Terminal decline in cognitive function
Terminal decline in cognitive function
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DOI：
10.1212/01.wnl.0000068019.60901.c1
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发表时间：
2003-06-10
期刊：
影响因子：
9.9
通讯作者：
Bennett, DA
中科院分区：
文献类型：
--
作者：
Wilson, RS;Beckett, LA;Bennett, DA
背景：濒死被认为与年龄相关的认知能力下降有关，但这种联系尚未得到充分研究。方法：参与者是763名老年罗马天主教修女，牧师和兄弟在基线时没有痴呆。他们平均完成了5.6次年度评估（范围2至9），幸存者的随访参与率> 95%。每次评估包括管理19个认知功能测试，从先前建立的全球认知（平均值= 0.108，SD = 0.502）和特定的认知功能的措施。在一系列变点随机效应模型中，确定了死亡前认知能力下降率变化的平均点，并估计了最佳变点前后的认知能力下降率，控制了年龄、性别和教育程度的影响。结果：观察期内死亡122例。那些死亡的人在基线时的整体认知功能低于幸存者（0.103个单位; p = 0.03），从死亡前43个月开始，他们的整体认知能力年下降率从每年0.026个单位急剧加速到0.173个单位，增加了六倍多。在控制基线健康和残疾的分析中，结果具有可比性。几乎所有死亡者的终末认知能力下降都很明显，但死亡率差异很大。幸存者的认知能力几乎没有下降。情节记忆、语义记忆、工作记忆、知觉速度和视觉空间能力的下降也在死亡前3至6年大大增加。结论：平均而言，认知能力下降在生命的最后几年急剧加速。
Background: Impending death is thought to be associated with age-related cognitive decline, but this association has not been well studied. Methods: Participants were 763 older Roman Catholic nuns, priests, and brothers without dementia at baseline. They completed an average of 5.6 annual evaluations ( range 2 to 9), with > 95% follow-up participation in survivors. Each evaluation included administration of 19 cognitive function tests from which previously established measures of global cognition ( mean = 0.108, SD = 0.502) and specific cognitive functions were derived. In a series of change point random effects models, the average point before death when rate of cognitive decline changed was identified, and rates of cognitive decline before and after the optimal change point were estimated, controlling for the effects of age, sex, and education. Results: There were 122 deaths during the observation period. Those who died had lower global cognitive function at baseline than survivors ( by 0.103 unit; p = 0.03), and beginning about 43 months before death, their annual rate of global cognitive decline sharply accelerated from an annual loss of 0.026 to 0.173 unit, a more than sixfold increase. Results were comparable in analyses that controlled for baseline health and disability. Terminal cognitive decline was evident in nearly all of those who died, but at highly variable rates. Remarkably little cognitive decline was evident in survivors. Decline in episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability also greatly increased about 3 to 6 years prior to death. Conclusion: On average, cognitive decline sharply accelerates in the last years of life.