A plausible explanation is that, in the absence of neuropathogenic cognitive decline, most people may maintain stable or slightly declining functions into old age, with a more severe deterioration indicating biological compromise e. Lastly, our results showed that education did not moderate the rate of cognitive decline prior to death in both of these observational studies investigated Figure 3 , despite that education was found to modify the association between AD pathology assessed post-mortem and levels of cognitive function in proximity to death in some other studies . All in all, these results refer to a variation in cognitive changes before death, partially due to interindividual differences and due to the diversity of methodology employed which makes difficult to define the period of terminal decline as a holistic phenomenon  One of the modifiable risk factors, which have received a substantial interest in this area of research, is education. We used mixed-effects model with a change point. Ram, Inquiry into terminal decline: five objectives for future study.
View large Download slide Individual thin lines and typical thick lines late-life trajectories of change for the well-being indicator of life satisfaction, as obtained from now-deceased participants in the Berlin Aging Study. For example, does terminal decline manifest differently across individuals?
Notions of terminal decline have highlighted two aspects of late-life development Kleemeier, But, terminal decline is by definition a within-person change phenomenon and our real interest is how end-of-life change in multiple domains is organized within person. Alternative approaches would include engagement with data and study designs that provide for more direct examination of within-person associations. Alternatively, late-life change may manifest as a stability maintenance process that governs how individuals maintain physical, emotional, and cognitive function after perturbation. Wilson, R.
Cunningham, Research on the psychology of aging: Principles, concepts, and theory, in Handbook of the psychology of aging, J. Some differences were depicted in this cross-cohort comparison. Advanced Search Abstract Notions of terminal decline propose that late-life change is primarily driven by processes closely tied to pathology and mortality rather than chronological age.
As with other phases of life, differential development is ubiquitous Rutter, First, we compared survivors and decedents on their trajectories of 5 cognitive functions learning, memory, language, psychomotor speed, executive functions , dissociating practice effects which can mask clinically significant decline from age-associated cognitive decline. J Clin Exp.
Interrelationships in Terminal Decline The third objective focuses on the individual as a multivariate entity. Backman, Contrasting cognitive trajectories of impending death and preclinical dementia in the very old. Here, we review research on individual differences in terminal decline.
Deary, A life course approach to cognitive reserve: A model for cognitive aging and development?
However, there is evidence that terminal decline is also somewhat homogenous. This situation is illustrated in figure 1 in a very simplified format, where the true time-to-death effects on cognitive functions could be those represented by scenarios I, II, or III. In doing so, we note that there are relatively robust descriptions of terminal decline across a variety of different domains, as well as the extent of interindividual differences in the levels of function, rates of change, and timing of terminal decline research rationales 1 and 2.
Thorvaldsson, V. Christensen, The effect of education on the onset and rate of terminal decline. Taken together, there is growing evidence that the phenomenon of terminal decline manifests as multiphase change in cognitive, well-being, and other domains of functioning. A plausible explanation is that, in the absence of neuropathogenic cognitive decline, most people may maintain stable or slightly declining functions into old age, with a more severe deterioration indicating biological compromise e. Annals of Neurology, However, terminal decline trajectories are not uniform across all domains.
Palmore, E. Theory and research application of the reserve concept. One of the groups was characterized by relative stability across time, whereas another group was characterized by a major drop in spatial ability with minor changes in other abilities; a third group of participants experienced a developmental cascade of poor performance in declarative memory, followed by increasing dedifferentiation of cognitive performance toward generalized low performance, dementia diagnosis, and death. MacDonald, Death and cognition: Synthesis and outlook.
Periods characterised by slow-but-steady cognitive decline may be linked to other protracted preterminal causes of death e. Some people entered the terminal phase earlier e. For details, see Figures 1 and 2 in Gerstorf et al. In our own work, we described the typical well-being changes with the experience of more than 20 critical life events Gerstorf, Ram, et al. J Geriatr. Interrelationships in Terminal Decline The third objective focuses on the individual as a multivariate entity.