{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:10:26Z","timestamp":1792084226804,"version":"4.4.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAD"],"published-print":{"date-parts":[[2022,10,25]]},"abstract":"<jats:p>Background: There is increasing recognition of cognitive and pathological heterogeneity in early-stage Alzheimer\u2019s disease and other dementias. Data-driven approaches have demonstrated cognitive heterogeneity in those with mild cognitive impairment (MCI), but few studies have examined this heterogeneity and its association with progression to MCI\/dementia in cognitively unimpaired (CU) older adults. Objective: We identified cluster-derived subgroups of CU participants based on comprehensive neuropsychological data and compared baseline characteristics and rates of progression to MCI\/dementia or a Dementia Rating Scale (DRS) of \u2264129 across subgroups. Methods: Hierarchical cluster analysis was conducted on individual baseline neuropsychological test scores from 365 CU participants in the UCSD Shiley-Marcos Alzheimer\u2019s Disease Research Center longitudinal cohort. Cox regressions examined the risk of progression to consensus diagnosis of MCI or dementia, or to DRS score \u2264129, by cluster group. Results: Cluster analysis identified 5 groups: All-Average (n\u200a=\u200a139), Low-Visuospatial (n\u200a=\u200a46), Low-Executive (n\u200a=\u200a51), Low-Memory\/Language (n\u200a=\u200a83), and Low-All Domains (n\u200a=\u200a46). Subgroups had unique demographic and clinical characteristics. Rates of progression to MCI\/dementia or to DRS \u2264129 were faster for all subgroups (Low-All Domains progressed the fastest\u200a&gt;\u200aLow Memory\/Language\u2265Low-Visuospatial and Low-Executive) relative to the All-Average subgroup. Conclusion: Faster progression in the Low-Visuospatial, Low-Executive, and Low-Memory\/Language groups compared to the All-Average group suggests that there are multiple pathways and\/or unique subtle cognitive decline profiles that ultimately lead to a diagnosis of MCI\/dementia. Use of comprehensive neuropsychological test batteries that assess several domains may be a key first step toward an individualized approach to early detection and fewer missed opportunities for early intervention.<\/jats:p>","DOI":"10.3233\/jad-220684","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T11:38:41Z","timestamp":1663069121000},"page":"323-331","source":"Crossref","is-referenced-by-count":14,"title":["Cognitive Heterogeneity and Risk of Progression in Data-Driven Subtle Cognitive Decline Phenotypes"],"prefix":"10.1177","volume":"90","author":[{"given":"Kelsey R.","family":"Thomas","sequence":"first","affiliation":[{"name":"Research Service, VA San Diego Healthcare System, San Diego, CA, USA"},{"name":"Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine J.","family":"Bangen","sequence":"additional","affiliation":[{"name":"Research Service, VA San Diego Healthcare System, San Diego, CA, USA"},{"name":"Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra J.","family":"Weigand","sequence":"additional","affiliation":[{"name":"San Diego State University\/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Research Service, VA San Diego Healthcare System, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla S.","family":"Walker","sequence":"additional","affiliation":[{"name":"Research Service, VA San Diego Healthcare System, San Diego, CA, USA"},{"name":"San Diego State University, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David 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