Project 2 studies the longitudinal relationships between cognitive impairment in older persons and both strengths and deficits in adaptive functioning and other qualities of life. We concentrate on the borderzone range of cognitive impairment with an intermediate probability of being diagnosed as dementia (ADRD): some borderzone subjects meet criteria for a diagnosis of near equal distributions of Latinos, African- Americans and Caucasians. We hypothesize that subjects in the borderzone of cognitive impairment, who are diagnosed at NOT ADRD: 1. Show an increased prevalence and incidence of impairments in function/quality. 2. Have a higher incidence (especially if there are impairments in function/quality) of ADRD than normal subjects. 3. Have rates of impairment and ADRD incidence which are influenced by socio-cultural factors (especially ethnicity and income). 4. Show an increase in service utilization; especially prolonged hospitalization with co-morbid medical conditions, and when subjects become eligible with ADRD. 6. Show more positive aspects of function/quality than borderzone subjects diagnosed as ADRD; these will persist over long periods of time. Cognitive impairment is defined by test scores. Adaptive function refers to activities of daily living at the basic, instrumental and higher levels. Other qualities of life include depression, symptomatic distress, social activities, disturbing behavior, self-perceived ill- health, and subjective memory complaints. Intervening variables include socio-culture (e.g. education, income, culture, social support), co- morbid conditions (e.g. Parkinson's disease, stroke, other medical conditions) as well as Alzheimer's disease. Subjects are those entered into the NMAP Registry in 1993: from the Reporting System (651 in borderzone range) and the Survey (645 in borderzone). Assessment information will include annual reinterviews (1994-1997) with all Registry subjects (Reported and Survey components), neuropsychology and informant interviews for borderzone subjects, medical evaluation and diagnosis for subjects in the borderzone or more impaired range; brain imaging and laboratory testing of functioning in subsamples.
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