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American Journal of Epidemiology Advance Access originally published online on July 15, 2009
American Journal of Epidemiology 2009 170(3):331-342; doi:10.1093/aje/kwp154
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Trajectories of Cognitive Function in Late Life in the United States: Demographic and Socioeconomic Predictors

Arun S. Karlamangla, Dana Miller-Martinez, Carol S. Aneshensel, Teresa E. Seeman, Richard G. Wight and Joshua Chodosh

Correspondence to Dr. Arun S. Karlamangla, UCLA Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095 (e-mail: akarlamangla{at}mednet.ucla.edu).

Received for publication February 11, 2009. Accepted for publication May 11, 2009.

This study used mixed-effects modeling of data from a national sample of 6,476 US adults born before 1924, who were tested 5 times between 1993 and 2002 on word recall, serial 7's, and other mental status items to determine demographic and socioeconomic predictors of trajectories of cognitive function in older Americans. Mean decline with aging in total cognition score (range, 0–35; standard deviation, 6.00) was 4.1 (0.68 standard deviations) per decade (95% confidence interval: 3.8, 4.4) and in recall score (range, 0–20; standard deviation, 3.84) was 2.3 (0.60 standard deviations) per decade (95% confidence interval: 2.1, 2.5). Older cohorts (compared with younger cohorts), women (compared with men), widows/widowers, and those never married (both compared with married individuals) declined faster, and non-Hispanic blacks (compared with non-Hispanic whites) and those in the bottom income quintile (compared with the top quintile) declined slower. Race and income differences in rates of decline were not sufficient to offset larger differences in baseline cognition scores. Educational level was not associated with rate of decline in cognition scores. The authors concluded that ethnic and socioeconomic disparities in cognitive function in older Americans arise primarily from differences in peak cognitive performance achieved earlier in the life course and less from declines in later life.

aged; cognition; health status disparities; longitudinal studies; social class

Abbreviations: AHEAD, The Study of Assets and Health Dynamics Among the Oldest Old; CI, confidence interval; SES, socioeconomic status


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