Cognitive decline in adulthood: an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area study

Am J Psychiatry. 1999 Jan;156(1):58-65. doi: 10.1176/ajp.156.1.58.


Objective: The epidemiology of cognitive decline over 11.5 years was investigated in a large community-residing population, with a special emphasis on the relationship between education and cognitive decline.

Method: The study was an 11.5-year follow-up of a probability sample of the adult household residents of east Baltimore. From the Baltimore cohort of the Epidemiologic Catchment Area study, 1,488 participants completed the Mini-Mental State during three study waves in 1981, 1982, and 1993-1996. For each study participant, the difference in scores on the Mini-Mental State between waves 2 and 3 was calculated.

Results: Over a median interval of 11.5 years, the study participants' scores on the Mini-Mental State declined a mean of 1.41 points, and the scores of 68% of the participants declined by at least 1 Mini-Mental State point. With and without adjustment for age, greater declines were associated with having 8 years or less of formal education and with being African American.

Conclusions: Over a long time period, cognitive decline occurred in all age groups. Having more than 8 years of formal education was associated with less decline. However, beyond 9 years, additional education was not associated with a further reduction in cognitive decline. This suggests that a minimal amount of education during early critical periods might confer protection against cognitive decline later in life.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Baltimore / epidemiology
  • Black or African American / psychology
  • Black or African American / statistics & numerical data
  • Catchment Area, Health
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / epidemiology*
  • Cohort Studies
  • Critical Period, Psychological
  • Educational Status
  • Female
  • Follow-Up Studies
  • Geriatric Assessment
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests / statistics & numerical data*
  • Risk Factors