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Cognitive Difficulty - Ages 65+
Cognitive Difficulty - Ages 65+ in Maine

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Percentage of adults ages 65 and older who reported having physical, mental or emotional problems or difficulty remembering, concentrating or making decisions

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Cognitive Difficulty - Ages 65+ by State

Percentage of adults ages 65 and older who reported having physical, mental or emotional problems or difficulty remembering, concentrating or making decisions

Cognitive Difficulty - Ages 65+ Trends

Percentage of adults ages 65 and older who reported having physical, mental or emotional problems or difficulty remembering, concentrating or making decisions

Trend: Cognitive Difficulty - Ages 65+ in Maine, United States, 2023 Senior Report

Percentage of adults ages 65 and older who reported having physical, mental or emotional problems or difficulty remembering, concentrating or making decisions

United States

 U.S. Census Bureau, American Community Survey

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About Cognitive Difficulty - Ages 65+

US Value: 7.8%

Top State(s): Wisconsin: 5.3%

Bottom State(s): Mississippi: 10.7%

Definition: Percentage of adults ages 65 and older who reported having physical, mental or emotional problems or difficulty remembering, concentrating or making decisions

Data Source and Years: U.S. Census Bureau, American Community Survey, 2021

Suggested Citation: America's Health Rankings analysis of U.S. Census Bureau, American Community Survey, United Health Foundation,, accessed 2023.


Family, friends and other unpaid caregivers often bear the responsibility of providing daily assistance and emotional support to older adults with severe cognitive impairments such as Alzheimer's, the most common form of dementia. As the 65 and older population increases, the number of older adults living with Alzheimer’s disease is projected to reach 12.7 million by 2050.

Cognitive impairment can be caused by conditions such as Alzheimer’s disease, brain injury and stroke, as well as treatable health issues like medication side effects, vitamin B12 deficiency and depression. While people of all ages can experience cognitive impairment, age is the greatest risk factor for Alzheimer’s. Modifiable risk factors include smoking, diabetes, obesity, hypertension, high cholesterol and binge drinking, as well as physical, social and mental inactivity. Hearing loss is also associated with an increased risk of dementia, but using hearing aids can help protect against severe cognitive impairment.

Cognitive difficulty places a large burden on health care systems:

  • Older adults with cognitive impairment spend twice as many days hospitalized as older adults without it.
  • Medicare beneficiaries with dementia are more likely to have additional chronic diseases than beneficiaries without dementia.
  • Average annual health care costs are nearly 3 times higher for Medicare beneficiaries ages 65 and older with dementia than for those without it.

The cost of caring for adults with severe cognitive impairment, including Alzheimer’s and other dementias, was estimated at $321 billion in 2022 and is projected to reach nearly $1 trillion by 2050.

The prevalence and risk of severe cognitive impairment are higher among:

  • Women compared with men.
  • Older adults with less than eight years of education, who have more than twice as high a risk of developing dementia compared with those with more education. Lower occupational attainment is also associated with increased rates of dementia.
  • Black older adults compared with white older adults. However, the mortality rate from Alzheimer’s disease is higher among non-Hispanic white older adults than non-Hispanic Black older adults. Racial disparities in cognitive difficulty may, furthermore, be compounded by socioeconomic and educational disparities.

Changes in the brain often occur before symptoms of cognitive difficulty appear, suggesting that it may be possible to delay the onset of symptoms. A 2021 review of the evidence suggested that preventive interventions could improve cognitive functioning among older adults, including:

  • Cognitive training and memory exercises aimed at problem-solving.
  • Increased physical activity.
  • Blood pressure management among individuals with hypertension.
  • Social engagement and activity.

Racial disparities in cognitive decline may be addressed by interventions to improve educational and occupational opportunities early in life. The Centers for Disease Control and Prevention’s Healthy Brain Initiative has produced a guide to preventing and addressing cognitive impairment for state and local public health agencies. A free educational communications toolkit on brain health and aging is available through the National Institute on Aging.

Healthy People 2030 has several objectives related to cognitive difficulty, including:

  • Increasing the proportion of adults with subjective cognitive decline who have discussed their symptoms with a provider. 
  • Increasing the proportion of older adults with dementia, or their caregivers, who know they have it. 
  • Reducing the proportion of preventable hospitalizations in older adults with dementia.

Alzheimer’s Association. “2022 Alzheimer’s Disease Facts and Figures.” Alzheimer’s & Dementia 18, no. 4 (April 2022): 700–789.

Alzheimer’s Association, and Centers for Disease Control and Prevention. “Healthy Brain Initiative, State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map.” Chicago, IL: Alzheimer’s Association, 2018.

Downey, Autumn, Clare Stroud, Story Landis, and Alan I. Leshner, eds. Preventing Cognitive Decline and Dementia: A Way Forward. Washington, D.C.: National Academies Press (US), 2017.

Laws, Keith R., Karen Irvine, and Tim M. Gale. “Sex Differences in Cognitive Impairment in Alzheimer’s Disease.” World Journal of Psychiatry 6, no. 1 (March 22, 2016): 54–65.

Omura, John D., Lisa C. McGuire, Roshni Patel, Matthew Baumgart, Raza Lamb, Eva M. Jeffers, Benjamin S. Olivari, Janet B. Croft, Craig W. Thomas, and Karen Hacker. “Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years — United States, 2019.” MMWR. Morbidity and Mortality Weekly Report 71, no. 20 (May 20, 2022): 680–85.

Stern, Yaakov. “Cognitive Reserve in Ageing and Alzheimer’s Disease.” The Lancet Neurology 11, no. 11 (November 1, 2012): 1006–12.

Tejada-Vera, Betzaida. “Mortality from Alzheimer’s Disease in the United States: Data for 2000 and 2010.” NCHS Data Brief No. 116. Hyattsville, MD: National Center for Health Statistics, March 2013.

Weuve, Jennifer, Lisa L. Barnes, Carlos F. Mendes de Leon, Kumar B. Rajan, Todd Beck, Neelum T. Aggarwal, Liesi E. Hebert, David A. Bennett, Robert S. Wilson, and Denis A. Evans. “Cognitive Aging in Black and White Americans: Cognition, Cognitive Decline, and Incidence of Alzheimer Disease Dementia.” Epidemiology 29, no. 1 (January 2018): 151–59.

Yeo, Brian Sheng Yep, Harris Jun Jie Muhammad Danial Song, Emma Min Shuen Toh, Li Shia Ng, Cyrus Su Hui Ho, Roger Ho, Reshma Aziz Merchant, Benjamin Kye Jyn Tan, and Woei Shyang Loh. “Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis.” JAMA Neurology, December 5, 2022.

Zhang, X.-X., Y. Tian, Z.-T. Wang, Y.-H. Ma, L. Tan, and J.-T. Yu. “The Epidemiology of Alzheimer’s Disease Modifiable Risk Factors and Prevention.” The Journal of Prevention of Alzheimer’s Disease, 2021, 1–9.

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