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Cognitive decline in an elderly population – a two wave study of change

Published online by Cambridge University Press:  09 July 2009

C. Brayne ,
C. Gill ,
E. S. Paykel ,
F. Huppert  and
D. W. O'Connor
C. Brayne*
Affiliation:
Departments of Community Medicine, Psychiatry and MRC Biostatistics Unit, Institute of Public Health, University of Cambridge; Department of Psychogeriatrics, Monash University, Melbourne, Australia
C. Gill
Affiliation:
Departments of Community Medicine, Psychiatry and MRC Biostatistics Unit, Institute of Public Health, University of Cambridge; Department of Psychogeriatrics, Monash University, Melbourne, Australia
E. S. Paykel
Affiliation:
Departments of Community Medicine, Psychiatry and MRC Biostatistics Unit, Institute of Public Health, University of Cambridge; Department of Psychogeriatrics, Monash University, Melbourne, Australia
F. Huppert
Affiliation:
Departments of Community Medicine, Psychiatry and MRC Biostatistics Unit, Institute of Public Health, University of Cambridge; Department of Psychogeriatrics, Monash University, Melbourne, Australia
D. W. O'Connor
Affiliation:
Departments of Community Medicine, Psychiatry and MRC Biostatistics Unit, Institute of Public Health, University of Cambridge; Department of Psychogeriatrics, Monash University, Melbourne, Australia
*
1Address for correspondence: Dr Carol Brayne, Department of Community Medicine, University of Cambridge, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR.
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Synopsis

A sample of 1111 survivors from a population aged 75 years and over completed the Mini-Mental State Examination (MMSE) twice, separated by 28 months on average. There was a mean decline of 1·3 points in MMSE score. With increasing age, mean drop in score also increased. The proportion at each age identified as newly cognitively impaired according to any standard cut-point on MMSE rose markedly. Mean decline was greater in women than men even after adjustment for age. Cognitive change on the MMSE was approximately unimodally and normally distributed. This distribution was a marked contrast to the distribution of MMSE scores themselves, which was skewed due to truncation of scores at the maximum. The decline was not due to the inclusion of individuals with physical impairment. These findings indicate that cognitive decline, like dementia, becomes increasingly common with advancing age, and suggest that dementia may be regarded as one extreme of the continuum of cognitive decline.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 4 , July 1995 , pp. 673 - 683
Copyright
Copyright © Cambridge University Press 1995

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington DC.Google Scholar
Bassett, S. S. & Folstein, M. F. (1991). Cognitive impairment and functional disability in the absences of psychiatric diagnosis. Psychological Medicine 21, 77–84.CrossRefGoogle ScholarPubMed
Berg, S. (1980). Psychological functioning in 70–75-year-old people. A study in an industrialized city. Acta Psychiatrica Scandinavica 62, suppl. 288.Google Scholar
Brayne, C. & Calloway, P. (1988). Normal ageing, impaired cognitive function, and senile demential of the Alzheimer's type: a continuum? Lancet i, 1265–1266.CrossRefGoogle Scholar
Brayne, C. & Calloway, P. (1990). The case of identification of demential in the community: a comparison of methods. International Journal of Geriatric Psychiatry 5, 309–316.CrossRefGoogle Scholar
Brayne, C., Gill, C., Hyppert, F. A., Barkley, C., Gelilhaar, E., Girling, D. M., O'Connor, D. M. & Paykel, E. S. (1995). Incidence of clinically diagnosed subtypes of dementia in an elderly population – results from the Cambridge Project for Later Life. British Journal Psychiatry 167 (in the press).CrossRefGoogle Scholar
Burns, A., Lewis, G., Jacoby, R. & Levy, R. (1991). Factors affecting survival in Alzheimer's disease. Psychological Medicine 21, 363–370.CrossRefGoogle ScholarPubMed
Colsher, P. L. & Wallace, R. B. (1991). Epidemiological considerations in studies of cognitive function in the elderly: methodology and nondementing acquired dysfunction. Epidemiologic Reviews 13, 1–27.CrossRefGoogle ScholarPubMed
Colsher, P. L. (1992). Epidemiologic studies of cognitive function in the elderly: rational, methods and findings. In The Epidemiologic Study of the Elderly (ed. Wallace, R. B. and Woolson, R. F.), pp. 130–156. Oxford University Press: Oxford.Google Scholar
Esiri, M. (1994). Dementia and normal aging: neuropathology. In Dementia and Normal Aging (ed. Huppert, F. A., Brayne, C. and O'Connor, D. W.), pp. 385–436. Cambridge University Press: Cambridge.Google Scholar
Fillenbaum, G. G., Hughes, D. C., Heyman, A., George, L. K. & Blazer, D. G. (1988). Relationship of health and demographic characteristics to Mini-Mental State Examination score among community residents. Psychological Medicine 18, 719–726.CrossRefGoogle ScholarPubMed
Folstein, M. R., Folstein, S. E. & McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Forbes, W. F. & Hirdes, J. P. (1993). The relationship between aging and disease: geriatric ideology and myths of senility. Journal of American Geriatric Society 41, 1267–1271.CrossRefGoogle ScholarPubMed
Heeren, J. J., Lagaay, A. M., van Beek, W. C. A., Rooymans, H. G. M. & Hijmans, W. (1990). Reference values for the Mini-Mental State Examination in octo- and nonagenerians. Journal of the American Geriatric Society 38, 1093–1096.CrossRefGoogle Scholar
Holzer, C. E., Tischler, G. L., Leaf, P. J. & Myers, J. K. (1984). An epidemiologic assessment of cognitive impairment in a community population. Research in Community and Mental Health 4, 3–32.Google Scholar
Houx, P. J., Vreeling, F. W. & Jolles, J. (1991). Rigorous health screening reduces age effect on memory scanning task. Brain and Cognition 15, 246–260.CrossRefGoogle ScholarPubMed
Huppert, F. A. (1994). Memory function in dementia and normal aging – dimension or dichotomy? In Dementia and Normal Aging (ed. Huppert, F. A., Brayne, C. and O'Connor, D. W.), pp. 291–330. Cambridge University Press: Cambridge.Google Scholar
Huppert, F. A. & Brayne, C. (1994). What is the relationship between dementia and normal ageing? In Dementia and Normal Aging (ed. Huppert, F. A., Brayne, C. & O'Connor, D. W.), pp. 3–11. Cambridge University Press: Cambridge.Google Scholar
Huppert, F. A., Brayne, C., Gill, C., Paykel, E. S. & Beardsall, L. (1995). CAMCOG – a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. British Journal of Psychology 167 (in the press).Google Scholar
Jagger, C., Clarke, M. & Anderson, J. (1992). Screening for dementia – a comparison of two tests using Receiver Operating Characteristics Analysis. International Journal of Geriatric Psychiatry 7, 659–665.CrossRefGoogle Scholar
Khaw, K.-T. (1994). Public health implications of a continuous model for dementia. In Dementia and Normal Aging (ed. Huppert, F. A., Brayne, C. and O'Connor, D. W.), pp. 552–560. Cambridge University Press: Cambridge.Google Scholar
Katzman, R., Brown, T., Thai, L. J., Fuld, P. A., Aronson, M., Butters, N., Klauber, M. R., Wiederhold, W., Pay, M., Renburg, X., Ooi, W. L., Hofstetter, R. & Terry, R. D. (1988). Comparison of rate of annual change of mental status score in four independent studies of patients with Alzheimer's disease. Annals of Neurology 24, 384–389.CrossRefGoogle ScholarPubMed
Last, J. M. (1988). A Dictionary of Epidemiology. Oxford University Press: Oxford.Google Scholar
Morris, J. C., Edland, S., Clark, C., Galasko, D., Koss, E., Mohs, R., van Belle, G., Fillenbaum, G. & Heyman, A. (1993). The consortium to establish a registry for Alzheimer's disease. Part IV. Rates of cognitive change in the longitudinal assessment of probable Alzheimer's disease. Neurology 43, 2457–2465.CrossRefGoogle Scholar
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellows, J. L., Miller, N. D., Brook, C. P. B., Reiss, B. B. & Roth, M. (1989 a). The prevalence of dementia as measured by the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatrica Scandinavica 79, 190–198.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellows, J. L., Millder, N. D., Brook, C. P. & Reiss, B. B. (1989 b). The reliability and validity of the Mini-Mental State in a British community survey. Journal of Psychiatric Research 23, 87–96.CrossRefGoogle Scholar
O'Connor, D. W., Pollitt, P. A., Jones, B. J., Hypde, J. B., Fellows, J. L. & Miller, N. D. (1991). Continued clinical validation of dementia diagnosed in the community using the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatrica Scandinavica 83, 41–45.CrossRefGoogle ScholarPubMed
Paykel, E. S., Brayne, C., Huppert, F. A., Gill, C., Barkley, C., Gelilhaar, E., Beardsall, L., Girling, D. M., Pollitt, P. & O'Connor, D. (1994). The incidence of dementia in a population older than 75 years in the United Kingdom. Archives of General Psychiatry 51, 325–332.CrossRefGoogle Scholar
Palmore, E. (1974). Normal Aging II. Duke University Press: Durham, NC.Google Scholar
Perls, R. R., Morris, J. N., Ooi, W. L. & Lipsitz, L. A. (1993). The relationship between age, gender and cognitive performance in the very old: the effect of selective survival. Journal of American Geriatric Society 41, 1193–1201.CrossRefGoogle ScholarPubMed
Rabbitt, P. (1990). Applied cognitive gerontology: some problems, methodologies and data. Applied Cognitive Psychology 4, 225–246.CrossRefGoogle Scholar
Rose, G. (1992). The Strategy of Preventive Medicine. Oxford University Press: Oxford.Google Scholar
Roses, A. D., Strittmatter, W. J., Pericak-Varice, M. A., Corder, E., Saunders, A. M. & Schmechel, D. E. (1994). Clinical application of apolipoprotein E genotyping to Alzheimer's disease. Lancet 343, 1564–1565.CrossRefGoogle ScholarPubMed
Roth, M., Tyn, E., Mountjoy, C. Z., Huppert, F. A., Hendrie, H., Verma, S. & Goddard, R. (1986). CAMDEX. A standardized instrument for the diagnoses of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698–709.CrossRefGoogle Scholar
Roth, M., Huppert, F. A., Tym, E. & Mountjoy, C. Q. (1988). CAMDEX. The Cambridge Examination for Mental Disorders of the Elderly. Cambridge University Press: Cambridge.Google Scholar
Schaie, K. W. & Labouvie-Vief, G. (1974). Generational versus ontogenic components in change in adult cognitive behaviour: a 14 year cross-sequential study. Developmental Psychology 10, 305–320.CrossRefGoogle Scholar
Scherr, K. W., Albert, M. S., Funkenstein, H. H., Cook, N. R., Hennekens, C. H., Branch, L. G., White, L. R., Taylor, J. O. & Evans, D. A. (1988). Correlates of cognitive function in an elderly community population. American Journal of Epidemiology 128, 1084–1101.CrossRefGoogle Scholar
Tombaugh, T N. & McIntyre, N. J. (1992). The Mini-Mental State Examination: a comprehensive review. Progress in Gerontology 40, 922–935.Google ScholarPubMed
Tomlinson, B. E., Blessed, G. & Roth, M. (1968). Observations on the brains of non-demented old people. Journal of Neurological Sciences 7, 351–356.CrossRefGoogle ScholarPubMed
van Belle, G., Uhlmann, R. F., Hughes, J. P. & Larson, E. B. (1990). Reliability of estimates of changes in mental status test performance in senile dementia of the Alzheimer type. Journal of Clinical Epidemiology 43, 589–595.CrossRefGoogle ScholarPubMed
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar