Incidence of the progression and remission of cognitive decline in older adults
Main Article Content
Keywords
Incidence, Cognition, Prevalence Ratio
Abstract
Abstract
Background: In communities with higher social inequality, tracking the progression and remission of cognitive dysfunction (PR-CD) and its associated factors provides an epidemiological overview of dementia risk.
Objective: To investigate the incidence and factors associated with PR-CD in older adults (OAs) at three clinics of the Mexican Social Security Institute in an industrial area of Western Mexico State.
Material and methods: A two-year longitudinal study of 231 OAs (≥ 60 years) assessed cognitive function using the Montreal Cognitive Assessment (MoCA). After 2 years, outcomes were categorized into three groups: healthy cognitive function (MoCA scores > 20 on all three measurements), remitting cognitive impairment (one or two measurements with MoCA scores < 20), and progressive cognitive impairment (MoCA scores < 20 on all three measurements). Additionally, sociodemographic, clinical, and functional data were collected. Cumulative incidence and relative risk factors were analyzed using regression.
Results: The sample consisted of individuals with six or fewer years of schooling, and 70% identified as female. The incidence of P-CD was 28.1%, while that of R-CD was 32.5%. Factors associated with R-CD included low cognitive reserve and diminished physical performance. In contrast, factors linked to P-CD included age, low educational attainment, low cognitive reserve, age-related sarcopenia, education-related sarcopenia, age-related instrumental Activities of Daily Living (IADLs), and the interaction among age, cognitive reserve, IADLs, and SPBB.
Conclusion: In a region of social inequality in Western Mexico State, there is a high incidence of R-CD and P-CD, associated with risk factors that contribute to cognitive dysfunction among OAs.
References
1. Stephan BCM, Cochrane L, Kafadar AH, et al. Population attributable fractions of modifiable risk factors for dementia: a systematic review and meta-analysis. Lancet Healthy Longev. 2024;5(6):e406-e421. doi: 10.1016/S2666-7568(24)00061-8. PMID: 38824956; PMCID: PMC11139659.
2. Mukadam N, Wolters FJ, Walsh S, et al. Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies. Lancet Public Health. 2024 Jul;9(7):e443-e460. doi: 10.1016/S2468-2667(24)00120-8. Erratum in: Lancet Public Health. 2024;9(10):e718. doi: 10.1016/S2468-2667(24)00212-3.
3. Ribeiro FS, Teixeira-Santos AC, Leist AK. The prevalence of mild cognitive impairment in Latin America and the Caribbean: a systematic review and meta-analysis. Aging Ment Health. 2022;26(9):1710-1720. doi: 10.1080/13607863.2021.2003297.
4. Bartley MM, Baer-Benson H, Schroeder DR, et al. Social Determinants of Health among Older Adults with Dementia in Urban and Rural Areas. J Prev Alzheimers Dis. 2023;10(4):895-902. doi: 10.1007/s42414-023-0002-2.
5. Connell CM, Janevic MR, Gallant MP. Los costos del cuidado: impacto de la demencia en los cuidadores familiares. J Geriatr Psychiatry Neurol. 2001;14:179-87.
6. Dautzenberg G, Lijmer J, Beekman A. Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls. Int J Geriatr Psychiatry. 2020;35(3):261-269.
7. Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572-628. doi: 10.1016/S0140-6736(24)01296-0.
8. Jessen F, Amariglio RE, Buckley RF, et al. The characterisation of subjective cognitive decline. Lancet Neurol. 2020;19(3):271-278. doi: 10.1016/S1474-4422(19)30368-0.
9. García-Herranz S, Díaz-Mardomingo MC, Peraita H. Evaluación y seguimiento del envejecimiento sano y con deterioro cognitivo leve (DCL) a través del TAVEC. Anales de Psicología. 2014;30(1):372-379. doi: 10.6018/ANALESPS.30.1.150711.
10. Fasnacht JS, Wueest AS, Berres M, et al. Conversion between the Montreal Cognitive Assessment and the Mini-Mental Status Examination. J Am Geriatr Soc. 2023;71(3):869-879. doi: 10.1111/jgs.18124.
11. Araujo MA, González-Rivas JP. Physical activity in adults: considerations for its prescription and proper implementation. Rev Venez Endocrinol Metab. 2019;17(3):93-101. Disponible en: https://www.redalyc.org/journal/3755/375563338002/375563338002.pdf
12. Instituto Nacional de Geriatría. Guía de Instrumentos de Valoración Geriátrica Integral. Ciudad de México: Instituto Nacional de Geriatría; 2020. Disponible en: https://www.gob.mx/inger/documentos/guia-de-instrumentos-de-evaluacion-geriatrica-integral
13. Sánchez-Arenas R, Buenfil-Fuentes R, Díaz-Olavarrieta C, et al. The association between low cognitive reserve and subjective memory complaints in functionally independent older women. Exp Gerontol. 2023;172:112061. doi: 10.1016/j.exger.2022.112061.
14. Wilson VanVoorhis CR, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol. 2007;3(2):43-50. doi: 10.20982/tqmp.03.2.p043.
15. Bracamontes-Nevárez J, Camberos-Castro M. Trampas de desigualdad en México y sus regiones 2018–2022. Rev Econ Polít Soc (Equilibrio Económico). 2025;21(59):82-101. Disponible en: https://revistas.uadec.mx/equilibrioeconomico/article/view/74
16. Austria-Reyes A, Santander-Hernández JJ, Maya-Sánchez A, et al. Level of cognitive impairment of older adults in the community of Tlahuelilpan, Hidalgo, Mexico. Rev Enferm Neurol. 2021;20(1):45-48. doi: 10.51422/ren.v20i1.324.
17. Pérez-García L, Herrera-González N, Herrera-Olvera I, et al. Deterioro cognitivo y fragilidad física en adultos mayores de la UMF No. 75 Nezahualcóyotl. Invest Clín Mex. 2023;2 (Suppl 1):9-12. Disponible en: https://hdl.handle.net/20.500.14330/TES01000828993
18. Zegarra-Valdivia JA, Chino-Vilca BN, Paredes-Manrique CN. Cognitive impairment prevalence in Peruvian middle-age and elderly adults. Rev Ecuat Neurol. 2023;32(1):43-54. doi: 10.46997/REVECUATNEUROL32100043
19. Islam N, Hashem R, Gad M. Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: A systematic review and meta-analysis. Alzheimers Dement. 2023;19(7):3235-3243.
20. Terracciano A, Luchetti M, Karakose S, et al. Meta-analyses of personality change from the preclinical to the clinical stages of dementia. Ageing Res Rev. 2025;112:102852. doi: 10.1016/j.arr.2025.102852.
21. Lara E, Koyanagi A, Caballero F, et al. Cognitive reserve is associated with quality of life: A population-based study. Exp Gerontol. 2017;87(Pt A):67-73. doi: 10.1016/j.exger.2016.10.012.
22. Wang AY, Hu HY, Ou YN, et al. Socioeconomic Status and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 39 Prospective Studies. J Prev Alzheimers Dis. 2023;10(1):83-94. doi: 10.14283/jpad.2022.81.
23. Grande G, Vetrano DL, Kalpouzos G, et al. Brain Changes and Fast Cognitive and Motor Decline in Older Adults. J Gerontol A Biol Sci Med Sci. 2023;78(2):326-332. doi: 10.1093/gerona/glac177.
24. Deng S, Guo Z, Liu M. Metabolic syndrome, social isolation, and sarcopenia in mild cognitive impairment: A multifaceted analysis of risk factors and mediating pathways. PLoS One. 2025;20(10):e0333266. doi: 10.1371/journal.pone.0333266. PMID: 41066484; PMCID: PMC12510577.
25. Liu C, Ma Y, Hofman A, et al. Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors. Ann Neurol. 2023;94(1):13-26. doi: 10.1002/ana.26647. Epub 2023 Apr 27. PMID: 36966451; PMCID: PMC12488220.
26. Barba Gallardo PA. La reserva cognitiva como prevención en el deterioro de las funciones neurocognitivas en la vejez. Horizontes. Revista de Investigación en Ciencias de la Educación. 2021;5(20):1074-1083. doi: 10.33996/revistahorizontes.v5i20.258.
27. Camacho-Ruíz J, Rendón-Macías ME, Bernabe-García M, et al. Grupos de función cognitiva en personas mayores y factores de riesgo. Rev Med Inst Mex Seguro Soc. 2024;62(3):1-11. doi: 10.5281/zenodo.10998801
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.