Skip to main content
    • Aa
    • Aa

Comparing measures of decline to dementia in amnestic MCI subjects in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set

  • Sarah E. Monsell (a1), Danping Liu (a1), Sandra Weintraub (a2) and Walter A. Kukull (a1) (a3)

Background: Many studies have investigated factors associated with the rate of decline and evolution from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia in elderly patients. In this analysis, we compared the rates of decline to dementia estimated from three common global measures of cognition: Mini-Mental State Examination (MMSE) score, Clinical Dementia Rating sum of boxes (CDR-SB) score, and a neuropsychological tests composite score (CS).

Methods: A total of 2,899 subjects in the National Alzheimer's Coordinating Center Uniform Data Set aged 65+ years diagnosed with amnestic mild cognitive impairment (aMCI) were included in this analysis. Population-averaged decline to dementia rates was estimated and compared for standardized MMSE, CDR-SB, and CS using Generalized Estimating Equations (GEE). Associations between rate of decline and several potential correlates of decline were also calculated and compared across measures.

Results: The CDR-SB had the steepest estimated slope, with a decline of 0.49 standard deviations (SD) per year, followed by the MMSE with 0.22 SD per year, and finally the CS with 0.07 SD per year. The rate of decline of the three measures differed significantly in a global test for differences (p < 0.0001). Age at visit, body mass index (BMI) at visit, Apolipoprotein E (APOE) ɛ4 allele status, and race (black vs. white) had significantly different relationships with rate of decline in a global test for difference among the three measures.

Conclusions: These results suggest that both the rate of decline and the effects of AD risk factors on decline to dementia can vary depending on the evaluative measure used.

Corresponding author
Correspondence should be addressed to: Sarah E. Monsell, MS, National Alzheimer's Coordinating Center, University of Washington, 4311 11th Ave NE #300, Campus box 354983 Seattle, WA 98105, USA. Phone: +1 206-616-6208; Fax: +1 206-616-5927. Email:
Hide All
AlbertM. S., MossM. B., TanziR. and JonesK. (2001). Preclinical prediction of AD using neuropsychological tests. Journal of the International Neuropsychological Society, 7, 631639.
BeeklyD. L. et al. (2007). The National Alzheimer's Coordinating Center (NACC) database: the Uniform Data Set. Alzheimer Disease and Associated Disorders, 21, 249258.
ClarkeD. E., KoJ. Y., LyketsosC., RebokG. W. and EatonW. W. (2010). Apathy and cognitive and functional decline in community-dwelling older adults: results from the Baltimore ECA longitudinal study. International Psychogeriatrics, 22, 819829.
CosentinoS. et al. (2008). APOE epsilon 4 allele predicts faster cognitive decline in mild Alzheimer disease. Neurology, 70, 18421849.
CronkB. B., JohnsonD. K. and BurnsJ. M. (2010). Body mass index and cognitive decline in mild cognitive impairment. Alzheimer Disease and Associated Disorders, 24, 126130.
FolsteinM. F., FolsteinS. E. and McHughP. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
HubbardA. E. et al. (2010). To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology, 21, 467474.
KaplanE., GoodglassH. and WeintraubS. (1983). The Boston Naming Test. Philadelphia, PA: Lea and Febiger.
LandauS. M. et al. (2010). Comparing predictors of conversion and decline in mild cognitive impairment. Neurology, 75, 230238.
LiangK. Y. and ZegerS. (1973). Longitudinal data analysis using generalized linear models. Biometrika, 1, 1322.
LittleR. J. A. and RubinD. B. (1987). Statistical Analysis with Missing Data. New York: J. Wiley & Sons.
MorrisJ. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 24122414.
MorrisJ. C. et al. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 11591165.
MorrisJ. C. et al. (2001). Mild cognitive impairment represents early-stage Alzheimer disease. Archives of Neurology, 58, 397405.
PetersenR. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.
PetersenR. C. et al. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 19851992.
R Development Core Team (2008). R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing.
ReisbergB. (2007). Global measures: utility in defining and measuring treatment response in dementia. International Psychogeriatrics, 19, 421456.
ReitanR. and WolfsonD. (1993). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Tucson, AZ: Neuropsychology Press.
RubinD. B. and SchenkerN. (1991). Multiple imputation in health-care databases: an overview and some applications. Statistics in Medicine, 10, 585598.
StorandtM., GrantE. A., MillerJ. P. and MorrisJ. C. (2002). Rates of progression in mild cognitive impairment and early Alzheimer's disease. Neurology, 59, 10341041.
van BuurenS. (2007). Multiple imputation of discrete and continuous data by fully conditional specification. Statistical Methods in Medical Research, 16, 219242.
WechslerD. (1981). Wechsler Adult Intelligence Scale – Revised. San Antonio, TX: Psychological Corporation.
WechslerD. (1987). Wechsler Memory Scale – Revised Manual. San Antonio, TX: Psychological Corporation.
WeintraubS. et al. (2009). The Alzheimer's Disease Centers’ Uniform Data Set (UDS): the neuropsychologic test battery. Alzheimer Disease and Associated Disorders, 23, 91101.
WhitehairD. C. et al. (2010). Influence of apolipoprotein E varepsilon4 on rates of cognitive and functional decline in mild cognitive impairment. Alzheimers & Dementia, 6, 412419.
WilkoszP. A. et al. (2010). Trajectories of cognitive decline in Alzheimer's disease. International Psychogeriatrics, 22, 281290.
WilsonR. S., LeurgansS. E., BoyleP. A., SchneiderJ. A. and BennettD. A. (2010). Neurodegenerative basis of age-related cognitive decline. Neurology, 75, 10701078.
WilsonR. S., LeurgansS. E., BoyleP. A. and BennettD. A. (2011). Cognitive decline in prodromal Alzheimer disease and mild cognitive impairment. Archives of Neurology, 68, 351356.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 4
Total number of PDF views: 16 *
Loading metrics...

Abstract views

Total abstract views: 148 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.