Terminal Cognitive Decline: Accelerated Loss of Cognition in the Last Years of Life

Abstract

In old age, cognitive decline markedly accelerates during the last 3 to 4 years of life, consistent with the terminal decline hypothesis.

Personality and personal control make a difference for life satisfaction in the oldest-old: findings in a longitudinal population-based study of individuals 80 and older

“…In their studies of late life changes in life satisfaction, Gerstorf and colleagues applied a time-to-death time metric that mainly has been used in the investigation of psychological change in the end of life in terms of change in cognitive functions (Gerstorf et al 2008a, b). Gerstorf et al argue that a similar pattern of terminal decline, as seen in cognitive abilities (Bosworth and Siegler 2002;Bäckman and MacDonald 2006;Sliwinski et al 2003, Wilson et al 2003Wilson et al 2007), may be expected in subjective well-being given the age-graded stability in subjective well-being measures. Parallel findings have been presented for changes in self-perceptions of aging where satisfaction with aging showed a steeper mortality-related decline as compared to age-related decline (Kotter-Grühnet al 2009).…”

Between-Person Disparities in the Progression of Late-Life Well-Being

“…It would also be instrumental to determine the shared and unique contributions of processes involved in accumulating disability and approaching death to late-life changes in well-being. In addition, the cognitive aging literature suggests that terminal decline is relatively independent of cause of death (e.g., Anstey et al, 2006;Small et al, 2003; but see Wilson et al, 2007), but this pattern may not generalize to terminal decline in well-being. Unfortunately, researchers are often unable to examine such questions with the data at hand because (reliable) information about cause of death is not available.…”

“…For example, Birren and Cunningham (1985) proposed that a "cognitive and social slipping" may occur some "months to years" prior to death (Birren & Cunningham, 1985, p. 21). Following pioneering work in the cognitive aging literature (Sliwinski et al, 2006;Wilson et al, 2003Wilson et al, , 2007, we have applied recent developments in multi-phase growth modeling to estimate empirically the prototypical location of this transition.…”

“…In other words, all persons are assumed to transition into terminal decline at exactly the same point in time. While likely unrealistic, such an assumption is often required by the limited nature of within-person change data available (e.g., five or six measurement occasions:Gerstorf, Ram et al, 2008b;Sliwinski et al, 2006;Wilson et al, 2003Wilson et al, , 2007.Using data from 400 individuals who provided 12 or more data points over 25 years, we were able to relax this assumption and allow for interindividual differences in the timing of the transition to terminal decline (Gerstorf, Ram et al, 2008a). As expected, there were considerable between-person differences in where the estimated transition point was located.…”

“…For example, Birren and Cunningham (1985) proposed that a "cognitive and social slipping" may occur some "months to years" prior to death (Birren & Cunningham, 1985, p. 21). Following pioneering work in the cognitive aging literature (Sliwinski et al, 2006;Wilson et al, 2003Wilson et al, , 2007, we have applied recent developments in multi-phase growth modeling to estimate empirically the prototypical location of this transition.Results from various data sets converged on a time window between three and five years prior to death after which normative rates of well-being decline steepened by a factor of three or more (for overview, see the right-hand column of Table 1). Again, effect sizes for this decline are gloomy: The prototypical individual's life satisfaction (e.g., among decedents in the national German data) declines nearly a full standard deviation over the last four years of life.…”