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Demographic, Neuropsychological, and Functional Predictors of Rate of Longitudinal Cognitive Decline in Hispanic Older Adults

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Objective

The identification of older adults who are at increased risk of future cognitive decline is often difficult, particularly in individuals of an ethnic minority. This study evaluated which baseline demographic, neuropsychological, and functional variables were most strongly associated with future longitudinal decline in global cognitive function.

Design/Setting

Participants were part of a community-based prospective longitudinal study of 1,789 older Hispanics (Sacramento Area Latino Study on Aging).

Participants

A subsample of 639 individuals was evaluated, comprising cognitively normal, mildly impaired, and dementia cases, and were followed longitudinally for up to 7 years. Sixty-three percent were tested in Spanish.

Measurements

Latent growth curve modeling of longitudinal data was used to assess the effects of age, gender, education, language of test administration (Spanish or English), acculturation, baseline measures of neuropsychological function (i.e., verbal memory and confrontation naming), and baseline everyday functioning (as measured by the Informant Questionnaire on Cognitive Decline in the Elderly) on rate of change in global cognitive impairment (measured by the 3MS).

Results

Less education, being tested in English, and poorer scores on the neuropsychological tests were all cross-sectionally associated with lower baseline 3MS scores. However, longitudinal decline in global cognition over time was primarily associated with older age and poorer everyday function at baseline.

Conclusions

Informant-based ratings of functional impairment, which are easy to collect in a clinical setting, have significant use in identifying Hispanic older adults at increased risk for future cognitive decline.

Section snippets

Participant Sample

Participants in this study were all part of the Sacramento Area Latino Study on Aging (SALSA). The SALSA project is an epidemiologic, longitudinal study of cognitive and functional impairment in older Hispanics. Recruitment methods have been extensively described previously.17., 18., 19. Briefly, SALSA recruitment targeted Census tracts of Sacramento County and neighboring counties with proportional densities of Hispanics >5% based on 1990 and 1998 U.S. Census information. The recruitment

RESULTS

A total of 760 participants were enrolled in the study and had baseline cognitive testing. Of those, 688 individuals completed at least one follow-up evaluation. Forty-one of this 688 had missing data for at least one of the covariates in this study (age, education, gender, acculturation, language of administration), yielding a total sample of 639. Six follow-up evaluations were completed by 217 of the 639, 115 completed five follow-ups, 77 had four follow-ups, 86 had three follow-ups, 72 had

CONCLUSIONS

The aim of this study was to identify the factors that help to determine which individuals are likely to be in the midst of a declining cognitive trajectory. A major finding was that the degree of everyday functional impairment at baseline (as measured by the IQCODE) is a strong predictor of future decline in global cognition, and this was independent of demographic factors. Currently, it is not well understood whether impairments in cognition and daily function develop simultaneously or

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    The authors thank the participant volunteers and study partners without whom this research would be impossible.

    This work was supported by the National Institutes of Health/National Institute of Aging (NIA grants AG 12975, AG 10129, AG 10220, and AG 21511). Presented as a poster at the International Conference on Alzheimer Disease (ICAD) in Chicago, 2008.

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