Background-Few longitudinal studies evaluate differences in patterns of change of category compared to letter fluency across the spectrum of cognitive impairment.

We explored the effect of education and occupational complexity on the rate of cognitive decline (as measured by the Mini-Mental State Examination) in 171 patients with a confirmed Alzheimer's disease (AD) diagnosis. Complexity was measured as substantive complexity of work and complexity of work with data, people, and things. Average lifetime occupational complexity was calculated based on years at each occupation. Participants were followed for an average of 2.5 years and 3.7 visits. In multivariate mixed-effects models, high education, high substantive complexity, and high complexity of work with data and people predicted faster rates of cognitive decline, controlling for age, gender, native language, dementia severity, and entry into the analyses at initial versus follow-up testing. These results provide support for the concept of cognitive reserve according to which greater reserve may postpone clinical onset of AD but also accelerate cognitive decline after the onset.

Our study suggests that current use of tamoxifen may adversely effect cognition. Further study of tamoxifen and cognition is needed so that healthy women considering tamoxifen for the primary prevention of breast cancer have comprehensive information about the side effects of the treatment.

Background: Many types of research on dementia and cognitive impairment require large sample sizes. Detailed in-person assessment using batteries of neuropyschologic testing is expensive. This study evaluates whether a brief telephone cognitive assessment strategy can reliably classify cognitive status when compared to an in-person "gold-standard" clinical assessment.

The clock-drawing task is an appealing measure of cognitive function for large epidemiological studies because it is a simple, self-administered test that is easily adapted to mail surveys and correlates with more-detailed and more-time-consuming cognitive screens. Although it is relatively free of influence by language, cultural, or ethnic factors, our study shows that even in a highly educated population, clock drawing is influenced by educational level and other known risk factors for Alzheimer's disease. Thus a clock-drawing task may help predict cognitive frailty and future disability in older people. Such determination can direct high-risk individuals to earlier diagnosis, potential therapies, and better management.

Our study suggests that five or more years of tamoxifen use increases risk of cataracts. Healthy women considering tamoxifen use to reduce risk of breast cancer should be advised of the possibility of cataract development. Women choosing such therapy should be diligent about receiving regular ocular exams.

Aims: To test the hypotheses that performance on a clock-drawing task (CDT) diminishes over time and that poor performance is associated with development of dementia and reduced survival. Methods: Participants in the population-based Leisure World Cohort Study were asked to complete a CDT in follow-up questionnaires mailed in 1992 and 1998. Dementia status was determined using in-person evaluations, follow-up questionnaires, hospital data, and death certificates. Results: Of the 4,842 cohort members (mean age 80 years) who completed the CDT in 1992, 1,521 also completed it in 1998. Although performance in the CDT diminished over time in only a proportion of the cohort, the mean total score and the percentage of subjects with correctly drawn clocks decreased with each successive 5-year age group (p = 0.0001) and over time. Mean scores were lower in non-demented subjects later identified as demented compared with those who remained free of dementia. A low CDT score in 1992 was associated with a 28% increased risk of dementia and 13% reduced survival. Conclusion: A CDT may help predict cognitive decline and future disability in the elderly. Identification of high-risk individuals using a CDT may lead to earlier diagnosis and treatment and improved patient management.

Objective: To examine 3 cognitive screening tasks in older adults and determine which demographic, medical and lifestyle variables obtained 13–17 years previously predicted cognitive performance. Design: Population-based longitudinal cohort study begun in 1981. Setting: Leisure World Laguna Hills, a California retirement community. Participants: The cohort is predominantly white, well educated, upper-middle class; two thirds are women. Data from 1,744 participants (mean age 83 years, range 57–103) were analyzed. Measurements: The baseline postal survey (1981–1985) asked demographic information, medical history, selected drug use and personal habits. The 1998 follow-up included 3 tasks to assess cognitive function: (1) clock drawing, (2) copying a box drawing and (3) narrative writing to describe a pictured scene. Results: Within age groups, women tended to have lower scores than men on box copying, similar scores on clock drawing, but higher informational and complexity scores on narrative writing. Performance decreased with increasing age and was poorest in individuals ≧90 years old. In addition to age, sex and education, significant predictors of performance were: exercise, body mass index and cataract surgery (clock); vitamin E supplements, daily aspirin use and gallbladder surgery (box); vitamin A supplements (narrative writing). Mean scores on all tasks were lower in those later identified as demented compared with nondemented but significantly different only for clock and box drawings. Conclusion: Performance on 3 cognitive tests showed significant effects of age, sex and education and was related to later dementia. Better performance by users of antioxidant supplements and aspirin suggests that these drugs may maintain cognitive function in later life.