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© 2009 American Academy of Neurology Predictors of maintaining cognitive function in older adultsThe Health ABC StudyFrom the Departments of Psychiatry (K.Y., A.J.F.), Epidemiology and Biostatistics (K.Y., E.V., S.M.R., H.N.A.), Neurology (K.Y.), and Medicine (K.L.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.), CA; Clinical Research Branch (E.M.S.) and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), National Institute on Aging, Baltimore, MD; Department of Epidemiology (A.B.N., C.R.), Graduate School of Public Health, Pittsburgh, PA; and Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis. Address correspondence and reprint requests to Dr Fiocco, Department of Psychiatry, School of Medicine, University of California, San Francisco, 4150 Clement St., San Francisco, CA 94117 jazzfiocco{at}hotmail.com Background: Although several risk factors for cognitive decline have been identified, much less is known about factors that predict maintenance of cognitive function in advanced age.
Methods: We studied 2,509 well-functioning black and white elders enrolled in a prospective study. Cognitive function was measured using the Modified Mini-Mental State Examination at baseline and years 3, 5, and 8. Random effects models were used to classify participants as cognitive maintainers (cognitive change slope Results: Over 8 years, 30% of the participants maintained cognitive function, 53% showed minor decline, and 16% had major cognitive decline. In the multivariate model, baseline variables significantly associated with being a maintainer vs a minor decliner were age (odds ratio [OR] = 0.65, 95% confidence interval [CI] 0.55–0.77 per 5 years), white race (OR = 1.72, 95% CI 1.30–2.28), high school education level or greater (OR = 2.75, 95% CI 1.78–4.26), ninth grade literacy level or greater (OR = 4.85, 95% CI 3.00–7.87), weekly moderate/vigorous exercise (OR = 1.31, 95% CI 1.06–1.62), and not smoking (OR = 1.84, 95% CI 1.14–2.97). Variables associated with major cognitive decline compared to minor cognitive decline are reported. Conclusion: Elders who maintain cognitive function have a unique profile that differentiates them from those with minor decline. Importantly, some of these factors are modifiable and thus may be implemented in prevention programs to promote successful cognitive aging. Further, factors associated with maintenance may differ from factors associated with major cognitive decline, which may impact prevention vs treatment strategies.
Abbreviations: 3MS = Modified Mini-Mental State Examination; BMI = body mass index; CES-D = Center for Epidemiologic Studies–Depression Scale score; CI = confidence interval; CRP = C-reactive protein; Health ABC = Health, Aging and Body Composition; IL = interleukin; MI = myocardial infarction; OR = odds ratio; REALM = Rapid Estimate of Adult Literacy in Medicine; TNF = tumor necrosis factor.
Funded by N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106, and AG021918. Supported in part by the Intramural Research Program of the NIH, National Institute on Aging. K.Y. is supported in part by AG 031155 and an anonymous foundation. A.J.F. is supported by the CIHR Institute of Aging Fellowship Award. Disclosure: The authors report no disclosures. Received November 21, 2008. Accepted in final form March 11, 2009. This article has been cited by other articles:
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0), minor decliners (slope <0 and >1 SD below mean), or major decliners (slope 
1 SD below mean). Logistic regression was used to identify domain-specific factors associated with being a maintainer vs a minor decliner. 
