Development and Preliminary Validation of Standardized Regression-Based Change Scores as Measures of Transitional Cognitive Decline

Abstract

Objective: An increasing focus in Alzheimer's disease and aging research is to identify transitional cognitive decline. One means of indexing change over time in serial cognitive evaluations is to calculate standardized regression-based (SRB) change indices. This paper includes development and preliminary validation of SRB indices for the Uniform Data Set 3.0 Neuropsychological Battery, as well as base rate data to aid in their interpretation.

Method: The sample included 1341 cognitively intact older adults with serial assessments over 0.5-2 years in the National Alzheimer's Coordinating Center Database. SRB change scores were calculated in half of the sample, then validated in the other half of the sample. Base rates of SRB decline were evaluated at z-score cut-points, corresponding to two-tailed p-values of .20 (z = -1.282), 0.10 (z = -1.645) and .05 (z = -1.96). We examined convergent associations of SRB indices for each cognitive measure with each other, as well as concurrent associations of SRB indices with Clinical Dementia Rating sum of box scores (CDR-SB).

Results: SRB equations were able to significantly predict the selected cognitive variables. The base rate of at least one significant SRB decline across the entire battery ranged from 28.91% to 64.90%. SRB indices for cognitive measures demonstrated theoretically expected significant positive associations with each other. Additionally, CDR-SB impairment was associated with decline on three different SRB indices.

Conclusions: This paper provides preliminary validation of SRB indices in a large sample, and we present a user-friendly tool for calculating SRB values.

Keywords: Assessment; Norms; Standardized regression-based change; Transitional cognitive decline; Uniform data set.