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.Subjects: 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.Conclusion: 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.
Highlights
In the Cambridge City over 75 Cohort Study (CC75C), we examined the terminal decline hypothesis previously [12, 13], but models used did not allow us to test for associations of risk factors with this onset [14]
Deviance Information Criterion (DIC) values obtained from the Tobit (DIC = 51518.5) and regular models (DIC = 51524.3) were similar, they suggested that the Tobit model supported the data best
Our results indicate that the onset of terminal decline in global cognitive function measured using the Mini Mental State Exam (MMSE) occurred at 6.2 years before death
Summary
The terminal decline hypothesis suggests an accelerated decline in cognitive function before death [2]. Evidence is inconsistent, varying by ability examined. Some did not find an accelerating change of primary and episodic memory, word recognition, verbal and visuospatial ability, MMSE scores and perceptual speed [3,4,5]. Others reported constant rate of decline for Block Design score, an ‘age-vulnerable’ activity, and accelerating rate of decline in Information scores, an ‘age-maintained’ ability [6]. Results about the onset of terminal decline varied by study and ability, ranging from 2.7 years before death for perceptual speed [7] to 14.8 years for spatial ability [8]
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