title: Education associated with a delayed onset of terminal decline.
abstract: BACKGROUND
  the terminal decline hypothesis suggests an acceleration in the rate of loss of cognitive function before death. Evidence about the association of educational attainment and the onset of terminal decline is scarce.
  
  
  OBJECTIVE
  to investigate the association of education with the onset of terminal decline in global cognitive function measured by Mini Mental State Exam (MMSE) scores.
  
  
  METHODS
  deceased participants of the Cambridge City over 75 Cohort Study who were interviewed at about 2, 7, 9, 13, 17 and 21 years after baseline.
  
  
  METHODS
  regular and Tobit random change point growth models were fitted to MMSE scores to identify the onset of terminal decline and assess the effect of education on this onset.
  
  
  RESULTS
  people who left school at an older age had a delayed onset of terminal decline. Thus better educated individuals experience a slightly shorter period of faster decline before death.
  
  
  CONCLUSIONS
  an important finding emerging from our work is that education does appear to delay the onset of terminal decline, although only by a limited amount.
authors.affiliation: MRC Lifelong Health and Ageing Unit, UCL, 33 Bedford Place, London WC1B 5JU, UK.
authors.forename: Graciela Muniz
authors.initials: GM
authors.lastname: Terrera
authors.forename: Thais
authors.initials: T
authors.lastname: Minett
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Matthews
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control* / Q000523:psychology; D004522:Educational Status; D004739:England / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D013997:Time Factors
keywords: MMSE; change points; older people; terminal decline