Abstract

Factors such as education have been associated with both late-life cognitive ability and cognitive decline. How education relates to decline in the final stages of life is not clear. We examined the association between education and the onset of terminal decline in a population-based longitudinal study of ageing.

Participants came from the Cambridge City over 75 Cohort Study (n=2166). They were at least 75 years old at baseline (1985–1987) and registered at any of six selected primary care practices in the Cambridge City (UK) area. Participants were followed-up over a 21-year period. Global cognitive function was assessed using the Mini Mental State Examination 2, 7, 9, 13, 17 and 21 years after baseline.

People with higher education had a slightly delayed onset of terminal decline. Cognitive performance 2 years before death and its rate of change before the onset of terminal decline varied across individuals. However, in the terminal phase, we did not find evidence of variability across individuals in rate of decline nor its change. Thus, more educated individuals experience a slightly shorter period of accelerated cognitive decline before death.

Two findings emerge from this cohort in which almost all individuals have died. The first is that education does appear to have a slight delay on the onset of terminal decline. The second is that once initiated, terminal decline is a relatively uniform process in those aged 75 and over. Such findings have implications in early life enhancement of cognitive function and planning for the end of life.