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However, midlife rather than late\u2010life risk factors are often most relevant to cognitive health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We quantified the association between measured serum lipids in midlife and subsequent 20\u2010year change in performance on three cognitive tests in 13,997 participants of the Atherosclerosis Risk in Communities study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Elevated total cholesterol, low\u2010density lipoprotein cholesterol, and triglycerides were associated with greater 20\u2010year decline on a test of executive function, sustained attention, and processing speed. Higher total cholesterol and triglycerides were also associated with greater 20\u2010year decline in memory scores and a measure summarizing performance on all three tests. High\u2010density lipoprotein cholesterol was not associated with cognitive change. 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