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Cited by 339Dementia and Cognitive Impairment ResearchAging, Health, and DisabilityFrailty in Older Adults

Executive Function, More Than Global Cognition, Predicts Functional Decline and Mortality in Elderly Women

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Johnson, J. K., Lui, L.-Y., Yaffe, K.·2007·The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
DOI 10.1093/gerona/62.10.1134PMC PMC2049089
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Abstract

BACKGROUND: Functional impairment in community-dwelling older adults is common and is associated with poor outcomes. Our goal was to compare the contribution of impairment in executive function or global cognitive function to predicting functional decline and mortality. METHODS: We studied 7717 elderly women enrolled in a prospective study (mean age 73.3 years) and identified women with poor baseline executive function (score > 1 standard deviation [SD] below the mean on the Trail Making Test B (Trails B; n = 957, 12.4%), poor global cognitive function (score > 1 SD below the mean on a modified Mini-Mental State Examination [mMMSE], n = 387, 5.0%), impairment in both (n = 249, 3.2%), or no impairment (n = 6124, 79.4%). We compared level of functional difficulty (Activities of Daily Living [ADLs] and Instrumental ADLs [IADLs]) at baseline and at 6-year follow-up and survival at follow-up. We also determined if the association was independent of age, education, depression, medical comorbidities, and baseline functional ability. RESULTS: At baseline, women with Trails B impairment only or impairment on both tests reported the highest proportion of ADL and IADL dependence compared to the other groups. At the 6-year follow-up after adjusting for age, education, medical comorbidities, depression, and baseline ADL or IADL, women with only Trails B impairment were 1.3 times more likely to develop an incident ADL dependence (adjusted odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.07-1.69) and 1.5 times more likely to develop a worsening of ADL dependence (adjusted OR = 1.48; 95% CI, 1.16-1.89) when compared to women with no impairment on either test. In addition, women with only Trails B impairment had a 1.5-fold increased risk of mortality (adjusted hazard ratio [HR] = 1.48; 95% CI, 1.21-1.81). In contrast, women with impairment on only mMMSE were not at increased risk to develop incident ADL or IADL dependence, a worsening of ADL or IADL dependence, or mortality. CONCLUSION: Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.

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  • Declines in executive functioning, even more than global cognitive declines, exert the largest negative impact on older adults, threatening their ability to manage their lives and live independently.

    “Declines in executive functioning, even more than global cognitive declines, exert the largest negative impact on older adults, threatening their ability to manage their lives and live independently (Cahn‐Weiner et al. 2000; Carlson et al. 1999; Johnson, Lui, and Yaffe 2007; Marshall et al. 2011).”

    From Human Capital and Administrative Burden: The Role of Cognitive Resources in Citizen‐State Interactions (2020) · cites this paper as Johnson, Lui, and Yaffe 2007

    The Discussion reports that executive dysfunction predicted functional difficulty and that the executive-function measure was a stronger predictor of functional decline than the global-cognition measure. The study examined community-dwelling elderly women, however, and describes prediction and association—not a causal finding that executive decline has the largest negative impact on older adults generally. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Executive planning and organizational skills are important to maintaining functional independence.

    “Executive planning and organizational skills appear to be important to maintaining functional independence (4–7) and appear to be particularly vulnerable to declines at later ages (8–10) along with the prefrontal cortical regions of the brain that support them (11–14).”

    From Evidence for Neurocognitive Plasticity in At-Risk Older Adults: The Experience Corps Program (2009) · cites this paper as [6]

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Research works printed but not linked: 2

  1. [14]Lezak MD. Neuropsychological Assessment. 3. New York: Oxford University Press; 1995. [Google Scholar]
  2. [23]Reitan RM. Trail Making Test: Manual for Administration and Scoring. Tuscon, AZ: Reitan Neuropsychology Laboratory; 1992. [Google Scholar]

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Authors
Johnson, J. K., Lui, L.-Y., & Yaffe, K.
Affiliations
University of California, San Francisco (US)
Corresponding author
Johnson, J. K.
ORCID
Yaffe, K.
Venue
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Publisher
Oxford University Press (OUP)
Published
2007-10-01
Volume
62
Issue
10
Pages
1134-1141
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
DOI
10.1093/gerona/62.10.1134
PMC
PMC2049089
OpenAlex
W2115744692
Cited by
339
References
62
Citations by year
2026: 5 · 2025: 13 · 2024: 15 · 2023: 18 · 2022: 25 · 2021: 24 · 2020: 18 · 2019: 24 · 2018: 19 · 2017: 17 · 2016: 28 · 2015: 16 · 2014: 29 · 2013: 13 · 2012: 20
FWCI
7.27
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Aging (R01AG005394, R01AG021918, AG05394, R01AG005407, R01AG022538, AG-05407, R01AG026720, L30 AG024692, R01-AG22538)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR035584, AR35583, AR-35584, AR 35582, R01AR035582, R01AR035583)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
functions, global cognitive function, functional decline, mortality, older women, activities of daily living, instrumental activities of daily living, Trail Making Test Part B, Modified Mini-Mental State Examination, cognitive impairment, community-dwelling older adults, functional disability, dementia risk, depression, comorbidities, aging in place
MeSH terms
Activities of Daily Living, Aged, Aged, 80 and over, Cognition Disorders, Female, Follow-Up Studies, Health Status, Humans, Motor Activity, Sex Factors, Time Factors, Geriatric Assessment, Case-Control Studies

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