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Onset and rate of cognitive change before dementia diagnosis: findings from two Swedish population-based longitudinal studies

Journal article
Authors Valgeir Thorvaldsson
Stuart W S Macdonald
Laura Fratiglioni
Bengt Winblad
Miia Kivipelto
Erika Jonsson Laukka
Ingmar Skoog
Simona Sacuiu
Xinxin Guo
Svante Östling
Anne Börjesson-Hanson
Deborah Gustafson
Boo Johansson
Lars Bäckman
Published in Journal of the International Neuropsychological Society
Volume 17
Issue 1
Pages 154-62
ISSN 1469-7661
Publication year 2011
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Department of Psychology
Pages 154-62
Language en
Keywords Cognitive decline, Preclinical dementia, Change point, Accelerated change, Fluid abilities, Crystallized abilities
Subject categories Psychiatry, Psychology


We used data from two population-based longitudinal studies to estimate time of onset and rate of accelerated decline across cognitive domains before dementia diagnosis. The H70 includes an age-homogeneous sample (127 cases and 255 non-cases) initially assessed at age 70 with 12 follow-ups over 30 years. The Kungsholmen Project (KP) includes an age-heterogeneous sample (279 cases and 562 non-cases), with an average age of 82 years at initial assessment, and 4 follow-ups spanning 13 years. We fit mixed linear models to the data and determined placement of change points by a profile likelihood method. Results demonstrated onset of accelerated decline for fluid (speed, memory) versus crystallized (verbal, clock reading) abilities occurring approximately 10 and 5 years before diagnosis, respectively. Although decline before change points was greater for fluid abilities, acceleration was more pronounced for crystallized abilities after the change points. This suggests that onset and rate of acceleration vary systematically along the fluid-crystallized ability continuum. There is early onset in fluid abilities, but these changes are difficult to detect due to substantial age-related decline. Onset occurred later and acceleration was greater in crystallized abilities, suggesting that those markers may provide more valid identification of cases in later stages of the prodromal phase.

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