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Am J Geriatr Psychiatry. 2008 May;16(5):355-65. doi: 10.1097/JGP.0b013e318160f312.

Terminal-decline effects for select cognitive tasks after controlling for preclinical dementia.

Author information

  • 1Aging Research Center, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden. Erika.Jonsson.Laukka@ki.se

Abstract

OBJECTIVE:

In a previous study, the authors found no accelerated decline in close proximity to death for a measure of global cognitive functioning, after excluding persons in a preclinical phase of dementia. However, specific cognitive tasks might be more sensitive to terminal-decline effects. The purpose of this study was to explore possible terminal-decline effects for a range of cognitive tasks after controlling for preclinical dementia.

DESIGN:

Community-based cohort study.

SETTING:

The Kungsholmen district of Stockholm.

PARTICIPANTS:

A total of 585 persons (75+ years) were repeatedly assessed over an 11-year period. Level and change in cognitive performance were compared for three groups: persons in close proximity to death, persons in a preclinical phase of dementia, and persons who remained alive and nondemented throughout the study.

MEASUREMENTS:

Tasks assessing primary and episodic memory, verbal ability, and visuospatial skill.

RESULTS:

Compared with an analysis where all dead subjects were included in the impending-death group, removing the preclinical dementia cases resulted in markedly attenuated mortality-related effects. However, the impending-death group still declined at a faster rate relative to the comparison group on Digit Span-forward, word recognition, and category fluency. Notably, these were tasks for which the comparison group showed no significant decline.

CONCLUSIONS:

A considerable proportion of the terminal-decline effect is accounted for by the impact of preclinical dementia. However, for tasks that are relatively resistant to age-related change, such effects might be detected independently of preclinical dementia.

PMID:
18448848
[PubMed - indexed for MEDLINE]
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