Changes in cognition during the course of eight years in elderly Japanese Americans: A multistate transition model

Arnold Mitnitski, Nader Fallah, Yougui Wu, Kenneth Rockwood, Amy R. Borenstein

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Resumen

Purpose: To analyze cognitive changes in relation to mortality with the use of a multistate transition model. Methods: In a prospective cohort study of Japanese Americans living in King County, WA, study (n = 1985) cognitive states were defined as the errors in the Cognitive Abilities Screening Instrument score. Transition probabilities were modeled by the use of a modified Poisson distribution with the Poisson mean and mortality dependent on the cognitive state and covariates. Results: During an 8-year follow-up, 21.5% died (95% confidence interval [95% CI], 19.3-23.7), 26.6% experienced cognitive decline (95% CI, 24.2-29.1), and 51.9% remained stable or improved cognitively (95% CI, 49.2-54.6). In multivariable analyses, improvements were notably more likely to occur among younger, more-educated people and in women. Older age, male sex, and less education were each significantly related to mortality. Conclusions: A multistate transition model can be used to estimate the impact of covariates on the individual probabilities of cognitive improvement, stability, decline, and death. This approach can have advantages for considering how interventions might work on patterns of cognitive change over time, especially if factors associated with the prevention of decline are also associated with risk of death.

Idioma originalEnglish
Páginas (desde-hasta)480-486
Número de páginas7
PublicaciónAnnals of Epidemiology
Volumen20
N.º6
DOI
EstadoPublished - jun. 2010

Nota bibliográfica

Funding Information:
These analyses were supported by the Canadian Institutes for Health Research (CIHR) operating grant MOP-64169 and by the Dalhousie Medical Research Foundation (DMRF) . All the data reported here were gathered with National Institute of Health funding R01 AG09769 (Kame Project) and public funding from the National Health Research Development Program, which administrated a grant from the Seniors' Independence Research program ( 6606-3954-MC(S) ). Additional support came from the Dalhousie Medical Research Foundation (career support to K.R. as Kathryn Allen Weldon Professor of Alzheimer Research) and the Fountain Innovation Fund of the QEII Research Foundation and Mathematics, Information Technologies and Computer Science (MITACS) postdoctoral award. The decision to submit this work was entirely the decision of the authors and not the sponsors, who had no role in design, analysis or writing of the article.

ASJC Scopus Subject Areas

  • Epidemiology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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