On the Question of the Mental State of Centenarians

Abstract

The number of individuals over age 100 years in the United States will increase from 25,000 in 1986 to more than 108,000 by the year 2000. Despite this expected growth there is almost no information about their intellectual function. This is unfortunate since the study of centenarians offers valuable insight into the effects of aging upon the central nervous system. It may also clarify whether Alzheimer''s disease represents premature aging. To better understand their mental state, I evaluated 20 centenarians (17 women and 3 men) with a mean age of 101.75 years. The group completed on average 6.6 years of education and each had 4 illnesses and took 3.5 prescribed drugs. Eighty percent were in nursing homes, mostly due to inadequate social supports. Caregivers had thought that the majority were not demented. During evaluation, 75% had impaired vision while half had disturbed hearing. The speed of thought and body movement were slowed significantly. Centenarians had poor awareness of their environment, in general (p = 0.0019) and had impaired judgement (p = 0.006). Additionally, only 3 individuals had a history and examination to suggest Alzheimer''s disease. Unfortunately, the Folstein Mini-Mental State Exam (MMSE) and the Washington University Clinical Dementia Rating (CDR) were often difficult to score. Mean scores for the MMSE of 7.5 (1 standard deviation, 7.134) and the CDR of 2.08 (1.07) suggested dementia. These observations suggest that impaired intellectual function may be common in this group but there are several limitations on evaluating and interpreting such data.

First episodes of behavioral symptoms in Alzheimer's disease patients at age 90 and over, and early‐onset Alzheimer's disease: Comparison with senile dementia of Alzheimer's type

“…‘Impaired wakefulness’ and ‘confusion’ were more severe and ‘waking up and wandering at night’ was also more frequent as the first episode in D90G than in LOG. Our results are probably compatible with those of Powell 7,8 . He suggested that common disturbed pattern of dementia in the oldest old age consisted of preserved awareness of environment, normal participation in conversations and memory impairment with diminished ability to acquire new information.…”

“…Therefore, AD could be regarded as an ‘age‐related’ rather than an ‘aging‐related’ disorder. In contrast, most of the subjects who survive over 100 are cognitively impaired or demented 7,8 , 11,14 . This indicates that aging might be considered another risk factor precipitating cognitive impairment and that dementia in the oldest old could be different from that of earlier onset.…”

Determinants of Functional Status in Healthy Italian Nonagenarians and Centenarians: A Comprehensive Functional Assessment by the Instruments of Geriatric Practice

“…Indeed, none of our subjects could be defined as demented according to DSM‐III‐R criteria, 12 but most of them had MMSE scores below the usual threshold for diagnosis of cognitive impairment. Data on the cognitive status of the oldest‐old' 21,22 confirm the paramount weight of schooling in MMSE performance pointed out previously in younger old cohorts 1 . Because education in our sample was generally of a very low level, many individuals who are actually free of dementia exhibit cognitive impairment using the usual MMSE cut‐off of 24/30.…”

Senile Dementia of Extreme Aging: A Common Disorder of Centenarians

“…Necessary clinical attributes for the diagnosis of probable DAT were absent in the majority of subjects in this study [17,22,23], Establishing the pres ence of apraxia is difficult since apraxia is excluded by motor disturbance that might interfere with testing.…”