02584nas a2200445 4500008004100000022001400041245012100055210006900176260001600245300001100261490000800272520130700280653002101587653000901608653002201617653002201639653002201661653002801683653001601711653001301727653002201740653002401762653001101786653002201797653001101819653003101830653000901861653003001870653001701900653001501917653003201932653001701964653002101981100002002002700001802022700002102040700002002061700002102081856003602102 2015 eng d a1476-625600aEmpirically Derived Trajectories to Dementia Over 15 Years of Follow-up Identified by Using Mixed Membership Models.0 aEmpirically Derived Trajectories to Dementia Over 15 Years of Fo c2015 Aug 15 a366-740 v1823 a
Alzheimer disease is the most common form of dementia in the elderly, and the complex relationships among risk factors produce highly variable natural histories from normal cognition through the prodromal stage of mild cognitive impairment (MCI) to clinical dementia. We used a novel statistical approach, mixed membership trajectory models, to capture the variety of such pathways in 652 participants in the Cardiovascular Health Study Cognition Study over 22 years of follow-up (1992-2014). We identified 3 trajectories: a "healthy" profile with a peak probability of MCI between 95 and 100 years of age and only a 50% probability of dementia by age 100; an "intermediate" profile with a peak probability of MCI between 85 and 90 years of age and progression to dementia between 90 and 95 years; and an "unhealthy" profile with a peak probability of progressing to MCI between ages 75 and 80 years and to dementia between the ages of 80 and 85 years. Hypertension, education, race, and the ϵ4 allele of the apolipoprotein E gene all affected the closeness of an individual to 1 or more of the canonical trajectories. These results provide new insights into the natural history of Alzheimer disease and evidence for a potential difference in the pathophysiology of the development of dementia.
10aAge Distribution10aAged10aAged, 80 and over10aAlzheimer Disease10aApolipoprotein E410aCardiovascular Diseases10aComorbidity10aDementia10aDiabetes Mellitus10aDisease Progression10aFemale10aFollow-Up Studies10aHumans10aMagnetic Resonance Imaging10aMale10aMild Cognitive Impairment10aNeuroimaging10aPrevalence10aProportional Hazards Models10aRisk Factors10aSex Distribution1 aLecci, Fabrizio1 aJunker, Brian1 aKuller, Lewis, H1 aLopez, Oscar, L1 aBecker, James, T uhttps://chs-nhlbi.org/node/6822