Terminal Pathologies Affect Rates of Decline to Different Extents and Age Accelerates the Effects of Terminal Pathology on Cognitive Decline

Objectives. To test whether different terminal pathologies are associated with different rates of age-related decline in fluid and crystallized mental abilities and whether pathology-associated declines are accelerated by age. Methods. During a 20-year longitudinal study, 6,203 participants were quadrennially assessed on the Helm's (Heim, A 1970) The AH4 series of intelligence tests Slough, UK: NEP) AH4-1 and AH4-2 tests of fluid intelligence and on the Raven's (Raven, J. C. 1965) The Mill Hill Vocabulary Scale London: H.K. Lewis) Mill Hill A and B tests of recognition and production vocabulary. Dates and proximate causes of death were logged for 2,499 participants. Multilevel modelling compared rates of decline after effects of sex, demographics, and practice were taken into consideration. Results. Rates of cognitive decline markedly differed across pathologies, being most rapid for dementias and infections, slower for malignancies, and most prolonged for cardiovascular conditions. Pathologies were associated with faster declines in older individuals. Discussion. After sex, age, and demographics have also been considered, different terminal pathologies are associated with markedly different rates of decline. Age accelerates pathology-related decline. This raises the further question as to whether any, or how much of, age-related cognitive decline is brought about by other causes than an increasing burden of pathologies.