Skip to main content
    • Aa
    • Aa

Normal rates of cognitive change in successful aging: The Freedom House Study

  • DONALD R. ROYALL (a1) (a2) (a3), RAYMOND PALMER (a4), LAURA K. CHIODO (a2) and MARSHA J. POLK (a2)

We determined the rates of cognitive change associated with twenty individual measures. Participants included 547 noninstitutionalized septuagenarians and octogenarian residents of a comprehensive care retirement community who were studied over three years. Latent growth curves (LGC) of multiple cognitive measures were compared to a LGC model of the rates of change in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). All curves were standardized relative to each variable's baseline distribution. Baseline scores were within their expected normal age-specific ranges. Most measures showed significant rates of change over time. There was also significant variability about those rates, suggesting clinical heterogeneity. Many deteriorated over time, as did ADLs and IADLs. However, performance on some measures improved, consistent with learning effects. The rates of change in two measures, the Executive Interview and the Trail Making Test, were closely related to decline in IADLs. These results suggest that age-related cognitive decline is a dynamic longitudinal process affecting multiple cognitive domains. Heterogeneity in the rates of cognitive change may reflect the summed effects of age and comorbid conditions affecting cognition. Some measures may be ill-suited for measuring age-related changes in cognition, either because they are insensitive to change, or hindered by learning effects. Nonverbal measures appear to be particularly well suited for the prediction of age-related functional decline. These observations are relevant to the definition and diagnosis of “dementing” conditions. (JINS, 2005, 11, 899–909.)

Corresponding author
Reprint requests to: Dr. Donald Royall, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7792. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Allen, S.C., Jain, M., Ragab, S., & Malik, N. (2003). Acquisition and short-term retention of inhaler techniques require intact executive function in elderly participants. Age Ageing, 32, 299302.

Anstey, K.J., Hofer, S.M., & Luszcz, M.A. (2003). A latent growth curve analysis of late-life sensory and cognitive function over 8 years: Evidence for specific and common factors underlying change. Psychology and Aging, 18, 714726.

Artero, S., Touchon, J., & Ritchie, K. (2001). Disability and mild cognitive impairment: A longitudinal population-based study. International Journal of Geriatric Psychiatry, 16, 10921097.

Basso, M.R., Bornstein, R.A., & Lang, J.M. (1999). Practice effects on commonly used measures of executive function across twelve months. Clinical Neuropsychologist, 13, 283292.

Bentler, P.M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238246.

Braak, H. & Braak, E. (1997). Frequency of stages of Alzheimer-related lesions in different age categories. Neurobiology of Aging, 18, 351357.

Braak, H. & Braak, E. (1998). Evolution of neuronal changes in the course of Alzheimer's disease. Journal of Neural Transmission, 53, 127140.

Comijs, H.C., Dik, M.G., Deer, D.J.H., & Jonker, C. (2004). The course of cognitive decline in older persons: Results from the Longitudinal Aging Study of Amsterdam. Dementia and Geriatric Cognitive Disorders, 17, 136142.

Dymek, M.P., Atchison, P., Harrell, L., & Marson, D.C. (2001). Competency to consent to medical treatment in cognitively impaired patients with Parkinson's disease. Neurology, 56, 1724.

Elias, M.F., Sullivan, L.M., D'Agostino, R.B., Elias, P.K., Besier, A., Au, R., Seshadri, A., DeCarli, C., & Wolf, P.A. (2004). Framingham Stroke Risk Profile and lowered cognitive performance. Stroke, 35, 404409.

Ferrer, E., Salthouse, T.A., Stewart, W.F., & Schwartz, B.S. (2004). Modeling age and retest processes in longitudinal studies of cognitive abilities. Psychology and Aging, 19, 243259.

Folstein, M., Folstein, S., & McHugh, P.R. (1975). ‘Mini-Mental State’: A practical method for grading the cognitive state of patients for the clinician. Psychiatric Research, 12, 189198.

Frerichs, R.J. & Tuokko, H.A. (2005). A comparison of methods for measuring cognitive change in older adults. Archives of Clinical Neuropsychology, 20, 321333.

Ghisletta, P. & Lindenberger, U. (2004). Static and dynamic longitudinal structural analyses of cognitive changes in old age. Gerontology, 50, 1216.

Haaland, K.Y., Vranes, L.F., Goowdwin, J.S., & Garry, P.J. (1987). Wisconsin Card Sorting Test performance in a healthy elderly population. Journal of Gerontology, 42, 345346.

Hertzog, C., Dixon, R.A., Hultsch, D.F., & MacDonald, S.W. (2003). Latent change models of adult cognition: Are changes in processing speed and working memory associated with changes in episodic memory?Psychology and Aging, 18, 755769.

Jacqmin-Gadda, H., Fabrigoule, C., Commenges, D., & Dartigues, J.F. (1997). A 5-year longitudinal study of the Mini-Mental State Examination in normal aging. American Journal of Epidemiology, 145, 498506.

Jehkonen, M., Ahonen, J.P., Dastidar, P., Laippala, P., & Vilkki, J. (2000). Unawareness of deficits after right hemisphere stroke: Double-dissociations of anosognosias. Acta Neurologica Scandinavica, 102, 378384.

Johnson, S.C., Saykin, A., Flashman, L.A., McAllister, T.W., & Sparling, M.B. (2001). Brain activation on fMRI and verbal memory ability: Functional anatomic correlates of CVLT performance. Journal of the International Neuropsychological Society, 7, 5562.

Kraemer, H.C., Yesavage, J.A., Taylor, J.L., & Kupfer, D. (2000). How can we learn about developmental processes from cross-sectional studies, or can we?American Journal of Psychiatry, 157, 163171.

Lineweaver, T.T., Bond, M.W., Thomas, R.G., & Salmon, D.P. (1999). A normative study of Nelson's (1976) modified version of the Wisconsin card sorting test in healthy older adults. Clinical Neuropsychologist, 13, 328347.

Linn, R.T., Wolf, P.A., Bachman, D.L., Knoefel, J.E., Cobb, J.L., Belanger, A.J., Kaplan, E.F., & D'Agostino, R.B. (1995). The “Preclinical” Phase” of probable Alzheimer's disease: A 13-year prospective study of the Framingham cohort. Archives of Neurology, 52, 485490.

Maixner, S.M., Burke, W.J., Roccaforte, W.H., Wengel, S.P., & Potter, J.F. (1995). A comparison of two depression scales in a geriatric assessment clinic. American Journal of Geriatric Psychiatry, 3, 6067.

Mann, L.S., Westlake, T., Wise, T.N., Beckman, A., Beckman, P., & Portez, D. (1999). Executive functioning and compliance in HIV patients. Psychological Reports, 84, 319322.

McArdle, J. & Hamagami, F. (1992). Modeling incomplete longitudinal and cross sectional data using latent growth structural models. Experimental Aging Research, 18, 145166.

McGue, M. & Christensen, K. (2002). Heritability of level of and rate of change in cognitive functioning in Danish twins aged 70 years and older. Experimental Aging Research, 28, 435451.

Petersen, R.C., Doody, R., Kurz, A., Mohs, R.C., Morris, J.C., Rabins, P.V., Ritchie, K., Russor, W., Thal, L., & Winblad, B. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 198592.

Petersen, R.C., Smith, G.E., Waring, S.C., Ivnik, R.J., Tangalos, E.G., & Kokmen, E. (1999). Mild Cognitive Impairment: Clinical characteristics and outcomes. Archives of Neurology, 56, 303308.

Rapp, S.R., Espeland, M.A., Hogan, P., Jones, B.N., & Dugan, E. (2003). Baseline experience with Modified Mini-Mental State Exam: The Women's Health Initiative Memory Study (WHIMS). Aging and Mental Health, 7, 217213.

Ratcliff, G., Dodge, H., Birzescu, M., & Ganguli, M. (2003). Tracking cognitive functioning over time: Ten-year longitudinal data from a community-based study. Applied Neuropsychology, 10, 7688.

Reitan, R.M. (1958). Validity of the Trail Making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271276.

Reynolds, C.A., Finkle, D., Gatz, M., & Pedersen, N.L. (2002). Sources of influence on rate of cognitive change over time in Swedish twins: An application of latent growth models. Experimental Aging Research, 28, 407433.

Royall, D.R. (2005). “Silent stroke”: An oxymoron meaning “dementia”. Seminars in Cerebrovascular Diseases and Stroke, 4, 97101.

Royall, D.R., Cordes, J., & Polk, M.J. (1997). Executive control and the comprehension of medical information by elderly retirees. Experimental Aging Research, 23, 301313.

Royall, D.R., Cabello, M., & Polk, M.J. (1998a). Executive dyscontrol: An important factor affecting the level of care received by elderly retirees. Journal of the American Geriatrics Society, 46, 15191524.

Royall, D.R., Cordes, J.A., & Polk, M. (1998b). CLOX: An executive clock drawing task. Journal of Neurology, Neurosurgery and Psychiatry, 64, 588594.

Royall, D.R., Chiodo, L.K., & Polk, M.J. (2000). Correlates of disability among elderly retirees with “sub-clinical” cognitive impairment. Journals of Gerontology, Series A, Biological Sciences and Medical Sciences, 55, M541546.

Royall, D.R., Chiodo, L.K., & Polk, M. (2003). Executive dyscontrol in normal aging: Normative data, factor structure, and clinical correlates. Current Neurology and Neuroscience Reports, 3, 487493.

Royall, D.R., Chiodo, L.K., & Polk, M.J. (2004). Misclassification is likely in the assessment of Mild Cognitive Impairment. Neuroepidemiology, 23, 185191.

Royall, D.R., Mahurin, R.K., & Gray, K.F. (1992). Bedside assessment of executive cognitive impairment: The Executive Interview (EXIT). Journal of the American Geriatrics Society, 40, 12211226.

Royall, D.R., Palmer, R., Chiodo, L.K., & Polk, M.J. (2004). Declining executive control in normal aging predicts change in functional status: The Freedom House Study. Journal of the American Geriatrics Society, 52, 346352.

Royall, D.R., Palmer, R., Chiodo, L.K., & Polk, M.J. (2005). Executive control mediates memory's association with change in functional status: The Freedom House Study. Journal of the American Geriatrics Society, 53, 1117.

Royall, D.R., Palmer, R., Mulroy, A., Polk, M.J., Román, G.C., David, J-P., & Delacourte, A. (2002). Pathological determinants of clinical dementia in Alzheimer's disease. Experimental Aging Research, 28, 143162.

Royall, D.R. & Polk, M. (1998). Dementias that present with and without posterior cortical features: An important clinical distinction. Journal of the American Geriatrics Society, 46, 98105.

Saykin, A.J., Johnson, S.C., Flashman, L.A., McAllister, T.W., Sparling, M., Darcey, T.M., Moritz, C.H., Guerin, S.J., Weaver, A., & Mamourian, A. (1999). Functional differentiation of medial temporal and frontal regions involved in processing novel and familiar words. Brain, 122, 19631971.

Singer, T., Verhaeghen, P., Ghisletta, P., Lindenberger, U., & Baltes, P.B. (2003). The fate of cognition in very old age: Six-year longitudinal findings in the Berlin Aging Study (BASE). Psychology and Aging, 18, 318331.

Sliwinski, M.J., Hofer, S.M., Hall, C., Buschke, H., & Liptom, R.B. (2003). Modeling memory decline in older adults: The importance of preclinical dementia, attrition, and chronological age. Psychology and Aging, 18, 658671.

Suh, G.-H., Ju, Y.-S., Yeon, B.K., & Shah, A. (2004). A longitudinal study of Alzheimer's disease: Rates of cognitive and functional decline. International Journal of Geriatric Psychiatry, 19, 817824.

Willet, J. & Sayer, A. (1994). Using covariance structure analysis to detect correlates and predictors of individual change over timePsychological Bulletin, 116, 363381.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 35 *
Loading metrics...

Abstract views

Total abstract views: 173 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 29th May 2017. This data will be updated every 24 hours.