Predictors of cognitive decline and mortality of aged people over a 10‐year period
Abstract
BACKGROUND: The search for preventable and remediable risk conditions of cognitive decline is ongoing, but results have thus far been inconsistent. According to the hypothesis of our 10-year prospective study, the predictive values of different risk indicators change over time in a general 75+ population. METHODS: A population-based sample of 75-, 80-, and 85-year-old individuals (n=650) underwent comprehensive clinical examinations in 1990 in Helsinki, Finland. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and/or Clinical Dementia Rating (CDR) at baseline and after 1, 5, and 10 years. RESULTS: At baseline, a low MMSE score was associated with age, history of stroke, apolipoprotein E allele epsilon4 (APOE4), and intermittent claudication. After 1 year, cognitive decline was typical of participants suffering from vascular diseases, e.g., heart failure and intermittent claudication. Five-year decline was predicted by the presence of atrial fibrillation (RR [relative risk] 2.8), APOE4 (RR 2.4), elevated C-reactive protein (CRP) (RR 2.3), diabetes mellitus (RR 2.2), and heart failure (RR 1.8). They also tended to increase 5-year all-cause mortality. At 10 years, the decline associated with APOE4 (RR 3.3), slightly elevated serum ionized calcium (RR 3.3), and feelings of loneliness (RR 3.0). CONCLUSIONS: Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75+ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.
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Earlier studies on social factors and cognitive decline in middle-and older-aged adults have commonly followed a single measurement approach.
“Earlier studies on social factors and cognitive decline in middle-and older-aged adults have commonly followed a single measurement approach.[13][14][15]”
From Are loneliness and social isolation associated with cognitive decline? (2019) · cites this paper as [15]
Baseline age, gender, and educational level were controlled for in all analyses.
“Baseline age (years), gender, and educational level (years) are all well-established covariates of late-life cognitive function (Barnes et al., 2003;Tervo et al., 2004;Tilvis et al., 2004) and were controlled for in all analyses.”
From Living alone and cognitive function in later life (2019) · cites this paper as Tilvis et al., 2004
Age, gender, and education are established covariates of late-life cognition.
“which are established covariates of late-life cognition [35–37].”
From Social isolation, cognitive reserve, and cognition in healthy older people (2018) · cites this paper as [37]
In one study that reported diabetes status of individuals lost to follow-up, diabetic participants had higher mortality and/or lower follow-up rates than those without diabetes.
“Indeed, in one study, which did report diabetes status of individuals lost to follow-up, diabetic participants had a higher mortality and/ or lower follow-up rates than those without diabetes [55].”
From Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies (2005) · cites this paper as [55]
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BRITTAIN, K., KINGSTON, A., DAVIES, K., COLLERTON, J., ROBINSON, L. A., KIRKWOOD, T. B. L., BOND, J., & JAGGER, C. (2017) · Ageing and Society · doi:10.1017/s0144686x15001142 · Cited by 63 · see citing works
Cardiac Rehabilitation Improves Cognitive Performance in Older Adults With Cardiovascular Disease
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Atrial Fibrillation, Cognitive Decline, and Dementia: an Epidemiologic Review
Ding, M., & Qiu, C. (2018) · Current Epidemiology Reports · doi:10.1007/s40471-018-0159-7 · Cited by 57 · see citing works
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- Authors
- Tilvis, R. S., Kahonen-Vare, M. H., Jolkkonen, J., Valvanne, J., Pitkala, K. H., & Strandberg, T. E.
- Affiliations
- Helsinki University Hospital (FI)
- Corresponding author
- Tilvis, R. S.
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-03-01
- Volume
- 59
- Issue
- 3
- Pages
- M268-M274
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2101934488
- Cited by
- 578
- References
- 39
- Citations by year
- 2026: 15 · 2025: 11 · 2024: 21 · 2023: 28 · 2022: 34 · 2021: 65 · 2020: 35 · 2019: 37 · 2018: 36 · 2017: 27 · 2016: 22 · 2015: 30 · 2014: 31 · 2013: 24 · 2012: 27
- FWCI
- 9.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Helsingin Yliopisto
- Academy of Finland (48613)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- cognitive decline, mortality, oldest old, APOE ε4, atrial fibrillation, heart failure, diabetes mellitus, C-reactive protein, vascular disease, loneliness, hypercalcemia, stroke, risk factors
- MeSH terms
- Aged, Aged, 80 and over, Cognition Disorders, Female, Follow-Up Studies, Geriatrics, Humans, Male, Mortality, Prognosis, Prospective Studies, Time Factors
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