Objective:Theories of brain aging emphasize frontal dysfunction as a general marker of age-related cognitive decline (West, 1996). Most of the supporting behavioral evidence derives from high-functioning, community dwelling young old adults. However, in the oldest old, a multimodal process of brain aging involving more than one brain area seems likely. Design:To identify neuropsychological predictors of subsequent longitudinal cognitive decline in nondemented very old nursing home residents. Materials and Methods:Performance in eight neuropsychological marker tests for frontal and temporal brain function at baseline of 138 residents (Mean age = 83.54 ± 7.92 years) from the Jewish Home and Hospital for the Aged (Bronx, New York), were examined as predictors of subsequent longitudinal decline in the overall score of the Mini-Mental State Examination (MMSE; Folstein et al., 1975). We applied a multilevel hierarchical regression approach to model longitudinal change in the MMSE as a function of neuropsychological performance at baseline. Data from the eight neuropsychological variables were reduced using a principal components analysis with varimax rotation. Two distinct factor scores, corresponding to frontal and temporal function, emerged. These factor scores were then analyzed as predictors of change in the MMSE over time. Results:Independent of age, gender, and education, both temporal and frontal factor scores were equally reliable predictors of subsequent cognitive decline in very old nondemented nursing home residents (p < .05). Conclusion:Results suggest an effect of both frontal and temporal brain aging on subsequent cognitive decline, supporting the notion of a multimodal process of brain aging in the oldest old.
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