Education and Cognitive Change over 15 Years: The Atherosclerosis Risk in Communities Study

Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/2012; 60(10):1847-53. DOI: 10.1111/j.1532-5415.2012.04164.x
Source: PubMed


To evaluate whether education level is associated with change in cognitive performance.
Prospective cohort study.
The Atherosclerosis Risk in Communities (ARIC) Study, a community-based cohort.
Nine thousand two hundred sixty-eight ARIC participants who underwent cognitive evaluation at least twice over a 15-year period.
Education was evaluated as a predictor of change in word recall, the Digit Symbol Substitution Test (DSST), and word fluency. A random-effects linear regression model, and a time by educational level interaction was used.
Educational level was highly associated with cognitive performance. The effect on performance of a less than high school education (vs more than high school) was equivalent to the effect of as much as 22 years of cognitive aging, but educational level was not associated with change in cognitive performance in whites or blacks, with the exception of the DSST for whites, in whom those with lower levels of education had less decline in scores.
Educational level was not associated with change in cognitive performance, although the higher baseline cognitive performance of individuals with more education might explain lower rates of dementia in more-educated individuals, because more decline would have to take place between baseline higher performance and time at which dementia was diagnosed in more-educated individuals.

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Available from: Andrea Lauren Christman Schneider, Mar 11, 2014
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    • "By using a quasi-experimental design, Harum et al. (2003) found a significant difference in word recall tests when comparing those subjects completing elementary school to those subjects completing high school and college. Similarly, Schneider et al. (2012) found that the effect on performance of a less than high school education is equivalent to the effect of as much as 22 years of cognitive aging. This evidence drives our second level of splitting. "
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    DESCRIPTION: This paper investigates the effects of individual and environmental determinants on physical and cognitive impairment of Europeans aged 50 and older using data drawn from the Survey of Health Aging and Retirement in Europe (SHARE). The aim is to understand the different paths that need related determinants of long-term care might take across individuals. As dependent variables, we consider several measures of physical and cognitive disability which are regressed on a list of covariates which includes biological, health, behavioural, socio-demographic and early-life conditions of individuals. We adopt a methodology that combines the structure of random effects models for longitudinal data with the flexibility of a tree regression method. We show the existence of clusters in the main determinants of functional decline (physical and cognitive). Our findings are in line with the existing literature, but, at the same time, we further characterize previous evidence: 1) cognitive impairment, measured by the results of a memory test, strongly depends on educational attainments, age and respondents’ country of residence; 2) physical impairment, measured through the loss of handgrip strength, basic and instrumental activities of daily living (ADLs, IADLs) and mobility, strongly depends on health and behavioural factors.
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    • "The most widely accepted interpretation is that years of education are beneficial to the cognitive reserve capacity, which is expected to protect cognition against brain disease. Thus, persons with more schooling are likely to experience more cognitive decline before reaching a threshold at which point dementia is diagnosed [22] [46]. "
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    ABSTRACT: With a longer life expectancy and an increased prevalence of neurodegenerative diseases, investigations on trajectories of cognitive aging have become exciting and promising. This study aimed to estimate the patterns of age-related cognitive decline and the potential associated factors of cognitive function in community-dwelling residents of Beijing, China. In this study, 1248 older adults aged 52-88 years [including 175 mild cognitive impairment (MCI) subjects] completed a battery of neuropsychological scales. The personal information, including demographic information, medical history, eating habits, lifestyle regularity and leisure activities, was also collected. All cognitive function exhibited an agerelated decline in normal volunteers. Piece-wise linear fitting results suggested that performance on the Auditory Verbal Learning Test remained stable until 58 years of age and continued to decline thereafter. The decline in processing speed and executive function began during the early 50's. Scores on visual-spatial and language tests declined after 66 years of age. The decline stage of the general mental status ranged from 63 to 70 years of age. However, the MCI group did not exhibit an obvious age-related decline in most cognitive tests. Multivariate linear regression analyses indicated that education, gender, leisure activities, diabetes and eating habits were associated with cognitive abilities. These results indicated various trajectories of age-related decline across multiple cognitive domains. We also found different patterns of agerelated cognitive decline between MCI and normal elderly. These findings could help improve the guidance of cognitive intervention program and have implications for public policy issues.
    Current Alzheimer Research 09/2014; 11(8):806-16. DOI:10.2174/156720501108140910123112 · 3.89 Impact Factor
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    • "The mechanism by which low education and occupation are thought to increase risk of AD is by lowering cognitive reserve. A longitudinal study that followed 9,000 people semi-annually for 15 years found that the main effect of education was to increase the baseline cognitive performance of individuals.151 Thus, subjects with higher education take longer to reach the dementia threshold. "
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    ABSTRACT: With the aging of the population, the burden of Alzheimer's disease (AD) is rapidly expanding. More than 5 million people in the US alone are affected with AD and this number is expected to triple by 2050. While men may have a higher risk of mild cognitive impairment (MCI), an intermediate stage between normal aging and dementia, women are disproportionally affected with AD. One explanation is that men may die of competing causes of death earlier in life, so that only the most resilient men may survive to older ages. However, many other factors should also be considered to explain the sex differences. In this review, we discuss the differences observed in men versus women in the incidence and prevalence of MCI and AD, in the structure and function of the brain, and in the sex-specific and gender-specific risk and protective factors for AD. In medical research, sex refers to biological differences such as chromosomal differences (eg, XX versus XY chromosomes), gonadal differences, or hormonal differences. In contrast, gender refers to psychosocial and cultural differences between men and women (eg, access to education and occupation). Both factors play an important role in the development and progression of diseases, including AD. Understanding both sex- and gender-specific risk and protective factors for AD is critical for developing individualized interventions for the prevention and treatment of AD.
    Clinical Epidemiology 01/2014; 6(1):37-48. DOI:10.2147/CLEP.S37929
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