Longitudinal Patterns and Predictors of Cognitive Impairment Classification Stability

Classifications such as Cognitive Impairment, No Dementia (CIND) are thought to represent the transitory, pre-clinical phase of dementia. However, increasing research demonstrates that CIND represents a nonlinear, unstable entity that does not always lead to imminent dementia. The present study utilizes a longitudinal repeated measures design to gain a thorough understanding of CIND classification stability patterns and identify predictors of future stability. The objectives were to i) explore patterns of longitudinal stability in cognitive status across multiple assessments and ii) investigate whether select baseline variables could predict 6-year CIND stability patterns.

Participants (N = 259) included older adults (aged 65-90 years) from Project MIND, a six-year longitudinal repeated measures design in which participants were classified as either normal cognition (NC) or CIND at each annual assessment. A latent transition analysis approach was adapted in order to identify and characterize transitions in CIND status across annual assessments. Participants were classified as either Stable NC, Stable CIND, Progressers, Reverters, or Fluctuaters. Multinomial logistic regression was employed to test whether baseline predictors were associated with cognitive status stability patterns.

The sample demonstrated high rates of reversion and fluctuation in CIND status across annual assessments. Additionally, premorbid IQ and CIND severity (i.e., single vs. multi-domain impairment) at baseline were significantly associated with select stability outcomes.

CIND status was unstable for several years following baseline assessment and cognitive reserve may delay or protect against demonstrable cognitive impairment. Further, consideration of cognitive impairment severity at the time of initial classification may improve CIND classifications.