Sudden declines in intelligence in old age predict death and dropout from longitudinal studies

It is well known that approaching death accelerates cognitive decline. The converse issue, that is, the question of whether rapid declines in cognitive ability are risk factors for imminent death, has not been investigated. Every 4 years between 1983 and 2003, we gave 1,414 healthy community residents who were aged between 49 and 93 years the Heim AH4-1 test of fluid intelligence. A modified Andersen-Gill model evaluated AH4-1 scores at entry to the study and changes in scores between successive quadrennial test sessions as risk factors for death and dropout. Deaths, dropouts, age, gender, occupational categories, and recruitment cohorts were also taken into account. Participants with lower AH4-1 scores on entry were significantly more likely to die or to drop out. At all ages and levels of baseline intelligence, the risks of deaths and dropouts further increased if test scores fell by 10%, and again increased if they fell by 20% during 4-year intervals between successive assessments.