Change in cognitive function in older persons from a community population - Relation to age and Alzheimer disease

Objective: To examine change in cognitive function in older persons sampled from a community population, and its relation to age and Alzheimer disease . Design: Prospective cohort study with an average of 3.5 years of follow-up. Setting: East Boston, Mass-a geographically defined, urban, working-class c ommunity. Participants: A stratified, random sample of persons 65 years and older und erwent uniform, structured clinical evaluation for Alzheimer disease. The 3 88 persons (89.2% of those eligible) who completed at least 1 annual follow -up evaluation were studied: 97 had Alzheimer dis ease at baseline; 95 deve loped Alzheimer disease during the study; and 196 were unaffected. Outcome Measures: Eight cognitive performance tests were administered, then converted to population-weighted z scores and averaged to create a composi te summary measure of cognitive function. Initial level of and change in th is score were the outcome measures. Results: In the population as a whole, many persons experienced a decline i n cognitive performance, and age was related to both initial level and rate of decline. Analyses were conducted in 3 subgroups: persons with Alzheimer disease at baseline, those who developed Alzheimer disease during the stud y, and those who remained unaffected. In both Alzheimer disease subgroups, substantial cognitive decline was observed, but neither initial level nor r ate of decline was related to age. In unaffected persons, little cognitive decline was evident, and there was a small, inverse association of age with initial level of cognitive function. Conclusion: In a general population sample, there was little evidence of co gnitive decline during a 3.5-year period among persons who remained free of Alzheimer disease.