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Eur Psychiatry. 2019 May;58:80-86. doi: 10.1016/j.eurpsy.2019.03.001. Epub 2019 Mar 12.

Differences in cognitive performance and cognitive decline across European regions: a population-based prospective cohort study.

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National Institute of Mental Health, 250 67 Klecany, Czech Republic.
National Institute of Mental Health, 250 67 Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
National Institute of Mental Health, 250 67 Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic. Electronic address:



A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline.


We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline.


Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%).


There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.


Change; Cognition; Epidemiology; Reserve

[Indexed for MEDLINE]

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