The Cognitive-Functional Composite is sensitive to clinical progression in early dementia: longitudinal findings from the Catch-Cog study cohort

Abstract

Introduction: In an attempt to capture clinically meaningful cognitive decline in early dementia, we developed the Cognitive-Functional Composite (CFC). We investigated the CFC's sensitivity to decline in comparison to traditional clinical endpoints. Methods: This longitudinal construct validation study included 148 participants with subjective cognitive decline, mild cognitive impairment or mild dementia. The CFC and traditional tests were administered at baseline, 3, 6 and 12 months. Sensitivity to change was investigated using linear mixed models and R2 effect-sizes. Results: CFC scores declined over time (β=-.16,p <.001), with steepest decline observed in mild Alzheimer's dementia (β=-.25,p <.001). The CFC showed medium-to-large effect-sizes at succeeding follow-up points (R2=.08-.42), exhibiting greater change than the Clinical Dementia Rating scale (R2=.02-.12). Moreover, change on the CFC was significantly associated with informant reports of cognitive decline (β=.38,p<.001). Discussion: By showing sensitivity to decline, the CFC could enhance the monitoring of disease progression in dementia research and clinical practice.

Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations

“…Furthermore, it has been proposed that the Integrated AD Rating Scale, comprising the ADAS-Cog and a scale of activities of daily living (ADCS-iADL), may provide a better signal-to-noise ratio than the CDR-SOB [ 183 , 184 ]. The Cognitive-Functional Composite (CFC) has also emerged as a useful scale due to its feasibility, validity, and reliability, as well as clinical relevance in AD and has been used in clinical trials [ 185 , 186 ]. However, the CFC has only been used in a small number of patients with DLB, limiting the conclusions on its applicability in DLB clinical trials [ 186 ].…”

Neuropsychological profile in the preclinical stages of dementia: principal component analysis approach

“…This is because the latter are not sensitive to mild changes related to episodic memory and executive function, 24 which may have been affected in the first stages of the decline. 25 Likewise, it has been shown that composite scores are good predictors in follow-up studies 26 and clinical trials, 27 and ease the communication in the clinical context. 28 Recent studies have associated these composite factors to biomarkers of tau protein and beta-amyloid in different stages of the neurodegenerative process.…”

“…28 Recent studies have associated these composite factors to biomarkers of tau protein and beta-amyloid in different stages of the neurodegenerative process. 26 From this perspective, neuropsychological evaluation is relevant to establish cognitive characteristics, especially in the preclinical stages of dementia, and to determine a neuropsychological profile, sensitive to the decline of aged adults. Consequently, this research aims to compare the neuropsychological performance of participants in preclinical stages of dementia using principal components analysis.…”

FLAME: A computerized neuropsychological composite for trials in early dementia

“…Composite neuropsychological scores, both paper and pencil and computerized, may provide an advantage over single instruments. Evolving composites include the Preclinical Alzheimer's Cognitive Composite (PACC) 19‐21 . Developed to maximize sensitivity to change in people who are amyloid positive, PACC has reported encouraging preliminary validation data in a longitudinal cohort of 66 participants 19 .…”

“…Encouraging baseline data for capturing changes in cognition (CatchCog) have demonstrated good correlation between a three‐factor composite (memory, executive function, instrumental activities of daily living) and both informant‐reported cognitive decline and cortical atrophy 20 . A 12‐month follow‐up study has now been reported, showing moderate to high levels of sensitivity to change in 131 people assessed longitudinally, although only 24 of the participants had either subjective cognitive decline or MCI 21 . A further scoring approach, the AD Composite Score (ADCOMS), based on specific items of commonly used dementia assessments from four MCI trials demonstrated potentially improved sensitivity over ADAS Cog and MMSE, although the level of sensitivity was less advantageous for the group with amnestic MCI 22 .…”