Skip to main content Accessibility help
×
×
Home

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

  • C. Brayne (a1), C. Gill (a1), E. S. Paykel (a1), F. Huppert (a1) and D. W. O'Connor (a1)...
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.

Copyright
Corresponding author
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.
References
Hide All
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington DC.
Bassett, S. S. & Folstein, M. F. (1991). Cognitive impairment and functional disability in the absences of psychiatric diagnosis. Psychological Medicine 21, 7784.
Berg, S. (1980). Psychological functioning in 70–75-year-old people. A study in an industrialized city. Acta Psychiatrica Scandinavica 62, suppl. 288.
Brayne, C. & Calloway, P. (1988). Normal ageing, impaired cognitive function, and senile demential of the Alzheimer's type: a continuum? Lancet i, 12651266.
Brayne, C. & Calloway, P. (1990). The case of identification of demential in the community: a comparison of methods. International Journal of Geriatric Psychiatry 5, 309316.
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).
Burns, A., Lewis, G., Jacoby, R. & Levy, R. (1991). Factors affecting survival in Alzheimer's disease. Psychological Medicine 21, 363370.
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, 127.
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. 130156. Oxford University Press: Oxford.
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. 385436. Cambridge University Press: Cambridge.
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, 719726.
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, 189198.
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, 12671271.
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, 10931096.
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, 332.
Houx, P. J., Vreeling, F. W. & Jolles, J. (1991). Rigorous health screening reduces age effect on memory scanning task. Brain and Cognition 15, 246260.
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. 291330. Cambridge University Press: Cambridge.
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. 311. Cambridge University Press: Cambridge.
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).
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, 659665.
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. 552560. Cambridge University Press: Cambridge.
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, 384389.
Last, J. M. (1988). A Dictionary of Epidemiology. Oxford University Press: Oxford.
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, 24572465.
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, 190198.
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, 8796.
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, 4145.
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, 325332.
Palmore, E. (1974). Normal Aging II. Duke University Press: Durham, NC.
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, 11931201.
Rabbitt, P. (1990). Applied cognitive gerontology: some problems, methodologies and data. Applied Cognitive Psychology 4, 225246.
Rose, G. (1992). The Strategy of Preventive Medicine. Oxford University Press: Oxford.
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, 15641565.
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, 698709.
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.
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, 305320.
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, 10841101.
Tombaugh, T N. & McIntyre, N. J. (1992). The Mini-Mental State Examination: a comprehensive review. Progress in Gerontology 40, 922935.
Tomlinson, B. E., Blessed, G. & Roth, M. (1968). Observations on the brains of non-demented old people. Journal of Neurological Sciences 7, 351356.
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, 589595.
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.
Recommend this journal

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

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed