The Utility of Assessing Health-Related Quality of Life to Predict Cognitive Decline and Dementia

Article type: Research Article

Authors: Phyo, Aung Zaw Zaw^a | Gonzalez-Chica, David A.^{b; c} | Stocks, Nigel P.^b | Storey, Elsdon^a | Woods, Robyn L.^a | Murray, Anne M.^{d; e} | Orchard, Suzanne G.^a | Shah, Raj C.^f | Gasevic, Danijela^{a; g} | Freak-Poli, Rosanne^{a; h; 2} | Ryan, Joanne^{a; i; 2; *} | on behalf of the ASPREE Investigator Group¹

Affiliations: [a] School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia | [b] Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia | [c] Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia | [d] Berman Center for Outcomes and Clinical Research, Hennepin HealthCare Research Institute, Hennepin HealthCare Minneapolis, Minnesota, MN, USA | [e] Division of Geriatrics, Department of Medicine, Hennepin HealthCare and University of Minnesota, Minneapolis, Minnesota, MN, USA | [f] Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [g] Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, UK | [h] Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands | [i] PSNREC, Univ Montpellier, INSERM, Montpellier, France

Correspondence: [*] Correspondence to: Associate Professor Joanne Ryan, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 5, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, VIC 3004, Australia. E-mail: joanne.ryan@monash.edu.

Note: [1] These authors contributed equally as co-senior authors.

Note: [2] ASPREE Investigator Group listed on http://www.aspree.org.

Abstract: Background:Health-related quality of life (HRQoL) has been shown to predict adverse health outcome in the general population. Objective:We examined the cross-sectional association between HRQoL and cognitive performance at baseline. Next, we explored whether baseline HRQoL predicted 5-year incident cognitive decline and dementia and whether there were gender differences. Methods:19,106 community-dwelling participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, aged 65–98 years, free of major cognitive impairments, and completed the HRQoL 12-item short-form (SF-12) at baseline (2010–2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were calculated. The cognitive tests were assessed at baseline, year 1, 3, 5, and 7 or close-out visit. Cognitive decline was defined as > 1.5 SD drop from baseline on any of the cognitive tests. Dementia was adjudicated according to DSM-IV criteria. Linear and Cox proportional-hazards regressions were used to examine the cross-sectional and longitudinal associations respectively. Results:At baseline, higher PCS and MCS were associated with better cognition. Over a median 4.7-year follow-up, higher MCS was associated with a reduced risk of cognitive decline and dementia (12% and 15% respectively, per 10-unit increase) and a 10-unit higher PCS was associated with a 6% decreased risk of cognitive decline. PCS did not predict dementia incidence. Findings were not different by gender. Conclusion:Our study found that higher HRQoL, in particular MCS, predicted a reduced risk of cognitive decline and dementia over time in community-dwelling older people.

Keywords: Cognition, cognitive dysfunction, dementia, health-related quality of life (HRQoL), quality of life

DOI: 10.3233/JAD-201349

Journal: Journal of Alzheimer's Disease, vol. 80, no. 2, pp. 895-904, 2021