Related Experiment Video
Updated: Apr 4, 2026

The 4 Mountains Test: A Short Test of Spatial Memory with High Sensitivity for the Diagnosis of Pre-dementia Alzheimer's Disease
Published on: October 13, 2016
Trajectories of decline in cognition and daily functioning in preclinical dementia
Vincentius J A Verlinden1, Jos N van der Geest2, Renée F A G de Bruijn3
1Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Introduction:
Although preclinical dementia is characterized by decline in cognition and daily functioning, little is known on their temporal sequence. We investigated trajectories of cognition and daily functioning in preclinical dementia, during 18 years of follow-up.
Methods:
In 856 dementia cases and 1712 controls, we repetitively assessed cognition and daily functioning with memory complaints, mini-mental state examination (MMSE), instrumental activities of daily living (IADL), and basic activities of daily living (BADL).
Results:
Dementia cases first reported memory complaints 16 years before diagnosis, followed by decline in MMSE, IADL, and finally BADL. Vascular dementia related to earlier decline in daily functioning but later in cognition, compared with Alzheimer's disease. Higher education related to larger preclinical cognitive decline, whereas apolipoprotein E (APOE) ε4 carriers declined less in daily functioning.
Discussion:
These results emphasize the long hierarchical preclinical trajectory of functional decline in dementia. Furthermore, they show that various pathologic, environmental, and genetic factors may influence these trajectories of decline.
More Related Videos
Related Concept Videos
Alzheimer's Disease: Overview
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...
Dementia
The progression of dementia is generally gradual....
Cognitive Development During Adulthood
Alzheimer's Disease: Treatment
Long-term Depression
Calcium Ion Concentration Mechanism
If over...
Amnesia
The severity and duration of memory loss vary depending on the type and underlying cause. Amnesia is classified into two main types: retrograde and anterograde.
Retrograde amnesia is marked by the loss of memories formed before the onset of the condition. Patients may recall distant past events but often forget those occurring shortly before the incident.
Anterograde...

