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Prodromal cognitive signs of dementia in 85-year-olds using four sources of information

From the Neuropsychiatric Epidemiology Unit (Drs. Sacuiu, Sjögren, Gustafson, and Skoog), Psychiatry Section, Institute of Clinical Neuroscience, Sahlgrenska Academy, and Institute of Psychology (Dr. Johansson), Göteborg University, Sweden.

Address correspondence and reprint requests to Dr. S. Sacuiu, Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; e-mail: simona.sacuiu{at}neuro.gu.se

Objective: To evaluate the utility of assessing four cognitive domains obtained from four information sources to identify individuals at risk for developing dementia, Alzheimer disease (AD), and vascular dementia (VaD).

Methods: A representative population sample of nondemented 85-year-olds (n = 313) from Gothenburg, Sweden, was examined regarding memory, language, and visuospatial and executive functions, using self- and key informant reports and neuropsychiatric and psychometric examinations. The sample was followed 3 years for incident dementia, AD, or possible VaD.

Results: All cases of dementia, AD, and VaD were preceded by low performance in most domains irrespective of information source. Isolated low memory performance or low cognitive performance with unimpaired memory did not predict dementia. Positive predictive values increased with number of domains affected. Self- and key informant reports were less useful for predicting dementia than neuropsychiatric and psychometric examinations. The best positive predictive value (88%) was for low cognitive performance in all domains using neuropsychiatric and psychometric examinations; however, sensitivity was only 18%.

Conclusions: Although memory impairment was necessary to predict dementia, it was not sufficient. Other cognitive domains needed to be affected. Relying on self-reports or key informants for early detection of dementia excluded a large group at risk. In addition, vascular dementia appeared to have a prodromal stage.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 27 issue to find the title link for this article.

Supported by grants from the Swedish Medical Research Council (grant no. 11267), Swedish Council for Working Life and Social Research (no. 2835), Stiftelsen Söderström-Königska Sjukhemmet, Stiftelsen för Gamla Tjänarinnor, Handlanden Hjalmar Svenssons Forskningsfond, and Stiftelsen Professor Bror Gadelius' Minnesfond.

Disclosure: The authors report no conflicts of interest.

Received April 11, 2005. Accepted in final form September 12, 2005.

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