Am J Epidemiol 2003; 157:327-334.
Copyright © 2003 by Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Relation between Cognitive Function and Mortality in Middle-aged Adults
The Atherosclerosis Risk in Communities Study
1 Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX.
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
3 Mayo Clinic, Rochester, MN.
4 School of Medicine, University of Mississippi Medical Center, Jackson, MS.
5 Department of Medicine, Baylor College of Medicine, Houston, TX.
An independent, inverse association between cognitive function and all-cause mortality has been reported in elderly cohorts. The purpose of this study was to determine whether the same association exists in middle-aged persons. The Atherosclerosis Risk in Communities Study is a cohort study initiated in 1987 to investigate the development of atherosclerosis in middle-aged persons. Three cognitive function measures were included in the second cohort examination conducted from 1990 to 1992 when the participants were aged 48–67 years: the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST) (a subtest from the Wechsler Adult Intelligence Scale-Revised), and the Word Fluency Test from the Multilingual Aphasia Examination. Cox proportional hazards modeling was used to determine whether all-cause mortality ascertained through 1997 was associated with each measure after adjustment for sociodemographic, biologic, psychologic, and behavioral risk factors. Without adjustment, there was a significantly lower mortality hazard associated with higher scores on all three measures. After covariate adjustment, the hazard ratios for the DWRT and the DSST remained significant (hazard ratio1-point DWRT score increment = 0.90, 95% confidence interval: 0.84, 0.97; hazard ratio7-point DSST score increment = 0.86, 95% confidence interval: 0.80, 0.93). Cognitive function measured in middle age appears to have prognostic importance for life expectancy similar to that reported in elderly adults.
cognition; cohort studies; mortality; risk factors
Abbreviations: Abbreviations: ARIC, Atherosclerosis Risk in Communities; DSST, Digit Symbol Substitution Test; DWRT, Delayed Word Recall Test; WFT, Word Fluency Test.
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