Predictors of cognitive stability or decline during aging: A longitudinal study in primary care

Abstract

We aimed to identify the early predictors of cognitive decline, and primary care physicians’ (PCP) ability to diagnose cognitively impaired subjects, in a cohort of individuals recruited in primary care centers. Independent adults, aged ≥50 years at inception, with an overall low level of education, undertook a prospective clinical and cognitive evaluation targeting memory, attention and executive functions. At follow-up subjects were classified as cognitively normal (CN) or impaired (CI). Of 275 subjects (70.4 ± 8.3 years old, 176 females, 7.5 ± 4.4 education, 162 with MRI), 31 (11.2%) presented CI 4.9 years later, the majority (64.5%) presenting subjective cognitive complaints. PCP could correctly identify 40% of CI individuals, particularly if they presented current cognitive complaints. Male sex (OR = 3.117; CI95%: 1.007–9.645), age (OR = 1.063; CI95%: 1.004–1.126) and baseline scores on TMT-B (OR = 0.225; CI95%: 0.073–0.688) and Vocabulary (OR =  0.940; 95% CI: 0.894–0.986) predicted CI. This study shows that measures indicating poor cognitive reserve and low executive performance (as shown by low vocabulary and executive test scores, respectively) can be early indicators of the risk of decline, stressing the role of cognitive assessment as part of prevention/early intervention programs. The results also underline the need to help PCP to improve the detection of subjects with cognitive decline.

Keywords:

• Cognitive aging
• cognitive decline
• primary care diagnosis
• risk factors for dementia

Acknowledgments

The authors are indebted to all participating primary care centers and Primary care Doctors who joined the study: Drs. Teresa Costa, Teresa Mota, Elisabete da Fonseca, Luís Afonso, Renato Graça, Cristina Galamba, Helena Febra (Centro de Saúde da Lapa); Cecília Cabral, Eugénio Oliveira, Paula Freitas, Neto Nogueira, Edite Branco, helena Ferreira (Centro de Saúde de Alcântara); Luísa Romeiro, Rosário Braz, Teresa Libório, Óscar Miranda, Teresa Campos, Áurea Farinha, Isabel Santos, Nave Ferreira, Cristina Bastos, Rita Lourenço, Judite Viana, Manuel Rosmaninho, Luísa Costa, Isabel Santos, Bernardino Costa, Luísa Teixeira (Centro de Saúde de Oeiras), Elisabete Serra, João Reis, Maria José Heleno, Rui Coias, Maria João Mendes, Sónia Pereira, Carla Coimbra (Centro de Saúde de Paço d’Arcos); Ana Paula Granadeiro, Rosa Oliveira, Analila Cruz, Vítor Cardoso (Centro de Saúde da Moita); João Belbut, Manuela Ribeiro, José Luís Gomes, Susete Gomes, Maria José Rosa (Centro de Saúde do Barreiro); Jaime Torre, Miguel Santos, Luís Pinto, Paula Dias, Raquel Caetano (Centro de Saúde do Lavradio); Manuela Cruz (Centro de Saúde de Benfica); Graça Carneiro, Ana Maria Ferreira, Pedro Silva, Elvira Nunes, Paula Atalaia (Centro de Saúde de Alvalade); Fátima Portugal, Maria João Palma, Maria José Luís (Centro de Saúde de Sete Rios). We also thank Dr Bruno Miranda for his careful criticism to the final version of the article.

Disclosure statement

The authors declare no conflicts of interest, regarding the investigation or the results of this study.

Additional information

Funding

This study was supported by a grant from Fundação Bial (ref.: 63/10) and a Nunes Vicente Grant from the Portuguese Society of Neurology.