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Cognitive Impairment in Older Adults Without Dementia: Clinical and Pathologic Outcomes in a Community-Based Sample

Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, wanglucy{at}u.washington.edu, Department of Psychiatry and Behavioral Sciences, Health University of Washington, Seattle, Washington

James B. Leverenz, MD

Department of Neurology, University of Washington, Seattle, Washington, Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, Parkinson's Disease Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington

Eric B. Larson, MD

Center for Health Studies, Group Health Cooperative, Seattle, Washington, Department of Internal Medicine, University of Washington, Seattle, Washington

Darcy A. Vavrek, ND, MS

Western States Chiropractic College, Portland, Oregon, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Walter A. Kukull, PhD

National Alzheimer's Coordinating Center, Seattle, Washington, Department of Epidemiology, University of Washington, Seattle, Washington

Wayne McCormick, MD

Department of Internal Medicine, University of Washington, Seattle, Washington

James D. Bowen, MD

Evergreen Healthcare System, Kirkland, Washington

Linda Teri, PhD

Department of Psychosocial & Community, Health University of Washington, Seattle, Washington

Thomas Montine, MD, PhD

Department of Pathology, , University of Washington, Seattle, Washington

Debby W. Tsuang, MD, MSc

Department of Psychiatry and Behavioral Sciences, , University of Washington, Seattle, Washington

This study examines clinical and neuropathologic characteristics of 37 participants in a community-based dementia series who had cognitive complaints at enrollment but did not meet dementia criteria. Participants had neuropsychological testing, were followed until death, and underwent autopsy. Twenty-four participants progressed to dementia, and their baseline characteristics were analyzed. Of the 24, 13 met criteria for neuropathologic Alzheimer disease (AD). The 13 participants who progressed to neuropathologic AD (mean intake age 78.5 ± 7.7, mean enrollment 6.4 ± 2.1 years) performed worse than the 11 who progressed to neuropathologic non-AD dementias (mean intake age 79.0 ± 6.0, mean enrollment 6.0 ± 3.2 years) on baseline Wechsler Memory Scale (WMS) delayed logical memory (3.4 ± 2.9 vs 6.3 ± 3.9, P = .05) and delayed visual reproduction (1.4 ± 2.1 vs 3.1 ± 2.7, P = .02). These observations are consistent with the view that nondemented patients with underlying AD may be more likely to present with memory than nonmemory cognitive impairment.

Key Words: autopsy • neuropathology • dementia • mild cognitive impairment

This version was published on December 1, 2009

Journal of Geriatric Psychiatry and Neurology, Vol. 22, No. 4, 256-265 (2009)
DOI: 10.1177/0891988709335796


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