TitleSubjective Cognitive Decline Prediction of Mortality: Results from the Einstein Aging Study.
Publication TypeJournal Article
Year of Publication2018
AuthorsKatz, MJ, Wang, C, Derby, CA, Lipton, RB, Zimmerman, ME, Sliwinski, MJ, Rabin, LA
JournalJ Alzheimers Dis
Volume66
Issue1
Pagination239-248
Date Published2018
ISSN1875-8908
KeywordsAged, Aged, 80 and over, Aging, Cognitive Dysfunction, Cohort Studies, Diagnostic Self Evaluation, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Mortality, Predictive Value of Tests, Surveys and Questionnaires
Abstract

<p><b>BACKGROUND: </b>The relation of pre-dementia stages to mortality has not been fully explored. Previous work examining subjective cognitive decline (SCD) and mortality is limited and mixed regarding methods used and consistency of findings.</p><p><b>OBJECTIVE: </b>To examine SCD and mortality in a longitudinal, community-based cohort, using item response theory (IRT) methodology to form a composite SCD measure. Also, to assess whether this relationship was independent of clinical cognitive status.</p><p><b>METHODS: </b>The Einstein Aging Study is a diverse longitudinal cohort of adults aged ≥70. SCD items were extracted from baseline CERAD questionnaires and a composite score was formed using IRT methodology. A total of 1,741 participants with complete data were clinically diagnosed as cognitively normal, or as having amnestic mild cognitive impairment (aMCI), nonamnestic mild cognitive impairment (naMCI), or dementia. 645 deaths occurred over a period of 8,912 person-years of follow-up. Cox proportional hazard models predicted time to death adjusting for covariates.</p><p><b>RESULTS: </b>A one standard deviation unit increase in level of SCD was associated with >20% higher risk of mortality. However, when models were adjusted for clinical cognitive status, the association was no longer significant. Both dementia and aMCI predicted mortality. Furthermore, when analyses focused only on those without cognitive impairment, SCD level did not predict mortality.</p><p><b>CONCLUSIONS: </b>The association of SCD with mortality may be due to the association of SCD with clinical cognitive status. Thus, SCD may be used as a community-based screen to initially identify those with cognitive impairment who may be at greatest risk for death.</p>

DOI10.3233/JAD-180335
PubMed ID30282356
Grant ListP01 AG003949 / AG / NIA NIH HHS / United States
R01 AG039409 / AG / NIA NIH HHS / United States
R21 AG056920 / AG / NIA NIH HHS / United States