ArticleThe lancet. Healthy longevity2021
Comparison of the predictive accuracy of multiple definitions of cognitive impairment for incident dementia: a 20-year follow-up of the Whitehall II cohort study.
Article in The lancet. Healthy longevity, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed, 7 citations in OpenAlex.
- Olfactory dysfunction increases progression to dementia in cognitively impaired older adults: a 12-year population-based study.GeroScience · 2026Article
- Adverse childhood experiences, early menopause, cognition, and dementia in older adults in the United States.Communications health · 2026Article
- Developing and testing AI-based voice biomarker models to detect cognitive impairment among community dwelling adults: a cross-sectional study in Japan.The Lancet regional health. Western Pacific · 2025Article
- Combinations of multimodal neuroimaging biomarkers and cognitive test scores to identify patients with cognitive impairment.Frontiers in aging neuroscience · 2025Article
- Pathways explaining racial/ethnic and socio-economic disparities in incident all-cause dementia among older US adults across income groups.Translational psychiatry · 2022Article
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundStudies generally use cognitive assessment done at one timepoint to define cognitive impairment in order to examine conversion to dementia. Our objective was to examine the predictive accuracy and conversion rate of seven alternate definitions of cognitive impairment for dementia.
methodsIn this prospective study, we included participants from the Whitehall II cohort study who were assessed for cognitive impairment in 2007-09 and were followed up for clinically diagnosed dementia. Algorithms based on poor cognitive performance (defined using age-specific and sex-specific thresholds, and subsequently thresholds by education or occupation levels) and objective cognitive decline (using data from cognitive assessments in 1997-99, 2002-04, and 2007-09) were used to generate seven alternate definitions of cognitive impairment. We compared predictive accuracy using Royston's
findings5687 participants, with a mean age of 65·7 years (SD 5·9) in 2007-09, were included and followed up for a median of 10·5 years (IQR 10·1-10·9). Over follow-up, 270 (4·7%) participants were clinically diagnosed with dementia. Cognitive impairment defined using both cognitive performance and decline had higher hazard ratios (from 5·08 [95% CI 3·82-6·76] to 5·48 [4·13-7·26]) for dementia than did definitions based on cognitive performance alone (from 3·25 [2·52-4·17] to 3·39 [2·64-4·36]) and cognitive decline alone (3·01 [2·37-3·82]). However, all definitions had poor predictive performance (C-statistic ranged from 0·591 [0·565-0·616] to 0·631 [0·601-0·660]), primarily due to low sensitivity (21·6-48·4%). A predictive model containing age, sex, and education without measures of cognitive impairment had better predictive performance (C-statistic 0·783 [0·758-0·809], sensitivity 74·2%, specificity 72·2%) than all seven definitions of cognitive impairment (all p<0·0001).
interpretationThese findings suggest that cognitive impairment in early old age might not be useful for dementia prediction, even when it is defined using longitudinal data on cognitive decline and thresholds of poor cognitive performance additionally defined by education or occupation.
fundingNational Institutes of Health, UK Medical Research Council.
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