title: Cognitive impairment and mortality in older mexican americans.
abstract: OBJECTIVE
  To examine the extent to which cognitive status and decline in cognitive status predict mortality in older Mexican Americans.
  
  
  METHODS
  Longitudinal cohort.
  
  
  METHODS
  Older Mexican Americans residing in five southwestern states in the United States.
  
  
  METHODS
  Two thousand six hundred twenty-five persons aged 65 and older living in Texas, New Mexico, Colorado, Arizona, and California.
  
  
  METHODS
  The cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE) in 1993-94 and again in 1995-96. Cognitive decline was defined using two sets of criteria: a drop to 17 or less (moderate-severe cognitive impairment) on the MMSE at 2-year follow-up and a decrease of at least four points, a threshold change in scores that was used to predict mortality in this sample. Cox proportional hazards models were conducted to examine the association between the MMSE and increased risk for mortality, after controlling for sociodemographic characteristics, medical conditions, and depressive symptoms.
  
  
  RESULTS
  Five-year mortality risk was significantly associated with persons in the moderately-severely cognitively impaired category (hazard ratio (HR) = 2.35, P <.001). Moreover, mild cognitive impairment was also predictive of mortality in older Mexicans (HR = 1.45, P <.001). Two-year declines in cognitive functioning, particularly in persons who had declined to the moderate-severe impairment category (HR = 2.23, P <.001) and those who dropped at least four points on the MMSE (HR = 1.30, P <.001), were predictive of mortality 3 years later, after controlling for important variables.
  
  
  CONCLUSIONS
  Baseline moderate-severe and mild cognitive status and 2-year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.
authors.affiliation: Center on Aging, University of Texas Medical Branch, Galveston, Texas 77555, USA.
authors.forename: Ha T
authors.initials: HT
authors.lastname: Nguyen
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Black
authors.forename: Laura A
authors.initials: LA
authors.lastname: Ray
authors.forename: David V
authors.initials: DV
authors.lastname: Espino
authors.forename: Kyriakos S
authors.initials: KS
authors.lastname: Markides
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017058:Mexican Americans