Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment
•We examined the association between education and cognitive impairment (CI).•Moderating influences of age, sex, ethnicity, and APOE*4 carriage were tested.•Higher education was related to lower CI risk, but this effect weakened with age.•The effect of education on lower CI risk was stronger in wome...
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| Veröffentlicht in: | Archives of gerontology and geriatrics 2020-11, Vol.91, p.104112-104112, Article 104112 |
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| creator | Makkar, Steve R. Lipnicki, Darren M. Crawford, John D. Kochan, Nicole A. Castro-Costa, Erico Lima-Costa, Maria Fernanda Diniz, Breno Satler Brayne, Carol Stephan, Blossom Matthews, Fiona Llibre-Rodriguez, Juan J. Llibre-Guerra, Jorge J. Valhuerdi-Cepero, Adolfo J. Lipton, Richard B. Katz, Mindy J. Zammit, Andrea Ritchie, Karen Carles, Sophie Carriere, Isabelle Scarmeas, Nikolaos Yannakoulia, Mary Kosmidis, Mary Lam, Linda Fung, Ada Chan, Wai Chi Guaita, Antonio Vaccaro, Roberta Davin, Annalisa Kim, Ki Woong Han, Ji Won Suh, Seung Wan Riedel-Heller, Steffi G. Roehr, Susanne Pabst, Alexander Ganguli, Mary Hughes, Tiffany F. Jacobsen, Erin P. Anstey, Kaarin J. Cherbuin, Nicolas Haan, Mary N. Aiello, Allison E. Dang, Kristina Kumagai, Shuzo Narazaki, Kenji Chen, Sanmei Ng, Tze Pin Gao, Qi Nyunt, Ma Shwe Zin Meguro, Kenichi Yamaguchi, Satoshi Ishii, Hiroshi Lobo, Antonio Lobo Escolar, Elena De la Cámara, Concepción Brodaty, Henry Trollor, Julian N. Leung, Yvonne Lo, Jessica W. Sachdev, Perminder |
| description | •We examined the association between education and cognitive impairment (CI).•Moderating influences of age, sex, ethnicity, and APOE*4 carriage were tested.•Higher education was related to lower CI risk, but this effect weakened with age.•The effect of education on lower CI risk was stronger in women than men.•High School education lowered CI risk in Blacks and Asians, but not Whites.
We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).
Participants were 30,785 dementia-free individuals aged 55–103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.
Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P |
| doi_str_mv | 10.1016/j.archger.2020.104112 |
| format | Article |
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We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).
Participants were 30,785 dementia-free individuals aged 55–103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.
Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers.
High School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.</description><identifier>ISSN: 0167-4943</identifier><identifier>EISSN: 1872-6976</identifier><identifier>DOI: 10.1016/j.archger.2020.104112</identifier><identifier>PMID: 32738518</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Age ; Aged ; Aged, 80 and over ; Ageing ; Apolipoprotein E4 ; Apolipoprotein E4 - genetics ; Cognitive decline ; Cognitive Dysfunction ; Cognitive Dysfunction - epidemiology ; Cognitive Dysfunction - genetics ; Education ; Educational Status ; Ethnic Groups ; Ethnicity ; Female ; Humans ; Life Sciences ; Longitudinal Studies ; Male ; Risk Factors ; Sex</subject><ispartof>Archives of gerontology and geriatrics, 2020-11, Vol.91, p.104112-104112, Article 104112</ispartof><rights>2020 Elsevier B.V.</rights><rights>Copyright © 2020 Elsevier B.V. All rights reserved.</rights><rights>Attribution - ShareAlike</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c567t-dca1a9c7c934edd22eac601edd5650e55e82ea7d9b59c904e8083710537e94113</citedby><cites>FETCH-LOGICAL-c567t-dca1a9c7c934edd22eac601edd5650e55e82ea7d9b59c904e8083710537e94113</cites><orcidid>0000-0001-9585-855X ; 0000-0002-9706-9316 ; 0000-0001-9385-0669 ; 0000-0001-9110-7054 ; 0000-0001-6453-8908 ; 0000-0002-9595-3220 ; 0000-0001-5141-0673 ; 0000-0003-0792-5439 ; 0000-0003-2418-4257 ; 0000-0002-9098-655X ; 0000-0002-1252-2397 ; 0000-0003-0432-5681 ; 0000-0002-1235-360X ; 0000-0003-0792-1104 ; 0000-0001-9312-4501 ; 0000-0001-5307-663X ; 0000-0002-2137-7750</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.archger.2020.104112$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32738518$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.inrae.fr/hal-03394410$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Makkar, Steve R.</creatorcontrib><creatorcontrib>Lipnicki, Darren M.</creatorcontrib><creatorcontrib>Crawford, John D.</creatorcontrib><creatorcontrib>Kochan, Nicole A.</creatorcontrib><creatorcontrib>Castro-Costa, Erico</creatorcontrib><creatorcontrib>Lima-Costa, Maria Fernanda</creatorcontrib><creatorcontrib>Diniz, Breno Satler</creatorcontrib><creatorcontrib>Brayne, Carol</creatorcontrib><creatorcontrib>Stephan, Blossom</creatorcontrib><creatorcontrib>Matthews, Fiona</creatorcontrib><creatorcontrib>Llibre-Rodriguez, Juan J.</creatorcontrib><creatorcontrib>Llibre-Guerra, Jorge J.</creatorcontrib><creatorcontrib>Valhuerdi-Cepero, Adolfo J.</creatorcontrib><creatorcontrib>Lipton, Richard B.</creatorcontrib><creatorcontrib>Katz, Mindy J.</creatorcontrib><creatorcontrib>Zammit, Andrea</creatorcontrib><creatorcontrib>Ritchie, Karen</creatorcontrib><creatorcontrib>Carles, Sophie</creatorcontrib><creatorcontrib>Carriere, Isabelle</creatorcontrib><creatorcontrib>Scarmeas, Nikolaos</creatorcontrib><creatorcontrib>Yannakoulia, Mary</creatorcontrib><creatorcontrib>Kosmidis, Mary</creatorcontrib><creatorcontrib>Lam, Linda</creatorcontrib><creatorcontrib>Fung, Ada</creatorcontrib><creatorcontrib>Chan, Wai Chi</creatorcontrib><creatorcontrib>Guaita, Antonio</creatorcontrib><creatorcontrib>Vaccaro, Roberta</creatorcontrib><creatorcontrib>Davin, Annalisa</creatorcontrib><creatorcontrib>Kim, Ki Woong</creatorcontrib><creatorcontrib>Han, Ji Won</creatorcontrib><creatorcontrib>Suh, Seung Wan</creatorcontrib><creatorcontrib>Riedel-Heller, Steffi G.</creatorcontrib><creatorcontrib>Roehr, Susanne</creatorcontrib><creatorcontrib>Pabst, Alexander</creatorcontrib><creatorcontrib>Ganguli, Mary</creatorcontrib><creatorcontrib>Hughes, Tiffany F.</creatorcontrib><creatorcontrib>Jacobsen, Erin P.</creatorcontrib><creatorcontrib>Anstey, Kaarin J.</creatorcontrib><creatorcontrib>Cherbuin, Nicolas</creatorcontrib><creatorcontrib>Haan, Mary N.</creatorcontrib><creatorcontrib>Aiello, Allison E.</creatorcontrib><creatorcontrib>Dang, Kristina</creatorcontrib><creatorcontrib>Kumagai, Shuzo</creatorcontrib><creatorcontrib>Narazaki, Kenji</creatorcontrib><creatorcontrib>Chen, Sanmei</creatorcontrib><creatorcontrib>Ng, Tze Pin</creatorcontrib><creatorcontrib>Gao, Qi</creatorcontrib><creatorcontrib>Nyunt, Ma Shwe Zin</creatorcontrib><creatorcontrib>Meguro, Kenichi</creatorcontrib><creatorcontrib>Yamaguchi, Satoshi</creatorcontrib><creatorcontrib>Ishii, Hiroshi</creatorcontrib><creatorcontrib>Lobo, Antonio</creatorcontrib><creatorcontrib>Lobo Escolar, Elena</creatorcontrib><creatorcontrib>De la Cámara, Concepción</creatorcontrib><creatorcontrib>Brodaty, Henry</creatorcontrib><creatorcontrib>Trollor, Julian N.</creatorcontrib><creatorcontrib>Leung, Yvonne</creatorcontrib><creatorcontrib>Lo, Jessica W.</creatorcontrib><creatorcontrib>Sachdev, Perminder</creatorcontrib><creatorcontrib>for Cohort Studies of Memory in an International Consortium (COSMIC)</creatorcontrib><title>Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment</title><title>Archives of gerontology and geriatrics</title><addtitle>Arch Gerontol Geriatr</addtitle><description>•We examined the association between education and cognitive impairment (CI).•Moderating influences of age, sex, ethnicity, and APOE*4 carriage were tested.•Higher education was related to lower CI risk, but this effect weakened with age.•The effect of education on lower CI risk was stronger in women than men.•High School education lowered CI risk in Blacks and Asians, but not Whites.
We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).
Participants were 30,785 dementia-free individuals aged 55–103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.
Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers.
High School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.</description><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ageing</subject><subject>Apolipoprotein E4</subject><subject>Apolipoprotein E4 - genetics</subject><subject>Cognitive decline</subject><subject>Cognitive Dysfunction</subject><subject>Cognitive Dysfunction - epidemiology</subject><subject>Cognitive Dysfunction - genetics</subject><subject>Education</subject><subject>Educational Status</subject><subject>Ethnic Groups</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Risk 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and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment</title><author>Makkar, Steve R. ; Lipnicki, Darren M. ; Crawford, John D. ; Kochan, Nicole A. ; Castro-Costa, Erico ; Lima-Costa, Maria Fernanda ; Diniz, Breno Satler ; Brayne, Carol ; Stephan, Blossom ; Matthews, Fiona ; Llibre-Rodriguez, Juan J. ; Llibre-Guerra, Jorge J. ; Valhuerdi-Cepero, Adolfo J. ; Lipton, Richard B. ; Katz, Mindy J. ; Zammit, Andrea ; Ritchie, Karen ; Carles, Sophie ; Carriere, Isabelle ; Scarmeas, Nikolaos ; Yannakoulia, Mary ; Kosmidis, Mary ; Lam, Linda ; Fung, Ada ; Chan, Wai Chi ; Guaita, Antonio ; Vaccaro, Roberta ; Davin, Annalisa ; Kim, Ki Woong ; Han, Ji Won ; Suh, Seung Wan ; Riedel-Heller, Steffi G. ; Roehr, Susanne ; Pabst, Alexander ; Ganguli, Mary ; Hughes, Tiffany F. ; Jacobsen, Erin P. ; Anstey, Kaarin J. ; Cherbuin, Nicolas ; Haan, Mary N. ; Aiello, Allison E. ; Dang, Kristina ; Kumagai, Shuzo ; Narazaki, Kenji ; Chen, Sanmei ; Ng, Tze Pin ; Gao, Qi ; Nyunt, Ma Shwe Zin ; Meguro, Kenichi ; Yamaguchi, Satoshi ; Ishii, Hiroshi ; Lobo, Antonio ; Lobo Escolar, Elena ; De la Cámara, Concepción ; Brodaty, Henry ; Trollor, Julian N. ; Leung, Yvonne ; Lo, Jessica W. ; Sachdev, Perminder</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c567t-dca1a9c7c934edd22eac601edd5650e55e82ea7d9b59c904e8083710537e94113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ageing</topic><topic>Apolipoprotein E4</topic><topic>Apolipoprotein E4 - genetics</topic><topic>Cognitive decline</topic><topic>Cognitive Dysfunction</topic><topic>Cognitive Dysfunction - epidemiology</topic><topic>Cognitive Dysfunction - genetics</topic><topic>Education</topic><topic>Educational Status</topic><topic>Ethnic Groups</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Risk Factors</topic><topic>Sex</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Makkar, Steve R.</creatorcontrib><creatorcontrib>Lipnicki, Darren M.</creatorcontrib><creatorcontrib>Crawford, John D.</creatorcontrib><creatorcontrib>Kochan, Nicole A.</creatorcontrib><creatorcontrib>Castro-Costa, Erico</creatorcontrib><creatorcontrib>Lima-Costa, Maria Fernanda</creatorcontrib><creatorcontrib>Diniz, Breno Satler</creatorcontrib><creatorcontrib>Brayne, Carol</creatorcontrib><creatorcontrib>Stephan, Blossom</creatorcontrib><creatorcontrib>Matthews, Fiona</creatorcontrib><creatorcontrib>Llibre-Rodriguez, Juan J.</creatorcontrib><creatorcontrib>Llibre-Guerra, Jorge J.</creatorcontrib><creatorcontrib>Valhuerdi-Cepero, Adolfo J.</creatorcontrib><creatorcontrib>Lipton, Richard B.</creatorcontrib><creatorcontrib>Katz, Mindy J.</creatorcontrib><creatorcontrib>Zammit, Andrea</creatorcontrib><creatorcontrib>Ritchie, Karen</creatorcontrib><creatorcontrib>Carles, Sophie</creatorcontrib><creatorcontrib>Carriere, Isabelle</creatorcontrib><creatorcontrib>Scarmeas, Nikolaos</creatorcontrib><creatorcontrib>Yannakoulia, Mary</creatorcontrib><creatorcontrib>Kosmidis, Mary</creatorcontrib><creatorcontrib>Lam, Linda</creatorcontrib><creatorcontrib>Fung, Ada</creatorcontrib><creatorcontrib>Chan, Wai Chi</creatorcontrib><creatorcontrib>Guaita, Antonio</creatorcontrib><creatorcontrib>Vaccaro, Roberta</creatorcontrib><creatorcontrib>Davin, Annalisa</creatorcontrib><creatorcontrib>Kim, Ki Woong</creatorcontrib><creatorcontrib>Han, Ji Won</creatorcontrib><creatorcontrib>Suh, Seung Wan</creatorcontrib><creatorcontrib>Riedel-Heller, Steffi G.</creatorcontrib><creatorcontrib>Roehr, Susanne</creatorcontrib><creatorcontrib>Pabst, Alexander</creatorcontrib><creatorcontrib>Ganguli, Mary</creatorcontrib><creatorcontrib>Hughes, Tiffany F.</creatorcontrib><creatorcontrib>Jacobsen, Erin P.</creatorcontrib><creatorcontrib>Anstey, Kaarin J.</creatorcontrib><creatorcontrib>Cherbuin, Nicolas</creatorcontrib><creatorcontrib>Haan, Mary N.</creatorcontrib><creatorcontrib>Aiello, Allison E.</creatorcontrib><creatorcontrib>Dang, Kristina</creatorcontrib><creatorcontrib>Kumagai, Shuzo</creatorcontrib><creatorcontrib>Narazaki, Kenji</creatorcontrib><creatorcontrib>Chen, Sanmei</creatorcontrib><creatorcontrib>Ng, Tze Pin</creatorcontrib><creatorcontrib>Gao, Qi</creatorcontrib><creatorcontrib>Nyunt, Ma Shwe Zin</creatorcontrib><creatorcontrib>Meguro, Kenichi</creatorcontrib><creatorcontrib>Yamaguchi, Satoshi</creatorcontrib><creatorcontrib>Ishii, Hiroshi</creatorcontrib><creatorcontrib>Lobo, Antonio</creatorcontrib><creatorcontrib>Lobo Escolar, Elena</creatorcontrib><creatorcontrib>De la Cámara, Concepción</creatorcontrib><creatorcontrib>Brodaty, Henry</creatorcontrib><creatorcontrib>Trollor, Julian N.</creatorcontrib><creatorcontrib>Leung, Yvonne</creatorcontrib><creatorcontrib>Lo, Jessica W.</creatorcontrib><creatorcontrib>Sachdev, Perminder</creatorcontrib><creatorcontrib>for Cohort Studies of Memory in an International Consortium (COSMIC)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of gerontology and geriatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Makkar, Steve R.</au><au>Lipnicki, Darren M.</au><au>Crawford, John D.</au><au>Kochan, Nicole A.</au><au>Castro-Costa, Erico</au><au>Lima-Costa, Maria Fernanda</au><au>Diniz, Breno Satler</au><au>Brayne, Carol</au><au>Stephan, Blossom</au><au>Matthews, Fiona</au><au>Llibre-Rodriguez, Juan J.</au><au>Llibre-Guerra, Jorge J.</au><au>Valhuerdi-Cepero, Adolfo J.</au><au>Lipton, Richard B.</au><au>Katz, Mindy J.</au><au>Zammit, Andrea</au><au>Ritchie, Karen</au><au>Carles, Sophie</au><au>Carriere, Isabelle</au><au>Scarmeas, Nikolaos</au><au>Yannakoulia, Mary</au><au>Kosmidis, Mary</au><au>Lam, Linda</au><au>Fung, Ada</au><au>Chan, Wai Chi</au><au>Guaita, Antonio</au><au>Vaccaro, Roberta</au><au>Davin, Annalisa</au><au>Kim, Ki Woong</au><au>Han, Ji Won</au><au>Suh, Seung Wan</au><au>Riedel-Heller, Steffi G.</au><au>Roehr, Susanne</au><au>Pabst, Alexander</au><au>Ganguli, Mary</au><au>Hughes, Tiffany F.</au><au>Jacobsen, Erin P.</au><au>Anstey, Kaarin J.</au><au>Cherbuin, Nicolas</au><au>Haan, Mary N.</au><au>Aiello, Allison E.</au><au>Dang, Kristina</au><au>Kumagai, Shuzo</au><au>Narazaki, Kenji</au><au>Chen, Sanmei</au><au>Ng, Tze Pin</au><au>Gao, Qi</au><au>Nyunt, Ma Shwe Zin</au><au>Meguro, Kenichi</au><au>Yamaguchi, Satoshi</au><au>Ishii, Hiroshi</au><au>Lobo, Antonio</au><au>Lobo Escolar, Elena</au><au>De la Cámara, Concepción</au><au>Brodaty, Henry</au><au>Trollor, Julian N.</au><au>Leung, Yvonne</au><au>Lo, Jessica W.</au><au>Sachdev, Perminder</au><aucorp>for Cohort Studies of Memory in an International Consortium (COSMIC)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment</atitle><jtitle>Archives of gerontology and geriatrics</jtitle><addtitle>Arch Gerontol Geriatr</addtitle><date>2020-11-01</date><risdate>2020</risdate><volume>91</volume><spage>104112</spage><epage>104112</epage><pages>104112-104112</pages><artnum>104112</artnum><issn>0167-4943</issn><eissn>1872-6976</eissn><abstract>•We examined the association between education and cognitive impairment (CI).•Moderating influences of age, sex, ethnicity, and APOE*4 carriage were tested.•Higher education was related to lower CI risk, but this effect weakened with age.•The effect of education on lower CI risk was stronger in women than men.•High School education lowered CI risk in Blacks and Asians, but not Whites.
We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).
Participants were 30,785 dementia-free individuals aged 55–103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.
Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers.
High School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>32738518</pmid><doi>10.1016/j.archger.2020.104112</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-9585-855X</orcidid><orcidid>https://orcid.org/0000-0002-9706-9316</orcidid><orcidid>https://orcid.org/0000-0001-9385-0669</orcidid><orcidid>https://orcid.org/0000-0001-9110-7054</orcidid><orcidid>https://orcid.org/0000-0001-6453-8908</orcidid><orcidid>https://orcid.org/0000-0002-9595-3220</orcidid><orcidid>https://orcid.org/0000-0001-5141-0673</orcidid><orcidid>https://orcid.org/0000-0003-0792-5439</orcidid><orcidid>https://orcid.org/0000-0003-2418-4257</orcidid><orcidid>https://orcid.org/0000-0002-9098-655X</orcidid><orcidid>https://orcid.org/0000-0002-1252-2397</orcidid><orcidid>https://orcid.org/0000-0003-0432-5681</orcidid><orcidid>https://orcid.org/0000-0002-1235-360X</orcidid><orcidid>https://orcid.org/0000-0003-0792-1104</orcidid><orcidid>https://orcid.org/0000-0001-9312-4501</orcidid><orcidid>https://orcid.org/0000-0001-5307-663X</orcidid><orcidid>https://orcid.org/0000-0002-2137-7750</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0167-4943 |
| ispartof | Archives of gerontology and geriatrics, 2020-11, Vol.91, p.104112-104112, Article 104112 |
| issn | 0167-4943 1872-6976 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7724926 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Age Aged Aged, 80 and over Ageing Apolipoprotein E4 Apolipoprotein E4 - genetics Cognitive decline Cognitive Dysfunction Cognitive Dysfunction - epidemiology Cognitive Dysfunction - genetics Education Educational Status Ethnic Groups Ethnicity Female Humans Life Sciences Longitudinal Studies Male Risk Factors Sex |
| title | Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment |
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