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Neurology 2003;60:1489-1494
© 2003 American Academy of Neurology

Natural history of cognitive decline in the old old

D. B. Howieson, PhD, R. Camicioli, MD, J. Quinn, MD, L. C. Silbert, MD, B. Care, M. M. Moore, A. Dame, G. Sexton, PhD and J. A. Kaye, MD

From the Departments of Neurology (Drs. Howieson, Quinn, Silbert, and Kaye, and B. Care, M.M. Moore, and A. Dame) and Medicine, Surgery, and Public Health (G. Sexton), Oregon Health & Science University, Portland; the Portland Veterans Affairs Medical Center (Drs. Kaye, Quinn, and Silbert), OR; and the Department of Medicine (Neurology) (R. Camicioli), University of Alberta, Edmonton, Canada.

Address correspondence and reprint requests to Dr. Diane B. Howieson, Layton Aging and Alzheimer’s Disease Center CR-131, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098; e-mail: howiesod{at}ohsu.edu

Objective: To prospectively examine the occurrence and outcome of cognitive decline in healthy, community-dwelling elders.

Methods: Ninety-five elders (mean age 84 years) who at entry had no cognitive impairment were followed for up to 13 years. Cognitive decline was defined as obtaining either a Clinical Dementia Rating (CDR) = 0.5 or Mini-Mental State Examination (MMSE) score < 24 on two examinations.

Results: Three outcomes of aging were determined: intact cognition, persistent cognitive decline without progression to dementia, and dementia. Whereas 49% remained cognitively intact, 51% developed cognitive decline. Mean follow-up to first CDR 0.5 was 3.8 years and age at conversion was 90.0 years. Those who remained cognitively intact had better memory at entry and were less likely to have APOE4 than those who developed cognitive decline. Of the 48 participants with cognitive decline, 27 (56%) developed dementia (CDR >=1) a mean of 2.8 years later. Participants with cognitive decline who progressed to dementia had poorer confrontation naming at the time of their first CDR 0.5 than those with persistent cognitive decline who did not progress during follow-up.

Conclusion: The old old are at high risk for developing cognitive decline but many will not progress to dementia in the next 2 to 3 years or even beyond. These findings are important for understanding the prognosis of cognitive decline and for the design of treatment trials for AD. APOE genotype is a risk factor for cognitive decline.




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