All ETDs from UAB

Advisory Committee Chair

Virginia G Wadley

Advisory Committee Members

Olivio J Clay

Michael Crowe

Virginia J Howard

Richard E Kennedy

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

The AD8 is a sensitive and specific screening measure of mild dementia, although less research exists pertaining to its use as a self-report measure and in non-clinical samples. This study examined the relationship of incident cognitive impairment and cognitive decline over a 10-year span to self-reported dementia symptoms and functional impairment in the national, population-based, longitudinal, and prospective REasons for Geographic and Racial Differences in Stroke (REGARDS) sample (N = 14,453). A validated cutoff of ≥ 2 symptoms endorsed on the AD8 was used for dementia status. Functional status was determined by 5 activities of daily living (ADL) and 7 instrumental activities of daily living (IADL) items that were coded as independent vs. having difficulty/needing assistance. Incident cognitive impairment was defined via change from intact to impaired status in Six-Item Screener (SIS) score, and cognitive decline was defined by trajectories computed for animal fluency (AF), letter F fluency (LF), Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word list learning (WLL), and CERAD word list delayed recall (WLD). Logistic regression models controlled for demographic variables, health behaviors, and vascular risk factors and disease at baseline, and depressive symptoms at 10-year follow-up (i.e., 10-item Center for Epidemiological Studies Depression Scale). Incident cognitive impairment significantly increased the odds of self-reporting dementia and IADL impairment by 96% and 59%, respectively. A one word decline in WLL significantly increased the odds of self-reporting dementia (27%), ADL impairment, and IADL impairment (16%, respectively). The findings of this study elucidate the relationship of cognitive change over time to self-reported dementia symptoms and functional impairment in a large, population-based sample.

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