title: Cognitive decline in adulthood: an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area study.
abstract: OBJECTIVE
  The epidemiology of cognitive decline over 11.5 years was investigated in a large community-residing population, with a special emphasis on the relationship between education and cognitive decline.
  
  
  METHODS
  The study was an 11.5-year follow-up of a probability sample of the adult household residents of east Baltimore. From the Baltimore cohort of the Epidemiologic Catchment Area study, 1,488 participants completed the Mini-Mental State during three study waves in 1981, 1982, and 1993-1996. For each study participant, the difference in scores on the Mini-Mental State between waves 2 and 3 was calculated.
  
  
  RESULTS
  Over a median interval of 11.5 years, the study participants' scores on the Mini-Mental State declined a mean of 1.41 points, and the scores of 68% of the participants declined by at least 1 Mini-Mental State point. With and without adjustment for age, greater declines were associated with having 8 years or less of formal education and with being African American.
  
  
  CONCLUSIONS
  Over a long time period, cognitive decline occurred in all age groups. Having more than 8 years of formal education was associated with less decline. However, beyond 9 years, additional education was not associated with a further reduction in cognitive decline. This suggests that a minimal amount of education during early critical periods might confer protection against cognitive decline later in life.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA. kostas@jhmi.edu
authors.forename: C G
authors.initials: CG
authors.lastname: Lyketsos
authors.forename: L S
authors.initials: LS
authors.lastname: Chen
authors.forename: J C
authors.initials: JC
authors.lastname: Anthony
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D002391:Catchment Area, Health; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003423:Critical Period, Psychological; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D012307:Risk Factors