Change point models for cognitive tests using semi-parametric maximum likelihood

Random-effects change point models are formulated for longitudinal data obtained from cognitive tests. The conditional distribution of the response variable in a change point model is often assumed to be normal even if the response variable is discrete and shows ceiling effects. For the sum score of a cognitive test, the binomial and the beta-binomial distributions are presented as alternatives to the normal distribution. Smooth shapes for the change point models are imposed. Estimation is by marginal maximum likelihood where a parametric population distribution for the random change point is combined with a non-parametric mixing distribution for other random effects. An extension to latent class modelling is possible in case some individuals do not experience a change in cognitive ability. The approach is illustrated using data from a longitudinal study of Swedish octogenarians and nonagenarians that began in 1991. Change point models are applied to investigate cognitive change in the years before death. (c) 2012 Elsevier B.V. All rights reserved.