"The changes in thinking and memory that precede obvious symptoms of Alzheimer's disease begin decades before," said study author Kumar B Rajan with Rush University Medical Center in Chicago.
"While we cannot currently detect such changes in individuals at risk, we were able to observe them among a group of individuals who eventually developed dementia due to Alzheimer's," Kumar said.
For the study, 2,125 European-American and African-American people from Chicago with an average age of 73 without Alzheimer's disease were given tests of memory and thinking skills every three years for 18 years.
Those who scored lower overall on the memory and thinking tests had an increased risk of developing the disease.
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During the first year of the study, people with lower test scores were about 10 times more likely to be diagnosed with Alzheimer's disease than people with higher scores, with the odds increasing by 10 for every standard deviation that the score was lower than the average.
Based on tests completed 13 to 18 years before the final assessments took place, one unit lower in performance of the standardised cognitive test score was associated with an 85 per cent greater risk (relative risk of 1.85) of future dementia.
"Efforts to successfully prevent the disease may well require a better understanding of these processes near middle age," Kumar said.