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The sample was recruited in 1965\u20131968 (ages 45\u201368 years). Longitudinal performance of cognitive abilities and mortality status were assessed from Exam 4 (1991\u20131993) through June 2014. Latent class analysis revealed 2 groups: maintainers retained relatively high levels of cognitive functioning until death and decliners demonstrated significant cognitive waning several years prior to death. Maintainers were more likely to have greater education, diagnosed coronary heart disease, and presence of the apolipoprotein E (APOE) \u03b52 allele and FOXO3 G allele (SNP rs2802292). Decliners were more likely to be older and have prior stroke, Parkinson\u2019s disease, dementia, and greater depressive symptoms at Exam 4, and the APOE \u03b54 allele. Findings support terminal decline using distance to death as the basis for modeling change. Significant differences were observed between maintainers and decliners 15 years prior to death, a finding much earlier compared to the majority of previous investigations.<\/jats:p>","DOI":"10.1093\/gerona\/glab327","type":"journal-article","created":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T01:12:25Z","timestamp":1639703545000},"page":"1525-1533","source":"Crossref","is-referenced-by-count":12,"title":["Novel Functional, Health, and Genetic Determinants of Cognitive Terminal Decline: Kuakini Honolulu Heart Program\/Honolulu-Asia Aging Study"],"prefix":"10.1093","volume":"77","author":[{"given":"Jennifer A","family":"Margrett","sequence":"first","affiliation":[{"name":"Department of Human Development and Family Studies, College of Human Sciences, Iowa State University , Ames, Iowa , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schofield","sequence":"additional","affiliation":[{"name":"Department of Human Development and Family Studies, College of Human Sciences, Iowa State University , Ames, Iowa , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Human Development and Family Studies, College of Human Sciences, Iowa State University , Ames, Iowa , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard W","family":"Poon","sequence":"additional","affiliation":[{"name":"Institute of Gerontology, University of Georgia , Athens, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Masaki","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, John A. 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