Psychological Medicine

Original Articles

The association of cognitive performance with mental health and physical functioning strengthens with age: the Whitehall II cohort study

M. Jokelaa1a2 c1, A. Singh-Manouxa1a3, J. E. Ferriea1, D. Gimenoa1a4, T. N. Akbaralya1a5, M. J. Shipleya1, J. Heada1, M. Elovainioa1a6, M. G. Marmota1 and M. Kivimäkia1a7

a1 Department of Epidemiology and Public Health, University College London, UK

a2 Department of Psychology, University of Helsinki, Finland

a3 INSERM U687, AP-HP, France

a4 Division of Environmental and Occupational Health Sciences, School of Public Health, The University of Texas Health Science Center at Houston, TX, USA

a5 INSERM U888, Montpellier, France

a6 National Research and Development Centre for Welfare and Health, Helsinki, Finland

a7 Finnish Institute of Occupational Health, Finland


Background Cognitive performance has been associated with mental and physical health, but it is unknown whether the strength of these associations changes with ageing and with age-related social transitions, such as retirement. We examined whether cognitive performance predicted mental and physical health from midlife to early old age.

Method Participants were 5414 men and 2278 women from the Whitehall II cohort study followed for 15 years between 1991 and 2006. The age range included over the follow-up was from 40 to 75 years. Mental health and physical functioning were measured six times using SF-36 subscales. Cognitive performance was assessed three times using five cognitive tests assessing verbal and numerical reasoning, verbal memory, and phonemic and semantic fluency. Socio-economic status (SES) and retirement were included as covariates.

Results High cognitive performance was associated with better mental health and physical functioning. Mental health differences associated with cognitive performance widened with age from 39 to 76 years of age, whereas physical functioning differences widened only between 39 and 60 years and not after 60 years of age. SES explained part of the widening differences in mental health and physical functioning before age 60. Cognitive performance was more strongly associated with mental health in retired than non-retired participants, which contributed to the widening differences after 60 years of age.

Conclusions The strength of cognitive performance in predicting mental and physical health may increase from midlife to early old age, and these changes may be related to SES and age-related transitions, such as retirement.

(Received November 20 2008)

(Revised June 26 2009)

(Accepted July 16 2009)

(Online publication September 01 2009)


c1 Address for correspondence: Dr M. Jokela, Department of Psychology, University of Helsinki, PO Box 9, FIN-00014, Finland. (Email: