Longitudinal assessments are crucial in evaluating the disease state and trajectory in patients of neurodegenerative diseases. Neuropsychological outcomes measured over time often have a non-linear trajectory with autocorrelated residuals and skewed distributions. Due to these issues, statistical analysis and interpretation involving longitudinal cognitive outcomes can be a difficult and controversial task, thus hindering most convenient transformations (e.g. logarithmic) to avoid the assumption violations of common statistical modelling techniques. We propose the Adjusted Local Linear Trend (ALLT) model, an extended state space model in lieu of the commonly-used linear mixed-effects model (LMEM) in modeling longitudinal neuropsychological outcomes. Our contributed model has the capability to utilize information from the stochasticity of the data while accounting for subject-specific trajectories with the inclusion of covariates and unequally-spaced time intervals. The first step of model fitting involves a likelihood maximization step to estimate the unknown variances in the model before parsing these values into the Kalman Filter and Kalman Smoother recursive algorithms. Results from simulation studies showed that the ALLT model is able to attain lower bias, lower standard errors and high power, particularly in short longitudinal studies with equally-spaced time intervals, as compared to the LMEM. The ALLT model also outperforms the LMEM when data is missing completely at random (MCAR), missing at random (MAR) and, in certain cases, even in data with missing not at random (MNAR). In terms of model selection, likelihood-based inference is applicable for the ALLT model. Although a Chi-Square distribution with k degrees of freedom, where k is the number of parameter lost during estimation, was not the asymptotic distribution in the case of ALLT, we were able to derive an asymptotic distribution approximation of the likelihood ratio test statistics using the power transformation method for the utility of a Gaussian distribution to facilitate model selections for ALLT. In light of these findings, we believe that our proposed model will shed light into longitudinal data analysis not only in the neuropsychological data realm but also on a broader scale for statistical analysis of longitudinal data. / 2023-10-05T00:00:00Z