Associations of status and change measures of neuropsychological function with pathologic changes in elderly, originally nondemented subjects
H. A. Crystal, D. Dickson, M. Sliwinski, D. Masur, A. Blau and R. B. Lipton
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
OBJECTIVE: To describe the association between status and change of
neuropsychological function and postmortem neuropathologic findings in
subjects with Alzheimer's disease, vascular dementia, normal aging, and
pathologic aging. DESIGN: Volunteer cohort study. SETTING: Volunteers were
interviewed and tested in outpatient-clinical research offices.
PARTICIPANTS: Nondemented, healthy, community-residing subjects, initially
between 75 and 85 years of age, who participated in the Bronx Aging Study
and had at least 2 years of neuropsychological data and quantitative
neuropathologic examinations. MAIN OUTCOME MEASURES: Initial summary
neuropsychological score, rate of change score. RESULTS: Summary
neuropsychological scores at baseline in subjects who subsequently
developed pathologically confirmed Alzheimer's disease or vascular dementia
were 0.8 z units lower than those of subjects classified in the normal or
pathologic aging subgroups (P < .05). Subjects with Alzheimer's disease
showed more neuropsychological change over time than subjects in the normal
or pathologic aging groups (P < .001). Normal subjects and subjects with
pathologic aging did not differ in baseline scores or rate of change. Level
of education was strongly associated with initial neuropsychological scores
(P < .004), but not with change scores. CONCLUSIONS: Among elderly,
initially nondemented subjects who were followed up until death, subjects
with pathologically confirmed Alzheimer's disease or vascular dementia had
lower neuropsychological scores at initial evaluation than normal subjects
or subjects with pathologic aging. Subjects with Alzheimer's disease had a
more rapid rate of decline than normal subjects or subjects with pathologic
aging.