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Terminal cognitive decline refers to the relatively precipitous and widespread drop in cognitive function that occurs in the period preceding death.1 The concept was originally proposed and investigated by developmental psychologists who were interested in the lifelong trajectories of intellectual and other cognitive abilities.1,–,3 Terminal decline change points (inflection points), where cognitive decline accelerates in relation to a future time point of death, have been confirmed among older cohorts free from dementia.2,4,–,6 However, it is not clear whether the terminal cognitive decline is due to latent underlying AD or other disease pathology not sufficiently severe enough to cross the clinical threshold, or whether it is attributable to biological processes presumably related to impending mortality.
An important concept and hypothesis linked to terminal decline is the dedifferentiation of cognitive abilities at the end of life. This hypothesis posits that in the course of human aging, cognitive abilities that in the preterminal period (the period before the inflection point of cognitive decline) remain differentiated into discrete systems and domains, become in late life increasingly intercorrelated and dedifferentiated.7 The hypothesis …
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