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Open Access Research article

A comparison of parametric models for the investigation of the shape of cognitive change in the older population

Graciela Muniz Terrera1*, Fiona Matthews1 and Carol Brayne2

Author Affiliations

1 MRC Biostatistics Unit, Institute of Public Health, Robinson Way, University Forvie Site, CB2 0SR, Cambridge, UK

2 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, CB2 0SR, Cambridge, UK

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BMC Neurology 2008, 8:16  doi:10.1186/1471-2377-8-16

Published: 16 May 2008

Abstract

Background

Cognitive decline is a major threat to well being in later life. Change scores and regression based models have often been used for its investigation. Most methods used to describe cognitive decline assume individuals lose their cognitive abilities at a constant rate with time. The investigation of the parametric curve that best describes the process has been prevented by restrictions imposed by study design limitations and methodological considerations. We propose a comparison of parametric shapes that could be considered to describe the process of cognitive decline in late life.

Attrition plays a key role in the generation of missing observations in longitudinal studies of older persons. As ignoring missing observations will produce biased results and previous studies point to the important effect of the last observed cognitive score on the probability of dropout, we propose modelling both mechanisms jointly to account for these two considerations in the model likelihood.

Methods

Data from four interview waves of a population based longitudinal study of the older population, the Cambridge City over 75 Cohort Study were used. Within a selection model process, latent growth models combined with a logistic regression model for the missing data mechanism were fitted. To illustrate advantages of the model proposed, a sensitivity analysis of the missing data assumptions was conducted.

Results

Results showed that a quadratic curve describes cognitive decline best. Significant heterogeneity between individuals about mean curve parameters was identified. At all interviews, MMSE scores before dropout were significantly lower than those who remained in the study. Individuals with good functional ability were found to be less likely to dropout, as were women and younger persons in later stages of the study.

Conclusion

The combination of a latent growth model with a model for the missing data has permitted to make use of all available data and quantify the effect of significant predictors of dropout on the dropout and observational processes. Cognitive decline over time in older persons is often modelled as a linear process, though we have presented other parametric curves that may be considered.