Does Retirement Affect Cognitive Functioning?

ArticleinJournal of Health Economics 31(3):490-501 · March 2012with 657 Reads
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Abstract
This paper analyses the effect of retirement on cognitive functioning using a longitudinal survey among older Americans, which allows controlling for individual heterogeneity and endogeneity of the retirement decision by using the eligibility age for social security as an instrument. The results highlight a significant negative effect of retirement on cognitive functioning. Our findings suggest that reforms aimed at promoting labour force participation at an older age may not only ensure the sustainability of social security systems but may also create positive health externalities for older individuals.

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  • Article
    Prior literature has documented a positive association between income and cognitive function at older ages; however, the extent to which this association represents causal effects is unknown. In this study, we use an exogenous change in Social Security income due to amendments to the Social Security Act in the 1970s to identify the causal impact of Social Security income on cognitive function of elderly individuals. We find that higher benefits led to significant improvements in cognitive function and that these improvements in cognition were clinically meaningful. Our results suggest that interventions even at advanced ages can slow the rate of decline in cognitive function. © 2016 American Society of Health Economists and Massachusetts Institute of Technology.
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  • Article
    Objectives Retirement timing has been linked to a host of outcomes for individuals, families, and societies. The present study predicted retirement timing using profiles of preretirement family caregiving and gender. Method Using longitudinal data from the Health and Retirement Study, cluster analysis was used to create profiles of preretirement family caregiving (operationalized as time and financial transfers to aging parents and adult children). These profiles, as well as gender, were used to predict later retirement timing. Results Four distinct preretirement caregiving profiles were evident. All profiles retired, on average, earlier than their full eligibility for Social Security benefits. A main effect of caregiving profile, but not gender, was evident. The Eldercare profile, which was characterized by high levels of time and financial transfers to aging parents, retired the earliest. There was not a significant interaction between caregiving profile and gender. Discussion When men enacted female-typical caregiving roles, their retirement timing resembled women's. Eldercare, in particular, was associated with earlier retirement timing. Implications for individual retirement decision-making and policy are discussed.
  • Article
    Full-text available
    This article investigates whether and to what extent retirement changes health behaviour. For identification we use an instrumental variable approach that exploits exogenous variations in the early and normal retirement ages within and across 10 European countries. Our results reveal that among those who abstained from alcohol and vigorous or moderate exercise at baseline, retirement increased those activities. Non-smokers did not increase smoking upon retirement. Retirement led to less smoking for those who smoked before retiring. It also brought about an increase in vigorous exercise for those who had the behaviour at baseline. These results further vary by a person’s job type, but less so with respect to gender or geographic region. Overall, our findings provide new empirical evidence on the causal link between retirement and health behaviours and how such link relates to four sources of individual heterogeneity: gender, European geographic region, job type and baseline health behaviour.
  • Article
    The ageing population is a major concern for policy makers, with the ever-increasing strains placed on health budgets. One overlooked area of research is the impact that cognitive impairment (an early marker of potential dementia onset) has on the healthcare utilization of an ageing population. Based on the theoretical micro-economic foundations of healthcare demand, we study the relationship between cognitive functioning and impairment, measured by word recall and changes thereof, and healthcare utilization among over 50s in nine European countries. The contribution of this article is to produce estimates for cognitive functioning and impairment, as opposed to full dementia, in the context of healthcare utilization. We apply regression models to healthcare utilization data from Waves 1, 2 and 4 of the Survey of Health, Ageing and Retirement in Europe and find that recalling one additional word is associated with a reduction in visits to a medical doctor of 0.32, per year (p<0.01). Even after controlling for self-assessed health, this association is strong at just over 0.1 visits – this is the additional impact, over and above the average number of visits for similar individuals without cognitive impairment.
  • Article
    Prior research on change in cognitive performance before and after retirement suffers from inattention to gender context. This study theoretically motivates the testing of gender differences in cognitive decline after retirement. I drew 67,905 observations of cognitive function based on the Telephone Interview for Cognitive Status from 18,453 participants (7,830 men and 10,623 women) in the Health and Retirement Study (1992–2014). I used fixed-effects two-stage least square models to account for unobserved heterogeneity between men and women in the sample and the endogeneity of retirement decision. I also controlled for change in depressive symptoms, mobility limitations, individual wealth, medical expenses, and spousal income. Retirement predicts a decrease in the cognitive score by 2.168 on a scale of 0–35 for women, but no change for men. Continued employment may buffer against risk factors that aggravate women’s cognitive health.
  • Article
    This article describes an exploratory study that investigates the extent to which two sets of psychological factors, fluid cognitive ability and personality traits, predict late-in-life work and retirement outcomes. Using longitudinal data from the Health and Retirement Study, we first provide a detailed characterization of within-subject work-toretirement pathways, spanning 14 years of data for each individual, and identify the most frequent pathway classes. We found that only 37% of workers followed the "standard" pattern of retiring completely from a full-time job. We then examined how cognitive ability and personality traits predict these work-to-retirement pathways. We found that individuals with better cognitive ability work longer, both in full- and in part-time jobs, and extraversion is a strong predictor of working longer, mainly in part-time jobs. These results are robust to the inclusion of many covariates, including demographics, health, socioeconomic status, and labor market variables. Although the observed patterns match individuals' retirement expectations to some extent, there also seems to be evidence of some surprise. Practical implications and suggestions for future research are discussed.
  • Article
    Full-text available
    Source memory decline has been identified as one of the types of memory most seriously affected during older age. It refers to our capacity to recollect the contextual information in which our experiences take place. Although most elderly adults will be affected by progressive source memory decline, a subset of individuals will not follow this average pattern; instead, their source memory capabilities will remain functional. Likewise, a minority of individuals will manifest an extreme decay of their source memory abilities. The objective of the present study was to identify among 120 potential predictors that significantly contributed to these two extreme source memory outcomes. Spatial source memory was measured in a sample of 519 healthy individuals between 61 and 80 years old. Individuals who performed below the 20th and above the 80th percentiles in the source memory task were defined as individuals whose episodic memory failed and succeeded, respectively. Logistic models identified five and six significant predictors of source memory success and failure in older age, respectively. High source memory performance was mainly predicted by healthy cardiovascular markers and psychological traits, whereas low source memory performance was primarily predicted by consumption habits and by less engagement in mental activities. The models identified relevant biological and life experiences that underlie these unusual source memory outcomes in older age.
  • Article
    The role of wages in the health‐employment nexus can be important for designing employment policies aimed at older workers with health limitations. We, therefore, estimate the direct effect of health on employment and hours worked and its indirect effect that is mediated through wages using individual‐level panel data from SHARE. The endogeneity of self‐reported health is controlled for by instrumenting it with severe health conditions in a correlated random effects model. For men, we find that the direct effects of health deterioration, as measured by a reduction in health from the 75th to the 50th percentile of the health distribution, are about a 20% point lower employment probability and about 171 fewer hours worked per year. The indirect health effects through wages work in the opposite directions as health positively affects wages and wages negatively affect employment and hours worked. The total effects of this health deterioration amount to a 12% point lower employment probability and 95 fewer hours worked per year. In particular our finding of a large direct health effect on employment suggests an instrumental role for policy aimed at accommodating workers with health limitations to keep them employed at older ages.
  • Article
    We investigate the causal impact of retirement on health care utilization using SHARE data for 10 European countries. We show that the number of doctor's visits and the probability of visiting a doctor more than four times a year (our measures of health care utilization) increase after retirement. The increase in health care utilization is found to depend mainly on the years spent in retirement, suggesting that adjustment may take time. We find evidence of heterogeneous effects by gender and across different patterns of time use prior to retirement (i.e., working long hours and combined work and out‐of‐work activities). Overall, the empirical findings suggest that the increase in health care utilization is consistent with the decrease in the opportunity cost of time faced by individuals when they retire.
  • Article
    Full-text available
    Background: Huntington's disease (HD) presents with motor, cognitive, and behavioral symptoms that impair functional capacity and the ability to maintain employment. The relative contribution of cognitive decline to work disability remains controversial. Objective: To evaluate the association of cognitive decline, compared with motor decline, with the decision to leave work. Methods: Data from the Enroll-HD observational study were analyzed. The correlation of age of cognitive symptom onset and age of motor symptom onset with age at leaving work was assessed. The association of the Stroop Color Naming Test (SCNT) cognitive assessment and the Total Motor Score (TMS) assessment (reverse scored) with the Total Functional Capacity (TFC) assessment was also assessed. Results: For every year delay in cognitive symptom onset, there was a 0.806 year increase in age at leaving work (SE = 0.030, p < 0.001, adj-R2 = 0.628). For every year delay of motor symptom onset, there was a 0.814 year increase in age at leaving work (SE = 0.031, p < 0.001, adj-R2 = 0.603). For every additional correct SCNT response given and for every unit increase in TMS, there was a 0.105 unit increase (SE = 0.006, p < 0.001, adj-R2 = 0.315) and a 0.104 unit decrease in TFC (SE = 0.003, p < 0.001, adj-R2 = 0.640), respectively. Conclusions: Cognitive symptoms have a significant association, comparable to that of motor symptoms, with occupational functioning and the decision to leave work, suggesting that development of therapies for both cognitive and motor decline would be important for allowing people with HD to remain in the workforce longer.
  • Article
    One of the major aspects of successful ageing is active engagement in later life. Retirement and widowhood are two significant life transitions that may largely influence leisure engagement patterns among older adults. Limited findings exist regarding the impact of life transitions on leisure activity engagement due to the scarcity of longitudinal data with repeated measurement of older individuals’ leisure engagement. This study longitudinally examined changes in leisure activity engagement as influenced by retirement and widowhood using five waves of national panel data from the Health and Retirement Study and its supplementary Consumption and Activities Mail Survey. Multi-level modelling was conducted with retirement and widowhood status as time-varying variables. Socio-economic status, depressive symptoms, cognitive function, self-rated health and functional limitations were also included as time-varying and time-invariant covariates. Findings show that engagement in mental, physical, social and household activities significantly decreased during an eight-year period. Moreover, transition from working to retired status was associated with increased engagement in mental, social and household activities but decreased engagement in physical activities among men only. Transition from married to widowhood status was associated with decreased engagement in household activities among women only. Encouraging active leisure engagement among individuals who experience either or both life transitions may help maintain their health after transition.
  • Article
    Full-text available
    OBJECTIVE: To estimate the average treatment effect of working past the current retirement age on the health of Japanese men. METHODS: We used publicly available data from the National Survey of Japanese Elderly, extracting a sample of 1288 men who were 60 years or older. Survey respondents were followed-up for at most 15 years for the onset of four health outcomes: death, cognitive decline, stroke and diabetes. By using the propensity score method, we adjusted for the healthy worker effect by incorporating economic, sociodemographic and health data in the form of independent variables. By calculating the differences in times to a health outcome between those in employment and those not employed, we estimated the average treatment effects on health of being in paid work past retirement age. FINDINGS: Compared with those not employed, those in employment lived 1.91 years longer (95% confidence interval, CI: 0.70 to 3.11), had an additional 2.22 years (95% CI: 0.27 to 4.17) before experiencing cognitive decline, and had a longer period before the onset of diabetes and stroke of 6.05 years (95% CI: 4.44 to 7.65) and 3.35 years (95% CI: 1.42 to 5.28), respectively. We also observed differences between employees and the self-employed: the self-employed had longer life expectancies than employees. In terms of years to onset of diabetes or stroke, however, we only observed significant benefits to health of being an employee but not self-employed. CONCLUSION: Our study found that being in employment past the current age of retirement had a positive impact on health.
  • Article
    Retirement is a key hallmark of life for many in modern society. The Baby Boom generation has resulted in increasing numbers of retirees. Given this trend, it is important to identify key factors that promote better health and longevity in the years following retirement. We used data from 4,266 participants of the Health and Retirement Study who retired over the course of the study to examine whether levels of episodic memory at retirement and rates of change before and after retirement would be associated with disability, cardiovascular disease, and mortality risk following retirement, above and beyond socio-demographics and known risk factors. Individuals who exhibited higher levels of episodic memory at the time of retirement and relative stability in episodic memory prior to and following retirement had a decreased likelihood for disability, cardiovascular disease incidence, and mortality following retirement. The effects of disability remained when controlling for socio-demographics and known risk factors, whereas the effects of level and change prior to retirement on cardiovascular disease incidence and mortality were no longer significant with the inclusion of known risk factors. Better episodic memory was consistently associated with lower risk of disability, cardiovascular disease, and mortality following retirement. Less decline or stability in episodic memory during the time prior to retirement was also associated with lower risk of disability and cardiovascular disease, but not with mortality risk, during the period after retirement. Our discussion focuses on the importance of maintaining episodic memory and possible mechanisms through which it affects health following retirement.
  • Article
    We have prospectively followed over a 5-year period 434 volunteers who were at intake ambulatory, functional, presumably nondemented, and between 75 and 85 years of age. Fifty-six (an incidence of 3.53 per 100 person-years at risk) developed a progressive dementia: 32 met diagnostic criteria for Alzheimer's disease (AD) (an incidence of 2.0 per 100 person-years at risk), 15 had vascular or mixed dementia, and 9 had other disorders or remain undiagnosed. New cases of dementia were as common as myocardial infarction and twice as common as stroke. Risk factors for both dementia and AD were age (over 80) and gender (female); other reported risk factors such as family history, prior head injury, thyroid disease, maternal age, and smoking were not risk factors for AD in this elderly cohort. Prior stroke was the major risk factor for vascular or mixed dementia; diabetes and left ventricular hypertrophy but not a history of hypertension per se were also risk factors for vascular dementia. The major predictor of the development of AD was the mental status score on entry. The 58.5% of the cohort who made zero to two errors on a 33-item mental status test had a less than 0.6% per year chance of developing AD, whereas the 16% of the cohort with five to eight errors on this test developed AD at a rate of over 12% per year. Thus, it is possible to identify a large cohort of 80-year-olds who are at low risk for AD and a smaller cohort at very high risk.
  • Article
    Although it is well-known that cognitive impairment in the elderly is usually accompanied by limitations in activities of daily living (ADL), it is not known whether cognitive impairment predicts the onset of new ADL limitations. The purpose of this analysis was to determine whether poor scores on a brief measure of cognitive functioning at baseline (1982) would predict the onset of persistent limitations in ADL during the subsequent 3 years, in a probability sample of community-dwelling elderly persons living in New Haven, Connecticut, who were initially free of ADL limitations (n=1,856). Cognitive functioning was assessed with Pfeiffer's Short Portable Mental Status Questionnaire. Persistent incident ADL limitations were defined as the onset of one or more ADL limitations after 1982, with no subsequent reports of zero ADL limitations. Compared with persons who scored zero to one errors on the Short Portable Mental Status Questionnaire at baseline, persistent, incident ADL limitations occurred more frequently in persons who scored four or more errors (odds ratio for males=2.72, 95% confidence interval 1.36–5.43; odds ratio for females=2.60, 95% confidence interval 1.52–4.44) after adjustment for the confounding effects of housing type, age, race, history of chronic health conditions, and incident health conditions. These results suggest that knowledge of scores on brief cognitive function tests can be used to forecast service needs and to develop intervention programs to prepare for the possible onset of ADL limitations.
  • Book
    With an ever increasing population of aging people in the western world, it is more crucial than ever that we try to understand how and why cognitive competence breaks down with advancing age why do some people follow normal patterns of cognitive change, while others follow a path of progressive decline, with neurodegenerative diseases such as Alzheimer's. What can be done to prevent cognitive decline or - to avoid neurodegenerative diseases? The answers, if they come, will not emerge from research within one discipline, but from work being done across a range of scientific and medical specialities. This book delves into the subjects of cognitive aging, neuroscience, pharmacology, health, genetics, sensory biology, and epidemiology. This book is about new frontiers rather than past research and accomplishments. Recently cognitive aging research has taken several new directions, linking with, and benefiting from, rapid technological and theoretical advances in these neighbouring disciplines. This book provides unique interdisciplinary coverage of the topic. © Roger A. Dixon, Lars Bäckman, and Lars Göran-Nilsson 2004. All rights reserved.
  • Chapter
    Full-text available
    Reviews findings that support the interpretation of age-related declines in recall and recognition in terms of age-related degeneration in medial-temporal lobe and frontal lobe regions in light of new evidence. The authors also consider age-related changes in forms of memory that are mediated by regions other than the medial-temporal and frontal lobe areas implicated in recall and recognition. These include memory measures of skill learning, repetition priming, and conditioning, each of which are dissociable from recall and recognition. The authors ask whether these forms of memory, and their underlying neural bases, are relatively spared in aging or whether they too are compromised together with recall and recognition. The authors also consider normal age-related changes in memory performance in relation to 2 common age-related neurological diseases, Alzheimer's disease (AD) and Parkinson's disease. They review age-comparative studies of 4 forms of long-term memory: declarative memory, skill learning, repetition priming, and conditioning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    It is widely believed that keeping mentally active will prevent age-related mental decline. The primary prediction of this mental-exercise hypothesis is that the rate of age-related decline in measures of cognitive functioning will be less pronounced for people who are more mentally active, or, equivalently, that the cognitive differences among people who vary in level of mental activity will be greater with increased age. Although many training studies, and comparisons involving experts, people in specific occupations, and people whose mental activity levels are determined by their self-reports, have found a positive relation between level of activity and level of cognitive functioning, very few studies have found an interactive effect of age and mental activity on measures of cognitive functioning. Despite the current lack of empirical evidence for the idea that the rate of mental aging is moderated by amount of mental activity, there may be personal benefits to assuming that the mental-exercise hypothesis is true. © 2006 Association for Psychological Science.
  • Article
    The author compares the work role centrality of married working women and men and the factors related to it. The factors of socialization, status, status inconsistency, and work values as well as job satisfaction are examined. Although in the aggregate women are found to be less work-centered than men, further specification indicates that this is true mainly in the intermediate socioeconomic status (SES) categories, but not in others. The author proposes that this is related to the greater status inconsistency that women experience in these SES categories, and to their dual role as wives and mothers and employed workers. For women only, country of origin is of relevance to work role centrality (WRC), suggesting the importance of socialization. A combined model of status, work values, and job satisfaction explains WRC best for men, whereas status, socialization, and job satisfaction explains it best for women.
  • Article
    Full-text available
    The current preliminary research presents initial findings of a cross-sectional study between 1981 and 2006. This is follow-up research regarding ‘meaning of work’ studies held in 1981 and 1993 and examines the changes of relative centrality of major life domains (work, family, leisure, community and religion) in Israel according to gender. The participants are representative samples of the Israeli labor force in 1981, 1993 and 2006. The results indicate that, as in the past, family centrality is higher among women than among men. While in 1981 and 1993 men showed a higher work centrality than women, in 2006 no traditional gender differences were found in work centrality. Moreover, only in 2006 community and religion are regarded more important among men than among women. The paper discusses the main changes taking place and suggests some explanations. Esta investigación preliminar presenta resultados iníciales de un estudio seccional cruzado entre los años 1981 y 2006. Esta es una investigación de seguimiento sobre estudios de la ‘esencia del trabajo’ que fueron realizados en los años 1981 y 1983 que examina los cambios de centralidad relativa de importantes áreas de la vida (trabajo, familia, tiempo libre, comunidad y religión) en Israel de acuerdo con el género. Los participantes forman parte de un muestreo representativo de la fuerza de trabajo Israelí en los años 1981, 1993 y 2006. Los resultados indican que así como en el pasado, la centralidad de la familia es mayor entre las mujeres que entre los hombres. Mientras que en 1981 y 1993 los hombres mostraban una mayor centralidad laboral que las mujeres, en el año 2006 no se encontraron diferencias genéricas en la centralidad laboral. Además, sólo en el año 2006 comunidad y religión fueron catalogadas como más importantes entre los hombres que entre las mujeres. Este artículo aborda los principales cambios ocurridos y sugiere algunas explicaciones.
  • Article
    We investigate the relationship between ageing, cognitive abilities and retirement using the Survey on Health, Ageing and Retirement in Europe (SHARE), a household panel that offers the possibility of comparing several European countries using nationally representative samples of the population aged 50 . The human capital framework suggests that retirement may cause an increase in cognitive decline, since after retirement individuals lose the market incentive to invest in cognitive repair activities. Our empirical results, based on an instrumental variable strategy to deal with the potential endogeneity of retirement, confirm this key prediction. They also indicate that education plays a fundamental role in explaining heterogeneity in the level of cognitive abilities.
  • Article
    Although the health effect of retirement has important policy implications, few economists have researched the topic. This paper utilizes longitudinal data from the Health and Retirement Study and instruments retirement status using exogenous variation in public and private pensions. Subjective health change models indicate retirement preserves the health of both men and women, although insignificant results for objective health change models suggest the preservation may be more perceived than real. The same pattern of results is found using continuous measures of annual hours. At the very least, the results give strong evidence against the anecdotal idea that retirement harms health.
  • Article
    Panel data based studies in econometrics use the analysis of covariance approach to control for various ‘individual effects’ by estimating coefficients from the ‘within’ dimension of the data. Often, however, the results are unsatisfactory, with ‘too low’ and insignificant coefficients. Errors of measurement in the independent variables whose relative importance gets magnified in the within dimension are then blamed for this outcome.Errors-in-variables models have not been used widely, in part because they seem to require extraneous information to be identified. We show how a variety of errors-in-variables models may be identifiable and estimable in panel data without the use of external instruments and apply it to a relatively simple but not uninteresting case: the estimation of ‘labor demand’ relationships, also known as the ‘short-run increasing returns to scale’ puzzle.
  • Article
    Full-text available
    We draw attention to two problems associated with the use of instrumental variables (IV), the importance of which for empirical work has not been fully appreciated. First, the use of instruments that explain little of the variation in the endogenous explanatory variables can lead to large inconsistencies in the IV estimates even if only a weak relationship exists between the instruments and the error in the structural equation. Second, in finite samples, IV estimates are biased in the same direction as ordinary least squares (OLS) estimates. The magnitude of the bias of IV estimates approaches that of OLS estimates as the R(2) between the instruments and the endogenous explanatory variable approaches 0. To illustrate these problems, we reexamine the results of a recent paper by Angrist and Krueger, who used large samples from the U.S. Census to estimate wage equations in which quarter of birth is used as an instrument for educational attainment. We find evidence that, despite huge sample sizes, their IV estimates may suffer from finite-sample bias and may be inconsistent as well. These findings suggest that valid instruments may be more difficult to find than previously imagined. They also indicate that the use of large data sets does not necessarily insulate researchers from quantitatively important finite-sample biases. We suggest that the partial R(2) and the F statistic of the identifying instruments in the first-stage estimation are useful indicators of the quality of the IV estimates and should be routinely reported.d
  • Article
    What are the health impacts of retirement? As talk of raising retirement ages in pensions and social security schemes continues around the world, it is important to know both the costs and benefits for the individual, as well as the governments' budgets. In this paper we use the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset to address this question in a multi-country setting. We use country-specific early and full retirement ages as instruments for retirement behavior. These statutory retirement ages clearly induce retirement, but are not related to an individual's health. Exploiting the discontinuities in retirement behavior across countries, we find significant evidence that retirement has a health-preserving effect on overall general health. Our estimates indicate that retirement leads to a 35 percent decrease in the probability of reporting to be in fair, bad, or very bad health, and an almost one standard deviation improvement in the health index. While the self-reported health seems to be a temporary impact, the health index indicates there are long-lasting health differences.
  • Article
    This paper examines trends in the work and retirement patterns of males aged 58 to 63 in 1969 and 1989 respectively. The labor force attachments of this group have fallen for reasons unrelated to changes in individual characteristics or occupational attainment. Especially sharp reductions at age 62 hint at an increasingly important role for the early retirement provisions in Social Security. Attachments to longest jobs have also declined substantially beginning at age 55. Although pension incentives may be significant, the observed correlations between pensions and employment status may also reflect the role of confounding factors such as poorly measured nonpension wealth.
  • Article
    Social Security Programs and Retirement around the World represents the second stage of an ongoing research project studying the relationship between social security and labor. In the first volume, Jonathan Gruber and David A. Wise revealed enormous disincentives to continued work at older ages in developed countries. Provisions of many social security programs typically encourage retirement by reducing pay for work, inducing older employees to leave the labor force early and magnifying the financial burden caused by an aging population. At a certain age there is simply no financial benefit to continuing to work. In this volume, the authors turn to a country-by-country analysis of retirement behavior based on micro-data. The result of research compiled by teams in twelve countries, the volume shows an almost uniform correlation between levels of social security incentives and retirement behavior in each country. The estimates also show that the effect is strikingly uniform in countries with very different cultural histories, labor market institutions, and other social characteristics.
  • Article
    We estimate the magnitude of any direct effect of retirement on health. Since retirement is endogenous to heath, it is not possible to estimate this effect by comparing the health of individuals before and after they retire. As an alternative we use institutional features of the pension system in the United Kingdom that are exogenous to the individual to isolate exogenous variation in retirement behavior. Data used will include both vital statistics and survey data that include both “objective” physical measurements and respondent self-reports. We find no evidence of negative health effects of retirement and some evidence that there may be a positive effect, at least for men.
  • Article
    This paper constructs a model of saving for retired single people that includes heterogeneity in medical expenses and life expectancies, and bequest motives. We estimate the model using Assets and Health Dynamics of the Oldest Old data and the method of simulated moments. Out-of-pocket medical expenses rise quickly with age and permanent income. The risk of living long and requiring expensive medical care is a key driver of saving for many higher-income elderly. Social insurance programs such as Medicaid rationalize the low asset holdings of the poorest but also benefit the rich by insuring them against high medical expenses at the ends of their lives. (c) 2010 by The University of Chicago. All rights reserved..
  • Article
    The authors use the Current Population Survey to describe what they believe are the most salient aspects of labor force behavior of older men and women during the last two decades. First, they show that early retirement has increased dramatically and this trend continued through the 1980s. Second, the authors show that the factors that most sharply distinguish propensities toward early retirement are those usually associated with low wages. Third, they show that trends in reduced participation for older men parallel those for younger men, while a pattern of increasing female participation is to be expected given the behavior of younger cohorts. Copyright 1994 by University of Chicago Press.
  • Article
    Previous research finds a systematic decrease in consumption at retirement, a finding that is inconsistent with the life cycle/permanent income hypothesis if retirement is an expected event. In this paper, we use workers' subjective beliefs about their retirement dates as an instrument for retirement. After demonstrating that subjective retirement expectations are strong predictors of subsequent retirement decisions, we still find a consumption decline at retirement for workers who retire when expected. However, our estimates of this consumption fall are about a third less than those found when we instead rely on the instrumental variables strategy used in prior studies. Copyright by the President and Fellows of Harvard College and the Massachusetts Institute of Technology.
  • Article
    Full-text available
    This paper tests the rationality of retirement expectations, controlling for sample selection and reporting biases. We find that retirement expectations in the Health and Retirement Study are consistent with the rational expectations hypothesis. We also analyze how new information affects the evolution of retirement expectations and discover that, on average, individuals correctly anticipate most uncertain events when planning their retirement, except for some health shocks, the need for additional private health coverage, and the probability of a job change. Our results support a wide variety of models in economics that assume rational behavior. Copyright (c) 2005 President and Fellows of Harvard College and the Massachusetts Institute of Technology.
  • Article
    Both social psychologists and social gerontologists have expressed considerable interest in adaptation to the loss of central life roles. The relationship between retirement and morale, where morale is viewed as an indicator of adaptation, is an example of research within this theoretical framework. In this study, longitudinal data for a select sample of 58 male subjects were used to examine intensively the process of adaptation to retirement. The strongest finding was evidence of high levels of adaptation in the sample as reflected in the overwhelming stability of morale over time. Multiple regression analysis indicated that social resources, particularly marital status and socioeconomic status, condition the relationship between adaptation and retirement. In summary, our analysis supports current suggestions that retirement be viewed as an event which occasions a complex social process of adaptation conditioned by a variety of resource and temporal variables.
  • Article
    We evaluated memory function in a group of 161 community-dwelling, cognitively normal individuals aged 62 to 100 years recruited as part of the Mayo Clinic Alzheimer's Disease Patient Registry. We used the Free and Cued Selective Reminding Test and the Rey Auditory Verbal Learning Test to evaluate two aspects of memory function thought to be sensitive to the effects of aging: learning (acquisition) and delayed recall (forgetting). The results were quite consistent and demonstrated that learning or acquisition performance declines uniformly with increasing age but is not related to education. Delayed recall or forgetting, however, remained relatively stable across age when adjusted for the amount of material initially learned. These findings are relevant for assessing normal memory function relative to the early impairments found in dementia and form a baseline against which memory performance can be assessed by the clinician. In particular, suspicion regarding a disorder of brain function affecting memory processes should be raised if learning performance declines more rapidly than expected or if delayed recall is impaired to any significant extent.
  • Article
    Although gerontologists have shown considerable interest in describing possible phases of retirement, the temporal course of retirement experience remains largely unspecified. This study of 293 male retirees from the normative aging study used cross-sectional data to compare levels of life satisfaction and lesiure activities across 6-month time intervals within the first 3 years after retirement. Regression models were used to test the hypothesis that men retired 0 to 6 months differed from men retired for longer periods. Findings showed that, compared with these recent retirees, men retired 13 to 18 months had lower levels of overall life satisfaction and self-perceived involvement in physical activities. Analyses of the constituents of life satisfaction showed greater optimism and future orientation among recent retirees and a comparative deficit at 13 to 18 months. These findings support an interpretation that the immediate postretirement period is marked by more enthusiasm and that some degree of temporary letdown or dysphoria is likely during the second year of retirement.
  • Article
    Gave 275 male Berkeley S1 rats injections of saline or 2mg/kg of methamphetamine. Ss either remained in the home cage or were placed individually into an enriched environment for 2 hr/day during the light or dark hours. Ss placed singly in large enriched-environment cages over a 30-day period were different from home-cage control littermates in weights of brain sections and in brain-enzyme activities. These differences were small, however, unless S's interaction with the stimulus objects was facilitated. Such priming was accomplished by placement in the dark under the influence of methamphetamine. It is concluded that social stimulation, which previously has always been included in the enriched condition, is unnecessary. (25 ref.)
  • Article
    Dementia is a growing problem in developed countries. The aim of this paper is to estimate incidence rates of dementia, Alzheimer's disease and vascular dementia in a community population of South-Western France. A sample of 2792 subjects was selected and followed-up 1 year and 3 after the initial screening. At each visit, a standardized questionnaire was administered by trained psychologists. Demented subjects were identified using a two-step procedure. The first step consisted of a systematic screening by the psychologist using DSM IIIR criteria for dementia. In the second step, subjects who fulfilled the DSM IIIR criteria were examined by a neurologist. NINCDS-ADRDA criteria were applied to diagnose Alzheimer's disease. Incidences of dementia and Alzheimer's disease were estimated at 16.3 and 11.4 per 1000 per year, respectively. Incidence estimates increased with age from 2 per 1000 in subjects aged 65-69 years to 74 per 1000 in subjects > 90 years. Incidence estimates of Alzheimer's disease showed the same increased from 0.7 per 1000 to 66 per 1000. Incidences of dementia and of Alzheimer's disease did not level off with age and were not different between genders.
  • Article
    Full-text available
    Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. Cohort incidence study. General community. A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. Incident dementia. We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [Cl], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% Cl, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% Cl, 1.32 to 3.84). The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations.
  • Article
    Full-text available
    A program of research is summarized that represents the author's lifelong efforts to understand the adult life course of intellectual abilities. The Seattle Longitudinal Study has assessed mental abilities in more than 5,000 adults and has followed some for as long as 35 years. Integrative findings are provided on patterns and magnitudes of age changes, cohort differences, factor structure of mental abilities, antecedents for individual differences in aging trajectories, and interventions designed to remediate cognitive aging effects.
  • Article
    In a community population of persons over the age of 65, cognitive function was assessed using brief performance tests on two occasions 3 years apart. Those with fewer years of formal education consistently had greater declines in cognitive function, independently of age, birthplace, language of interview, occupation, and income. These prospective findings suggest that low educational attainment or a correlate predicts cognitive decline. It is not clear, however, whether this relation represents a direct effect of education on future cognition, whether education might be related to occurrence of a disease leading to cognitive decline in older persons, or whether education might be a surrogate for some variable not included in the study.
  • Article
    The objective of this study is to determine the range of complex physical and cognitive abilities of older men and women functioning at high, medium and impaired ranges and to determine the psychosocial and physiological conditions that discriminate those in the high functioning group from those functioning at middle or impaired ranges. The subjects for this study were drawn from men and women aged 70-79 from 3 Established Populations for the Epidemiologic Study of the Elderly (EPESE) programs in East Boston MA, New Haven CT, and Durham County NC screened on the basis of criteria of physical and cognitive function. In 1988, 4030 men and women were screened as part of their annual EPESE interview. 1192 men and women met criteria for "high functioning". Age and sex-matched subjects were selected to represent the medium (n = 80) and low (n = 82) functioning groups. Physical and cognitive functioning was assessed from performance-based examinations and self-reported abilities. Physical function measures focused on balance, gait, and upper body strength. Cognitive exams assessed memory, language, abstraction, and praxis. Significant differences for every performance-based examination of physical and cognitive function were observed across functioning groups. Low functioning subjects were almost 3 times as likely to have an income of < or = $5000 compared to the high functioning group. They were less likely to have completed high school. High functioning subjects smoked cigarettes less and exercised more than others. They had higher levels of DHEA-S and peak expiratory flow rate. High functioning elders were more likely to engage in volunteer activities and score higher on scales of self-efficacy, mastery and report fewer psychiatric symptoms.
  • Article
    Full-text available
    The purpose of this prospective study was to (1) evaluate the impact of retirement, (2) monitor the change in adjustment across time, and (3) identify the resources predictive of short- and long-term adjustment in retirement. A sample of 117 male retirees was assessed on indices of physical and psychological health, perceived control, retirement satisfaction, and life satisfaction at 2–4 months preretirement, 1 year post-, and 6–7 years postretirement. The results provided support for a positive impact of retirement, as retirees evidenced increases in well-being during the first year. There was also evidence of a retirement adjustment process, in that aspects of well-being (i.e., psychological health) changed from short- to long-term retirement. Finally, physical health, income, and voluntary retirement status predicted short-term adjustment, while internal locus of control was an additional resource for long-term adjustment. Changes in resources over time also differentially predicted short- and long-term adjustment (e.g., an increase in internal locus of control predicted an increase in activity satisfaction at 1 year but not at 6-7 years postretirement).
  • Article
    The present review discusses the economic research to date on Alzheimer disease (AD). It focuses on estimates of the costs of AD and on economic evaluations of interventions in the disease. Empirical and conceptual issues concerning the interpretation of costs and the uses of evaluative methodologies also are discussed. We conclude that estimates of the national costs of AD are open to a large margin of uncertainty. We conclude further that significant opportunities exist for new cost-effectiveness or cost-benefit analyses of AD treatments, patient care options, and counselling, respite, or similar programs for AD caregivers.
  • Article
    In order to understand what cognitive changes can be expected with aging versus those caused by disease, the New England Centenarian Study examined correlations between neuropsychological evaluation and neuropathological studies of centenarian subjects. Sixty-nine subjects were administered an extensive neuropsychological test battery designed for centenarians. Six brain donors from this group have subsequently died, and neuropathological studies of their brains have been performed to determine the presence of Alzheimer's disease (AD) and other pathological states. Of these six centenarians, three subjects had Clinical Dementia Rating scores of 0 and no dementia on neuropsychological testing, and subsequent neuropathology showed very limited AD changes. In fact, despite a range of neuropsychological findings, none of the subjects in this series met neuropathological criteria for a diagnosis of definite AD. Findings suggest that dementia is not inevitable with aging and that dementia in this age group is surprisingly often not attributable to AD.
  • Article
    Because it allows direct mapping of synaptic activity during behavior in the normal subject, functional neuroimaging with the activation paradigm, especially positron emission tomography, has recently provided insight into our understanding of the functional neuroanatomy of episodic memory over and above established knowledge from lesional neuropsychology. The most striking application relates to the ability to distinguish the structures implicated in the encoding and the retrieval of episodic information, as these processes are extremely difficult to differentiate with behavioral tasks, either in healthy subjects or in brain-damaged patients. Regarding encoding and retrieval, the results from most studies converge on the involvement of the prefrontal cortex in these processes, with a hemispheric encoding/retrieval asymmetry (HERA) such that the left side is preferentially involved in encoding, and the right in retrieval. However, there are still some questions, for instance, about bilateral activation during retrieval and a possible specialization within the prefrontal cortex. More expected from human and monkey lesional data, the hippocampal formation appears to play a role in both the encoding and the retrieval of episodic information, but the exact conditions which determine hippocampal activation and its fine-grained functional neuroanatomy have yet to be fully elucidated. Other structures are activated during episodic memory tasks, with asymmetric activation that fits the HERA model, such as preferentially left-sided activation of the association temporal and posterior cingulate areas in encoding tasks and preferentially right-sided activation of the association parietal cortex, cerebellum, and posterior cingulate in retrieval tasks. However, this hemispheric asymmetry appears to depend to some extent on the material used. These new data enhance our capacity to comprehend episodic memory deficits in neuropsychology, as well as the neural mechanisms underlying the age-related changes in episodic memory performances.
  • Article
    Data from the Canadian Study of Health and Aging (CSHA) were used to examine the relation between severity of Alzheimer's disease, as measured by the Mini-Mental State Examination (MMSE), and costs of caring. The CSHA was a community-based survey of the prevalence of dementia, including subtypes such as Alzheimer's disease, among elderly Canadians. Survey subjects with a diagnosis of possible or probable Alzheimer's disease were grouped into disease severity levels of mild (MMSE score 21-26), mild to moderate (MMSE score 15-20), moderate (MMSE score 10-14) and severe (MMSE score below 10). Components of care available from the CSHA were use of nursing home care, use of medications, use of community support services by caregivers and unpaid caregiver time. Costs were calculated from a societal perspective and are expressed in 1996 Canadian dollars. The annual societal cost of care per patient increased significantly with severity of Alzheimer's disease. The cost per patient was estimated to be $9451 for mild disease, $16,054 for mild to moderate disease, $25,724 for moderate disease and $36,794 for severe disease. Institutionalization was the largest component of cost, accounting for as much as 84% of the cost for people with severe disease. For subjects living in the community, unpaid caregiver time and use of community services were the greatest components of cost and increased with disease severity. The societal cost of care of Alzheimer's disease increases drastically with increasing disease severity. Institutionalization is responsible for the largest cost component.
  • Article
    The purpose of this investigation was to study the role of dementia and other common age-related diseases as determinants of dependence in activities of daily living (ADL) in the elderly. The study population consisted of 1745 persons, aged 75 years and older, living in a district of Stockholm. They were examined at baseline and after a 3-year follow-up interval. Katz's index was used to measure functional status. Functional dependence at baseline, functional decline, and development of functional dependence at follow-up were examined in relation to sociodemographic characteristics and chronic conditions. At baseline, factors associated with functional dependence were age, dementia, cerebrovascular disease, heart disease, and hip fracture. However, only age and dementia were associated with the development of functional dependence and decline after 3 years. In a similar analysis, including only nondemented subjects. Mini-Mental State Examination scores emerged as one of the strongest determinants. The population attributable risk percentage of dementia in the development of functional dependence was 49%. In a very old population, dementia and cognitive impairment make the strongest contribution to both the development of long-term functional dependence and decline in function.
  • Article
    To assess whether an individual's main occupation predicts cognitive decline or dementia. The data were taken from a longitudinal study of 518 men aged 70 or over. Main occupation was coded into one of John Holland's six occupational categories. The subjects completed four cognitive tests and were diagnosed for dementia on two occasions three and a half years apart. The cognitive tests were the Mini-Mental State Examination, Episodic Memory Test, Symbol-Letter Modalities Test and National Adult Reading Test. Informants also completed the Informant Questionnaire on Cognitive Decline in the Elderly. Dementia was diagnosed by the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) and ICD-10 criteria using the Canberra Interview for the Elderly. Cross-sectional analysis of the wave 1 data showed that the realistic occupations, which include trade, technical and some service occupations, had poorer cognitive performance and a higher prevalence of DSM-III-R dementia. These differences held even when age, education and native English were statistically controlled. The greatest occupational difference was on the National Adult Reading Test, which estimates pre-morbid ability. By contrast, there were no occupational differences in longitudinal change in cognitive test performance, informant reports of cognitive decline or incident cases of dementia over three and a half years. Cross-sectional occupational differences on cognitive tests and in dementia prevalence are due to differences in pre-morbid ability rather than to differences in rate of cognitive decline.
  • Article
    Two experiments are reported in which young and old rats, housed in an impoverished (IE), enriched (EE), or standard (SE), environment, were tested on a series of complex, blind-alley mazes. In Experiment 1, 3-months exposure to IE exacerbated age differences in maze performance, relative to the differences between young and old rats in EE and SE. Old rats in the EE and SE conditions did not differ from each other. In Experiment 2, rats were raised for an additional 3 months in either IE or EE before further maze testing. The main findings were that the maze performance of old rats, transferred from IE to EE, improved significantly, whereas the performance of old rats, transferred from SE or EE to IE, declined. These results indicated that the deleterious effects of an impoverished environment on learning and memory are, at least partly, reversible, and that experience in a stimulating environment can protect old rats from the adverse effects of relocation to a deprived environment. Taken together, the results highlight the impact of environmental influences on cognitive function in old age, and emphasize the need to consider nonbiological factors in understanding the process of cognitive aging.
  • Article
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    Using a nationally representative sample of employed men and women in this longitudinal study, the authors extended for another 20 years findings based on 1964 and 1974 data (Kohn & Schooler, 1983) that substantively complex work improves intellectual functioning. This study provides evidence that intellectual functioning and substantive complexity of work continue to reciprocally affect each other. In addition, it shows that the intellectual flexibility measure used earlier (Kohn & Schooler, 1978, 1983) is highly correlated with more standard measures of intellectual functioning. Most importantly, it shows that, although substantively complex work significantly increased the level of intellectual functioning of both the younger and older halves of the sample, the effect is significantly greater among the older workers.
  • Article
    Structural MRIs of the brains of humans with extensive navigation experience, licensed London taxi drivers, were analyzed and compared with those of control subjects who did not drive taxis. The posterior hippocampi of taxi drivers were significantly larger relative to those of control subjects. A more anterior hippocampal region was larger in control subjects than in taxi drivers. Hippocampal volume correlated with the amount of time spent as a taxi driver (positively in the posterior and negatively in the anterior hippocampus). These data are in accordance with the idea that the posterior hippocampus stores a spatial representation of the environment and can expand regionally to accommodate elaboration of this representation in people with a high dependence on navigational skills. It seems that there is a capacity for local plastic change in the structure of the healthy adult human brain in response to environmental demands.
  • Article
    The age-related decline of cognitive functions generally refers to a mild deterioration in memory performance, executive functions, and speed of cognitive processing. The terms "age-related cognitive decline" (ARCD) and "aging-associated cognitive decline" have been proposed recently to indicate an objective decline in cognitive functioning associated to the ageing process but within normal limits given the person's age. Whether ARCD is expression of a normal ageing process or represents a distinct clinical entity or, eventually, is a continuum with dementia is, at present, difficult to establish. The causes of ARCD are unknown, but some studies have suggested that it may be prevented. Avoidance of cardiovascular and other chronic diseases, high educational level, and maintenance of vision and hearing have been identified as protective factors from ARCD. On the contrary, hypertension, effects of altered metabolism of steroid hormones, smoking, low-complexity occupation, higher density of persons/bedroom in home, and low level of physical activity have been identified as risk factors for ARCD. Recent findings suggest a possible role of diet in the ARCD. In fact, in an elderly population of Southern Italy with a typical Mediterranean diet, high monounsaturated fatty acids energy intake appeared to be associated with a high protection against cognitive decline. Dietary antioxidants, specific macronutrients, estrogens, and anti-inflammatory drugs, may act synergistically with other protective factors, opening new therapeutic interventions for cognitive decline.
  • Article
    Groups of normal old and young adults made episodic memory feeling-of-knowing (FOK) judgments and took 2 types of episodic memory tests (cued recall and recognition). Neuropsychological tests of executive and memory functions thought to respectively involve the frontal and medial temporal structures were also administered. Age differences were observed on the episodic memory measures and on all neuropsychological tests. Compared with young adults, older adults performed at chance level on FOK accuracy judgments. Partial correlations indicated that a composite measure of frontal functioning and FOK accuracy were closely related. Hierarchical regression analyses showed that the composite frontal functioning score accounted for a large proportion of the age-related variance in FOK accuracy. This finding supports the idea that the age-related decline in episodic memory FOK accuracy is mainly the result of executive or frontal limitations associated with aging.
  • Article
    The effect of age on memory and the brain has been the focus of many studies. Results have identified critical questions that need to be addressed to further our understanding of age-related memory decline: Is cognitive decline diffuse or selective? Where does memory decline localize to anatomically? Does decline represent an abnormal state? What are the causes of memory decline? What level of analysis is needed to investigate age-related cortical changes? These questions are reviewed herein, and attempts at early answers are discussed.
  • Article
    The New England Centenarian Study is a population-based study of all centenarians in 8 towns near Boston, MA. Age was confirmed for 43 centenarians all alive on a designated date. To determine prevalence of dementia in centenarians, the authors analyzed neuropsychological, medical, and functional status data for 34 (79%) of the centenarians. Definition of dementia was based on the Consortium to Establish a Registry for Alzheimer's Disease criteria, and a Clinical Dementia Rating (CDR) score was formulated for each participant. Seven (21%) had no dementia (CDR score 0), and an additional 4 (12%) were assigned a CDR score of 0.5, uncertain or deferred diagnosis. The remaining 22 (64%) had at least some degree of dementia. The authors calculated Barthel Index scores to determine ability to perform activities of daily living. There was a statistically significant correlation between CDR scores and Barthel Index scores (r = -0.73). Correlation was strongest for those with no or severe dementia, with the greatest range of function measured among those with moderate dementia.
  • Article
    Full-text available
    Environmental enrichment, behavioural experience and cell transplantation can each influence neuronal plasticity and recovery of function after brain damage, and each has been extensively investigated in its own right. However, the degree to which housing conditions or behavioural training can modify the survival, integration or function of transplanted tissues is less well established. Here we review the limited literature available, and suggest that this factor should be considered and integrated into the postoperative care that follows the clinical application of neural transplantation.
  • Article
    Episodic memory is a neurocognitive (brain/mind) system, uniquely different from other memory systems, that enables human beings to remember past experiences. The notion of episodic memory was first proposed some 30 years ago. At that time it was defined in terms of materials and tasks. It was subsequently refined and elaborated in terms of ideas such as self, subjective time, and autonoetic consciousness. This chapter provides a brief history of the concept of episodic memory, describes how it has changed (indeed greatly changed) since its inception, considers criticisms of it, and then discusses supporting evidence provided by (a) neuropsychological studies of patterns of memory impairment caused by brain damage, and (b) functional neuroimaging studies of patterns of brain activity of normal subjects engaged in various memory tasks. I also suggest that episodic memory is a true, even if as yet generally unappreciated, marvel of nature.
  • Article
    To determine whether leisure activities modify the risk for incident dementia. Although high educational and occupational attainments have been associated with reduced risk of incident dementia, the relation between leisure activities and dementia risk has not been adequately investigated. A total of 1,772 nondemented individuals aged 65 years or older, living in northern Manhattan, New York, were identified and followed longitudinally in a community-based cohort incidence study. Subjects' leisure activities at baseline were assessed, annual examinations with the same standardized neurologic and neuropsychological measures were performed for up to 7 years (mean 2.9 years), and incident dementia was assessed as the main outcome measure. Cox proportional hazards models, adjusting for age, ethnic group, education, and occupation, were used to estimate the relative risk (RR) of incident dementia associated with high leisure activities. Of the 1,772 subjects, 207 became demented. The risk of dementia was decreased in subjects with high leisure activities (RR, 0.62; 95% CI 0.46 to 0.83). The association of high leisure with decreased RR of incident dementia was present even when baseline cognitive performance, health limitations interfering with desired leisure activities, cerebrovascular disease, and depression were considered. The data suggest that engagement in leisure activities may reduce the risk of incident dementia, possibly by providing a reserve that delays the onset of clinical manifestations of the disease.