2 research outputs found
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Longitudinal decline in semantic versus letter fluency, but not their ratio, marks incident Alzheimer’s disease in Latinx Spanish-speaking older individuals
Objective: To compare longitudinal verbal fluency performance among Latinx Spanish speakers who develop Alzheimer’s disease to those who do not develop dementia in absolute number of words produced on each task and their ratio to combine both scores.
Method: Participants included 833 Latinx Spanish-speaking older adults from a community-based prospective cohort in Manhattan. We performed growth curve modeling to investigate the trajectories of letter and semantic fluency, and their ratio (i.e., ‘semantic index’), between individuals who developed Alzheimer’s disease and those who did not (i.e., controls). The semantic index quantifies the proportion of words generated for semantic fluency in relation to the total verbal fluency performance.
Results: Letter fluency performance did not decline in controls; we observed a linear decline in those who developed Alzheimer’s disease. Semantic fluency declined in both groups and showed an increased rate of change over time in the incident Alzheimer’s disease group; in comparison, the control group had a linear and slower decline. There were no group differences in the longitudinal trajectory (intercept and slope) of the semantic index.
Conclusion: A decline in letter fluency and a more rapid and accelerating decline over time in semantic fluency distinguished people who developed Alzheimer’s disease from controls. Using the semantic index was not a superior marker of incident Alzheimer’s disease compared to examining the two fluency scores individually. Results suggest the differential decline in verbal fluency tasks, when evaluated appropriately, may be useful for early identification of Alzheimer’s disease in Latinx Spanish speakers, a historically understudied population.
Keywords: category fluency, phonemic fluency, language, dementia, Hispani
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The presence of moderate extrapyramidal signs predicts poorer outcomes in a community‐based cohort of multi‐ethnic demented elders: Developing topics
Background: Extrapyramidal signs (EPS) are a common feature of Alzheimer's Disease (AD) associated with worse outcomes in observational studies of dementia. Prior studies have been primarily conducted in predominately white, clinic‐based samples. Less is known regarding the role of EPS in the disease course of dementia in ethnic minority and non‐clinic‐based populations.
Method: Predictors 3 (P3) is a multi‐ethnic community‐based cohort study of dementia. Recruitment began in 2011 and is ongoing. Participants are evaluated annually by trained investigators. 142 P3 participants with a baseline diagnosis of probable dementia were selected for this study. Moderate EPS was defined as a score of 2 or more on selected items from the Unified Parkinson's Disease Rating Scale. The cognitive endpoint was defined as a score of = 10 on the 17‐point Blessed Dementia Rating Scale, and the institutional equivalent endpoint as need for equivalent to nursing home care. Adjusted Cox models were fitted for time to death and cognitive, functional, and institutional equivalent endpoints with baseline moderate EPS as predictor. Effect modification was assessed by fitting cross‐product terms for moderate EPS by ethnicity, sex, age, education, and APOE polymorphism.
Result: Mean follow‐up time was 3.61 years (range: 0.29 ‐ 7.50, SD = 1.95). 33 participants (23.2%) had moderate EPS at baseline. 53 died (37.3%), 23 (17.2%) reached the cognitive endpoint, 45 (36.3%) the functional endpoint, and 44 (37.9%) the institutional equivalent endpoint post‐baseline. Moderate EPS at baseline was significantly associated with an increased hazard of death (HR = 2.57, 95% CI = 1.30, 5.10) and of reaching the functional endpoint (5.59, 95% CI = 2.36, 13.27). Associations between moderate EPS and the cognitive and institutional equivalent endpoints were not statistically significant. No evidence was found for effect modification of associations on either additive or multiplicative scales.
Conclusion: In a multi‐ethnic community‐dwelling cohort of demented elders, we found that baseline moderate EPS significantly predicted time to death and time to functional endpoint, but not time to cognitive and institutional equivalent care endpoints. These findings confirm those of previous studies conducted on predominately white, clinic‐based samples