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Cognitively normal older adults (ages 65\u201389 years, N = 199) were classified as normal or abnormal using neuroimaging and cerebrospinal-fluid biomarkers of \u03b2-amyloid, tau, and neurodegeneration. When cognitive change was modeled without accounting for biomarker status, significant decline was evident for semantic memory, processing speed, and working memory. However, after adjusting for biomarker status, we found that the rate of change was attenuated and that the biomarker-normal group demonstrated no decline for any cognitive domain. These results indicate that estimates of cognitive change in otherwise healthy older adults will be biased toward decline when the presence of early neurodegenerative disease is not accounted for.<\/jats:p>","DOI":"10.1177\/0956797620985518","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T16:35:10Z","timestamp":1622133310000},"page":"849-860","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Undetected Neurodegenerative Disease Biases Estimates of Cognitive Change in Older Adults"],"prefix":"10.1177","volume":"32","author":[{"given":"Karra D.","family":"Harrington","sequence":"first","affiliation":[{"name":"The Florey Institute, The University of Melbourne"},{"name":"Cooperative Research Centre for Mental Health, Parkville, Victoria, Australia"},{"name":"Center for Healthy Aging, The Pennsylvania State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Aschenbrenner","sequence":"additional","affiliation":[{"name":"Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St. Louis"},{"name":"Department of Neurology, Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Maruff","sequence":"additional","affiliation":[{"name":"The Florey Institute, The University of Melbourne"},{"name":"CogState, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin L.","family":"Masters","sequence":"additional","affiliation":[{"name":"The Florey Institute, The University of Melbourne"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Fagan","sequence":"additional","affiliation":[{"name":"Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St. Louis"},{"name":"Department of Neurology, Washington University in St. Louis"},{"name":"Hope Center for Neurological Disorders, Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammie L. 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