Cognitive function in a general population of men and women: a cross sectional study in the European Investigation of Cancer–Norfolk cohort (EPIC-Norfolk)

BMC Geriatrics, Dec 2014

Although ageing is strongly associated with cognitive decline, a wide range of cognitive ability is observed in older populations with varying rates of change across different cognitive domains. Cognitive function was measured as part of the third health examination of the European Prospective Investigation of Cancer in Norfolk (EPIC-Norfolk 3) between 2006 and 2011 (including measures from the pilot phase from 2004 to 2006). This was done using a battery consisting of seven previously validated cognitive function tests assessing both global function and specific domains. The battery included a shortened version of the Extended Mental State Exam (SF-EMSE); letter cancellation task; Hopkins Verbal Learning Test (HVLT); Cambridge Neuropsychological Test Automated Battery Paired Associates Learning Test (CANTAB-PAL); Visual Sensitivity Test (VST); Shortened version of the National Adult Reading Test (Short-NART) and a task to test for prospective memory. We report the distribution of cognitive function in different cognitive domains by age and sex and compare the utility of a number of assessment tests in a general population of older men and women. Cognitive test data were available for 8585 men and women taking part in EPIC-Norfolk 3. Increasing age was generally associated with declining mean cognitive function, but there was a wide range observed within each age group as well as variability across different cognitive domains. Some sex differences were also observed. Descriptive data are presented for this general population sample of older men and women. There is a wide range of cognitive performance seen in this population. Though average performance declines with age, there is large individual variability across different cognitive domains. These variations may provide insights into the determinants of cognitive function in later life.

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Cognitive function in a general population of men and women: a cross sectional study in the European Investigation of Cancer–Norfolk cohort (EPIC-Norfolk)

Research article Open Access Open Peer Review Cognitive function in a general population of men and women: a cross sectional study in the European Investigation of Cancer–Norfolk cohort (EPIC-Norfolk) Shabina A Hayat1Email author, Robert Luben1, Stephanie Moore1, Nichola Dalzell1, Amit Bhaniani1, Serena Anuj1, Fiona E Matthews2, Nick Wareham3, Kay-Tee Khaw1 and Carol Brayne1 BMC Geriatrics201414:142 https://doi.org/10.1186/1471-2318-14-142 ©  Hayat et al.; licensee BioMed Central. 2014 Received: 13 August 2014Accepted: 11 December 2014Published: 19 December 2014 Open Peer Review reports Abstract Background Although ageing is strongly associated with cognitive decline, a wide range of cognitive ability is observed in older populations with varying rates of change across different cognitive domains. Methods Cognitive function was measured as part of the third health examination of the European Prospective Investigation of Cancer in Norfolk (EPIC-Norfolk 3) between 2006 and 2011 (including measures from the pilot phase from 2004 to 2006). This was done using a battery consisting of seven previously validated cognitive function tests assessing both global function and specific domains. The battery included a shortened version of the Extended Mental State Exam (SF-EMSE); letter cancellation task; Hopkins Verbal Learning Test (HVLT); Cambridge Neuropsychological Test Automated Battery Paired Associates Learning Test (CANTAB-PAL); Visual Sensitivity Test (VST); Shortened version of the National Adult Reading Test (Short-NART) and a task to test for prospective memory. We report the distribution of cognitive function in different cognitive domains by age and sex and compare the utility of a number of assessment tests in a general population of older men and women. Results Cognitive test data were available for 8585 men and women taking part in EPIC-Norfolk 3. Increasing age was generally associated with declining mean cognitive function, but there was a wide range observed within each age group as well as variability across different cognitive domains. Some sex differences were also observed. Conclusion Descriptive data are presented for this general population sample of older men and women. There is a wide range of cognitive performance seen in this population. Though average performance declines with age, there is large individual variability across different cognitive domains. These variations may provide insights into the determinants of cognitive function in later life. Keywords Ag(e)ingFollow up studiesUnited KingdomMiddle agedCognitionCognition disorders Background Ageing is generally associated with memory impairment and cognitive decline, however, this decline is not inevitable [1] and not all domains of cognitive function are equally affected with age [2]. A broad range of cognitive capability is observed in the older population [3] as well as substantial inter-individual heterogeneity in rates of decline [4]. The range encompasses high cognitive functioning even in the very old [5], mild cognitive impairment (MCI), through to dementia at the other end of the spectrum. Mild Cognitive Impairment (MCI) is described as the transitional state between normal cognitive ageing and dementia [6], with detectable impairment to memory or cognitive abilities when compared to healthy controls, but not to the extent as seen in individuals suffering with mild dementia [7]. The amnestic form of MCI has been shown to be predictive of dementia [7–10], however, the conversion rate has been shown to vary significantly [7] and only a minority of individuals with MCI progress to dementia within clinically relevant time frames. As a result of the heterogeneity in both the aetiology and outcome of this condition, MCI is still an area of major debate, with no consensus on its classification [11]. Reliable identification of those individuals with MCI who remain stable compared to those who decline would maximise efficacy of potential treatments and preventive interventions around this transitional stage [12]. To determine the factors that contribute to this variability in not just the rates of decline in MCI, but also in the different cognitive abilities, will help to improve the understanding of the natural progression of decline in an ageing population. Substantial data already exist on dementia and cognitive impairment, mainly in the older population, from using a wide range of instruments, each with merits and limitations that assess different aspects or stages of cognition. Episodic memory deficits have been shown in a number of studies to be associated with the strongest and most persistent risk of cognitive decline [13, 14] and are the most common and earliest complaints in MCI [15]. However deficits in other cognitive domains can also occur, some early on, including attention, executive functioning, prospective memory, semantic memory, verbal ability, visuospatial skills (...truncated)


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Shabina A Hayat, Robert Luben, Stephanie Moore, Nichola Dalzell, Amit Bhaniani, Serena Anuj, Fiona E Matthews, Nick Wareham, Kay-Tee Khaw, Carol Brayne. Cognitive function in a general population of men and women: a cross sectional study in the European Investigation of Cancer–Norfolk cohort (EPIC-Norfolk), BMC Geriatrics, 2014, pp. 142, Volume 14, Issue 1, DOI: 10.1186/1471-2318-14-142