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Kristine Yaffe, MD; Laura E. Middleton, PhD; Li-Yung Lui, MA, MS; Adam P. Spira, PhD; Katie Stone, PhD; Caroline Racine, PhD; Kristine E. Ensrud, MD; Joel H. Kramer, PsyD

Arch Neurol. 2011;68(5):631-636. doi:10.1001/archneurol.2011.82

Background  The population of oldest old is increasing, but the prevalence of cognitive impairment is not well characterized in this group.

Objectives  To determine the prevalence of mild cognitive impairment (MCI), dementia, and their subtypes in oldest old women and to examine whether some groups of oldest old women were more likely to have cognitive impairment.

Design  Prospective cohort study.

Setting  Women Cognitive Impairment Study of Exceptional Aging.

Participants  A total of 1299 oldest old (85 years) women.

Main Outcome Measures  All the women completed a neuropsychological test battery. Those who screened positive for possible cognitive impairment (n = 634) were further assessed for a diagnosis of dementia, MCI, or normal cognition. The remaining women (n = 665) were considered cognitively normal. Dementia and MCI subtypes were determined using standard criteria.

Results  The women had a mean age of 88.2 years, and 27.0% were 90 years or older; 231 women (17.8%) were diagnosed as having dementia and 301 (23.2%) as having MCI, for a combined cognitive impairment prevalence of 41.0%. Clinical features consistent with Alzheimer disease and mixed dementia were most common, each accounting for 40% of dementia cases. Amnestic multiple domain and nonamnestic single domain were the most common MCI types, accounting for 33.9% and 28.9% of cases, respectively. Cognitive impairment was more frequent in women 90 years or older compared with those 85 to 89 years (dementia, 28.2% vs 13.9%, P < .001; MCI, 24.5% vs 22.7%, P = .02) and was more common in women with less education, a history of stroke, and prevalent depression.

Conclusions  In this large sample of oldest old women, 41.0% had clinically adjudicated cognitive impairment. Subtypes of dementia and MCI were similar to those in younger populations. Women in the fastest growing demographic, the oldest old, should be screened for cognitive disorders, especially high-risk groups.

Author Affiliations: Departments of Psychiatry (Dr Yaffe), Neurology (Drs Yaffe and Kramer), Epidemiology and Biostatistics (Dr Yaffe), and Neurological Surgery and Radiation Oncology (Dr Racine), School of Medicine, University of California at San Francisco; Department of Psychiatry, Veterans Affairs Medical Center, San Francisco (Dr Yaffe); Heart and Stroke Foundation Center for Stroke Recovery, Sunnybrook Hospital, Toronto, Ontario, Canada (Dr Middleton); Research Institute, California Pacific Medical Center, San Francisco (Dr Stone and Ms Lui); Department of Mental Health, The John Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Spira); and Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota (Dr Ensrud).

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