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Inference for random changepoint models : application to pre-dementia cognitive decline

Abstract : The aim of this work was to propose inferential methods to describe natural history of the pre-diagnosis phase of dementia. During this phase, which can last around fifteen years, the cognitive decline trajectories are nonlinear and heterogeneous between subjects. Because heterogeneity and nonlinearity, we chose a random changepoint mixed model to describe these trajectories. A first part of this work was to propose a testing procedure to assess the existence of a random changepoint. Indeed, in some subpopulations, the cognitive decline seems smooth and the question of the existence of a changepoint itself araises. This question is methodologically challenging because of identifiability issues on some parameters under the null hypothesis that makes standard tests useless. We proposed a supremum score test to answer this question. A second part of this work was the comparison of the temporal order of different markers changepoint. Dementia is a multidimensional disease where different dimensions of the cognition are affected. Hypothetic cascade models exist for describing this natural history but have not been evaluated on real data. Comparing change over time of different markers measuring different cognitive functions gives precious insight on this hypothesis. In this spirit, we propose a bivariate random changepoint model allowing proper comparison of the time of change of two cognitive markers, potentially non Gaussian. The proposed methodologies were evaluated on simulation studies and applied on real data from two French cohorts. Finally, we discussed the limitations of the two models we used that focused on the late acceleration of the cognitive decline before dementia diagnosis and we proposed an alternative model that estimates the time of differentiation between cases and non-cases.
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Corentin Segalas. Inference for random changepoint models : application to pre-dementia cognitive decline. Human health and pathology. Université de Bordeaux, 2019. English. ⟨NNT : 2019BORD0298⟩. ⟨tel-02460690⟩

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