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Intraindividual Cognitive Variability in Middle Age Predicts Cognitive Impairment 8–10 Years Later: Results from the Wisconsin Registry for Alzheimer’s Prevention

Published online by Cambridge University Press:  01 December 2016

Rebecca L. Koscik ,
Sara E. Berman ,
Lindsay R. Clark ,
Kimberly D. Mueller ,
Ozioma C. Okonkwo ,
Carey E. Gleason ,
Bruce P. Hermann ,
Mark A. Sager  and
Sterling C. Johnson
Rebecca L. Koscik*
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Sara E. Berman
Affiliation:
Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Lindsay R. Clark
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Kimberly D. Mueller
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Ozioma C. Okonkwo
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Carey E. Gleason
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison Wisconsin
Bruce P. Hermann
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Mark A. Sager
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Sterling C. Johnson
Affiliation:
Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison Wisconsin
*
Correspondence and reprint requests to: Rebecca Koscik, Wisconsin Alzheimer’s Institute, 7818 Big Sky Drive, Suite 215, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719. E-mail: rekoscik@wisc.edu
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Abstract

Objectives: Intraindividual cognitive variability (IICV) has been shown to differentiate between groups with normal cognition, mild cognitive impairment (MCI), and dementia. This study examined whether baseline IICV predicted subsequent mild to moderate cognitive impairment in a cognitively normal baseline sample. Methods: Participants with 4 waves of cognitive assessment were drawn from the Wisconsin Registry for Alzheimer’s Prevention (WRAP; n=684; 53.6(6.6) baseline age; 9.1(1.0) years follow-up; 70% female; 74.6% parental history of Alzheimer’s disease). The primary outcome was Wave 4 cognitive status (“cognitively normal” vs. “impaired”) determined by consensus conference; “impaired” included early MCI (n=109), clinical MCI (n=11), or dementia (n=1). Primary predictors included two IICV variables, each based on the standard deviation of a set of scores: “6 Factor IICV” and “4 Test IICV”. Each IICV variable was tested in a series of logistic regression models to determine whether IICV predicted cognitive status. In exploratory analyses, distribution-based cutoffs incorporating memory, executive function, and IICV patterns were used to create and test an MCI risk variable. Results: Results were similar for the IICV variables: higher IICV was associated with greater risk of subsequent impairment after covariate adjustment. After adjusting for memory and executive functioning scores contributing to IICV, IICV was not significant. The MCI risk variable also predicted risk of impairment. Conclusions: While IICV in middle-age predicts subsequent impairment, it is a weaker risk indicator than the memory and executive function scores contributing to its calculation. Exploratory analyses suggest potential to incorporate IICV patterns into risk assessment in clinical settings. (JINS, 2016, 22, 1016–1025)

Keywords

Prodromal periodMild cognitive impairmentAlzheimer’s diseaseNeuropsychological testsRisk screeningPsychometrics
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 22 , Special Issue 10: Special Issue: Preclinical Prediction , November 2016 , pp. 1016 - 1025
Copyright
Copyright © The International Neuropsychological Society 2016 

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Table S1

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