Cognitive Declines Precede and Predict Functional Declines in Aging and Alzheimer's Disease

Objective: To investigate the temporal ordering of cognitive and functional declines separately in older adults with or without Alzheimer's disease (AD). Design and Setting: 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 Hopital de la Salpetriere in Paris, France (the Predictors Study). Participants: 3,443 initially non-demented older adults (612 with eventual incident dementia) and 517 patients with AD. Main Outcome Measures: 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. Results: 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. Conclusions: 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.