Brain MRI markers and dropout in a longitudinal study of cognitive aging
The Three-City Dijon Study
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Abstract
Objective: Longitudinal studies of dementia rely on the assumption that individuals who drop out are comparable to those who remain in the study, adjusting for measured covariates. Existing methods to handle dropouts account for differences based on past health and cognitive measures. We assess whether such adjustments fully account for differences in future dementia risk.
Methods: Among Three-City Study participants in Dijon, France, with 1 (n = 1,633) or 2 (n = 1,168) brain MRI scans, we tested whether white matter lesion volume (WMLV), hippocampal volume, or brain CSF volume predicted dropout (“unable to contact” or “refused interview”) in repeated-measures logistic regression with up to 4 follow-ups (average 3.5 waves). Using linear regression, we also estimated differences in MRI volumes and MRI changes by subsequent dropout status and estimated plausible ranges for selective attrition bias based on these associations. Models were adjusted for demographic, health, and cognitive score covariates.
Results: Baseline greater WMLV predicted increased odds of dropping out (adjusted odds ratio = 1.71; 95% confidence interval [CI] 1.20−2.43). Among participants with 2 MRI scans, individuals who subsequently dropped out had significantly worse declines in hippocampal volume (−0.30 SD difference; 95% CI −0.43 to −0.17) between the first and second MRI scans.
Conclusions: Higher future dementia risk, indicated by worse past brain MRI findings, predicted future study dropout. Adjustment for selective attrition, based on MRI markers when available, may help reduce bias in estimates of dementia incidence and improve research on dementia risk factors. MRI findings may also help prospectively identify cohort members at elevated risk of attrition.
GLOSSARY
- BVRT=
- Benton Visual Retention Test;
- CI=
- confidence interval;
- IADL=
- instrumental activities of daily living;
- ICV=
- intracranial volume;
- ISAAC=
- Isaacs' test of verbal/category fluency;
- MMSE=
- Mini-Mental State Examination;
- OR=
- odds ratio;
- TMTB=
- Trail Making Test B;
- WMLV=
- white matter lesion volume
Footnotes
Study funding: M.M. Glymour was supported by NIH/National Institute on Aging grant AG03438501. The Three-City Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen–Bordeaux II University, and sanofi-aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research–INSERM Programme “Cohortes et collections de données biologiques.” Sponsors were not involved in the design of the study or in the data analyses or manuscript elaboration and the authors have no conflicts of interest.
Supplemental data at www.neurology.org
- Received February 13, 2012.
- Accepted May 8, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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