title: Long-term Cognitive Trajectories and Mortality in Older Women.
abstract: Few studies have examined whether change in cognition is linked to mortality. This study examined the relationship between cognitive trajectories in older age and risk of death.
  
  
  
  We studied community-dwelling, nondemented women aged 65+ (mean age = 71) enrolled in a prospective study of aging and followed up to 25 years. A modified Mini-Mental State Examination (mMMSE) and Trail Making Task Part B (TMTB) were administered at multiple visits during follow-up. We examined the association between cognitive trajectories (analyzed by quintiles) from baseline to age 80 (n = 7,477 for mMMSE and n = 6,503 for TMTB) and all-cause mortality after age 80 using Cox regression models, both unadjusted and adjusted for education, physical activity, alcohol, depression score, current smoking and history of hypertension and diabetes. Cause of death was determined from death certificates, classified as cardiovascular, cancer and other.
  
  
  
  Women with greater rate of decline were older, less educated, less physically active, had higher depression score and were more likely to have a history of hypertension and diabetes (all p < .01). Participants with the greatest decline (quintile 1) had an increased risk of death (mMMSE hazard ratio [HR] = 1.28; TMTB HR = 1.43] and those with the least decline (quintile 5) had a decreased risk of death (mMMSE HR = 0.73; TMTB HR = 0.61) compared with intermediate decliners (quintiles 2-4). Cognitive trajectories were associated with cardiovascular mortality and other causes of death, but not cancer deaths.
  
  
  
  Our study suggests that greater decline in general cognition or executive function is associated with higher rates of mortality in oldest-old women.
authors: Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco. Department of Mental Health, San Francisco VA Medical Center, California.
authors: Kristine
authors: K
authors: Yaffe
authors: Department of Mental Health, San Francisco VA Medical Center, California. NCIRE-The Veterans Health Research Institute, San Francisco, California. carrie.peltz2@va.gov.
authors: Carrie B
authors: CB
authors: Peltz
authors: Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco.
authors: Susan K
authors: SK
authors: Ewing
authors: Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco.
authors: Charles E
authors: CE
authors: McCulloch
authors: Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco.
authors: Steve R
authors: SR
authors: Cummings
authors: Department of Epidemiology, University of Pittsburgh, Pennsylvania.
authors: Jane A
authors: JA
authors: Cauley
authors: Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon.
authors: Teresa A
authors: TA
authors: Hillier
authors: School of Public Health, University of Minnesota, Minneapolis. Department of Medicine, Minneapolis VA Health Care System, Minnesota.
authors: Kristine E
authors: KE
authors: Ensrud
mesh_terms: D017677:Age Distribution; D000368:Aged; D000375:Aging; D015992:Body Mass Index; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D048909:Diabetes Complications / Q000401:mortality; D004522:Educational Status; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D006973:Hypertension / Q000401:mortality; D057187:Independent Living; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
keywords: All-cause mortality; Cardiovascular mortality; Cognitive trajectories; Executive function; Global cognition; Oldest old