Performance on Specific Cognitive Domains and Cause of Death: A Prospective Population-Based Study in Non-Demented Older Adults (NEDICES)

Article type: Research Article

Authors: Benito-León, Julián^{a; b; c; *} | Contador, Israel^d | Mitchell, Alex J.^e | Domingo-Santos, Ángela^a | Bermejo-Pareja, Félix^{a; b; c}

Affiliations: [a] Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain | [b] Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain | [c] Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain | [d] Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain | [e] Department of Neurology, Department of Psycho-oncology, Leicestershire Partnership Trust and University of Leicester, Leicester, UK

Correspondence: [*] Correspondence to: Julián Benito-León, MD, PhD, Avda. de la Constitución 73, portal 3, 7° Izquierda, E-28821 Coslada, Madrid, Spain. Tel.: +34916695467; E-mail: [email protected].

Abstract: Evidence regarding the relationship between performance on specific cognitive domains and cause of death is scarce. We assessed whether specific cognitive domains predicted mortality and the presence of any association with specific causes of death in a population-dwelling sample of non-demented older adults. In this population-based, prospective study (NEDICES), 2,390 non-demented subjects ≥65 years completed a brief neuropsychological battery. Cox’s proportional hazards models, adjusted by sociodemographic and comorbidity factors, global cognitive performance, educational level, and premorbid intelligence were used to assess the risk of death. Participants were followed for a median of 9.2 years (range 0.01–10.7), after which the death certificates of those who died were examined. 880 (36.8%) of 2,390 participants died over a median follow-up of 5.5 years (range 0.01–10.5). Using adjusted Cox regression models, we found that hazard ratios for mortality in participants within the lowest tertiles (worse performance) were 1.31 (speed of cognitive processing, p = 0.03); 1.22 (semantic fluency, p = 0.04), 1.32 (delayed free recall, p = 0.003), and 1.23 (delayed logical memory, p = 0.03). Poor performance on delayed recall and speed of cognitive processing tests were associated with dementia and cerebrovascular disease mortality, respectively. Further, poor performance on semantic fluency was associated with decreased cancer mortality. In this study of community dwelling non-demented older adults, worse neuropsychological performance was associated with increased risk of mortality. Performance on specific cognitive domains were related to different causes of death. Of particular note there appears to be an inverse association between poor semantic fluency and cancer mortality.

Keywords: Cause specific-mortality, cognitive aging, epidemiology, neuropsychology, prospective cohort, population-based study

DOI: 10.3233/JAD-150875

Journal: Journal of Alzheimer's Disease, vol. 51, no. 2, pp. 533-544, 2016