The long arm of childhood intelligence on terminal decline: Evidence from the Lothian Birth Cohort 1921

Dorina Cadar, Annie Robitaille, Alison Pattie, Ian Deary, GM Terrera

Research output: Contribution to journalArticlepeer-review


The current study investigates the heterogeneity of cognitive trajectories at the end of life by assigning individuals into groups according to their cognitive trajectories prior to death. It also examines the role of childhood intelligence and education on these trajectories and group membership. Participants were drawn from the Lothian Birth Cohort of 1921 (LBC1921), a longitudinal study of individuals with a mean age of 79 years at study entry, and observed up to a maximum of five times to their early 90s. Growth mixture modelling was employed to identify groups of individuals with similar trajectories of global cognitive function measured with the Mini-Mental State Examination (MMSE) in relation to time to death, accounting for childhood intelligence, education, the time to death from study entry, and health conditions (hypertension, diabetes and cardiovascular disease). Two distinct groups of individuals (classes) were identified: a smaller class (18% of the sample) of individuals whose MMSE scores dropped linearly with about 0.5 MMSE points per year closer to death, and a larger group (82% of the sample) with stable MMSE across the study period. Only childhood intelligence was found to be associated with an increased probability of belonging to the stable class of cognitive functioning prior to death (odds ratio=1.08, standard error=0.02, p≤.001). These findings support a protective role of childhood intelligence, a marker of cognitive reserve, against the loss of cognitive function prior to death. Our results also suggest that terminal decline is not necessarily a normative process.
Original languageEnglish
Pages (from-to)806-817
JournalPsychology and Aging
Issue number6
Early online date21 May 2020
Publication statusE-pub ahead of print - 21 May 2020


  • childhood intelligence
  • education
  • terminal decline
  • MMSE
  • Growth Mixture Models (GMM)


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