Progression of Cognitive, Functional, and Neuropsychiatric Symptom Domains in a Population Cohort With Alzheimer Dementia: The Cache County Dementia Progression Study
Open accessAbstract
Objectives Progression of Alzheimer’s dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains. Design Longitudinal, prospective cohort study Setting Cache County (Utah) Participants 328 persons diagnosed with Possible/Probable AD Measurements Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI). Results Over a mean follow-up of 3.80 (range 0.07–12.90) years, the mean (S.D.) annual rates of change were −1.53 (2.69) on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) scale points on the NPI. Among surviving participants, 30–58% progressed less than one point/year on these measures, even 5–7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r=−0.62, df=201, p<0.001) and between the CDR-sb and NPI (r=0.20, df=206, p<0.004). Females (LR χ2=8.7, df=2, p=0.013) and those with younger onset (LR χ2=5.7, df=2, p=0.058) declined faster on the MMSE. Although one or more APOE ε4 alleles and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain. Conclusions A significant proportion of persons with AD progresses slowly. The results underscore differences between population- vs. clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD.
AI snapshot
Written from the paper’s full text.
TL;DR
In a population-based incident Alzheimer dementia cohort, cognitive, functional, and neuropsychiatric symptoms worsened on average, but a substantial minority of survivors declined slowly. The authors argue that progression estimates from clinic-based samples may differ from population-based estimates.
Key findings
- Over mean follow-up of 3.80 years (range 0.07–12.90), mean annual rates of change were −1.53 (SD 2.69) on MMSE, +1.44 (SD 1.82) on CDR-sb, and +2.55 (SD 5.37) on NPI.
- Among survivors, 30–58% progressed less than one point/year on these measures even 5–7 years after dementia onset; this represented 5–10% of the entire cohort.
- MMSE and CDR-sb rates were correlated (r=−0.62, df=201, p<0.001), CDR-sb and NPI weakly correlated (r=0.20, df=206, p=0.004), and MMSE and NPI were not correlated (r=0.052, df=195, p=0.469).
- Females declined faster on MMSE (LR χ2=8.7, df=2, p=0.013), and younger onset showed faster MMSE decline (LR χ2=5.7, df=2, p=0.058); APOE ε4 and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores but not rate of progression in any domain.
Methods
- Longitudinal prospective population cohort from Cache County, Utah: 328 persons diagnosed with Possible/Probable AD, followed from near dementia onset.
- Progression measured with MMSE, CDR sum-of-boxes, and Neuropsychiatric Inventory; predictors included age of onset, gender, education, and APOE ε4.
- Analyses calculated annual rates of change/slopes and used mixed-effects models with time and time-squared terms, plus secondary analyses of anti-dementia medication use.
Limitations
- Stated: single measures of cognition, function, and NPS; missing MMSE scores due to sensory/motor impairment in 9%; lack of follow-up among 29% (mostly death); cursory examination of anti-dementia medications; and a primarily Caucasian population of northern European descent, limiting generalizability.
- Stated: the study did not consider duration or consistency of anti-dementia medication use.
- Evident: the text also reports that 112 participants (34%) lacked any follow-up, mostly due to death, and that these individuals were older and had lower diagnostic MMSE scores than those with follow-up.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
6 of 34 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Progression of Alzheimer's dementia is highly variable.
“Progression of Alzheimer’s dementia (AD) is highly variable.”
- Also stated in: § Conclusions · plain
“Numerous studies report significant variability in the rate of cognitive and functional decline in AD.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [2] Behl, 2005, Progress in clinical neurosciences: cognitive markers of progression in Alzheimer's disease, Can J Neurol Sci source
- Also stated in: § Conclusions · plain
- Interpretationcitation
The study's findings are consistent with recent work suggesting that APOE ε4 exerts deleterious effects early in the disease course.
“Our findings are consistent with recent work suggesting that APOE ε4 exerts deleterious effects early in the disease course.(12)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [12] Cosentino, 2008, APOE epsilon 4 allele predicts faster cognitive decline in mild Alzheimer disease, Neurology source
- Findingown data
Rates of change on CDR-sb and NPI were correlated (r=0.20, df=206, p<0.004).
“between the CDR-sb and NPI (r=0.20, df=206, p<0.004)”
Quote in the paperNot a substantial claim - Findingown data
Those with younger onset declined faster on the MMSE (LR χ2=5.7, df=2, p=0.058).
“Females (LR χ2=8.7, df=2, p=0.013) and those with younger onset (LR χ2=5.7, df=2, p=0.058) declined faster on the MMSE.”
Quote in the paperNot a substantial claim - Findingown data
Rates of change on MMSE and CDR-sb were correlated (r=−0.62, df=201, p<0.001).
“Rates of change were correlated between MMSE and CDR-sb (r=−0.62, df=201, p<0.001)”
Quote in the paperNot a substantial claim
- Findingown data
The mean annual rate of change on the MMSE in this population-based incident AD sample was −1.53 (S.D. 2.69) points.
“−1.53 (2.69) on the MMSE”
Quote in the paperSubstantial claim - Findingown data
The mean annual rate of change on the CDR-sb was 1.44 (S.D. 1.82) points.
“1.44 (1.82) on the CDR-sb”
Quote in the paperSubstantial claim - Findingown data
Ever-use of FDA-approved anti-dementia medications was associated with initial MMSE scores.
“Although one or more APOE ε4 alleles and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.”
Quote in the paperNot a substantial claim - Findingown data
Among surviving participants, 30-58% progressed less than one point/year on the MMSE, CDR-sb, and NPI, even 5-7 years after dementia onset.
“Among surviving participants, 30–58% progressed less than one point/year on these measures, even 5–7 years after dementia onset.”
Quote in the paperSubstantial claim - Findingown data
Ever-use of FDA-approved anti-dementia medications was not related to the rate of progression in any domain.
“Although one or more APOE ε4 alleles and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.”
Quote in the paperSubstantial claim - Findingown data
One or more APOE ε4 alleles were associated with initial MMSE scores.
“Although one or more APOE ε4 alleles and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.”
Quote in the paperNot a substantial claim - Findingown data
One or more APOE ε4 alleles were not related to the rate of progression in any domain.
“Although one or more APOE ε4 alleles and ever-use of FDA-approved anti-dementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.”
Quote in the paperSubstantial claim - Findingown data
The mean annual rate of change on the NPI was 2.55 (S.D. 5.37) scale points.
“2.55 (5.37) scale points on the NPI”
Quote in the paperNot a substantial claim - Findingown data
Females declined faster on the MMSE (LR χ2=8.7, df=2, p=0.013).
“Females (LR χ2=8.7, df=2, p=0.013) and those with younger onset (LR χ2=5.7, df=2, p=0.058) declined faster on the MMSE.”
Quote in the paperNot a substantial claim - Findingown data
Older age was associated with worse cognition at baseline.
“Older age was associated with worse cognition and function at baseline, while women declined more rapidly (in cognition) than men.”
Quote in the paperNot a substantial claim - Findingown data
Among the variables examined, no consistent set of factors influenced change across domains.
“Among the variables examined, there was no consistent set of factors that influenced change across domains.”
Quote in the paperSubstantial claim - Findingown data
APOE status did not affect the rate of cognitive decline.
“In cognition, carriers of the APOE ε4 allele performed worse at baseline than did non-carriers but APOE status did not affect rate of decline.”
Quote in the paperSubstantial claim - Findingown data
The majority (89%) of participants did not reach the floor of the MMSE over the observation period.
“Additionally, because we followed individuals with incident dementia, the majority (89%) of our participants did not reach the floor of this measure over the period of observation.”
Quote in the paperSubstantial claim - Findingown data
In cognition, APOE ε4 carriers performed worse at baseline than non-carriers.
“In cognition, carriers of the APOE ε4 allele performed worse at baseline than did non-carriers but APOE status did not affect rate of decline.”
Quote in the paperSubstantial claim - Findingown data
Education was not associated with decline on any of the outcomes.
“In DPS, education was associated with higher MMSE scores at onset, but not with decline on any of the outcomes.”
Quote in the paperSubstantial claim - Findingown data
Education was associated with higher MMSE scores at dementia onset.
“In DPS, education was associated with higher MMSE scores at onset, but not with decline on any of the outcomes.”
Quote in the paperNot a substantial claim - Findingown data
Older age was associated with worse function at baseline.
“Older age was associated with worse cognition and function at baseline, while women declined more rapidly (in cognition) than men.”
Quote in the paperNot a substantial claim - Findingnone given
A significant proportion of individuals with AD exhibit a slowly progressive course.
“In conclusion, a significant proportion of individuals with AD exhibit a slowly progressive course.”
Quote in the paperSubstantial claim- Rests on an assumption: The missing MMSE scores and loss to follow-up did not substantially bias the estimated progression.
- Premisecitation
Most estimates of AD progression derive from convenience samples from dementia clinics or research centers, where there is substantial potential for survival bias and other distortions.
“Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [5] Kokmen, 1996, Impact of referral bias on clinical and epidemiological studies of Alzheimer's disease, J Clin Epidemiol source
- cites [6] Tsuang, 1996, Impact of sample selection on APOE epsilon 4 allele frequency: a comparison of two Alzheimer's disease samples, J Am Geriatr Soc source
- cites [10] Ruitenberg, 2001, Prognosis of Alzheimer's disease: the Rotterdam Study, Neuroepidemiology source
- Interpretationown data
The results underscore differences between population- vs. clinic-based samples.
“The results underscore differences between population- vs. clinic-based samples”
Quote in the paperSubstantial claim - Interpretationown data
A significant proportion of persons with AD progresses slowly.
“A significant proportion of persons with AD progresses slowly.”
Quote in the paperSubstantial claim - Premisecitation
In its first wave, the CCSMA enrolled 90% of the 5677 county residents aged 65 years or older.
“In its first wave, CCSMA enrolled 90% of the 5677 county residents who were aged 65 years or older.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Breitner, 1999, APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: the Cache County Study, Neurology source
- Premisecitation
Clinic AD patients have higher educational and occupational attainment than population-ascertained AD cases.
“have higher educational and occupational attainment”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Kokmen, 1996, Impact of referral bias on clinical and epidemiological studies of Alzheimer's disease, J Clin Epidemiol source
- Study design and conductcitation
Diagnoses of AD and other dementias were assigned by a panel of experts using standard protocols (e.g., NINCDS-ADRDA research criteria for AD).
“A panel of experts in neurology, geropsychiatry, neuropsychology, and cognitive neuroscience reviewed all available clinical and neuropathological data and assigned diagnoses of AD and other forms of dementia according to standard protocols (e.g., NINCDS-ADRDA research criteria for AD (21)).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] McKhann, 1984, Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease, Neurology source
- Premisecitation
Clinic AD patients tend to suffer from fewer co-morbid conditions than population-ascertained AD cases.
“and tend to suffer from fewer co-morbid conditions.(7)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Massoud, 1999, A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia, Arch Neurol source
- Premisecitation
The few available population-based studies report lower ARCs in cognition or function.
“The few available population-based studies report lower ARCs in cognition or function.(3)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] Aguero-Torres, 1998, Natural history of Alzheimer's disease and other dementias: review of the literature in the light of the findings from the Kungsholmen Project, Int J Geriatr Psychiatry source
- Premisecitation
Survival bias may produce different estimates in prevalent vs. incident samples.
“so that survival bias may produce different estimates in prevalent vs. incident samples.(10)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] Ruitenberg, 2001, Prognosis of Alzheimer's disease: the Rotterdam Study, Neuroepidemiology source
- Premisecitation
Clinic AD patients are up to 20 years younger than population-ascertained AD cases.
“clinic AD patients are up to 20 years younger”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Kokmen, 1996, Impact of referral bias on clinical and epidemiological studies of Alzheimer's disease, J Clin Epidemiol source
- Interpretationcitation
The education finding is consistent with higher education conferring advantages early in the disease course.
“This finding contrasts with studies reporting more rapid decline among those with more years of education,(37) but is consistent with higher education conferring advantages early in the disease course.(38)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [38] Swanwick, 1998, Assessment of progression and prognosis in “possible” and “probable” Alzheimer's disease, Int J Geriatr Psychiatry source
- Premisecitation
Rate of decline is known to vary by stage of dementia severity.
“Rate of decline is known to vary by stage of dementia severity,(8),(9)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Morris, 1993, The consortium to establish a registry for Alzheimer's disease (CERAD), Part IV: rates of cognitive change in the longitudinal assessment of probable Alzheimer's disease, Neurology source
- cites [9] Stern, 1994, A longitudinal study of Alzheimer's disease: measurement, rate, and predictors of cognitive deterioration, Am J Psychiatry source
- Premisecitation
Clinic AD patients are more often married and living with a spouse than population-ascertained AD cases.
“are more often married and living with a spouse,(5)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Kokmen, 1996, Impact of referral bias on clinical and epidemiological studies of Alzheimer's disease, J Clin Epidemiol source
- Study design and conductreasoning
The measurement issues did not substantially affect the study results.
“We do not believe these issues substantially affected the results as a somewhat more sensitive measure, the 3MS, was employed in dementia screening in the Cache County population, and dementia diagnoses were based on rigorous clinical examination.”
Quote in the paperSubstantial claim- Rests on an assumption: The 3MS is a somewhat more sensitive measure than the MMSE.
- Study design and conductnone given
Dementia diagnoses were based on rigorous clinical examination.
“dementia diagnoses were based on rigorous clinical examination”
Quote in the paperSubstantial claim - Premisecitation
Clinic AD patients are more likely to be carriers of the APOE ε4 allele than population-ascertained AD cases.
“are more likely to be carriers of the Apolipoprotein E (APOE) ε4 allele,(6)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Tsuang, 1996, Impact of sample selection on APOE epsilon 4 allele frequency: a comparison of two Alzheimer's disease samples, J Am Geriatr Soc source
- Interpretationreasoning
The results may not generalize to populations with different ethnic representation.
“Thus, the results obtained here may not generalize to populations with different ethnic representation.”
Quote in the paperNot a substantial claim
- Classified as probably not a substantial claim. 32
- May combine two claims. 10
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA recent review reported that the mean annual rate of change on the MMSE varied from 0.8 to 4.4 points.
“a recent review reported that the mean annual rate of change (ARC) on the Mini-Mental State Exam (MMSE), a global measure of cognition, varied from 0.8 to 4.4 points.(2)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [2] Behl, 2005, Progress in clinical neurosciences: cognitive markers of progression in Alzheimer's disease, Can J Neurol Sci source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe MMSE has been criticized for significant floor effects when studying persons with severe dementia.
“Some measures (e.g., MMSE) have been criticized for differential performance in classifying the cognitive status of individuals from different ages and educational backgrounds, and for significant floor effects when studying persons with severe dementia (reviewed in (43)).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [43] Norton, 2009, Caregiver-recipient closeness and symptom progression in Alzheimer disease. The Cache County Dementia Progression Study, J Gerontol B Psychol Sci Soc Sci source
The Outcomes section (page unavailable) describes administering the MMSE to participants with advanced dementia and occasionally discontinuing it because of poor comprehension. It does not discuss floor effects. Searches for floor effects and the MMSE’s ability to detect further decline in advanced dementia found no passage supporting the attributed criticism. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationVariables available from the CCSMA included age of dementia onset, gender, education, and presence of one or two APOE ε4 alleles, determined from buccal DNA.
“Variables available from the CCSMA included age of dementia onset, gender, education, and presence of one or two APOE ε4 alleles, determined from buccal DNA.(24)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [24] Saunders, 1993, Association of apolipoprotein E allele epsilon 4 with late-onset familial and sporadic Alzheimer's disease, Neurology source
The Methods and Genomic DNA sections describe age-of-onset information and APOE genotyping, supporting those elements of the sentence. They do not describe CCSMA variables, gender or education data, or buccal DNA; the paper instead reports DNA from blood samples and brain tissue. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe MMSE has been criticized for differential performance in classifying cognitive status of individuals from different ages and educational backgrounds.
“Some measures (e.g., MMSE) have been criticized for differential performance in classifying the cognitive status of individuals from different ages and educational backgrounds, and for significant floor effects when studying persons with severe dementia (reviewed in (43)).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [43] Norton, 2009, Caregiver-recipient closeness and symptom progression in Alzheimer disease. The Cache County Dementia Progression Study, J Gerontol B Psychol Sci Soc Sci source
The Outcomes section (page not provided) describes the MMSE as a cognitive screening test, while the Analysis and Cognitive Trajectory sections examine age and education as predictors of MMSE scores or decline. None of these passages criticizes the MMSE for classifying cognitive status differently across age or educational groups. Searches for differential classification, age and education bias, and MMSE limitations found no such statement in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measured
The quote only partly states this claim.
Findingown dataWomen declined more rapidly in cognition than men.
“Older age was associated with worse cognition and function at baseline, while women declined more rapidly (in cognition) than men.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Findingnone givenThe Cache County population is primarily Caucasian and of northern European descent.
“Finally, the Cache County population is primarily Caucasian and of northern European descent.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe Mini-Mental State Exam (MMSE) is a measure of global cognitive functioning.
“The Mini-Mental State Exam (MMSE), a measure of global cognitive functioning,(22)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] Folstein, 1975, “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician, J Psychiatr Res source
May combine two claims.
Study design and conductcitationLack of follow-up affected 29% of the sample, mostly due to death.
“Other limitations included the missing MMSE scores at baseline and/or follow-up owing to sensory/motor impairments among 9% of the sample, the lack of follow-up among 29% of the sample (mostly due to death(44)), and our cursory examination of the effects of anti-dementia medications on dementia progression.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44] Treiber, 2008, Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study, Int Psychogeriatr source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe CCSMA is located in a U.S. county recognized for its residents' longevity.
“in a U.S. county recognized for its residents’ longevity”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Breitner, 1999, APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: the Cache County Study, Neurology source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe CDR was scored by a trained research nurse at each visit, considering the caregiver's report of symptoms and the participant's neuropsychological test performance.
“The CDR was scored by a trained research nurse at each visit, considering the caregiver’s report of symptoms and the participant’s neuropsychological test performance.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenA geriatric psychiatrist conducted the initial training and performed periodic reviews of the RN ratings.
“A geriatric psychiatrist conducted the initial training and performed periodic reviews of the RN ratings.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe NPI instrument screens for the presence of each symptom and follows positive responses with a series of standardized questions to characterize the symptom, its frequency, severity, and degree of change from premorbid characteristics.
“The instrument screens for the presence of each symptom and follows positive responses with a series of standardized questions to characterize the symptom, its frequency, severity, and degree of change from premorbid characteristics.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [23] Cummings, 1994, The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia, Neurology source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA study neuropsychologist trained the technicians and periodically reviewed audiotaped test sessions to ensure consistent techniques of standardized administration.
“A study neuropsychologist trained these individuals and periodically reviewed audiotaped test sessions to ensure consistent techniques of standardized administration.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSimilar variability is seen in functional decline in AD.
“Similar variability is seen in functional decline,(3)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Aguero-Torres, 1998, Natural history of Alzheimer's disease and other dementias: review of the literature in the light of the findings from the Kungsholmen Project, Int J Geriatr Psychiatry source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe CCSMA has examined the prevalence, incidence, and risk factors for dementia.
“which has examined the prevalence, incidence, and risk factors for dementia”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Breitner, 1999, APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: the Cache County Study, Neurology source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataMissing MMSE scores at baseline and/or follow-up due to sensory/motor impairments affected 9% of the sample.
“Other limitations included the missing MMSE scores at baseline and/or follow-up owing to sensory/motor impairments among 9% of the sample, the lack of follow-up among 29% of the sample (mostly due to death(44)), and our cursory examination of the effects of anti-dementia medications on dementia progression.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenAn adjusted MMSE score was calculated by discarding items missed because of sensory or motor impairment, noting the percent correct, and rescaling the final score on a 30-point scale.
“we calculated an adjusted MMSE score by discarding items missed because of sensory or motor impairment (e.g., severe vision or hearing loss, motor weakness, tremor, etc.), noting the percent correct, and rescaling the final score on a 30-point scale.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe Cache County Study on Memory in Aging (CCSMA) is a longitudinal, population-based study.
“the longitudinal, population-based Cache County Study on Memory in Aging (CCSMA)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Breitner, 1999, APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: the Cache County Study, Neurology source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataParticipants whose sensory or motor impairments affected more than 3 points were excluded from the analyses (n=30, 9%).
“Participants whose sensory or motor impairments affected more than 3 points were excluded from the analyses (n=30, 9%).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenMost individuals with incident dementia have been followed prospectively by the DPS.
“most individuals with incident dementia have been followed prospectively by the DPS”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningDifferences in results across studies may reflect sample differences in years of education and timing of observations along the dementia course.
“Differences in results may also reflect sample differences in years of education and the timing of observations along the course of dementia.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationNPS in AD are marked by increasing incidence over time and by an episodic course.
“NPS in AD are marked by increasing incidence over time and by an episodic course.(4)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] Chung, 2000, Neurobehavioral and neuropsychiatric symptoms in Alzheimer's disease: characteristics and treatment, Neurol Clin source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMore rapid decline among women with AD has been reported in some but not all studies.
“More rapid decline among women with AD has been reported in some,(31) but not all studies.(32)”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [31] Aguero-Torres, 1998, Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm, J Am Geriatr Soc source
- cites [32] Mohs, 2000, Longitudinal studies of cognitive, functional and behavioural change in patients with Alzheimer's disease, Stat Med source
May combine two claims.
Interpretationown dataThe finding that education was not associated with decline contrasts with studies reporting more rapid decline among those with more years of education.
“This finding contrasts with studies reporting more rapid decline among those with more years of education,(37) but is consistent with higher education conferring advantages early in the disease course.(38)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Koepsell, 2008, Education, cognitive function, and severity of neuropathology in Alzheimer disease, Neurology source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA trained research nurse administered the NPI to the caregiver.
“A trained research nurse administered the NPI (23) to the caregiver.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe Neuropsychiatric Inventory (NPI) assesses neuropsychiatric symptoms that commonly occur in dementia, including delusions, hallucinations, agitation-aggression, depression-dysphoria, apathy-indifference, elation-euphoria, anxiety, disinhibition, irritability-lability, and aberrant motor behavior.
“The Neuropsychiatric Inventory (NPI) assesses NPS that commonly occur in dementia including delusions, hallucinations, agitation-aggression, depression-dysphoria, apathy-indifference, elation-euphoria, anxiety, disinhibition, irritability-lability, and aberrant motor behavior.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [23] Cummings, 1994, The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia, Neurology source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study did not consider duration or consistency of anti-dementia medication use.
“Here, we did not consider duration or consistency of medication use; a thorough examination of the effects of anti-dementia medications will be the topic of a subsequent paper on dementia treatments.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe use of single measures of cognition, function, and NPS is a study limitation.
“Among the study limitations are the use of single measures of cognition, function and NPS.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe Clinical Dementia Rating (CDR) is a measure of functional ability in six areas: memory, orientation, judgment/problem solving, community affairs, participation in home/hobbies, and personal care.
“The Clinical Dementia Rating (CDR(19)) is a measure of functional ability in six areas: memory, orientation, judgment/problem solving, community affairs, participation in home/hobbies, and personal care.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Hughes, 1982, A new clinical scale for the staging of dementia, Br J Psychiatry source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe examination of the effects of anti-dementia medications on dementia progression was cursory.
“Other limitations included the missing MMSE scores at baseline and/or follow-up owing to sensory/motor impairments among 9% of the sample, the lack of follow-up among 29% of the sample (mostly due to death(44)), and our cursory examination of the effects of anti-dementia medications on dementia progression.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductreasoningThe mixed effects model approach allowed accounting for the dependence between within-subject repeated measures and for non-linear change with respect to time by incorporating time-squared effects.
“This approach allowed us to account for the dependence between within-subject repeated measures and for non-linear change with respect to time by incorporating time-squared effects.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study's extended follow-up after dementia onset is a strength.
“The study strengths include its population base, its focus on incident cases, the characterization of course in the three domains of dementia, the extended follow-up after dementia onset, and the high participation rates observed in dementia ascertainment and over the period of observation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study's focus on incident cases is a strength.
“The study strengths include its population base, its focus on incident cases, the characterization of course in the three domains of dementia, the extended follow-up after dementia onset, and the high participation rates observed in dementia ascertainment and over the period of observation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Study design and conductnone givenThe study's population base is a strength.
“The study strengths include its population base, its focus on incident cases, the characterization of course in the three domains of dementia, the extended follow-up after dementia onset, and the high participation rates observed in dementia ascertainment and over the period of observation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe present results suggest important differences between population- and clinic-based samples.
“The present results in general suggest important differences between population- vs. clinic-based samples.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe study had high participation rates in dementia ascertainment and over the period of observation.
“The study strengths include its population base, its focus on incident cases, the characterization of course in the three domains of dementia, the extended follow-up after dementia onset, and the high participation rates observed in dementia ascertainment and over the period of observation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Study design and conductnone givenThe study's characterization of course in the three domains of dementia is a strength.
“The study strengths include its population base, its focus on incident cases, the characterization of course in the three domains of dementia, the extended follow-up after dementia onset, and the high participation rates observed in dementia ascertainment and over the period of observation.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
AD causes impairment not only in cognition and function, but also in behavior prompted by neuropsychiatric symptoms (NPS).
“AD causes impairment not only in cognition and function, but also in behavior prompted by neuropsychiatric symptoms (NPS).”
The paper relies on this without support.
Most studies of AD progression describe the course of prevalent cases.
“Also, most studies of AD progression describe the course of prevalent cases.”
The paper relies on this without support.
Few studies have examined cognition, function, and NPS simultaneously.
“Furthermore, few studies have examined cognition, function, and NPS simultaneously, so their descriptions of AD progression are incomplete.”
The paper relies on this without support.
Many studies encompass limited time of follow-up in their descriptions of dementia course.
“Finally, many studies encompass limited time of follow-up in their descriptions of dementia course.”
The paper relies on this without support.
The 3MS is a somewhat more sensitive measure than the MMSE.
“as a somewhat more sensitive measure, the 3MS, was employed in dementia screening in the Cache County population”
The paper relies on this without support.
The missing MMSE scores and loss to follow-up did not substantially bias the estimated progression.
“Other limitations included the missing MMSE scores at baseline and/or follow-up owing to sensory/motor impairments among 9% of the sample, the lack of follow-up among 29% of the sample (mostly due to death(44)), and our cursory examination of the effects of anti-dementia medications on dementia progression.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Women with mild cognitive impairment or AD have faster cognitive decline than men.
“Our findings suggest that women are at risk for delayed identification of cognitive decline, yet more rapid trajectory of decline, suggesting increased risk of dementia and disability compared with men, consistent with research showing that women with mild cognitive impairment or AD have faster cognitive decline than men.32,33”
From Sex differences in cognitive decline among US adults (2021) · cites this paper as [32]
The Results (Association between Predictors and Rate of Change, MMSE) report that women with Alzheimer dementia declined cognitively faster than men. The paper studies people with AD, not mild cognitive impairment, so it does not support that part of the attributed claim. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSex is an important factor that contributes to clinical and biological heterogeneity in Alzheimer's disease.
“Sex is an important factor that contributes to the clinical and biological heterogeneities in Alzheimer’s disease (AD)”
From Sex-specific DNA methylation differences in Alzheimer’s disease pathology (2021) · cites this paper as [4]
The Results (Association between Predictors and Rate of Change; page unavailable) report sex differences in cognitive decline and impairment at onset, supporting clinical heterogeneity. The Discussion says the reasons for these differences are unclear; the paper does not establish that sex contributes to biological heterogeneity. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAfter diagnosis, women progress faster with more rapid cognitive and functional declines.
“After diagnosis, women also progress faster with more rapid cognitive and functional declines [3–8]”
From Sex-specific DNA methylation differences in Alzheimer’s disease pathology (2021) · cites this paper as [4]
The Results (Association between Predictors and Rate of Change; page not provided) report that women declined faster than men on the MMSE, a measure of cognition. For the CDR-sb, the paper reports greater impairment among women at onset, not a faster rate of functional decline. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOur findings are consistent with studies showing that women with mild cognitive impairment or AD have faster decline in global cognition than men.
“Our findings are consistent with studies showing that women with mild cognitive impairment or AD have faster decline in global cognition than men.32,33”
From Sex differences in cognitive decline among US adults (2021) · cites this paper as [32]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting percentages for participants without follow-up
MinorThe Results say 112 participants, or 34% of the cohort, lacked follow-up. The Discussion describes the lack of follow-up as affecting 29% of the sample.
“Individuals who lacked any follow-up numbered 112 (34%)”
“the lack of follow-up among 29% of the sample”
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · cited 1× · see citing works
“Measures of Dementia Progression The Mini-Mental State Exam (MMSE), a measure of global cognitive functioning,(22) was administered by trained neuropsychological technicians.”
MethodMcKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984) · Neurology · doi:10.1212/wnl.34.7.939 · Cited by 27,915 · see citing works
The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994) · Neurology · doi:10.1212/wnl.44.12.2308 · Cited by 7,568 · see citing works
A New Clinical Scale for the Staging of Dementia
Hughes, C. P., Berg, L., Danziger, W., Coben, L. A., & Martin, R. L. (1982) · British Journal of Psychiatry · doi:10.1192/bjp.140.6.566 · Cited by 7,056 · cited 2× · see citing works
“The Clinical Dementia Rating (CDR(19)) is a measure of functional ability in six areas: memory, orientation, judgment/problem solving, community affairs, participation in home/ hobbies, and personal care.”
MethodDrake, M. M. (1988) · American Journal of Occupational Therapy · doi:10.5014/ajot.42.10.683b · Cited by 5,303 · see citing works
The Mini‐Mental State Examination: A Comprehensive Review
Tombaugh, T. N., & McIntyre, N. J. (1992) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1992.tb01992.x · Cited by 5,152 · cited 1× · see citing works
“, MMSE) have been criticized for differential performance in classifying the cognitive status of individuals from different ages and educational backgrounds, and for significant floor effects when studying persons with severe dementia (reviewed in (43)).”
BackgroundJ Neuropsychiatry Clin Neurosci
Yudofsky, S. C., & Hales, R. E. (1992) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.4.4.359 · Cited by 3,818 · see citing works
Association of apolipoprotein E allele ϵ4 with late‐onset familial and sporadic Alzheimer's disease
Saunders, A. M., Strittmatter, W. J., Schmechel, D., St. George-Hyslop, P. H., Pericak-Vance, M. A., Joo, S. H., Rosi, B. L., Gusella, J. F., Crapper-MacLachlan, D. R., Alberts, M. J., et al. (1993) · Neurology · doi:10.1212/wnl.43.8.1467 · Cited by 3,786 · see citing works
Forecasting the global burden of Alzheimer's disease
Brookmeyer, R., Johnson, E., Ziegler‐Graham, K., & Arrighi, H. M. (2007) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2007.04.381 · Cited by 3,370 · cited 1× · see citing works
“2 million by 2050,(1) unless a means of prevention can be identified.”
Background(1987) · PubMed · Cited by 2,657 · see citing works
Rate of memory decline in AD is related to education and occupation: Cognitive reserve?
Stern, Y., Albert, S., Tang, M.-X., & Tsai, W.-Y. (1999) · Neurology · doi:10.1212/wnl.53.9.1942 · Cited by 557 · see citing works
Morris, J. C., Edland, S., Clark, C., Galasko, D., Koss, E., Mohs, R., van Belle, G., Fillenbaum, G., & Heyman, A. (1993) · Neurology · doi:10.1212/wnl.43.12.2457 · Cited by 441 · see citing works
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.3.390 · Cited by 408 · cited 1× · see citing works
“Rate of decline is known to vary by stage of dementia severity,(8),(9) so that survival bias may produce different estimates in prevalent vs.”
BackgroundBreitner, J. C. S., Wyse, B. W., Anthony, J. C., Welsh-Bohmer, K. A., Steffens, D. C., Norton, M. C., Tschanz, J. T., Plassman, B. L., Meyer, M. R., Skoog, I., et al. (1999) · Neurology · doi:10.1212/wnl.53.2.321 · Cited by 397 · see citing works
Self-citationVascular factors predict rate of progression in Alzheimer disease
Mielke, M. M., Rosenberg, P. B., Tschanz, J. T., Cook, L., Corcoran, C. M., Hayden, K. M., Norton, M. C., Rabins, P. V., Green, R. C., Welsh-Bohmer, K. A., et al. (2007) · Neurology · doi:10.1212/01.wnl.0000279520.59792.fe · Cited by 309 · see citing works
Self-citationPsychiatric Symptoms Vary With the Severity of Dementia in Probable Alzheimer's Disease
Lopez, O. L., Becker, J. T., Sweet, R. A., Klunk, W., Kaufer, D. I., Saxton, J., Habeych, M., & DeKosky, S. T. (2003) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.15.3.346 · Cited by 286 · cited 1× · see citing works
“(34) We also note that the occurrence of NPS varies with severity of dementia,(35) creating problems for cross-study comparisons, and that symptoms tend to be correlated.”
BackgroundLyketsos, C. G., Sheppard, J. E., Steinberg, M., Tschanz, J. A. T., Norton, M. C., Steffens, D. C., & Breitner, J. C. S. (2001) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.448 · Cited by 275 · cited 1× · see citing works
“(34) We also note that the occurrence of NPS varies with severity of dementia,(35) creating problems for cross-study comparisons, and that symptoms tend to be correlated.(36) Hence, a global summary score may not be optimal for examining associations between NPS and other clinical features of AD.”
BackgroundSelf-citationA Validation Study of the Dementia Questionnaire
Kawas, C. H., Segal, J., Stewart, W. F., Corrada, M. M., & Thal, L. J. (1994) · Archives of Neurology · doi:10.1001/archneur.1994.00540210073015 · Cited by 231 · cited 1× · see citing works
“This interview queried cognitive and functional impairments typical in dementia.(16) Participants whose interviews were suggestive of dementia or its prodrome, and those of the population subsample, were invited to undergo a clinical assessment (CA) by a trained research nurse and psychometric technician.”
MethodAPOE ε4 allele predicts faster cognitive decline in mild Alzheimer disease
Cosentino, S., Scarmeas, N., Helzner, E., Glymour, M. M., Brandt, J., Albert, M., Blacker, D., & Stern, Y. (2008) · Neurology · doi:10.1212/01.wnl.0000304038.37421.cc · Cited by 214 · see citing works
Han, L., Cole, M., Bellavance, F., McCusker, J., & Primeau, F. (2000) · International Psychogeriatrics · doi:10.1017/s1041610200006359 · Cited by 202 · cited 1× · see citing works
“7).(30) To our knowledge, the Kungsholmen project is the only population-based study that has reported an ARC on the MMSE.”
BackgroundLyketsos, C. G., Galik, E. M., Steele, C., Steinberg, M., Rosenblatt, A., Warren, A., Leoutsakos, J., Baker, A. S., & Brandt, J. (1999) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1999.tb07245.x · Cited by 182 · cited 1× · see citing works
“(20) Participants with suspected dementia were asked to undergo neuroimaging and laboratory studies as well as a geropsychiatric physician’s exam to provide differential diagnoses of dementia.”
MethodSelf-citationNEUROBEHAVIORAL AND NEUROPSYCHIATRIC SYMPTOMS IN ALZHEIMER'S DISEASE
Chung, J. A., & Cummings, J. L. (2000) · Neurologic Clinics · doi:10.1016/s0733-8619(05)70228-0 · Cited by 174 · cited 2× · see citing works
“NPS in AD are marked by increasing incidence over time and by an episodic course.(4)”
BackgroundResultDementia: The leading predictor of death in a defined elderly population
Tschanz, J. T., Corcoran, C. M., Skoog, I. G., Khachaturian, A. S., Herrick, J. S., Hayden, K. M., Welsh-Bohmer, K. A., Calvert, T., Norton, M. C., Zandi, P. P., et al. (2004) · Neurology · doi:10.1212/01.wnl.0000118210.12660.c2 · Cited by 154 · see citing works
Self-citationAgüero‐Torres, H., Fratiglioni, L., Guo, Z., Viitanen, M., & Winblad, B. (1998) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1998.tb02464.x · Cited by 147 · cited 2× · see citing works
“03 at the second follow-up after 3–7 more years).(31) We speculate that the Kungsholmen cases may not have entered the longitudinal analysis as shortly after diagnosis as the DPS cases, and that their case cohorts may therefore show some of the same phenomena (survival bias, entry into study when MMSE decline was more…”
BackgroundNorton, M. C., Piercy, K. W., Rabins, P. V., Green, R. C., Breitner, J. C. S., Ostbye, T., Corcoran, C., Welsh-Bohmer, K. A., Lyketsos, C. G., & Tschanz, J. T. (2009) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/gbp052 · Cited by 139 · see citing works
Self-citationEffects of Cardiovascular Medications on Rate of Functional Decline in Alzheimer Disease
Rosenberg, P. B., Mielke, M. M., Tschanz, J. T., Cook, L., Corcoran, C., Hayden, K. M., Norton, M. C., Rabins, P. V., Green, R. C., Welsh-Bohmer, K. A., et al. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e318181276a · Cited by 126 · see citing works
Self-citationPerson-specific paths of cognitive decline in Alzheimer's disease and their relation to age.
Wilson, R. S., Gilley, D. W., Bennett, D., Beckett, L. A., & Evans, D. A. (2000) · Psychology and Aging · doi:10.1037//0882-7974.15.1.18 · Cited by 120 · cited 1× · see citing works
“We also assess the influence of several variables reported to affect progression, including age of onset, gender, education, and APOE genotype.(11),(12)”
BackgroundTschanz, J. T., Welsh-Bohmer, K. A., Plassman, B. L., Norton, M. C., Wyse, B. W., & Breitner, J. C. S. (2002) · PubMed · Cited by 117 · see citing works
Self-citationEducation, cognitive function, and severity of neuropathology in Alzheimer disease
Koepsell, T. D., Kurland, B. F., Harel, O., Johnson, E. A., Zhou, X. H., & Kukull, W. A. (2008) · Neurology · doi:10.1212/01.wnl.0000284603.85621.aa · Cited by 115 · cited 1× · see citing works
“This finding contrasts with studies reporting more rapid decline among those with more years of education,(37) but is consistent with higher education conferring advantages early in the disease course.(38) Differences in results may also reflect sample differences in years of education and the timing of observations a…”
ResultCortes, F., Nourhashémi, F., Guérin, O., Cantet, C., Guyonnet, S., Andrieu, S., Ousset, P., Vellas, B. J., & REAL-FR Group (2008) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2007.10.018 · Cited by 106 · cited 1× · see citing works
“By contrast, the multi-center French Network on Alzheimer Disease (REAL-FR) consisting of a volunteer sample of 686 individuals reported that 23% of their sample could be characterized as “slow” progressors.(27) The French study also reported that 89% of their participants were receiving treatment for AD (cf.”
ResultImpact of referral bias on clinical and epidemiological studies of Alzheimer's disease
Kokmen, E., Özsarfati, Y., Beard, C. M., O'Brien, P. C., & Rocca, W. A. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(95)00031-3 · Cited by 105 · cited 1× · see citing works
“educational and occupational attainment, are more often married and living with a spouse, (5) are more likely to be carriers of the Apolipoprotein E (APOE) ε4 allele,(6) and tend to suffer from fewer co-morbid conditions.”
BackgroundRacial and Ethnic Disparities in the Treatment of Dementia Among Medicare Beneficiaries
Zuckerman, I. H., Ryder, P. T., Simoni-Wastila, L., Shaffer, T., Sato, M., Zhao, L., & Stuart, B. (2008) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/63.5.s328 · Cited by 102 · cited 1× · see citing works
“(28) Nonetheless, our analyses suggest that slow dementia progression is not attributable to treatment with anti-dementia medications.”
Massoud, F., Devi, G., Stern, Y., Lawton, A., Goldman, J. E., Liu, Y., Chin, S. S., & Mayeux, R. (1999) · Archives of Neurology · doi:10.1001/archneur.56.11.1368 · Cited by 91 · cited 1× · see citing works
“educational and occupational attainment, are more often married and living with a spouse, (5) are more likely to be carriers of the Apolipoprotein E (APOE) ε4 allele,(6) and tend to suffer from fewer co-morbid conditions.(7) The few available population-based studies report lower ARCs in cognition or function.”
BackgroundClinical Features Distinguishing Large Cohorts with Possible AD, Probable AD, and Mixed Dementia
Corey‐Bloom, J., Galasko, D. R., Hofstetter, C. R., Jackson, J. E., & Thal, L. J. (1993) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1993.tb05944.x · Cited by 81 · cited 2× · see citing works
“86) for Probable AD in patients at California AD Centers.(29) A meta-analysis of studies primarily from clinical/university research centers or hospitals reported a pooled ARC on the MMSE of of −3.”
BackgroundInfluentialPerson-specific paths of cognitive decline in Alzheimer's disease and their relation to age.
Wilson, R. S., Gilley, D. W., Bennett, D. A., et al. (2000) · Psychology and Aging · doi:10.1037/0882-7974.15.1.18 · Cited by 78 · see citing works
Treiber, K. A., Lyketsos, C. G., Corcoran, C., Steinberg, M., Norton, M., Green, R. C., Rabins, P., Stein, D. M., Welsh-Bohmer, K. A., Breitner, J. C. S., et al. (2008) · International Psychogeriatrics · doi:10.1017/s1041610208006704 · Cited by 73 · see citing works
Self-citationTsuang, D., Kukull, W., Sheppard, L., Barnhart, R. L., Peskind, E., Edland, S. D., Schellenberg, G., Raskind, M., & Larson, E. B. (1996) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1996.tb01836.x · Cited by 69 · see citing works
Dementia diagnoses from clinical and neuropsychological data compared
Tschanz, J. T., Welsh-Bohmer, K. A., Skoog, I. G., West, N., Norton, M. C., Wyse, B. W., Nickles, R., & Breitner, J. C. S. (2000) · Neurology · doi:10.1212/wnl.54.6.1290 · Cited by 67 · cited 1× · see citing works
“The CA included a structured physical and neurological examination and a battery of neuropsychological tests.(17) A knowledgeable informant provided information regarding the participant’s history of cognitive or functional impairment, medical history, and psychiatric symptoms.”
MethodSelf-citationPredictors of Cognitive Decline in the Early Stage of Probable Alzheimer’s Disease
Marra, C., Silveri, M. C., & Gainotti, G. (2000) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000017239 · Cited by 53 · cited 1× · see citing works
“, (25),(26)), but studies of incident cases from populations are lacking.”
BackgroundProgress in Clinical Neurosciences: Cognitive Markers of Progression in Alzheimer's Disease
Behl, P., Stefurak, T. L., & Black, S. E. (2005) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100003917 · Cited by 43 · cited 1× · see citing works
“4 points.(2) Similar variability is seen in functional decline,(3) although comparisons across studies are impeded by differences in instrumentation.”
BackgroundPrognosis of Alzheimer’s Disease: The Rotterdam Study
Ruitenberg, A., Kalmijn, S., de Ridder, M. A. J., Redekop, W. K., van Harskamp, F., Hofman, A., Launer, L. J., & Breteler, M. M. B. (2001) · Neuroepidemiology · doi:10.1159/000054786 · Cited by 41 · cited 1× · see citing works
“incident samples.(10) Furthermore, few studies have examined cognition, function, and NPS simultaneously, so their descriptions of AD progression are incomplete.”
BackgroundJohnsen, S., Hughes, S., Bullock, R. A., et al. (2003) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000072813 · Cited by 8 · cited 1× · see citing works
“, (25),(26)), but studies of incident cases from populations are lacking.”
BackgroundCorcoran, C. D., Pieper, C. F., Zandi, P. P., et al. (2008) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2008.05.969 · Cited by 3 · cited 1× · see citing works
“Alternate methods that characterize the non-linear nature of progression in each domain may reveal stronger associations.(34) We also note that the occurrence of NPS varies with severity of dementia,(35) creating problems for cross-study comparisons, and that symptoms tend to be correlated.”
MethodSelf-citation
Flagged first, then by citations
1 of the 48 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Dementia prevention, intervention, and care
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)31363-6 · Cited by 6,072 · see citing works
Defeating Alzheimer's disease and other dementias: a priority for European science and society
Winblad, B., Amouyel, P., Andrieu, S., Ballard, C., Brayne, C., Brodaty, H., Cedazo-Minguez, A., Dubois, B., Edvardsson, D., Feldman, H., et al. (2016) · The Lancet Neurology · doi:10.1016/s1474-4422(16)00062-4 · Cited by 1,676 · see citing works
Behavioral and psychological symptoms of dementia
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012) · Frontiers in Neurology · doi:10.3389/fneur.2012.00073 · Cited by 1,425 · see citing works
Education and cognitive functioning across the life span
Lövdén, M., Fratiglioni, L., Glymour, M. M., Lindenberger, U., & Tucker-Drob, E. M. (2020) · Psychological Science in the Public Interest · doi:10.1177/1529100620920576 · Cited by 1,224 · see citing works
“Three studies (total N = 587) reported no education-related differences in declines in performance on the MMSE (Aguero-Torres, Fratiglioni, Guo, Viitanen, & Winblad, 1998; Small, Viitanen, Winblad, & Bäckman, 1997; Tschanz et al., 2011).”
BackgroundInfluentialClinical epidemiology of Alzheimer&rsquo;s disease: assessing sex and gender differences
Mielke, M., Vemuri, P., & Rocca, W. (2014) · Clinical Epidemiology · doi:10.2147/clep.s37929 · Cited by 1,021 · see citing works
“Interestingly, women also have a faster rate of cognitive and functional decline after a diagnosis of AD.(63,64)”
Self-citationLong-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States
Kioumourtzoglou, M., Schwartz, J. D., Weisskopf, M. G., Melly, S. J., Wang, Y., Dominici, F., & Zanobetti, A. (2015) · Environmental Health Perspectives · doi:10.1289/ehp.1408973 · Cited by 475 · see citing works
“Tschanz et al. (2011) reported that the progression of disease is slow for a significant proportion of patients with neurodegenerative diseases, and for AD specifically, and urged the identification of modifiable factors that may further slow neurodegenerative progression.”
BackgroundSex differences in cognitive decline among US adults
Levine, D. A., Gross, A. L., Briceño, E. M., Tilton, N., Giordani, B. J., Sussman, J. B., Hayward, R. A., Burke, J. F., Hingtgen, S., Elkind, M. S. V., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0169 · Cited by 440 · see citing works
Peters, M. E., Schwartz, S., Han, D., Rabins, P. V., Steinberg, M., Tschanz, J. T., & Lyketsos, C. G. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14040480 · Cited by 400 · see citing works
“Acknowledgments Grant Support: This research was supported by the Cache County Memory Study, Dementia Progression Study, and the Joseph and Kathleen Bryan ADRC: R01AG11380, R01AG21136, R01AG18712.”
MethodInfluentialSelf-citationNeuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms
Lanctôt, K. L., Amatniek, J., Ancoli‐Israel, S., Arnold, S. E., Ballard, C., Cohen‐Mansfield, J., Ismail, Z., Lyketsos, C., Miller, D. S., Musiek, E., et al. (2017) · Alzheimer's & Dementia: Translational Research & Clinical Interventions · doi:10.1016/j.trci.2017.07.001 · Cited by 395 · see citing works
“[4] Tschanz JT, Corcoran CD, Schwartz S, Treiber K, Green RC, NortonMC, et al.”
BackgroundSelf-citationSex differences in the association between AD biomarkers and cognitive decline
Initiative, F. T. A. N., Koran, M. E. I., Wagener, M., & Hohman, T. J. (2017) · Brain Imaging and Behavior · doi:10.1007/s11682-016-9523-8 · Cited by 339 · see citing works
“males with AD appear to show more rapid cognitive decline than males with AD (Tschanz et al. 2011), likely driven by the tighter coupling of cognition and neuropathology previously highlighted.”
BackgroundShi, L., Wu, X., Yazdi, M. D., Braun, D., Awad, Y. A., Wei, Y., Liu, P., Di, Q., Wang, Y., Schwartz, J. D., et al. (2020) · The Lancet Planetary Health · doi:10.1016/s2542-5196(20)30227-8 · Cited by 320 · see citing works
“24,25 Furthermore, disease diagnosis probably occurs at a neurologist’s office and not during a hospital admission.”
Longitudinal course of behavioural and psychological symptoms of dementia: systematic review
van der Linde, R. M., Dening, T., Stephan, B. C. M., Prina, M. A., Evans, E. H., & Brayne, C. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.148403 · Cited by 294 · see citing works
“The total score on the NPI significantly increased over time, 26,34,75 and symptoms were mostly shown to be persistent, 26,31 stable or increasing.”
Sex: A Significant Risk Factor for Neurodevelopmental and Neurodegenerative Disorders
Pinares-Garcia, P., Stratikopoulos, M., Zagato, A., Loke, H., & Lee, J. (2018) · Brain Sciences · doi:10.3390/brainsci8080154 · Cited by 200 · see citing works
“Women also show more rapid loss of autonomy, greater disability and more rapid cognitive decline whilst men have a higher mortality and comorbidity and later onset [79,96,97].”
BackgroundThe paradox of syndromic diversity in Alzheimer disease
Warren, J. D., Fletcher, P. D., & Golden, H. L. (2012) · Nature Reviews Neurology · doi:10.1038/nrneurol.2012.135 · Cited by 197 · see citing works
Miguel-Álvarez, M., Santos‐Lozano, A., Sanchis‐Gomar, F., Fiuza‐Luces, C., Pareja-Galeano, H., Garatachea, N., & Lucía, A. (2015) · Drugs & Aging · doi:10.1007/s40266-015-0239-z · Cited by 197 · see citing works
“Each domain is rated on a 5-point scale scored from 0 (normal) to 3 (severe dementia), so that the final result varies from 0 to 18 [11].”
BackgroundSex Hormones and Cognition: Neuroendocrine Influences on Memory and Learning
Hamson, D. K., Roes, M., & Galea, L. A. M. (2016) · Comprehensive physiology · doi:10.1002/cphy.c150031 · Cited by 205 · see citing works
Considering Sex as a Biological Variable Will Be Valuable for Neuroscience Research
Shansky, R. M., & Woolley, C. S. (2016) · The Journal of Neuroscience · doi:10.1523/jneurosci.1390-16.2016 · Cited by 191 · see citing works
Fauth, E. B., Hess, K., Piercy, K., Norton, M. C., Corcoran, C., Rabins, P. V., Lyketsos, C. G., & Tschanz, J. T. (2012) · Aging & Mental Health · doi:10.1080/13607863.2012.678482 · Cited by 189 · see citing works
“Assessments were conducted by a trained research nurse and a neuropsychological technician, and a written informed consent was obtained for each assessment (Tschanz et al., 2011).”
MethodInfluentialSelf-citationDodel, R. C., Rominger, A., Bartenstein, P., Barkhof, F., Blennow, K., Förster, S., Winter, Y., Bach, J., Popp, J., Alferink, J., et al. (2013) · The Lancet Neurology · doi:10.1016/s1474-4422(13)70014-0 · Cited by 187 · see citing works
Serrano‐Pozo, A., Qian, J., Monsell, S. E., Betensky, R. A., & Hyman, B. T. (2015) · Annals of Neurology · doi:10.1002/ana.24369 · Cited by 176 · see citing works
Amyloid and tau imaging biomarkers explain cognitive decline from late middle-age
Betthauser, T. J., Koscik, R. L., Jonaitis, E. M., Allison, S. L., Cody, K. A., Erickson, C. M., Rowley, H. A., Stone, C. K., Mueller, K. D., Clark, L. R., et al. (2019) · Brain · doi:10.1093/brain/awz378 · Cited by 174 · see citing works
“…were largely conducted in older adults that are likely to have comorbid contributions to cognitive decline due to their age (Vassilaki et al. , 2015), and could have a survivor bias due to the age cognitively unimpaired inclusion criteria were applied (Tschanz et al. , 2011; Weuve et al. , 2015).”
Progression of Alzheimer's disease as measured by Clinical Dementia Rating Sum of Boxes scores
Williams, M., Storandt, M., Roe, C. M., & Morris, J. C. (2012) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2012.01.005 · Cited by 157 · see citing works
“Studies have examined annual rate of change in CDR-SB [24,25].”
BackgroundPlasma Sphingomyelins are Associated with Cognitive Progression in Alzheimer's Disease
Mielke, M. M., Haughey, N. J., Bandaru, V. V. R., Weinberg, D. D., Darby, E. J., Zaidi, N., Pavlik, V., Doody, R. S., & Lyketsos, C. G. (2011) · Journal of Alzheimer s Disease · doi:10.3233/jad-2011-110405 · Cited by 158 · see citing works
Self-citationBoutoleau-Bretonnière, C., Pouclet-Courtemanche, H., Gillet, A., Bernard, A., Deruet, A. L., Gouraud, I., Mazoue, A., Lamy, E., Rocher, L., Kapogiannis, D., et al. (2020) · Journal of Alzheimer's Disease · doi:10.3233/jad-200604 · Cited by 151 · see citing works
“Neuropsychiatric symptoms typically fluctuate in intensity over the course of AD [7].”
BackgroundNeuropsychiatric Symptoms and Global Functional Impairment along the Alzheimer’s Continuum
Wadsworth, L. P., Lorius, N., Donovan, N. J., Locascio, J. J., Rentz, D. M., Johnson, K. A., Sperling, R. A., & Marshall, G. A. (2012) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000342119 · Cited by 138 · see citing works
Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum
Eikelboom, W. S., van den Berg, E., Singleton, E. H., Baart, S. J., Coesmans, M., Leeuwis, A. E., Teunissen, C. E., van Berckel, B. N. M., Pijnenburg, Y. A. L., Scheltens, P., et al. (2021) · Neurology · doi:10.1212/wnl.0000000000012598 · Cited by 125 · see citing works
Rosenberg, P. B., Mielke, M. M., Han, D., Leoutsakos, J., Lyketsos, C. G., Rabins, P. V., Zandi, P. P., Breitner, J. C. S., Norton, M. C., Welsh-Bohmer, K. A., et al. (2012) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3769 · Cited by 117 · see citing works
“We, therefore, sought to examine the association of psychotropic medication use with cognitive, functional, and NPS trajectories in a longitudinal population-based study of incident AD participants enrolled in the Cache County Dementia Progression Study [DPS] (Tschanz et al., 2011).”
InfluentialSelf-citationPereira, J. B., Westman, E., & Hansson, O. (2017) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2017.06.002 · Cited by 118 · see citing works
Tsiknia, A. A., Edland, S. D., Sundermann, E. E., Reas, E. T., Brewer, J. B., Galasko, D. R., Banks, S. J., & Initiative, A. D. N. (2022) · Molecular Psychiatry · doi:10.1038/s41380-022-01675-8 · Cited by 98 · see citing works
Sanders, C., Behrens, S., Schwartz, S., Wengreen, H. J., Corcoran, C. D., Lyketsos, C. G., & Tschanz, J. T. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-150528 · Cited by 96 · see citing works
Self-citationGuercio, B. J., Donovan, N. J., Munro, C. E., Aghjayan, S. L., Wigman, S. E., Locascio, J. J., Amariglio, R. E., Rentz, D. M., Johnson, K. A., Sperling, R. A., et al. (2015) · Journal of Alzheimer s Disease · doi:10.3233/jad-150146 · Cited by 89 · see citing works
Treiber, K., Carlson, M. C., Corcoran, C., Norton, M. C., Breitner, J. C. S., Piercy, K. W., DeBerard, M. S., Stein, D. J., Foley, B., Welsh-Bohmer, K. A., et al. (2011) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbr023 · Cited by 77 · see citing works
Self-citationMild Cognitive Impairment: Statistical Models of Transition Using Longitudinal Clinical Data
Abner, E. L., Kryscio, R. J., Cooper, G. E., Fardo, D. W., Jicha, G. A., Mendiondo, M. S., Nelson, P. T., Smith, C. D., Eldik, L. J. V., Wan, L., et al. (2012) · International Journal of Alzheimer s Disease · doi:10.1155/2012/291920 · Cited by 76 · see citing works
“[40] noted in the Cache County cohort that while female sex and age at onset were predictive of decline in Mini-Mental Status Exam (MMSE) scores, education was not related to rate of MMSE decline, and APOE-4 was related to earlier onset of impairment but not rate of MMSE decline.”
BackgroundDementia severity and the longitudinal costs of informal care in the Cache County population
Rattinger, G. B., Schwartz, S., Mullins, C. D., Corcoran, C., Zuckerman, I. H., Sanders, C., Norton, M. C., Fauth, E. B., Leoutsakos, J. S., Lyketsos, C. G., et al. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2014.11.004 · Cited by 71 · see citing works
“Previous work in this and other samples suggest that the course of NPS (unlike those of cognitive and functional abilities) show marked fluctuation and variability over the course of dementia [16].”
BackgroundMethodResultInfluentialSelf-citationCharacterizing brain tau and cognitive decline along the amyloid timeline in Alzheimer’s disease
Cody, K. A., Langhough, R. E., Zammit, M. D., Clark, L. R., Chin, N. A., Christian, B. T., Betthauser, T. J., & Johnson, S. C. (2024) · Brain · doi:10.1093/brain/awae116 · Cited by 67 · see citing works
Predictors of progression to severe Alzheimer's disease in an incidence sample
Rabins, P. V., Schwartz, S., Black, B. S., Corcoran, C. D., Fauth, E. B., Mielke, M. M., Christensen, J., Lyketsos, C. G., & Tschanz, J. T. (2012) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2012.01.003 · Cited by 70 · see citing works
“The Cache County Memory Study [6,7] and its successor, that is, the Dementia Progression Study, offer an opportunity to address the question of factors affecting rate of progression of dementia.”
BackgroundSelf-citationFritz, A., Amrein, I., & Wolfer, D. P. (2017) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.31565 · Cited by 69 · see citing works
“to prevalence, severity, or disease course (Christensen et al., 2016; Golden & Voskuhl, 2017; Haaxma et al., 2007; Kokras & Dalla, 2017; Leger & Neill, 2016; Tschanz et al., 2011).”
BackgroundSex/gender differences in cognitive trajectories vary as a function of race/ethnicity
Avila, J. F., Vonk, J. M. J., Verney, S. P., Witkiewitz, K. A., Rentería, M. A., Schupf, N., Mayeux, R. P., & Manly, J. J. (2019) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2019.04.006 · Cited by 69 · see citing works
“Some studies have demonstrated that women demonstrate a faster rate of cognitive and functional decline after receiving a diagnosis of AD [23,24], yet most of the literature suggests that men and women decline at similar rates [16,25].”
BackgroundAlzheimer’s Disease: A Clinical Practice-Oriented Review
Alves, L., Correia, A. S., Miguel, R., Alegria, P., & Bugalho, P. (2012) · Frontiers in Neurology · doi:10.3389/fneur.2012.00063 · Cited by 69 · see citing works
Modifiable, Non-Modifiable, and Clinical Factors Associated with Progression of Alzheimer’s Disease
Loeffler, D. A. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-201182 · Cited by 67 · see citing works
“Conversely,manystudieshavefoundnosignificant association between APOE (cid:2) 4 and AD progression [34, 83, 196, 201, 235, 270–287], and some studies have even suggested that the presence of the APOE (cid:2) 4 allele may slow AD progression [199, 205, 270, 280, 288, 289].”
InfluentialNutritional Status is Associated With Severe Dementia and Mortality
Sanders, C. L., Wengreen, H. J., Schwartz, S., Behrens, S., Corcoran, C., Lyketsos, C. G., & Tschanz, J. T. (2018) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000274 · Cited by 65 · see citing works
Self-citationTschanz, J. T., Piercy, K. W., Corcoran, C. D., Fauth, E. B., Norton, M. C., Rabins, P. V., Tschanz, B. T., DeBerard, M. S., Snyder, C., Smith, C., et al. (2013) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2012.10.005 · Cited by 64 · see citing works
“Originating from the Cache County Study on Memory in Aging (CCSMA), DPS is an ongoing, longitudinal population-based study of persons with incident dementia (diagnosed within a few years of onset) and their caregivers.(2) DPS has conducted semiannual follow-ups of dementia patient and caregiver dyads, examining geneti…”
Self-citationTschanz, J. T., Norton, M. C., Zandi, P. P., & Lyketsos, C. G. (2013) · International Review of Psychiatry · doi:10.3109/09540261.2013.849663 · Cited by 64 · see citing works
“The use of dementia medications such as cholinesterase inhibitors or memantine, taken by approximately 22% of the cohort, was associated with higher baseline cognitive scores, but did not affect rate of decline (Tschanz et al., 2011).”
BackgroundResultInfluentialSelf-citationSnyder, C. M., Fauth, E., Wanzek, J., Piercy, K. W., Norton, M. C., Corcoran, C., Rabins, P. V., Lyketsos, C. G., & Tschanz, J. T. (2015) · Aging & Mental Health · doi:10.1080/13607863.2014.939610 · Cited by 63 · see citing works
“Persons identified with dementia from the CCSMA and their caregivers were invited to participate in a follow-up longitudinal study (the DPS) which is the dataset for these analyses (Tschanz et al., 2011).”
MethodSelf-citationBuckley, T., Fauth, E. B., Morrison, A. S., Tschanz, J. T., Rabins, P. V., Piercy, K. W., Norton, M. C., & Lyketsos, C. G. (2012) · International Psychogeriatrics · doi:10.1017/s1041610212000063 · Cited by 63 · see citing works
Self-citationEdwards, L., Joie, R. L., Iaccarino, L., Strom, A., Baker, S. L., Casaletto, K. B., Cobigo, Y., Grant, H. E., Kim, M., Kramer, J. H., et al. (2021) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2021.04.003 · Cited by 61 · see citing works
Apathy and APOE4 are associated with Reduced BDNF Levels in Alzheimer's Disease
Álvarez, A., Aleixandre, M., Linares, C., Masliah, E., & Moessler, H. (2014) · Journal of Alzheimer s Disease · doi:10.3233/jad-140849 · Cited by 61 · see citing works
“The influence of the APOE4 status on circulating BNDF was not evaluated before in AD, but the association of APOE4 with low MMSE scores in AD patients was already observed by other authors [39].”
Progression of Alzheimer’s Disease: A Longitudinal Study in Norwegian Memory Clinics
Eldholm, R. S., Barca, M. L., Persson, K., Knapskog, A., Kersten, H., Engedal, K., Selbæk, G., Brækhus, A., Skovlund, E., & Saltvedt, I. T. (2017) · Journal of Alzheimer s Disease · doi:10.3233/jad-170436 · Cited by 59 · see citing works
“In accordance with other studies assessing progression in dementia with CDR-SB [6, 8], patients who had an increase of less than 1 point in the CDR-SB score per year of follow-up were regarded as slow progressors.”
InfluentialSex-specific DNA methylation differences in Alzheimer’s disease pathology
Zhang, L., Young, J. I., Gomez, L., Silva, T. C., Schmidt, M. A., Cai, J., Chen, X., Martin, E. R., & Wang, L. (2021) · Acta Neuropathologica Communications · doi:10.1186/s40478-021-01177-8 · Cited by 58 · see citing works
Smits, L. L., Pijnenburg, Y. A. L., van der Vlies, A. E., Koedam, E., Bouwman, F. H., Reuling, I. E. W., Scheltens, P., & van der Flier, W. M. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.03.014 · Cited by 58 · see citing works
“Some studies found that presence of the E4 allele was associated with faster cognitive decline, while others found a slower cognitive decline, or concluded that there was no influence of APOE E4 on rate of cognitive decline at all (Frisoni et al., 1995; Hirono et al., 2003; Hoyt et al., 2005; Kleiman et al., 2006; Mar…”
InfluentialJutkowitz, E., MacLehose, R. F., Gaugler, J. E., Dowd, B. E., Kuntz, K. M., & Kane, R. L. (2016) · The Journals of Gerontology Series A · doi:10.1093/gerona/glw079 · Cited by 58 · see citing works
“To our knowledge, the NPI-Q has not been used to evaluate behavioral trajectories in dementia, but conceptually our analysis differs from others by incorporating cognitive status and race as explanatory variables (3,23).”
Kim, H. J., Kang, S. J., Kim, C., Kim, G. H., Jeon, S., Lee, J. M., Oh, S. J., Kim, J. S., Choe, Y. S., Lee, K. H., et al. (2013) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2013.01.002 · Cited by 58 · see citing works
Costa, A. S., Reich, A., Fimm, B., Ketteler, S. T., Schulz, J. B., & Reetz, K. (2013) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000351864 · Cited by 57 · see citing works
Sex-specific risk of cardiovascular disease and cognitive decline: pregnancy and menopause
Miller, V. M., Garovic, V. D., Kantarci, K., Barnes, J. N., Jayachandran, M., Mielke, M. M., Joyner, M. J., Shuster, L. T., & Rocca, W. A. (2013) · Biology of Sex Differences · doi:10.1186/2042-6410-4-6 · Cited by 56 · see citing works
“Compared with men, women are at increased risk for Alzheimer’s disease, the most common form of dementia [93-96], and their cognitive performance declines faster after the diagnosis of Alzheimer’s disease [97,98].”
BackgroundSelf-citationBehavioral and neuropsychiatric disorders in Alzheimer's disease
Cortés, N., Andrade, V., & Maccioni, R. B. (2018) · Journal of Alzheimer's Disease · doi:10.3233/jad-180005 · Cited by 57 · see citing works
“TheintensityofBNSincreasedoverthetime,how-everthesearevariableandepisodic[22],andBNS havebeendirectlyassociatedwithadiminishingin survivalrates[63].”
InfluentialVascular risk factors and neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study
Steinberg, M., Hess, K., Corcoran, C., Mielke, M. M., Norton, M. C., Breitner, J. C. S., Green, R. C., Leoutsakos, J., Welsh-Bohmer, K. A., Lyketsos, C. G., et al. (2013) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3980 · Cited by 58 · see citing works
“Because of the nature of the trajectory, a quadratic effect of time (time squared) was included in models predicting total NPI score (Tschanz et al., 2011), and to examine the association of each predictor with rate of change in NPI, interactions between predictors and time and time squared were…”
InfluentialSelf-citationNeuropsychiatric Symptoms and Functional Connectivity in Mild Cognitive Impairment
Munro, C. E., Donovan, N. J., Guercio, B. J., Wigman, S. E., Schultz, A. P., Amariglio, R. E., Rentz, D. M., Johnson, K. A., Sperling, R. A., & Marshall, G. A. (2015) · Journal of Alzheimer s Disease · doi:10.3233/jad-150017 · Cited by 57 · see citing works
“functional decline in early Alzheimer’s disease (AD) [1–5].”
BackgroundLeoutsakos, J., Forrester, S., Corcoran, C. D., Norton, M. C., Rabins, P. V., Steinberg, M. I., Tschanz, J. T., & Lyketsos, C. G. (2014) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4221 · Cited by 56 · see citing works
“The CCSMA is a longitudinal, population-based cohort that began in 1995 and included 90% of county residents over 65 years.”
BackgroundMethodResultInfluentialSelf-citationPiercy, K. W., Fauth, E. B., Norton, M. C., Pfister, R., Corcoran, C. D., Rabins, P. V., Lyketsos, C. G., & Tschanz, J. T. (2012) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbs116 · Cited by 56 · see citing works
Self-citationWong, D. Y., Atiya, S., Fogarty, J., Montero‐Odasso, M., Pasternak, S., Brymer, C., BORRIE, M. J., & Bartha, R. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-190773 · Cited by 56 · see citing works
“In addition to changes in episodic memory, many individuals diagnosed with AD also present with neuropsychiatric symptoms such as apathy, anxiety, agitation, and depression which typically worsen as the disease progresses [109, 110].”
Neuropsychiatric aspects of dementia
Ford, A. H. (2014) · Maturitas · doi:10.1016/j.maturitas.2014.04.005 · Cited by 52 · see citing works
Mielke, M. M., Leoutsakos, J., Corcoran, C. D., Green, R. C., Norton, M. C., Welsh-Bohmer, K. A., Tschanz, J. T., & Lyketsos, C. G. (2012) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2011.02.011 · Cited by 53 · see citing works
Self-citationPredicting the progression of Alzheimer's disease dementia: A multidomain health policy model
Green, C., & Zhang, S. (2016) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2016.01.011 · Cited by 51 · see citing works
“participant level data [24] have indicated that symptom scores for cognition, function, and behavior in people with AD can improve as well as decline, as reported in the data here.”
ResultThe clinical course and interrelations of dementia related symptoms
Haaksma, M. L., Leoutsakos, J., Bremer, J. A. E., Aalten, P., Ramakers, I. H. G. B., Verhey, F. R. J., Rikkert, M. G. M. O., Melis, R. J. F., Vernooij-Dassen, M., Moniz-Cook, E. D., et al. (2017) · International Psychogeriatrics · doi:10.1017/s1041610217000321 · Cited by 49 · see citing works
Self-citationTaylor, M. E., Lasschuit, D., Lord, S. R., Delbaere, K., Kurrle, S. E., Mikolaizak, A. S., Kvelde, T., & Close, J. (2017) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2017.07.023 · Cited by 49 · see citing works
“None-the-less, the mean rate of change over one year in the current study (-1.4 ± 2.9) was similar to results recently reported in populations with AD (Tschanz et al., 2011; Zhao et al., 2014), and declines in verbal fluency and TMT A performance were comparable to the one other study that has…”
BackgroundResultInfluentialBanning, L. C. P., Ramakers, I. H. G. B., Deckers, K., Verhey, F. R. J., & Aalten, P. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.09.014 · Cited by 49 · see citing works
“These symptoms occur in the vast majority of patients over the disease course, including in its prodromal phase (mild cognitive impairment, MCI) (Aalten et al., 2007; Monastero et al., 2009), and although they fluctuate (Tschanz et al., 2011), they are highly persistent (Steinberg et al., 2004).”
Rodella, C., Bernini, S., Panzarasa, S., Sinforiani, E., Picascia, M., Quaglini, S., Cavallini, E., Vecchi, T., Tassorelli, C., & Bottiroli, S. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-01912-0 · Cited by 48 · see citing works
Gilbert, M., Snyder, C., Corcoran, C., Norton, M. C., Lyketsos, C. G., & Tschanz, J. T. (2014) · International Psychogeriatrics · doi:10.1017/s1041610214000842 · Cited by 48 · see citing works
“The strengths of this study include the population-based sample, the assessment of TBI with respect to number, indicator of severity (loss of consciousness) and timing with respect to the onset of dementia, high participation rates (Tschanz et al., 2011), and assessment of functional and cognitive outcomes.”
BackgroundMethodInfluentialSelf-citationDisease-related determinants are associated with mortality in dementia due to Alzheimer’s disease
Rhodius‐Meester, H. F. M., Liedes, H., Koene, T., Lemstra, A. W., Teunissen, C. E., Barkhof, F., Scheltens, P., van Gils, M., Lötjönen, J. M. P., & van der Flier, W. M. (2018) · Alzheimer s Research & Therapy · doi:10.1186/s13195-018-0348-0 · Cited by 47 · see citing works
Leoutsakos, J., Han, D., Mielke, M. M., Forrester, S., Tschanz, J. T., Corcoran, C. D., Green, R. C., Norton, M. C., Welsh-Bohmer, K. A., & Lyketsos, C. G. (2012) · International Psychogeriatrics · doi:10.1017/s104161021200049x · Cited by 46 · see citing works
Self-citationAlzheimer’s Disease Progression: Factors Influencing Cognitive Decline
Ferrari, C., Lombardi, G., Polito, C., Lucidi, G., Bagnoli, S., Piaceri, I., Nacmias, B., Berti, V., Rizzuto, D., Fratiglioni, L., et al. (2017) · Journal of Alzheimer s Disease · doi:10.3233/jad-170665 · Cited by 45 · see citing works
“Studiesreported an annual Mini-Mental State Examination (MMSE) decline ranging from 0.8 to 4.4 points [2, 3], with a mean of 1.5 during the first year and 2.5 after the second year [4].”
InfluentialBanning, L. C. P., Ramakers, I. H. G. B., Rosenberg, P. B., Lyketsos, C. G., Leoutsakos, J., & Initiative, A. D. N. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5418 · Cited by 45 · see citing works
“Unlike the deterioration seen for cognition and daily function, “affective” NPS such as depression and apathy do not necessarily progress in one direction over time but rather may persist, remit, or recur episodically.(3) Although depression and apathy frequently cooccur, they also exist separately and it has been arg…”
Self-citationPeterson, D., Munger, C., Crowley, J., Corcoran, C., Cruchaga, C., Goate, A. M., Norton, M. C., Green, R. C., Munger, R. G., Breitner, J. C. S., et al. (2014) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2013.02.010 · Cited by 44 · see citing works
“Significant variability in the rate of progression has been previously reported in these individuals, with approximately one third to one half progressing slowly in their disease course, as defined by a one point (or less) per year change in function (CDR-sb) [20].”
BackgroundSelf-citationGatchel, J. R., Donovan, N. J., Locascio, J. J., Becker, J. A., Rentz, D. M., Sperling, R. A., Johnson, K. A., & Marshall, G. A. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.12.017 · Cited by 43 · see citing works
Demange, M., Lenoir, H., Pino, M., Cantegreil, I., Rigaud, A.-S., & Cristancho‐Lacroix, V. (2018) · Clinical Interventions in Aging · doi:10.2147/cia.s152561 · Cited by 43 · see citing works
Sex differences in default mode network connectivity in healthy aging adults
Ficek, B., Horien, C. L., Ju, S., Xu, W., Li, N., Lacadie, C., Shen, X., Scheinost, D., Constable, R. T., & Fredericks, C. A. (2022) · Cerebral Cortex · doi:10.1093/cercor/bhac491 · Cited by 42 · see citing works
Park, S., Kwon, E., & Lee, H. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14040393 · Cited by 41 · see citing works
“Existing studies, however, share limitations such as small samples or cross-sectional designs [10]; no study to date has comprehensively examined life course factors known to influence cognition in late life.”
BackgroundHsu, J., Lee, W., Liao, Y., Wang, S., & Fuh, J. (2017) · Alzheimer s Research & Therapy · doi:10.1186/s13195-017-0319-x · Cited by 41 · see citing works
“At present there is no reliable biomarker for predicting the speed of AD progression [41, 42].”
Rattinger, G. B., Fauth, E. B., Behrens, S., Sanders, C., Schwartz, S., Norton, M. C., Corcoran, C., Mullins, C. D., Lyketsos, C. G., & Tschanz, J. T. (2016) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2016.03.008 · Cited by 39 · see citing works
“The DPS is composed of community-dwelling participants, where all dementia cases were clinically diagnosed and followed for asmany as 10 years after the diagnosis of dementia, with rich information including caregiving hours, dementia progression, and caregiver factors [11].”
BackgroundInfluentialSelf-citationZuliani, G., Zuin, M., Romagnoli, T., Polastri, M., Cervellati, C., & Brombo, G. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-023-02675-6 · Cited by 41 · see citing works
“In 2011, Tschanz et al. evaluated, in a population-based sample of 328 incident AD cases, the progression of impairment in cognition, function, and neuropsychiatric symptoms [42].”
BackgroundHallikainen, I. T., Hongisto, K., Välimäki, T. H., Hänninen, T., Martikainen, J. A., & Koivisto, A. M. (2018) · Journal of Alzheimer s Disease · doi:10.3233/jad-170697 · Cited by 38 · see citing works
“In some previous reports, disinhibition [10–11] and anxiety [10, 12] have been increased over time, but in our study, they do not associate with AD progression.”
InfluentialNorton, M., Clark, C. J., Fauth, E. B., Piercy, K., Pfister, R., Green, R., Corcoran, C., Rabins, P., Lyketsos, C., & Tschanz, J. (2013) · International Psychogeriatrics · doi:10.1017/s1041610213001105 · Cited by 41 · see citing works
Self-citationCognitive and functional progression in Alzheimer disease: A prediction model of latent classes
Haaksma, M. L., Calderón‐Larrañaga, A., Rikkert, M. G. M. O., Melis, R. J. F., & Leoutsakos, J. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4893 · Cited by 39 · see citing works
Self-citationZahodne, L. B., Devanand, D. P., & Stern, Y. (2013) · Journal of Alzheimer s Disease · doi:10.3233/jad-121921 · Cited by 37 · see citing works
“Our finding of a significant longitudinal association between functional and cognitive changes in AD confirms and extends a previous report [7] by demonstrating that these outcomes are associated both between and within persons over time in a controlled, multivariate model.”
Adiponectin and sporadic Alzheimer’s disease: Clinical and molecular links
Letra, L., Rodrigues, T., Matafome, P. N., Santana, I. J., & Seiça, R. M. F. (2017) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2017.10.002 · Cited by 38 · see citing works
Yoneda, T. B., Lewis, N. A., Knight, J. E., Rush, J., Vendittelli, R., Kleineidam, L., Hyun, J., Piccinin, A. M., Hofer, S. M., Hoogendijk, E. O., et al. (2020) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaa268 · Cited by 37 · see citing works
“Consistent with previous literature (23,53), our findings indicate that across studies, male participants are more likely to transition from nonimpaired cognitive functioning to MCI and death, and from severe cognitive functioning to death (see Supplementary Table 4).”
ResultFan, Z., Harold, D. H., Pasqualetti, G., Williams, J. H., Brooks, D. J., & Edison, P. (2015) · Journal of Nuclear Medicine · doi:10.2967/jnumed.114.149443 · Cited by 36 · see citing works
Vernon, E. K., Cooley, B., Rozum, W., Rattinger, G. B., Behrens, S., Matyi, J., Fauth, E. B., Lyketsos, C. G., & Tschanz, J. T. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.11.010 · Cited by 36 · see citing works
Self-citationWatson, R., Sanson-Fisher, R., Bryant, J., & Mansfield, E. (2023) · BMC Public Health · doi:10.1186/s12889-023-15772-y · Cited by 36 · see citing works
“Deteriorating health and wellbeing [7, 26, 27], intensive [7] or limited treatment options [28], and negative impact on loved ones [29–31] are commonly associated with both cancer and dementia.”
BackgroundCognitive reserve and the severity of Alzheimer’s disease
Sobral, M., Pestana, M. H. D. A. P. E., & Paúl, C. (2015) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20150044 · Cited by 35 · see citing works
Glachet, O., & Haj, M. E. (2019) · Brain Sciences · doi:10.3390/brainsci9060135 · Cited by 33 · see citing works
“Given the prevalence of depression in AD patients [42] and its critical impact on autobiographical memory [43,44], we also expected a negative correlation between depression and the phenomenological characteristics of autobiographical memories (arousal, emotional valence subjective reliving and specificity) in this gr…”
BackgroundDistinct sex-specific DNA methylation differences in Alzheimer’s disease
C. Silva, T., Zhang, W., Young, J. I., Gomez, L., Schmidt, M. A., Varma, A., Chen, X. S., Martin, E. R., & Wang, L. (2022) · Alzheimer's Research & Therapy · doi:10.1186/s13195-022-01070-z · Cited by 33 · see citing works
“After diagnosis, women also progress faster with more rapid cognitive and functional decline [10, 11].”
BackgroundHaaksma, M. L., Rizzuto, D., Leoutsakos, J., Marengoni, A., Tan, E. C. K., Rikkert, M. G. M. O., Fratiglioni, L., Melis, R. J. F., & Calderón‐Larrañaga, A. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.03.025 · Cited by 33 · see citing works
Self-citationRattinger, G. B., Sanders, C. L., Vernon, E. K., Schwartz, S., Behrens, S., Lyketsos, C. G., & Tschanz, J. T. (2019) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1016/j.trci.2019.01.002 · Cited by 31 · see citing works
“This approach was previously applied to the DPS data when estimating costs [3].”
BackgroundMethodInfluentialSelf-citationPrevention of Unnecessary Hospitalization for Patients With Dementia
Lyketsos, C. G. (2012) · JAMA · doi:10.1001/jama.2011.2005 · Cited by 31 · see citing works
“The progression of dementia is highly variable, with as many as a third of cases progressing very little even after 5 years.(2) Several modifiable factors appear to affect its course and delay progression to severe dementia, the most disabling stage.”
BackgroundSelf-citationAffect Balance and Relationship With Well-Being in Nursing Home Residents With Dementia
Kolanowski, A. M., Haitsma, K. S. V., Meeks, S., & Litaker, M. S. (2014) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317513518657 · Cited by 30 · see citing works
Wu, C., Chu, C., Wang, F., Yang, H., Tseng, W.-S., Chang, C., & Chang, C. (2022) · Cell & Bioscience · doi:10.1186/s13578-022-00897-1 · Cited by 31 · see citing works
“presenting a long preclinical phase, with the initial deposition of AD pathology estimated to begin approximately 10–15 years before the onset of clinical symptoms [87, 88].”
BackgroundEikelboom, W. S., Singleton, E. H., van den Berg, E., Coesmans, M., Mattace-Raso, F. U. S., van Bruchem, R. L., Goudzwaard, J. A., de Jong, F. J., Koopmanschap, M. A., den Heijer, T., et al. (2019) · Alzheimer s Research & Therapy · doi:10.1186/s13195-019-0503-2 · Cited by 26 · see citing works
Predicting the Rate of Cognitive Decline in Alzheimer Disease
Canevelli, M., Kelaiditi, E., del Campo, N., Bruno, G., Vellas, B. J., & Cesari, M. (2015) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000124 · Cited by 26 · see citing works
“Longitudinal studies are increasingly documenting slow rates of progression among AD populations (16)(17)(25).”
BackgroundResultInfluentialClement, A., Wiborg, O., & Asuni, A. A. (2020) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2020.00056 · Cited by 26 · see citing works
- Authors
- Tschanz, J. T., Corcoran, C. D., Schwartz, S., Treiber, K., Green, R. C., Norton, M. C., Mielke, M. M., Piercy, K., Steinberg, M., Rabins, P. V., Leoutsakos, J.-M., Welsh-Bohmer, K. A., Breitner, J. C. S., & Lyketsos, C. G.
- Affiliations
- Utah State University (US)
- Boston University (US)
- Johns Hopkins University (US)
- Duke University (US)
- University of Washington (US)
- Corresponding author
- Tschanz, JoAnn T.
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 19
- Issue
- 6
- Pages
- 532-542
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC3101372
- OpenAlex
- W2014196617
- Semantic Scholar
- f0884283b020871180f9799273ae1011ce074273
- Cited by
- 244
- References
- 48
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 8 · 2023: 11 · 2022: 21 · 2021: 23 · 2020: 24 · 2019: 14 · 2018: 17 · 2017: 21 · 2016: 16 · 2015: 22 · 2014: 11 · 2013: 13 · 2012: 19
- FWCI
- 6.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion)
- PubMed Central (submittedVersion)
- Funders
- National Institutes of Health (5p30ag028377-05)
- National Institute on Aging (R01 AG 11380, T32AG 027668, P-30 AG028377, R01AG018712, R01 AG011380, R01AG021136, R01 AG18712, K24AG027841, P30AG013846, R01 AG 21136, P30-AG13846))
- National Human Genome Research Institute (R01 HG02213, R01 HG002213)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- Alzheimer's disease, dementia progression, cognitive decline, functional decline, neuropsychiatric symptoms, Mini-Mental State Examination, Clinical Dementia Rating, Neuropsychiatric Inventory, sex differences, age of onset, APOE ε4, population-based cohort
- MeSH terms
- Aged, 80 and over, Alleles, Alzheimer Disease, Cognition Disorders, Female, Humans, Male, Psychiatric Status Rating Scales, Sex Characteristics, Utah, Cohort Studies, Age of Onset, Disease Progression, Apolipoprotein E4
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-18.
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