Does the Cognitive Change Index Predict Future Cognitive and Clinical Decline? Longitudinal Analysis in a Demographically Diverse Cohort

Article type: Research Article

Authors: Nester, Caroline O.^{a; b; *} | Gao, Qi^c | Katz, Mindy J.^d | Mogle, Jacqueline A.^e | Wang, Cuiling^{c; d} | Derby, Carol A.^{c; d} | Lipton, Richard B.^{c; d; f} | Saykin, Andrew J.^g | Rabin, Laura A.^{a; h}

Affiliations: [a] Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA | [b] Department of Psychology, Queens College, City University of New York, Queens, NY, USA | [c] Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA | [d] The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA | [e] College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA | [f] Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA | [g] Department of Radiology and Imaging Sciences, Indiana Alzheimer’s Disease Research Center, IU Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA | [h] Department of Psychology, Brooklyn College, City University of New York, Brooklyn, NY, USA

Correspondence: [*] Correspondence to: Caroline O. Nester, Department of Psychology, The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, USA. Tel.: +1 212 817 7000; E-mail: [email protected].

Abstract: Background:The Cognitive Change Index (CCI) is a widely-used measure of self-perceived cognitive ability and change. Unfortunately, it is unclear if the CCI predicts future cognitive and clinical decline. Objective:We evaluated baseline CCI to predict transition from normal cognition to cognitive impairment in nondemented older adults and in predementia groups including, subjective cognitive decline, motoric cognitive risk syndrome, and mild cognitive impairment. Different versions of the CCI were assessed to uncover any differential risk sensitivity. We also examined the effect of ethnicity/race on CCI. Methods:Einstein Aging Study participants (N = 322, Mage = 77.57±4.96, % female=67.1, Meducation = 15.06±3.54, % non-Hispanic white = 46.3) completed an expanded 40-item CCI version (CCI-40) and neuropsychological evaluation (including Clinical Dementia Rating Scale [CDR], Montreal Cognitive Assessment, and Craft Story) at baseline and annual follow-up (Mfollow - up=3.4 years). CCI-40 includes the original 20 items (CCI-20) and the first 12 memory items (CCI-12). Linear mixed effects models (LME) and generalized LME assessed the association of CCI total scores at baseline with rate of decline in neuropsychological tests and CDR. Results:In the overall sample and across predementia groups, the CCI was associated with rate of change in log odds on CDR, with higher CCI at baseline predicting faster increase in the odds of being impaired on CDR. The predictive validity of the CCI broadly held across versions (CCI-12, 20, 40) and ethnic/racial groups (non-Hispanic black and white). Conclusions:Self-perception of cognitive change on the CCI is a useful marker of dementia risk in demographically/clinically diverse nondemented samples. All CCI versions successfully predicted decline.

Keywords: Alzheimer’s disease, cognitive change index, ethnic/racial minoritized groups, mild cognitive impairment, motoric cognitive risk syndrome, non-Hispanic Black older adults, normal aging, subjective cognitive decline

DOI: 10.3233/JAD-230752

Journal: Journal of Alzheimer's Disease, vol. 98, no. 1, pp. 319-332, 2024