Journal of the International Neuropsychological Society

Research Articles

Specific Measures of Executive Function Predict Cognitive Decline in Older Adults

Lindsay R. Clarka1, Dawn M. Schiehsera3a2, Gali H. Weissbergera1, David P. Salmona4, Dean C. Delisa2a3 and Mark W. Bondia2a3 c1

a1 San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California

a2 Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California

a3 Department of Veterans Affairs San Diego Healthcare System, San Diego, California

a4 Department of Neurosciences, University of California San Diego, School of Medicine, La Jolla, California


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)

(Received May 13 2011)

(Revised October 08 2011)

(Accepted October 11 2011)


c1 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: