Mf. Elias et al., The preclinical phase of Alzheimer disease - A 22-year prospective study of the Framingham cohort, ARCH NEUROL, 57(6), 2000, pp. 808-813
Objectives: To relate performance on tests of cognitive ability to the subs
equent development of probable Alzheimer disease (pAD) and to identify the
pattern of earliest changes in cognitive functioning associated with a diag
nosis of pAD.
Design: From May 1975 to November 1979, a screening neuropsychological batt
ery was administered to Framingham Study participants. They were followed u
p prospectively for 22 years and examined at least every years for the deve
lopment of PAD.
Setting: A community-based center for epidemiological research.
Participants: Subjects were 1076 participants of the Framingham Study aged
65 to 94 years who were free of dementia and stroke at baseline (initial) n
europsychological testing.
Main Outcome Measure: Presence or absence of pAD during a 22-year surveilla
nce period was related to test performance at initial neuropsychological te
sting.
Results: Lower scores for measures of new learning, recall, retention, and
abstract reasoning obtained during a dementia-free period were associated w
ith the development of pAD. Lower scores for measures of abstract reasoning
and retention predicted pAD after a dementia-free period of 10 years.
Conclusions: The "preclinical phase" of detectable lowering of cognitive fu
nctioning precedes the appearance of PAD by many years. Measures of retenti
on of information and abstract reasoning are among the strongest predictors
of pAD when the interval between initial assessment and the development of
pAD is long.