Skip to main content Accessibility help

Specific Measures of Executive Function Predict Cognitive Decline in Older Adults

  • Lindsay R. Clark (a1), Dawn M. Schiehser (a2) (a3), Gali H. Weissberger (a1), David P. Salmon (a4), Dean C. Delis (a2) (a3) and Mark W. Bondi (a2) (a3)...


Decline in executive function has been noted in the prodromal stage of Alzheimer's disease (AD) and may presage more global cognitive declines. In this prospective longitudinal study, five measures of executive function were used to predict subsequent global cognitive decline in initially nondemented older adults. Of 71 participants, 15 demonstrated significant decline over a 1-year period on the Dementia Rating Scale (Mattis, 1988) and the remaining participants remained stable. In the year before decline, the decline group performed significantly worse than the no-decline group on two measures of executive function: the Color-Word Interference Test (CWIT; inhibition/switching condition) and Verbal Fluency (VF; switching condition). In contrast, decliners and non-decliners performed similarly on measures of spatial fluency (Design Fluency switching condition), spatial planning (Tower Test), and number-letter switching (Trail Making Test switching condition). Furthermore, the CWIT inhibition-switching measure significantly improved the prediction of decline and no-decline group classification beyond that of learning and memory measures. These findings suggest that some executive function measures requiring inhibition and switching provide predictive utility of subsequent global cognitive decline independent of episodic memory and may further facilitate early detection of dementia. (JINS, 2012, 18, 118–127)


Corresponding author

Correspondence and reprint requests to: Mark W. Bondi, ABPP/CN, VA San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA 92161. E-mail:


Hide All
Albert, M.S., Moss, M.B., Tanzi, R., Jones, K. (2001). Preclinical prediction of AD using neuropsychological tests. Journal of the International Neuropsychological Society, 7(5), 631639.
Backman, L., Jones, S., Berger, A.K., Laukka, E.J., Small, B.J. (2005). Cognitive impairment in preclinical Alzheimer's disease: A meta-analysis. Neuropsychology, 19(4), 520531.
Baudic, S., Dalla Barba, G., Thibaudet, M.C., Smagghe, A., Remy, P., Traykov, L. (2006). Executive function deficits in early Alzheimer's disease and their relations with episodic memory. Archives of Clinical Neuropsychology, 21(1), 1521.
Bickel, H., Mosch, E., Seigerschmidt, E., Siemen, M., Forstl, H. (2006). Prevalence and persistence of mild cognitive impairment among elderly patients in general hospitals. Dementia and Geriatric Cognitive Disorders, 21(4), 242250.
Bisiacchi, P.S., Borella, E., Bergamaschi, S., Carretti, B., Mondini, S. (2008). Interplay between memory and executive functions in normal and pathological aging. Journal of Clinical and Experimental Neuropsychology, 30(6), 723733.
Blacker, D., Lee, H., Muzikansky, A., Martin, E.C., Tanzi, R., McArdle, J.J., Albert, M. (2007). Neuropsychological measures in normal individuals that predict subsequent cognitive decline. Archives of Neurology, 64(6), 862871.
Bondi, M.W., Houston, W.S., Eyler, L.T., Brown, G.G. (2005). fMRI evidence of compensatory mechanisms in older adults at genetic risk for Alzheimer's disease. Neurology, 64, 501508.
Bondi, M.W., Jak, A.J., Delano-Wood, L., Jacobson, M.W., Delis, D.C., Salmon, D.P. (2008). Neuropsychological contributions to the early identification of Alzheimer's disease. Neuropsychology Review, 18, 7390.
Bondi, M.W., Salmon, D.P., Galasko, D., Thomas, R.G., Thal, L.J. (1999). Neuropsychological function and Apolipoprotein E genotype in the preclinical detection of Alzheimer's disease. Psychology and Aging, 14, 295303.
Bondi, M.W., Salmon, D.P., Monsch, A.U., Galasko, D., Butters, N., Klauber, M.R., Saitoh, T. (1995). Episodic memory changes are associated with the APOE-epsilon 4 allele in nondemented older adults. Neurology, 45, 22032206.
Bookheimer, S.Y., Strojwas, M.H., Cohen, M.S., Saunders, A.M., Pericak-Vance, M.A., Mazziotta, J.C., Small, G.W. (2000). Patterns of brain activation in people at risk for Alzheimer's disease. New England Journal of Medicine, 343, 450456.
Brandt, J., Aretouli, E., Neijstrom, E., Samek, J., Manning, K., Albert, M.S., Bandeen-Roche, K. (2009). Selectivity of executive function deficits in mild cognitive impairment. Neuropsychology, 23(5), 607618.
Chang, Y.L., Bondi, M.W., Fennema-Notestine, C., McEvoy, L.K., Hagler, D.J., Jacobson, M.W., Dale, A.M. (2010). Brain substrates of learning and retention in mild cognitive impairment diagnosis and progression to Alzheimer's disease. Neuropsychologia, 48, 12371247.
Chang, Y.L., Jacobson, M.W., Fennema-Notestine, C., Hagler, D.J., Jennings, R.G., Dale, A.M., McEvoy, L.K. (2010). Level of executive function influences verbal memory in amnestic mild cognitive impairment and predicts prefrontal and posterior cingulate thickness. Cerebral Cortex, 20(6), 13051313.
Chapman, R.M., Mapstone, M., Porsteinsson, A.P., Gardner, M.N., McCrary, J.W., DeGrush, E., Guillily, M.D. (2010). Diagnosis of Alzheimer's disease using neuropsychological testing improved by multivariate analyses. Journal of Clinical and Experimental Neuropsychology, 32(8), 793808.
Chen, P.J., Ratcliff, G., Belle, S.H., Cauley, J.A., DeKosky, S.T., Ganguli, M. (2001). Patterns of cognitive decline in presymptomatic Alzheimer disease: A prospective community study. Archives of General Psychiatry, 58(9), 853858.
Delano-Wood, L., Bondi, M.W., Sacco, J., Abeles, N., Jak, A.J., Libon, D.J., Bozoki, A. (2009). Heterogeneity in mild cognitive impairment: Differences in neuropsychological profile and associated white matter lesion pathology. Journal of the International Neuropsychological Society, 15, 906914.
Delis, D.C., Kaplan, E., Kramer, J.H. (2001). Delis-Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation.
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A. (1987). The California Verbal Learning Test. San Antonio, TX: Psychological Corporation.
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A. (2000). California Verbal Learning Test: Second Edition. San Antonio, TX: Psychological Corporation.
Dickerson, B.C., Sperling, R.A., Hyman, B.T., Albert, M.S., Blacker, D. (2007). Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. Archives of General Psychiatry, 64(12), 14431450.
Eppig, J., Wambach, D.M., Nieves, C., Price, C.C., Lamar, M., Delano-Wood, L., Libon, D.J. (in press). Dysexecutive functioning in mild cognitive impairment: Derailment in temporal gradients. Journal of the International Neuropsychological Society.
Fine, E.M., Delis, D.C., Wetter, S.R., Jacobson, M.W., Jak, A.J., McDonald, C.R., Bondi, M.W. (2008). Cognitive discrepancies versus APOE genotype as predictors of cognitive decline in normal-functioning elderly individuals: A longitudinal study. American Journal of Geriatric Psychiatry, 16(5), 366374.
Ganguli, M., Dodge, H.H., Shen, C.Y., DeKosky, S.T. (2004). Mild cognitive impairment, amnestic type: An epidemiologic study. Neurology, 63(1), 115121.
Ganguli, M., Snitz, B.E., Saxton, J.A., Chang, C.-C.H., Lee, C.-W., Vander Bilt, J., Petersen, R.C. (2011). Outcomes of mild cognitive impairment by definition: A population study. Archives of Neurology, 68, 761767.
Han, S.D., Houston, W.S., Jak, A.J., Eyler, L.T., Nagel, B.J., Fleisher, A.S., Bondi, M.W. (2007). Verbal paired-associate learning by APOE genotype in nondemented adults: fMRI evidence of a right hemispheric compensatory response. Neurobiology of Aging, 28, 238247.
Hutchison, K.A., Balota, D.A., Ducheck, J.M. (2010). The utility of Stroop task switching as a marker for early stage Alzheimer's disease. Psychology and Aging, 25(3), 545559.
Jak, A.J., Bondi, M.W., Delano-Wood, L., Wierenga, C., Corey-Bloom, J., Salmon, D.P., Delis, D.C. (2009). Quantification of five neuropsychological approaches to defining mild cognitive impairment. American Journal of Geriatric Psychiatry, 17(5), 368375.
Lafleche, G., Albert, M.S. (1995). Executive function deficits in mild Alzheimer's disease. Neuropsychology, 9(3), 313320.
Lange, K.L., Bondi, M.W., Galasko, D.G., Delis, D.C., Salmon, D.P., Thal, L.J. (2002). Decline in verbal memory during preclinical Alzheimer's disease: Examination of the effect of Apolipoprotein E genotype. Journal of the International Neuropsychological Society, 8, 943955.
Libon, D.J., Xie, S.X., Eppig, J., Wicas, G., Lamar, M., Lippa, C., Wambach, D.M. (2010). The heterogeneity of mild cognitive impairment: A neuropsychological analysis. Journal of the International Neuropsychological Society, 16, 8493.
Logie, R.H., Cocchini, G., Della Sala, S., Baddeley, A.D. (2004). Is there a specific executive capacity for dual task coordination? Evidence from Alzheimer's disease. Neuropsychology, 18(3), 504513.
Mattis, S. (1988). Dementia rating scale: Professional manual. Odessa, FL: Psychological Assessment Resources Inc.
Mitchell, J., Arnold, R., Dawson, K., Nestor, P.J., Hodges, J.R. (2009). Outcome in subgroups of mild cognitive impairment (MCI) is highly predictable using a simple algorithm. Journal of Neurology, 256(9), 15001509.
Monsch, A.U., Bondi, M.W., Salmon, D.P., Butters, N., Thal, L.J., Hansen, L.A., Klauber, M.R. (1995). Clinical validity of the Mattis Dementia Rating Scale in detecting dementia of the Alzheimer type: A double cross-validation and application to a community-dwelling sample. Archives of Neurology, 52, 899904.
Nutter-Upham, K.E., Saykin, A.J., Rabin, L.A., Roth, R.M., Wishart, H.A., Pare, N., Flashman, L.A. (2008). Verbal fluency performance in amnestic MCI and older adults with cognitive complaints. Archives of Clinical Neuropsychology, 23(3), 229241.
Pedraza, O., Smith, G.E., Ivnik, R.J., Willis, F.B., Ferman, T.J., Petersen, R.C., Lucas, J.A. (2007). Reliable change on the Dementia Rating Scale. Journal of the International Neuropsychological Society, 13(4), 716720.
Petersen, R.C., Doody, R., Kurz, A., Mohs, R.C., Morris, J.C., Rabins, P.V., Winblad, B. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58(12), 19851992.
Petersen, R.C., Roberts, R.O., Knopman, D.S., Boeve, B.F., Geda, Y.E., Ivnik, R.J., Jack, C.R. (2009). Mild cognitive impairment: Ten years later. Archives of Neurology, 66, 14471455.
Raoux, N., Amieva, H., Le Goff, M., Auriacombe, S., Letenneur, L., Dartigues, J.-F. (2008). Clustering and switching processes in semantic verbal fluency in the course of Alzheimer's disease subjects: Results from the PAQUID longitudinal study. Cortex, 44, 11881196.
Rozzini, L., Chilovi, B.V., Conti, M., Bertoletti, E., Delrio, I., Trabucchi, M., Padovani, A. (2007). Conversion of amnestic mild cognitive impairment to Dementia of Alzheimer type is independent to memory deterioration. International Journal of Geriatric Psychiatry, 22(12), 12171222.
Salmon, D.P., Bondi, M.W. (2009). Neuropsychological assessment of dementia. Annual Review of Psychology, 60, 257282.
Salmon, D.P., Thomas, R.G., Pay, M.M., Booth, A., Hofstetter, C.R., Thal, L.J., Katzman, R. (2002). Alzheimer's disease can be accurately diagnosed in very mildly impaired individuals. Neurology, 59(7), 10221028.
Schmitter-Edgecombe, M., Sanders, C. (2009). Task switching in mild cognitive impairment: Switch and nonswitch costs. Journal of the International Neuropsychological Society, 15(1), 103111.
Sinai, M., Phillips, N.A., Chertkow, H., Kabani, N.J. (2010). Task switching performance reveals heterogeneity amongst patients with mild cognitive impairment. Neuropsychology, 24(6), 757774.
Stokholm, J., Vogel, A., Gade, A., Waldemar, G. (2006). Heterogeneity in executive impairment in patients with very mild Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 22(1), 5459.
Tabert, M.H., Manly, J.J., Liu, X.H., Pelton, G.H., Rosenblum, S., Jacobs, M., Devanand, D.P. (2006). Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment. Archives of General Psychiatry, 63(8), 916924.
Traykov, L., Raoux, N., Latour, F., Gallo, L., Hanon, O., Baudic, S., Rigaud, A.S. (2007). Executive functions deficit in mild cognitive impairment. Cognitive and Behavioral Neurology, 20(4), 219224.
Twamley, E.W., Ropacki, S.A., Bondi, M.W. (2006). Neuropsychological and neuroimaging changes in preclinical Alzheimer's disease. Journal of the International Neuropsychological Society, 12(5), 707735.


Related content

Powered by UNSILO

Specific Measures of Executive Function Predict Cognitive Decline in Older Adults

  • Lindsay R. Clark (a1), Dawn M. Schiehser (a2) (a3), Gali H. Weissberger (a1), David P. Salmon (a4), Dean C. Delis (a2) (a3) and Mark W. Bondi (a2) (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.