Defining MCI in the framingham heart study offspring: Education versus WRAT-based norms

Richard E. Ahl, Alexa Beiser, Sudha Seshadri, Sanford Auerbach, Philip A. Wolf, Rhoda Au

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


INTRODUCTION:: Psychometric definitions of mild cognitive impairment (MCI) typically use cut-off levels set at 1.5 SDs below age-adjusted and education-adjusted norms, assuming that the education adjustment accounts for premorbid abilities. However, noncognitive factors impact educational attainment, potentially leading to incorrect categorization as MCI. We examined whether using an adjustment based on reading performance [Wide Range Achievement Test (WRAT) Reading] improved MCI diagnostic accuracy. METHODS:: A total of 935 Framingham Offspring (mean age, 72±5 y) underwent tests of memory, executive function, abstraction, language, and visuospatial function as part of a neuropsychological test battery. Domain-specific test scores were regressed onto age and WRAT score, or education, to define MCI. Survival analyses were used to relate baseline MCI to incident dementia. RESULTS:: The 2 MCI definitions differed most for the lowest and highest education groups. The WRAT definition was more strongly associated with incident dementia for all 5 tests. MCI level abstraction performance was associated with incident dementia using the WRAT definition (HR=3.20, P=0.033), but not the education definition (HR=1.19, P=0.814). DISCUSSION:: The WRAT should be considered along with the standard measure of years of education, as it may be a better surrogate marker of premorbid abilities.

Original languageEnglish (US)
Pages (from-to)330-336
Number of pages7
JournalAlzheimer Disease and Associated Disorders
Issue number4
StatePublished - Oct 2013
Externally publishedYes


  • Alzheimer disease
  • longitudinal
  • mild cognitive impairment
  • neuropsychological assessment
  • premorbid abilities

ASJC Scopus subject areas

  • Clinical Psychology
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


Dive into the research topics of 'Defining MCI in the framingham heart study offspring: Education versus WRAT-based norms'. Together they form a unique fingerprint.

Cite this