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The new tests, especially Spot-the-Book, suggest that it might be possible to estimate pre-morbid ability without using vocabulary-based measures.
However, these studies did not adjust for pre-morbid ability.
Adjustment for estimated peak pre-morbid ability helped to counteract potential reverse causality.
The roles of dyslipidemia, hyperinsulinemia, hypertension, and pre-morbid ability as putative risk factors are as yet undetermined and require further investigation.
However, low mood correlates with NARTIQ in AD patients [ 25], which was not taken into account, so that their findings could be explained by pre-morbid ability.
A role for pre-morbid ability in young adulthood as influencing the risk of both diabetes and cognitive impairment has also been suggested.
However, where diabetes is associated with a steeper late-life cognitive decline in prospective analyses, the role of pre-morbid ability is as yet unclear, particularly as its role in promoting late-life cognitive decline per se is uncertain.
Compared with previous prospective studies in the general population that suggest a degree of complexity and do not always provide a consistent picture of vascular risk and cognitive impairment [ 10, 11], such studies in diabetic populations are much more scarce and often sub-optimal in design not least due to the neglect of consideration of pre-morbid ability [ 12].
The impact of stroke on cognitive function was demonstrated in the diabetic subpopulation of a Dutch study and in the ET2DS, in which an association between stroke and diminished cognitive function persisted after adjustment for estimated pre-morbid ability [ 20, 25, 51].
In one study, cross-sectional findings for 'any vascular event' (which was partly defined by PAD) remained significant after adjustment for an estimate of peak pre-morbid ability [ 20, 25], but after such an adjustment was made in the analysis of ABI and symptomatic PAD in the ET2DS, it did not quite achieve statistical significance [ 51].
Here, we found evidence for reverse causality: lower pre-morbid ability predisposed participants to a higher late-life level of cholesterol and to lower late-life cognitive function, and so confounding of previous cross-sectional (and potentially prospective) evidence is likely.
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