Trajectory of mild cognitive impairment onset

The objective was to identify the trajectories of onset of memory and other cognitive loss in persons destined to develop mild cognitive impairment (MCI) or dementia. Healthy, community dwelling, cognitively intact elders (if 156. mean a,,e at entry = 83 years) were examined annually for ail average of greater than 7 years. Those who developed at least two consecutive Clinical Dementia Ratings >= 0.5 were classified as having MCI. Longitudinal mixed effects models with a change point were used to model the aging process in those with and without an MCI diagnosis during follow-up and to model the rate of change relative to the age of onset of MCI. MCI had a preclinical stage of accelerated cognitive loss that was observed 3 to 4 years before the diagnosis of MCI on tests of verbal memory, animal trial fluency, and visuospatial constructions. Evidence from memory performance before the change point suggests that a slow decline in memory precedes the period of accelerated decline in the development of MCI. Aging transitions leading to MCI and dementia are characterized by unique linear and nonlinear cognitive changes in several domains that precede the diagnosis of MCI and dementia by at least several years.