Cognitive and functional progression of dementia in two longitudinal studies

Yuwei Wang, Miriam L. Haaksma, Inez H. G. B. Ramakers, Frans R. J. Verhey, Wiesje M. van de Flier, Philip Scheltens, Ingrid van Maurik, Marcel G. M. Olde Rikkert, Jeannie-Marie S. Leoutsakos, Rene J. F. Melis*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives Previous studies have identified several subgroups (ie, latent trajectories) with distinct disease progression among people with dementia. However, the methods and results were not always consistent. This study aims to perform a coordinated analysis of latent trajectories of cognitive and functional progression in dementia across two datasets. Methods Included and analyzed using the same statistical approach were 1628 participants with dementia from the US National Alzheimer's Coordinating Center (NACC) and 331 participants with dementia from the Dutch Clinical Course of Cognition and Comorbidity study (4C-Study). Trajectories of cognition and instrumental activities of daily living (IADL) were modeled jointly in a parallel-process growth mixture model. Results Cognition and IADL tended to decline in unison across the two samples. Slow decline in both domains was observed in 26% of the US sample and 74% of the Dutch sample. Rapid decline in cognition and IADL was observed in 7% of the US sample and 26% of the Dutch sample. The majority (67%) of the US sample showed moderate cognitive decline and rapid IADL decline. Conclusions Trajectories of slow and rapid dementia progression were identified in both samples. Despite using the same statistical methods, the number of latent trajectories was not replicated and the relative class sizes differed considerably across datasets. These results call for careful consideration when comparing progression estimates in the literature. In addition, the observed discrepancy between cognitive and functional decline stresses the need to monitor dementia progression across multiple domains.
Original languageEnglish
Pages (from-to)1623-1632
Number of pages10
JournalInternational Journal of Geriatric Psychiatry
Issue number11
Early online date26 Jul 2019
Publication statusPublished - Nov 2019


  • cognition
  • coordinated analysis
  • daily functioning
  • dementia progression
  • growth mixture model
  • trajectory

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