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Onset of terminal decline in cognitive abilities in individuals without dementia

From the Department of Psychology (V.T., B.J.) and Institute of Neuroscience and Physiology, Sahlgrenska Academy (I.S., S.S.), Göteborg University, Sweden; Department of Human Development and Family Sciences (S.M.H.), Oregon State University, Corvallis; and Institute of Gerontology (S.B.), School of Health Sciences, Jönköping University, Sweden.

Address correspondence and reprint requests to Dr. Valgeir Thorvaldsson, Department of Psychology, Göteborg University, Box 500, SE-405 30 Göteborg, Sweden valgeir.thorvaldsson{at}psy.gu.se

Objective: To identify time of onset and rate of mortality-related change (terminal decline) in cognitive abilities in later life.

Method: The sample consisted of 288 individuals without dementia (born 1901–1902) drawn from the population of Göteborg, Sweden. Participants were followed from age 70 until death, with up to 12 measurement occasions on three cognitive abilities. Change-point analysis was performed using an automated piecewise linear mixed modeling approach to identify the inflection point indicating accelerated within-person change related to mortality. A profile likelihood method was used to identify the change point that best fit the data for each of three cognitive abilities.

Results: Onset of terminal decline was identified 6.6 years prior to death for verbal ability, 7.8 years for spatial ability, and 14.8 years for perceptual speed.

Conclusions: There is substantial acceleration in cognitive decline many years prior to death among individuals without dementia. Time of onset and rate of terminal decline vary considerably across cognitive abilities.

Supplemental data at www.neurology.org

Editorial, page 874.

e-Pub ahead of print at www.neurology.org.

The H70 study is supported by grants from the Swedish Medical Research Council, the Delegation for Social Research within the Ministry of Health and Social Affairs, the Bank of Sweden Tercentenary Foundation, The Göteborg Medical Services and Social Services Administrations, Stiftelsen Söderström-Königska sjukhemmet, Konung Gustaf V:s och Drottning Victorias Stiftelse, Stiftelsen för Gamla Tjänarinnor, and Handlanden Hjalmar Svenssons Forskningsfond. Work on this article was supported by the Swedish Brain Power and the Swedish Council for Working Life and Social Research.

Disclosure: The authors report no disclosures.

Received September 21, 2007. Accepted in final form February 15, 2008.

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				R. S. Wilson Advancing age, impending death, and declining cognition Neurology, September 16, 2008; 71(12): 874 - 875. [Full Text] [PDF]