、马萨诸塞州综合医院和法国巴黎的萨尔佩特里埃医院（Predictors 研究）进行的多中心、基于诊所的 AD 现患纵向研究。
3443 名最初无痴呆的老年人（612 名最终发生痴呆）和 517 名 AD 患者。
认知测量包括改良的 Mini-Mental State 检查和来自标准化神经心理学测试的记忆和语言综合得分。功能采用 Blessed 痴呆评定量表进行测量，由参与者（在非痴呆老年人样本中）或知情人（在 AD 现患患者样本中）完成。数据分析采用自回归交叉滞后面板分析。
在非痴呆老年人、最终发生痴呆的参与者和 AD 现患患者中，认知评分更一致地预测随后的功能能力，而不是相反。
认知衰退似乎先于且导致痴呆诊断前和诊断后的功能衰退。标准化神经心理学测试是预测非痴呆和痴呆老年人后续功能变化的有效指标。
