Cognitive Performance in Adults Aged 60 and Over: National Health and Nutrition Examination Survey, 2011-2014

Abstract

Objective-This report describes cognitive performance in the U.S. noninstitutionalized population of older adults. The association of sociodemographic factors and self-reported cognitive and health status with low cognitive performance is also investigated. Methods-During 2011-2014, the cognitive performance of participants aged 60 and over was assessed during the National Health and Nutrition Examination Survey (NHANES). Cognitive assessment was based on scores from established objective cognitive tests (word list learning with immediate and delayed recall, animal naming, and a digit symbol substitution test). Mean scores and percentile distributions were described by sociodemographic characteristics. Logistic regression modeling was conducted to evaluate the relationship of sociodemographic and self-reported health factors with low cognitive performance, defined by scores in the lowest 25th percentile. The relationship between objective cognitive functioning measures and subjective cognitive decline also was evaluated by calculating sensitivity and specificity measures. Results-A total of 3,181 adults completed at least one of four objective cognitive tests. Mean scores for men were lower than for women in three of four assessments. Mean scores decreased with increasing age and with decreasing level of income and education. Persons reporting poorer health status and subjective cognitive decline were more likely to have low performance on the four assessments. The subjective cognitive decline question had low sensitivity (22.9%-26.7%) in identifying low cognitive performers, but had high specificity in identifying those who did not score low on the cognitive assessments (89.3%-90.9%). Conclusions-Cognitive performance has important implications for the U.S. aging population. Subjective cognitive decline along with older age, low income, low educational attainment, and fair or poor self-reported health were independently associated with lower cognitive performance in a representative sample of U.S. older adults.