Design: Community-based cohort study.

Setting: The Kungsholmen district of Stockholm.

Participants: A total of 585 persons (75+ years) were repeatedly assessed over an 11-year period. Level and change in cognitive performance were compared for three groups: persons in close proximity to death, persons in a preclinical phase of dementia, and persons who remained alive and nondemented throughout the study.

Measurements: Tasks assessing primary and episodic memory, verbal ability, and visuospatial skill.

Results: Compared with an analysis where all dead subjects were included in the impending-death group, removing the preclinical dementia cases resulted in markedly attenuated mortality-related effects. However, the impending-death group still declined at a faster rate relative to the comparison group on Digit Span-forward, word recognition, and category fluency. Notably, these were tasks for which the comparison group showed no significant decline.

Conclusions: A considerable proportion of the terminal-decline effect is accounted for by the impact of preclinical dementia. However, for tasks that are relatively resistant to age-related change, such effects might be detected independently of preclinical dementia.

Design: Longitudinal study.

Setting: San Diego, CA, Veterans Administration Hospital.

Participants: Twenty-four normal-functioning elderly individuals participated in the study, with 16 subjects exhibiting no change in their Dementia Rating Scale (DRS) scores over an 1-year period (Stable Group), and 8 subjects exhibiting a decline in DRS scores over the 1-year period (Decline group).

Measurements: A cognitive-discrepancy measure isolating cognitive switching was computed that contrasted performance on a new higher-level task of executive functioning (a Stroop/Switching measure) relative to a composite measure of lower-level Stroop conditions.

Results: a) In the year before their cognitive changes, the Decline group exhibited a significantly larger cognitive-discrepancy (Stroop/Switching versus lower-level Stroop conditions) score compared with a control (Stable) group; and b) the cognitive-discrepancy measure was superior to APOE genotype in predicting DRS decline.

Conclusion: Cognitive-discrepancy analysis isolating a component executive function ability not only seems to be a useful tool for identifying individuals at risk for cognitive deficits, but also shows promise in predicting individuals who may show subtle cognitive decline over time.

Design: Cross-sectional.

Setting: University medical setting.

Participants: Seventy-seven participants (NC: N = 39; MCI: N = 38), 60 to 90 years old (73.5 ± 6.6 years; 53% female).

Measurements: Neuropsychological and ADL measures.

Methods: Neuropsychological tests were administered to NC and MCI participants. Informants completed the Lawton and Brody Instrumental Activities of Daily Living and Physical Self-Maintenance Scale, including instrumental (IADL) and basic ADL (BADL) scales, as well as the Functional Capacities for Activities of Daily Living (FC-ADL), an error-based ADL measure.

Results: No statistically or clinically significant between-group differences emerged for the BADL or IADL subscales. However, a robust difference was noted for the FC-ADL scale (MCI errors > NC errors; F_(1,75)= 13.6, p <0.001; d = 0.84). Among MCI participants, correlations revealed that a measure of verbal learning was the only neuropsychological correlate of FC-ADL total score (r = –0.39, df = 36, p = 0.007). No neuropsychological measures were significantly associated with the IADL or BADL subscale score.

Conclusion: Traditional measures assessing global ADLs may not be sensitive to early functional changes related to MCI; however, error-based measures may capture the subtle evolving functional decline associated with MCI. Among MCI participants, early functional difficulties are associated with verbal learning performance, possibly secondary to the hallmark cognitive impairment associated with this cohort.

Design: We examined clinical and postmortem diagnoses of persons evaluated postmortem with thioflavin-S staining for plaques and tangles and immunohistochemical staining techniques for alpha synuclein, uhiquitin, and tau protein. Setting: Alzheimer Disease Center.

Participants: Clinically evaluated persons for whom tissue diagnosis was available.

Results: Of 313 evaluees, 166 met criteria for probable AD. An additional 59 subjects had clinical diagnoses that included AD, e.g., possible AD, Lewy body variant of AD, AD and Parkinsonism, and mixed AD and vascular dementia. Of the 166 probable AD cases, 147 of 166 (88.6%) met pathologic criteria for AD. When all five AD groups were combined, 194 of 225 subjects (86.2%) met pathologic criteria for AD. There were five cases diagnosed pathologically as tangle-only dementia, which was considered a variant of AD. A pathologic diagnosis of Lewy body variant of AD was made in 56 (17.9%) of cases, including 44 of 313 (14.1%) cases diagnosed as probable or possible AD. Pure dementia with Lewy bodies was seen in 13 (4.2%). There were 9 (2.9%) cases of mixed AD and vascular dementia, and 37 (11.4%) cases of frontotemporal dementia.

Conclusions: McKhann et al. criteria for probable and possible AD are valid for AD but do not exclude additional Lewy body pathology.

Design: Case-control study.

Setting: Memory clinic.

Participants: Fifty a-MCI patients, 50 mild AD patients, and 50 comparison subjects (COM) were enrolled.

Measurements: Information about facial emotion recognition was obtained from Penn Emotion Recognition Test. The Mental Deterioration Battery was used to measure cognitive impairment.

Results: Mild AD patients were more impaired in the recognition of almost all emotional stimuli of all intensities than a-MCI and COM subjects. However, there was an increased progression only in low-intensity facial emotion recognition deficit from COM to a-MCI to mild AD patients. In particular, a-MCI subjects differed significantly from COM in low-intensity fearful face recognition performance. This deficit in a-MCI patients was explained by the short-term verbal memory impairment, whereas the same deficit in mild AD patients was explained by the long-term verbal memory impairment.

Conclusions: Emotion recognition progresses from a deficit in low-intensity fearful facial recognition in a-MCI phase to a deficit in all intensities and emotions in mild AD. This could be an effect of the progressive degeneration of brain structures modulating emotional processing. An early detection of emotional impairment in MCI phases of dementia may have clinical implications.

Design: A 5-year prospective cohort study design with mortality surveillance.

Setting: Community based.

Participants: A total sample of 486 men and 742 women aged 65 years and over at the baseline.

Measurements: The NEO five-factor inventory was administered to assess the "big five" personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.

Results: During the 5-year follow-up period, 127 persons (73 men and 54 women) died. In Cox multivariate proportional hazards models adjusted for gender, age, number of years of education, living alone, presence of psychiatric problems, and presence of chronic diseases, conscientiousness (risk ratio [RR] = 0.50, 95% confidence interval [CI] = 0.33–0.76 and RR = 0.46, 95% CI = 0.29 to 0.71, for the middle and highest tertiles, respectively), extraversion (RR = 0.58, 95% CI = 0.37 to 0.92, for the highest tertile), and openness (RR = 0.62, 95% CI = 0.41 to 0.96, for the middle tertile) were independently and inversely associated with all-cause mortality. Neither neuroticism nor agreeableness was related to mortality.

Conclusions: Our results suggest that out of the five domains of personality traits, conscientiousness, extraversion, and openness are reliable predictors of all-cause mortality among community-dwelling elderly.

Design: Two-year observational cohort study.

Setting: University-based and independent practice primary care practices in greater Rochester.

Participants: All patients aged >65 years presenting for care on selected recruitment days were eligible to participate. Of 392 subjects enrolled, 316 (80.6%) completed study measures over a 2-year follow-up.

Measurements: Depression trajectories were derived by applying longitudinal cluster analysis to weekly depression status from the Longitudinal Interval Follow-up Evaluation.

Results: The authors identified six distinct trajectory clusters that followed clinically intuitive patterns. Although subjects initially nondepressed or in the subsyndromal to minor depression range had a range of possible outcomes over 2 years, the cluster initially near the major depression level remained at that level over time. Consistent predictors of depression trajectory were baseline depressive symptom severity, medical burden, and psychiatric functional status; for some clusters, previous history of depression and perceived social support also had prognostic significance.

Conclusion: The "real-world" outcomes of patients with more severe depressive symptoms are strikingly poor. Given the diverse outcomes of those with subsyndromal to mild forms of minor depression, clinicians might focus treatments on those at highest risk of poor outcome, i.e., those with greater depressive symptoms and medical burden and lower psychiatric functioning and social support. Preventive interventions research might focus on developing treatments to mitigate potentially modifiable risks such as deficits in social support.

Design: Cross-sectional case and comparison group study.

Setting: University medical center.

Participants: Fifty participants with MCI and 59 cognitively normal participants.

Measurements: The authors compared the groups on dimensions of both speed and accuracy in performing instrumental activities of daily living (IADLs), using a standardized Timed IADL measure that evaluates five functional domains commonly encountered in everyday life (telephone use, locating nutrition information on food labels, financial abilities, grocery shopping, medication management).

Results: Across Timed IADL domains, MCI participants demonstrated accuracy comparable with cognitively normal participants but took significantly longer to complete the functional activities, controlling for depressive symptoms (p< 0.001). Slower performance was demonstrated in each discrete domain except financial abilities.

Conclusion: These results suggest that slower speed of task performance is an important component and perhaps an early marker of functional change in MCI that would not be detected using traditional measurements of daily function. Future research should address the question of whether performance-based functional measures, as well as simple queries regarding whether functional activities take longer than usual to complete, may improve the prediction of future cognitive decline and disease progression among those individuals in whom MCI represents impending dementia.

Design: Prospective cohort study, first three waves (1993–1998) of the Asset and Health Dynamics Among the Oldest Old.

Setting: Data collection: University of Michigan; analysis: University of South Florida.

Participants: Nationally representative sample of community-dwelling adults age 70 and older (N = 7,381).

Measurements: DS (Center for Epidemiological Studies Depression, 8-item version), self-reported cancer, diabetes, heart disease, or stroke, difficulty with activities of daily living, death, and estimates of total, active, and disabled life expectancy.

Results: DS reduced ALE by 6.5 years for young–old men (age 70), 3.2 years for old–old men (age 85), 4.2 years for young–old women, and 2.2 years for old–old women, and these effects remained significant at all ages and across gender even after controlling for chronic disease, the one exception being DS and cancer in old–old women. DS also reduced total life expectancy significantly, although controlling for some chronic diseases (particularly cancer and stroke) eliminated the effect of DS across age and gender groups.

Conclusion: Depressive symptoms represent a serious and distinct threat to independent functioning in older adults. Whether experienced alone, or in combination with chronic diseases, depressive symptoms shorten ALE substantially. Timely diagnosis and treatment of depressive symptoms in older adults may delay the onset of disability and improve the quality of life.