Retest learning impacts estimates of cognitive aging, but its bases are uncertain. Here, we test the hypothesis that dementia-related neurodegeneration impairs retest learning. Older persons without cognitive impairment at enrollment (n = 567) had annual cognitive testing for a mean of 11 years, died, and had a neuropathologic examination to quantify 5 neurodegenerative pathologies. Change point models were used to divide cognitive trajectories into an early retest sensitive component and a later component less sensitive to retest. Performance on a global cognitive measure (baseline mean = 0.227, standard deviation = 0.382) increased an estimated mean of 0.142-unit per year for a mean of 1.5 years and declined an estimated mean of 0.123-unit per year thereafter. No pathologic marker was related to cognitive change before the change point; each was related to cognitive decline after the change point. Results were comparable in analyses that used specific cognitive outcomes, included 220 individuals with mild cognitive impairment at enrollment, or allowed a longer retest learning period. The findings suggest that neurodegeneration does not impact cognitive retest learning.
Keywords: Alzheimer's disease; Clinical-pathologic study; Cognitive decline; Longitudinal study; Retest learning; TDP-43 pathology.
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