Association Between Cognitive Trajectories and Subsequent Health Status, Depressive Symptoms, and Mortality Among Older Adults in the United States: Findings From a Nationally-Representative Study

Cognitive decline may be an early indicator of major health issues in older adults, though research using population-based data is lacking. Our objective was to assess the relationships between distinct cognitive trajectories and subsequent health outcomes, including health status, depressive symptoms, and mortality, using a nationally representative cohort. Data were drawn from the National Health and Aging Trends Study. Global cognition was assessed annually between 2011 and 2018. The health status of 4,413 people, depressive symptoms in 4,342 individuals, and deaths among 5,955 living respondents were measured in 2019. Distinct cognitive trajectory groups were identified using an innovative Bayesian group-based trajectory model. Ordinal logistic, Poisson, and logistic regression models were used to examine the associations between cognitive trajectories and subsequent health outcomes. We identified five cognitive trajectory groups with distinct baseline values and subsequent changes in cognitive function. Compared to the group with stably high cognitive function, worse cognitive trajectories (i.e., lower baseline values and sharper declines) were associated with higher risks of poor health status, depressive symptoms and mortality, even after adjusting for relevant covariates. Among older adults, worse cognitive trajectories are strongly associated with subsequent poor health status, high depressive symptoms, and high mortality risks. Regular screening of cognitive function may help to facilitate early identification and interventions for older adults susceptible to adverse health outcomes.