Terminal-Decline Effects for Select Cognitive Tasks after Controlling for Preclinical Dementia

Laukka, E. J.; MacDonald, Stuart W. S.; Bäckman, Linda

doi:10.1097/jgp.0b013e318160f312

Cited by 10 publications

(16 citation statements)

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“…While previous studies have confirmed the existence of terminal decline, [3][4][5][6][7] they have inadequately addressed practice or learning effects in cognitive test performance. Practice effects refer to the improvement in cognitive test scores over repeated administrations of cognitive tests.…”

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confidence: 99%

“…In the population-based longitudinal Kungsholmen project, 7 the impending death group had a faster rate of decline in Word Recognition and Category Fluency during the 3 years before death, compared with the survivors, even after excluding preclinical cases of dementia. In our study, language function, which included a Category Fluency test, showed the earliest inflection point along with executive function measured by Trails B, after controlling for practice effects.…”

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confidence: 99%

“…However, even in the absence of clinically diagnosed dementia, and after accounting for other illnesses, declining cognitive function is also associated with mortality. [1][2][3][4][5][6][7] Therefore, cognitive decline could reflect biological aging independently of dementia. The concept of terminal cognitive decline refers to the relatively precipitous drop in cognitive function occurring in the years preceding death.…”

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confidence: 99%

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Terminal decline and practice effects in older adults without dementia

et al. 2011

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Objective: To track cognitive change over time in dementia-free older adults and to examine terminal cognitive decline.Methods: A total of 1,230 subjects who remained free from dementia over 14 years of follow-up were included in a population-based epidemiologic cohort study. First, we compared survivors and decedents on their trajectories of 5 cognitive functions (learning, memory, language, psychomotor speed, executive functions), dissociating practice effects which can mask clinically significant decline from age-associated cognitive decline. We used longitudinal mixed-effects models with penalized linear spline. Second, limiting the sample to 613 subjects who died during follow-up, we identified the inflection points at which the rate of cognitive decline accelerated, in relation to time of death, controlling for practice effects. We used mixed-effects model with a change point.Results: Age-associated cognitive trajectories were similar between decedents and survivors without dementia. However, substantial differences were observed between the trajectories of practice effects of survivors and decedents, resembling those usually observed between normal and mildly cognitively impaired elderly. Executive and language functions showed the earliest terminal declines, more than 9 years prior to death, independent of practice effects.

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Terminal decline and practice effects in older adults without dementia

et al. 2011

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“…It has been argued that terminal changes in cognition at the end of life may reflect a general deterioration of the biological system [7,9,10]. On the other hand, evidence exists to suggest that terminal decline of cognition may be specific to individuals diagnosed with dementia [11][12][13].…”

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confidence: 99%

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

et al. 2018

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Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument – Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.

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“…Mild cognitive impairment is common in the elderly, and is associated with increased risk of dementia [1][2][3][4][5][6][7] and death. [8][9][10][11][12] During the 20th century, later-born cohorts performed better on cognitive tests than earlier-born cohorts. [13][14][15] Later-born cohorts may thus have better cognitive reserve that protects against or delays dementia onset, 15,16 and decreases the influence of impending death on cognitive function.…”

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confidence: 99%

Secular changes in cognitive predictors of dementia and mortality in 70-year-olds

Sacuiu

Gustafson²,

Sjögren³

et al. 2010

Neurology

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Terminal-Decline Effects for Select Cognitive Tasks after Controlling for Preclinical Dementia

Abstract: 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.

Cited by 10 publications

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Terminal decline and practice effects in older adults without dementia

Terminal decline and practice effects in older adults without dementia

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

Secular changes in cognitive predictors of dementia and mortality in 70-year-olds

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