Functional Trajectories Research Articles

Early developmental trajectories of the impaired hand in infants with unilateral cerebral palsy.

To identify developmental trajectories of impaired hand function in infants aged 3 to 15 months with unilateral cerebral palsy (CP). Sixty-three infants (37 male; median gestational age 37 weeks [interquartile range 30-39.1 weeks]) recruited as part of a randomized trial with a confirmed diagnosis of unilateral CP were included. All infants received early upper limb therapy. The Hand Assessment for Infants (HAI) was completed at baseline and until 12 to 15 months corrected age. Group-based trajectory modelling identified groups with similar trajectories of development of impaired hand function. Multinomial logistic regression determined associations between demographic variables and trajectory membership. The three-group trajectory model comprised 'low' 29%, 'moderate' 35%, and 'high' 36% functioning groups. The relative risk ratio of being in the low or moderate relative to high group increased by 16% (95% confidence interval [CI] 1.02-1.32) and 14% (95% CI 1.01-1.29) respectively for each 1 week increase in gestational age. Males were more likely to be in the low relative to high group (relative risk ratio 7.22; 95% CI 1.6-32.5). Three distinct trajectories of development of the impaired hand were identified. Males and infants born closer to term age were at higher risk of being in a low group with little improvement over time, despite receiving early intervention.

Cognitive trajectories and their relationships with education and diets among older adults: a network-based 10-year cohort study

ObjectivesFew studies have examined the underlying mechanisms of education, diets, and cognitive function in older adults. This study analyses the relationship between cognitive trajectories, education, and different dietary patterns in older adults from a network perspective, and further explores their longitudinal associations and mediation effects.MethodsData on cognitive trajectories were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018. Group-Based Trajectory Model (GBTM) was used to identify potential heterogeneity in the longitudinal changes in cognitive function. Multinomial logistic regression and network analysis were then applied to examine the relationships between different cognitive trajectories and years of education, food variety (FV), and plant-based dietary patterns. Cross-lagged panel model was used to examine the longitudinal associations between education, FV, and plant-based diet patterns. Furthermore, we constructed a mediation model based on categorical variables for cognitive trajectories to investigate the mediating effect of FV and plant-based diet index on education and cognitive.ResultsA total of 2,115 older adults were included in this study, revealing three distinct cognitive function trajectories. After controlling for potential confounders, education and dietary-related variables were associated with a cognitive stable decline trajectory (OR: 0.857/0.929/1.027) and a cognitive rapid decline trajectory (OR: 0.859/0.914, 95% CI: 0.775–0.882) compared to the cognitive stable trajectory. In the education, diet, and cognition network model, overall Plant-Based Diet Index (PDI) [expected influence (EI) = 1.82] and years of education (EI = 0.54) were the most central domains. There were longitudinal associations between education, FV, and plant-based dietary patterns, which were significant only in the slow decline group. FV acting as a mediator between education and cognitive trajectories.ConclusionYears of education are longitudinally associated with the diet of older adults in the slow cognitive decline group. Food diversity partially mediates the relationship between years of education and cognitive trajectories. Interventions targeting education and dietary behaviors may help alleviate cognitive decline in older adults.

Trajectories of Cognitive Function and Predictors Among Older Adults in Korea for 8 Years: A National Panel Data Analysis.

This study aims to examine the trajectory of older adults' cognitive function over time and identify its predictors. Based on the model of neuroplasticity and cognitive reserve, participants' general characteristics as well as their physical, mental, and social factors were included as predictors of cognitive function. A latent growth model analysis was used to examine the trajectory of cognitive function and its predictors. The analysis of the unconditional model revealed that older adults' cognitive function significantly decreased over time. The rate of cognitive decline was significantly related with age, current smoking status, depression scores, number of social activities, time spent in group cognitive activities, and number of individual cognitive activities. The findings identified predictors affecting initial cognitive function and the rate of cognitive decline in older adults. The rate of cognitive decline varies widely among individuals. Identifying these differences is essential for effectively tailoring interventions that address individual needs.

Effects of Protein Intake on Cognitive Function in Chinese Older Adults: A 10-Year Follow-Up Study

Background: As the global population ages, there is an increasing prevalence of mild cognitive impairment and dementia. Protecting and preserving cognitive function in older adults has become a critical public health concern. Methods: This study utilized data from four phases of the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018, encompassing a total of 2454 participants. Latent growth curve modeling was employed to analyze the trajectory and role of protein intake frequency and cognitive function. Results: The frequency of protein intake among older adults tends to rise, with individuals exhibiting higher initial levels experiencing smaller subsequent increases. Conversely, cognitive function generally declines, with those starting at higher levels experiencing more pronounced decreases. Notably, the initial frequency of protein intake is positively correlated with the initial level of cognitive function (β = 0.227, 95% CI: 0.156 to 0.299, p < 0.001), but does not significantly influence the rate of change in cognitive function (β = −0.030, 95% CI: −0.068 to 0.009, p = 0.128). The rate of change in protein intake frequency is positively associated with the rate of change in cognitive function (β = 0.152, 95% CI: 0.023 to 0.280, p = 0.020). Conclusions: The alterations in protein intake frequency are linked to alterations in cognitive function among older adults. Maintaining a stable high frequency of protein intake or increasing the frequency of protein intake may contribute to stabilizing cognitive function as well as reducing the risk of cognitive impairment and dementia in older adults.

Beyond nature, nurture, and chance: Individual agency shapes divergent learning biographies and brain connectome.

Individual choices shape life course trajectories of brain structure and function beyond genes and environment. We hypothesized that individual task engagement in response to a learning program results in individualized learning biographies and connectomics. Genetically identical female mice living in one large shared enclosure freely engaged in self-paced, automatically administered and monitored learning tasks. We discovered growing and increasingly stable interindividual differences in learning trajectories. Adult hippocampal neurogenesis and connectivity as assessed by a high-density multielectrode array positively correlated with the variation in exploration and learning efficiency. During some tasks, divergence transiently collapsed, highlighting the sustained significance of context for individualization. Thus, equal environments and equal genes do not result in equal learning biographies because life confronts individuals with choices that lead to divergent paths.

Physical functioning trajectories over statutory retirement: a finnish occupational cohort study

BackgroundThe association of workload and performance with physical functioning is recognised among the ageing public sector workforce. The characteristics of working conditions and social- and health-related factors associated with physical functioning after statutory retirement are still unknown. Also, previous studies on changes in physical functioning have not used a person-oriented approach. We examined physical functioning trajectories over statutory retirement and how social- and health-related factors are associated with them. Our aim was to identify distinct developmental trajectories of physical functioning over statutory retirement and to examine how social- (age, gender, marital status, education) and health-related (physical workload, self-reported sleep problems, alcohol consumption, smoking, fruit and vegetable (F&V) consumption, leisure-time physical activity (LTPA), and body mass index (BMI)) factors before retirement were associated with the identified trajectories.MethodsWe used data from the Helsinki Health Study cohort. Participants consisted of 2736 employees of the City of Helsinki, Finland who retired during the follow-up. Growth mixture modelling was used to identify physical functioning trajectories and multinominal regression analyses to examine associations of social- and health-related factors with them.ResultsThree distinct developmental patterns in physical functioning before and after retirement were found among ageing and retired employees. Lower educational level, sleep problems, physical inactivity, and obesity were associated with the trajectory groups of ‘fast decreasing’ and ‘slowly increasing’, compared to the ‘stable high’ trajectory.ConclusionThe results suggest that poor social- and health-related factors are key risk factors associated with declining and lower-level physical functioning over the retirement period. Supporting healthy lifestyles among older employees might maintaining good physical functioning until retirement and beyond.

Fetal growth restriction adversely impacts trajectory of hippocampal neurodevelopment and function.

The last pregnancy trimester is critical for fetal brain development but is a vulnerable period if the pregnancy is compromised by fetal growth restriction (FGR). The impact of FGR on the maturational development of neuronal morphology is not known, however, studies in fetal sheep allow longitudinal analysis in a long gestation species. Here we compared hippocampal neuron dendritogenesis in FGR and control fetal sheep at three timepoints equivalent to the third trimester of pregnancy, complemented by magnetic resonance image for brain volume, and electrophysiology for synaptic function. We hypothesized that the trajectory of hippocampal neuronal dendrite outgrowth would be decreased in the growth-restricted fetus, with implications for hippocampal volume, connectivity, and function. In control animals, total dendrite length increased with advancing gestation, but not in FGR, resulting in a significantly reduced trajectory of dendrite outgrowth in FGR fetuses for total length, branching, and complexity. Ex vivo electrophysiology analysis shows that paired-pulse facilitation was reduced in FGR compared to controls for cornu ammonis 1 hippocampal outputs, reflecting synaptic dysfunction. Hippocampal brain-derived neurotrophic factor density decreased over late gestation in FGR fetuses but not in controls. This study reveals that FGR is associated with a significant deviation in the trajectory of dendrite outgrowth of hippocampal neurons. Where dendrite length significantly increased over the third trimester of pregnancy in control brains, there was no corresponding increase over time in FGR brains, and the trajectory of dendrite outgrowth in FGR offspring was significantly reduced compared to controls. Reduced hippocampal dendritogenesis in FGR offspring has severe implications for the development of hippocampal connectivity and long-term function.

Modifiable risk factors and symptom progression in dementia over up to 8 years-Results of the DelpHi-MV trial.

This study investigated the association between modifiable factors and symptom progression in dementia over up to 8 years. Multilevel growth curve models assessed the role of modifiable risk factors (low education, hearing impairment and its treatment, depression, physical inactivity, diabetes and its treatment, smoking, hypertension and its treatment, obesity, alcohol consumption, social isolation, and visual impairment) on cognitive and functional trajectories in 353 people with dementia. Higher education was associated with higher initial cognitive status but faster decline. Antidiabetic medication was associated with slower cognitive decline, whereas depression and visual impairment were linked to low baseline functioning and faster cognitive decline. Several modifiable risk factors influenced symptom progression. Education initially had a protective effect, whereas depressive symptoms were linked to worse symptom progression. Treatment of comorbidities (diabetes, visual impairment) could have a positive impact on dementia symptoms. Modifiable risk factors are promising targets for tertiary prevention. Modifiable risk factors were associated with symptom progression in dementia over up to 8 years.More education was associated with higher initial cognitive status but faster decline.Depressive symptoms were linked to less favorable symptom progression.Treatment of comorbidities (diabetes, visual impairment) may positively impact the course of symptoms.Modifiable risk factors are promising targets for tertiary prevention.

Acute kidney disease in hospitalized pediatric patients: risk prediction based on an artificial intelligence approach

Background Acute kidney injury (AKI) and acute kidney disease (AKD) are prevalent among pediatric patients, both linked to increased mortality and extended hospital stays. Early detection of kidney injury is crucial for improving outcomes. This study presents a machine learning-based risk prediction model for AKI and AKD in pediatric patients, enabling personalized risk predictions. Methods Data from 2,346 hospitalized pediatric patients, collected between January 2020 and January 2023, were divided into an 85% training set and a 15% test set. Predictive models were constructed using eight machine learning algorithms and two ensemble algorithms, with the optimal model identified through AUROC. SHAP was used to interpret the model, and an online prediction tool was developed with Streamlit to predict AKI and AKD. Results The incidence of AKI and AKD were 14.90% and 16.26%, respectively. Patients with AKD combined with AKI had the highest mortality rate, at 6.94%, when analyzed by renal function trajectories. The LightGBM algorithm showed superior predictive performance for both AKI and AKD (AUROC: 0.813, 0.744). SHAP identified top predictors for AKI as serum creatinine, white blood cell count, neutrophil count, and lactate dehydrogenase, while key predictors for AKD included proton pump inhibitor, blood glucose, hemoglobin, and AKI grade. Conclusion The high incidence of AKI and AKD among hospitalized children warrants attention. Renal function trajectories are strongly associated with prognosis. Supported by a web-based tool, machine learning models can effectively predict AKI and AKD, facilitating early identification of high-risk pediatric patients and potentially improving outcomes.

Brain aging rejuvenation factors in adults with genetic and sporadic neurodegenerative disease.

The largest risk factor for dementia is age. Heterochronic blood exchange studies have uncovered age-related blood factors that demonstrate 'pro-aging' or 'pro-youthful' effects on the mouse brain. The clinical relevance and combined effects of these factors for humans is unclear. We examined five previously identified brain rejuvenation factors in cerebrospinal fluid of adults with autosomal dominant forms of frontotemporal dementia and sporadic Alzheimer's disease. Our frontotemporal dementia cohort included 100 observationally followed adults carrying autosomal dominant frontotemporal dementia mutations (Mage = 49.6; 50% female; 43% C9orf72, 24% GRN, 33% MAPT) and 62 non-carriers (Mage = 52.6; 45% female) with cerebrospinal fluid analysed on Somascan, and longitudinal (Mvisits = 3 years, range 1-7 years) neuropsychological and functional assessments and plasma neurofilament light chain. Our Alzheimer's disease cohort included 35 adults with sporadic Alzheimer's disease (Mage = 69.4; 60% female) and 56 controls (Mage = 68.8, 50% female) who completed the same cerebrospinal fluid and clinical outcome measures cross-sectionally. Levels of C-C motif chemokine ligand 11, C-C motif chemokine ligand 2, beta-2-micorglobulin, bone gamma-carboxyglutamate protein (aka Osteocalcin) and colony stimulating factor 2 in cerebrospinal fluid were linearly combined into a composite score, with higher values reflecting 'pro-youthful' levels. In genetic frontotemporal dementia, higher baseline cerebrospinal fluid rejuvenation proteins predicted slower decline across cognitive, functional, and neurofilament light chain trajectories; estimates were similar across genotypes. In transdiagnostic analyses, higher cerebrospinal fluid rejuvenation proteins associated with better functional, cognitive, and neurofilament light chain outcomes in adults with sporadic Alzheimer's disease. Proteins with pre-clinical evidence for brain rejuvenation show translational clinical relevance in adults with Alzheimer's disease and related dementias and warrant further investigation.

Impact and Heterogeneity of Self-reported Hearing on Trajectories of Cognitive Function in Middle-Aged and Older Couples.

Hearing status is identified as a significant predictor of cognitive function. The life course principle of linked lives posits that the lives of couples often become increasingly interconnected or embedded over time, thereby cumulatively intensifying their influence on spouse's health and well-being. We aim to examine the impact of self-reported hearing on cognitive function among married couples across adulthood and whether there is heterogeneity in the associations. Utilizing data from the 2011, 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (n=2847 middle-aged and older couples, totaling 5694 observations across all waves), we employ the growth curve model (GCM) to examine the impact of self-reported hearing, both individually and from spouses, on the age-related trajectories of cognitive function. This study demonstrates that poor self-reported hearing is significantly associated with worse cognitive function compared to those with good hearing. Additionally, there is a significant temporal association between poor spousal hearing and cognitive decline, compared to individuals whose spouses have good hearing. Heterogeneity analysis shows that the association between poor spousal hearing and increasing cognitive disadvantage across time is particularly significant among men and rural residents. This research provides new evidence of the longitudinal association between hearing and cognitive function among married couples, thus contributing to a growing body of literature documenting the importance of understanding how spousal health conditions impact health trajectories.

Characterizing the Clinical Trajectory and Predicting Persistence and Deterioration of Attenuated Psychotic Symptoms in Ultra-High-Risk Individuals.

Almost 40% of individuals at ultra-high risk (UHR) for psychosis experience persistent attenuated psychotic symptoms (APS) yet it is unclear (1) whether they share overlapping clinical and functional outcomes compared to individuals who transition to psychosis, (2) when symptom and functioning trajectories begin to diverge between UHR individuals with different clinical outcomes, and (3) whether non-remission (persistent APS or transition) can be predicted using baseline and/or longitudinal data. Participants were drawn from 2 randomized clinical trials: Neurapro (n = 220; discovery sample) and STEP (n = 180; external validation sample). First, 12-24 month symptoms and functioning were compared between UHR individuals with persistent APS, sustained remission, or transition to psychosis. Next, short-term changes in symptoms and functioning were compared between groups to determine timepoints at which trajectories began to diverge. Finally, we used support vector machines to predict non-remission (persistent APS or transition) vs sustained remission using data from baseline, 6-month follow-up, and combined baseline and 6-month follow-up. Individuals with persistent APS had substantially poorer outcomes compared to those who remitted, and more closely resembled individuals who later transitioned to psychosis. Despite few baseline differences between groups, clinical and functional trajectories of the persistent APS and transition groups rapidly diverged from those who remitted. Prediction of non-remission was poor using baseline data but improved substantially when using 6-month follow-up or combined baseline-6-month data. Ultra-high-risk individuals with persistent APS display similar clinical and functional trajectories to transitioned cases, suggesting that more intensive and sustained intervention is required for this subgroup. However, prospective identification of individuals with poor clinical outcomes (ie, persistence or deterioration of attenuated psychotic symptoms) may require longitudinal monitoring of symptom and functioning trajectories for several months.

A prognostic model for predicting functional impairment in youth mental health services.

Functional impairment is a major concern among those presenting to youth mental health services and can have a profound impact on long-term outcomes. Early recognition and prevention for those at risk of functional impairment is essential to guide effective youth mental health care. Yet, identifying those at risk is challenging and impacts the appropriate allocation of indicated prevention and early intervention strategies. We developed a prognostic model to predict a young person's social and occupational functional impairment trajectory over 3 months. The sample included 718 young people (12-25years) engaged in youth mental health care. A Bayesian random effects model was designed using demographic and clinical factors and model performance was evaluated on held-out test data via 5-fold cross-validation. Eight factors were identified as the optimal set for prediction: employment, education, or training status; self-harm; psychotic-like experiences; physical health comorbidity; childhood-onset syndrome; illness type; clinical stage; and circadian disturbances. The model had an acceptable area under the curve (AUC) of 0.70 (95% CI, 0.56-0.81) overall, indicating its utility for predicting functional impairment over 3 months. For those with good baseline functioning, it showed excellent performance (AUC=0.80, 0.67-0.79) for identifying individuals at risk of deterioration. We developed and validated a prognostic model for youth mental health services to predict functional impairment trajectories over a 3-month period. This model serves as a foundation for further tool development and demonstrates its potential to guide indicated prevention and early intervention for enhancing functional outcomes or preventing functional decline.

Pathophysiology of Intracerebral Hemorrhage: Recovery Trajectories.

Recovery trajectories in intracerebral hemorrhage (ICH) are recognized as distinct from those observed in ischemic stroke. This narrative review aims to clarify the pathophysiology underlying ICH recovery patterns, highlighting the unique timeline and nature of functional improvements seen in ICH survivors. Population-based cohort studies tracking functional outcomes in a longitudinal fashion, along with randomized clinical trial data with standardized outcome assessments, have demonstrated that ICH recovery generally has a delayed onset in the first weeks, followed by a steep early subacute stage recovery (typically up to 3 months) continuing in protracted, gradual improvements beyond 3 to 6 months. Understanding these recovery patterns, and how these differ from ischemic stroke, is crucial for providing accurate prognostic information, facilitating targeted health care delivery, and optimizing therapeutic interventions and the design of ICH randomized trials. This article synthesizes current evidence on early- and late-stage functional recovery trajectories in primary, spontaneous ICH and cognitive outcomes, emphasizing the clinical and research implications of these recovery patterns.

Comparison of pain, functional and psychological trajectories between total and unicompartmental knee arthroplasties: secondary analysis of a 6-month prospective observational study

IntroductionUnicompartmental knee arthroplasty (UKA) treats osteoarthritis in one knee compartment, while total knee arthroplasty (TKA) addresses all compartments. The debate focuses on UKA's advantages of quicker recovery and fewer complications versus TKA's lower long-term revision rates, emphasizing the need for thorough outcome evaluations. The aim of the present study is to describe and compare the pain, functional and psychological trajectories during a 6-month postoperative rehabilitation period between total and unicompartmental knee arthroplasties.Materials and Methods115 participants who had undergone either TKA or UKA were recruited. Outcome measurements were performed at 1, 4, 12 and 24 weeks post-surgery. Measurements included pain intensity (Visual Analog Scale), range of motion, walking speed (4 m walking test), physical performance (30-s chair stand test), health functioning (Western Ontario and McMaster Universities Osteoarthritis Index), pain catastrophizing (pain catastrophizing scale), fear of movement (Tampa Scale of Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale). A mixed-effects model was used to estimate the influence of type of surgery (either unicompartmental or total knee arthroplasty) to pain, function, and psychological trajectories.ResultsBoth TKA and UKA groups showed significant improvements across the six-month rehabilitation period except for anxiety symptoms in the TKA group, and fear of movement and depression in the UKA group. Between group analysis revealed that in the acute phase UKA patients showed improved range of motion and TKA patients displayed faster walking speed but higher fear of movement. Overall, the type of surgery does not significantly influence the overall rehabilitation pain, functional and psychological trajectories.ConclusionsDespite differences in the acute phase, there are no differences in pain, functional and psychological trajectories throughout the six-month rehabilitation period. These results should be acknowledged to better inform patients and to improve patient education during the perioperative period.Trial registration numberNCT03378440 (2017-12-18), retrospectively registered.Level of evidenceLevel II.

Functional Impairment Related to ADHD From Preschool to School Age

Objective: Children with ADHD often experience functional impairments across various aspects of daily life. This study addresses the dearth of longitudinal research on functional impairment trajectories from preschool to school age in children with symptoms of ADHD and comorbid disorders. Methods: We investigated the extent to which functional impairments were associated with ADHD symptoms, along with behavioral and anxiety symptoms, from age 3.5 to 8 years. Utilizing parent- and teacher-reported data, we analyzed associations between global impairment, and dimension scores (e.g., family; child quality of life (QoL); learning; play/leisure activities; and friends) and symptoms at ages 3.5 and 8 years (n = 783). Results: The mean parent global impairment score increased from 0.31 (standard deviation (SD) = 0.40) to 0.83 (SD = 0.63) from 3.5 to 8 years, while the teacher impairment scores slightly decreased. Specific parent impairment dimension scores, particularly QoL, learning, and friends, significantly increased. Preschool ADHD and comorbid behavioral symptoms reported by parents weakly predicted impairment at 8 years. By age 8 years, impairment and symptoms exhibited moderate to strong correlations for all impairment dimensions. Parents reported greater child impairment during school age across settings compared to preschool, while teachers’ impairment profiles remained consistent across ages. Conclusions: These findings suggest that parents perceive impairment as more pronounced at age 8 years and more strongly associated with symptoms of both ADHD and comorbid disorders than at age 3.5 years. Notably, for teachers, a robust correlation between inattention symptoms and learning impairment was observed, with substantially higher impairment scores reported for boys compared to girls.

Association between renal function trajectories and risk of cardiovascular disease: a prospective cohort study

Introduction It is unclear whether changing trajectories of renal function will increase the risk prediction information of cardiovascular disease (CVD). This study aimed to evaluate the trajectory patterns of estimated glomerular filtration rate (eGFR) and the association between eGFR trajectories and CVD risk. Methods A total of 4742 participants were included in the cohort from the 51st Regiment of Xinjiang Production and Construction Corps. The study endpoint was the occurrence of CVD events. eGFR trajectories were identified using a linear mixed-effects model in four distinct patterns. Multivariate Cox proportional hazards models analysed the correlations between eGFR trajectories and CVD. Results During a median follow-up period of 5.7 years, a total of 559 (11.8%) CVD, 404 (8.5%) myocardial infarction (MI), 244 (5.2%) ischemic stroke (IS), and 62 (1.3%) heart failure (HF) incidents occurred. After multivariable adjustment, gradual decline trajectory increased the risk of CVD (HR 1.42, 95% CI 1.16–1.74), MI (HR 1.41, 95% CI 1.11–1.79), and IS (HR 1.41, 95% CI 1.04–1.92); gradual increase trajectory reduced the risk of CVD (HR 0.40, 95% CI 0.25–0.64) and MI (HR 0.49, 95% CI 0.29–0.81). Consistent results were obtained in sensitivity and subgroup analyses. Conclusions Decline and increase of renal function were related to the risk of CVD, MI, and IS in the rural areas of Xinjiang. Monitoring eGFR changing trajectory is of great significance in improving the risk of CVD.

Integrated Whole-Life Cycle Accuracy Valvular Heart Disease Epidemiology Cohort Study (iWAVE): protocol for a prospective cohort study

IntroductionDespite the rapid advancements in cardiovascular surgery in China, the prevalence of valvular heart disease (VHD) continues to rise, particularly among the elderly population. In the resource-constrained western regions, the...

Construction of the Cognitive Function Trajectory File

Construction of the Cognitive Function Trajectory File

Revealing Patterns of Cognitive Function Trajectories in the Last Five Years of Life of Medicare Beneficiary

Revealing Patterns of Cognitive Function Trajectories in the Last Five Years of Life of Medicare Beneficiary