Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Am Geriatr Soc. 2018 Aug;66(8):1575-1580. doi: 10.1111/jgs.15431. Epub 2018 Jul 4.
To examine whether trajectories of global cognitive function over time in studies that change assessment protocols may be modeled based on an individual's performance relative to others in the study cohort.
Extended follow-up of a cohort originally enrolled in a clinical trial of postmenopausal hormone therapy.
The Women's Health Initiative Memory Study switched from an in-person interview with the Modified Mini-Mental State Examination to a telephone-based interview with the modified Telephone Interview for Cognitive Status to assess global cognitive function over long-term follow-up.
Women aged 75 to 92 (N=2,561).
Annual cognitive assessments from participants, ranked according to age-, race- and ethnicity-adjusted performance levels, were used to identify distinct trajectories. Participants assigned to the resulting trajectories were compared for selected risk factor profiles.
Our approach grouped participants into five trajectories according to relative cognitive performance over time. These groups differed significantly according to 3 known risk factors for cognitive decline-education level, apolipoprotein E-ϵ4 genotype, and type 2 diabetes mellitus-and a biomarker based on brain structure that has been linked to cognitive decline and Alzheimer's disease. Participants with consistently low relative levels of cognitive function over time and those whose relative performance over time declined to these levels tended to have poorer risk factor profiles.
Longitudinal measures of an individual's relative performance on different assessment protocols for global cognitive function can be used to identify trajectories of change over time that appear to have internal validity with respect to known risk factors.
研究在改变评估方案的研究中，个体在研究队列中相对于其他人的表现是否可以用来模拟随时间推移的全球认知功能轨迹。
对最初参加绝经后激素治疗临床试验的队列进行的扩展随访。
妇女健康倡议记忆研究从对修改后的简易精神状态检查的面对面访谈改为基于电话的修改后的电话认知状态访谈，以在长期随访中评估全球认知功能。
年龄在 75 至 92 岁之间的女性（N=2561）。
根据年龄、种族和民族调整后的表现水平对参与者进行的年度认知评估，用于识别不同的轨迹。根据由此产生的轨迹分配的参与者在选定的风险因素特征方面进行了比较。
我们的方法根据随时间推移的相对认知表现将参与者分为五个轨迹。这些组在三个已知的认知能力下降风险因素（教育水平、载脂蛋白 E-ε4 基因型和 2 型糖尿病）和基于与认知能力下降和阿尔茨海默病相关的大脑结构的生物标志物方面存在显著差异。随着时间的推移，认知功能相对水平持续较低的参与者以及相对表现随时间下降到这些水平的参与者往往具有较差的风险因素特征。
个体在不同的全球认知功能评估方案上的相对表现的纵向测量可以用来识别随时间变化的轨迹，这些轨迹似乎在内部具有有效性，与已知的风险因素有关。
