Introduction: We examined the relationship between previous fluctuations in Mini-Mental State Examination (MMSE) scores, future changes in MMSE scores, and attrition from follow-up surveys, which helps in a more comprehensive interpretation of repeatedly collected MMSE scores. Methods: This 4-year longitudinal study included 2,073 community-dwelling older adults aged ≥65 years in Japan. The MMSE was administered at baseline (T0), 2 years (T1), and 4 years (T2) follow-up. We performed multinomial logistic regression analysis with the dependent variable, indicating the change in MMSE score from T1 to T2 (categorized as increase, no change [reference category], and decrease) and attrition at T2. The independent variables included the change in MMSE scores from T0 to T1 and MMSE scores at T0 and T1. Results: The mean MMSE score was 29 across the three time points. A one-point decrease in MMSE score from T0 to T1 was associated with 79% (95% confidence interval: 1.62, 1.97) higher odds of an increase in MMSE score from T1 to T2 and 28% (1.17, 1.40) higher odds of attrition at T2. A one-point decrement in the MMSE score at T0 and T1 was also associated with an increase in the MMSE score from T1 to T2 and attrition at T2. Conclusion: Focusing on cognitive fluctuation for 2 years, rather than cognitive function at a point in time, would have no remarkable advantage when focusing on future cognitive function and attrition. Our results emphasize the need for further studies to identify factors that distinguish between those who continue to attend follow-up surveys and show improvements in cognitive test scores and those who drop out.

1.
Canevelli
M
,
Grande
G
,
Lacorte
E
,
Quarchioni
E
,
Cesari
M
,
Mariani
C
.
Spontaneous reversion of mild cognitive impairment to normal cognition: a systematic review of literature and meta-analysis
.
J Am Med Dir Assoc
.
2016
;
17
(
10
):
943
8
.
2.
Malek-Ahmadi
M
.
Reversion from mild cognitive impairment to normal cognition: a meta-analysis
.
Alzheimer Dis Assoc Disord
.
2016
;
30
(
4
):
324
30
.
3.
Ganguli
M
,
Jia
Y
,
Hughes
TF
,
Snitz
BE
,
Chang
CCH
,
Berman
SB
.
Mild cognitive impairment that does not progress to dementia: a population-based study
.
J Am Geriatr Soc
.
2019
;
67
(
2
):
232
8
.
4.
Overton
M
,
Pihlsgård
M
,
Elmståhl
S
.
Diagnostic stability of mild cognitive impairment, and predictors of reversion to normal cognitive functioning
.
Dement Geriatr Cogn Disord
.
2019
48
5–6
317
29
.
5.
Angevaare
MJ
,
Vonk
JMJ
,
Bertola
L
,
Zahodne
L
,
Watson
CWM
,
Boehme
A
.
Predictors of incident mild cognitive impairment and its course in a diverse community-based population
.
Neurology
.
2022
;
98
(
1
):
e15
26
.
6.
Aerts
L
,
Heffernan
M
,
Kochan
NA
,
Crawford
JD
,
Draper
B
,
Trollor
JN
.
Effects of MCI subtype and reversion on progression to dementia in a community sample
.
Neurology
.
2017
;
88
(
23
):
2225
32
.
7.
Lipnicki
DM
,
Crawford
J
,
Kochan
NA
,
Trollor
JN
,
Draper
B
,
Reppermund
S
.
Risk factors for mild cognitive impairment, dementia and mortality: the Sydney memory and ageing study
.
J Am Med Dir Assoc
.
2017
;
18
(
5
):
388
95
.
8.
Xue
HP
,
Hou
P
,
Li
YN
,
Mao
X
,
Wu
LF
,
Liu
YB
.
Factors for predicting reversion from mild cognitive impairment to normal cognition: a meta-analysis
.
Int J Geriatr Psychiatry
.
2019
;
34
(
10
):
1361
8
.
9.
Chatfield
MD
,
Brayne
CE
,
Matthews
FE
.
A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies
.
J Clin Epidemiol
.
2005
;
58
(
1
):
13
9
.
10.
Chang
CCH
,
Yang
HC
,
Tang
G
,
Ganguli
M
.
Minimizing attrition bias: a longitudinal study of depressive symptoms in an elderly cohort
.
Int Psychogeriatr
.
2009
;
21
(
5
):
869
78
.
11.
Maharani
A
,
Dawes
P
,
Nazroo
J
,
Tampubolon
G
,
Pendleton
N
Sense-Cog WP1 group
.
Visual and hearing impairments are associated with cognitive decline in older people
.
Age Ageing
.
2018
;
47
(
4
):
575
81
.
12.
Griswold
ME
,
Talluri
R
,
Zhu
X
,
Su
D
,
Tingle
J
,
Gottesman
RF
.
Reflection on modern methods: shared-parameter models for longitudinal studies with missing data
.
Int J Epidemiol
.
2021
;
50
(
4
):
1384
93
.
13.
Vega
S
,
Benito-León
J
,
Bermejo-Pareja
F
,
Medrano
MJ
,
Vega-Valderrama
LM
,
Rodríguez
C
.
Several factors influenced attrition in a population-based elderly cohort: neurological disorders in Central Spain Study
.
J Clin Epidemiol
.
2010
;
63
(
2
):
215
22
.
14.
Abe
T
,
Kitamura
A
,
Yamashita
M
,
Kim
H
,
Obuchi
SP
,
Ishizaki
T
.
Simple screening models for cognitive impairment in community settings: the IRIDE Cohort Study
.
Geriatr Gerontol Int
.
2022
;
22
(
4
):
292
7
.
15.
Folstein
MF
,
Folstein
SE
,
McHugh
PR
.
“Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician
.
J Psychiatr Res
.
1975 Nov
12
3
189
98
.
16.
Koyano
W
,
Shibata
H
,
Nakazato
K
,
Haga
H
,
Suyama
Y
.
Measurement of competence: reliability and validity of the TMIG index of competence
.
Arch Gerontol Geriatr
.
1991
;
13
(
2
):
103
16
.
17.
Satake
S
,
Arai
H
.
The revised Japanese version of the Cardiovascular Health Study criteria (revised J-CHS criteria)
.
Geriatr Gerontol Int
.
2020
;
20
(
10
):
992
3
.
18.
Chen
LK
,
Woo
J
,
Assantachai
P
,
Auyeung
TW
,
Chou
MY
,
Iijima
K
.
Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment
.
J Am Med Dir Assoc
.
2020
;
21
(
3
):
300
7.e2
.
19.
Kaufer
DI
,
Williams
CS
,
Braaten
AJ
,
Gill
K
,
Zimmerman
S
,
Sloane
PD
.
Cognitive screening for dementia and mild cognitive impairment in assisted living: comparison of 3 tests
.
J Am Med Dir Assoc
.
2008
;
9
(
8
):
586
93
.
20.
Hensel
A
,
Angermeyer
MC
,
Riedel-Heller
SG
.
Measuring cognitive change in older adults: reliable change indices for the Mini-Mental State Examination
.
J Neurol Neurosurg Psychiatry
.
2007
;
78
(
12
):
1298
303
.
21.
Tombaugh
TN
.
Test-retest reliable coefficients and 5-year change scores for the MMSE and 3MS
.
Arch Clin Neuropsychol
.
2005
;
20
(
4
):
485
503
.
22.
Young
AF
,
Powers
JR
,
Bell
SL
.
Attrition in longitudinal studies: who do you lose
.
Aust N Z J Public Health
.
2006
;
30
(
4
):
353
61
.
23.
Kawai
H
,
Ejiri
M
,
Tsuruta
H
,
Masui
Y
,
Watanabe
Y
,
Hirano
H
.
Factors associated with follow-up difficulty in longitudinal studies involving communitydwelling older adults
.
PLoS One
.
2020
;
15
(
8
):
e0237166
.
24.
Fielding
S
,
Fayers
PM
,
Loge
JH
,
Jordhøy
MS
,
Kaasa
S
.
Methods for handling missing data in palliative care research
.
Palliat Med
.
2006
;
20
(
8
):
791
8
.
25.
Jacobsen
E
,
Ran
X
,
Liu
A
,
Chang
CCH
,
Ganguli
M
.
Predictors of attrition in a longitudinal population-based study of aging
.
Int Psychogeriatr
.
2021
;
33
(
8
):
767
78
.
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