Sean A P Clouston1, Dylan M Smith1, Soumyadeep Mukherjee2, Yun Zhang3, Wei Hou4, Bruce G Link5, Marcus Richards6. 1. Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York. 2. Community and Public Health Promotion, Health and Physical Education Department, Rhode Island College, Providence, Rhode Island. 3. Program in Public Health, Stony Brook University, New York. 4. Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York. 5. Department of Sociology and School of Public Policy, University of California - Riverside, Riverside, California. 6. Unit for Lifelong Health and Ageing at University College London, London, UK.
Abstract
BACKGROUND: The objective of this study was to examine the association between education and incidence of accelerated cognitive decline. METHODS: Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N = 28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer's disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister studies. Life expectancy ratios (LER) and 95% confidence intervals (CIs) were reported. RESULTS: This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER = 1.031 95% CI = [1.013-1.015], p < 1E-06). Replication analyses using data from 14 countries identified similar results. CONCLUSIONS: These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
BACKGROUND: The objective of this study was to examine the association between education and incidence of accelerated cognitive decline. METHODS: Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N = 28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer's disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister studies. Life expectancy ratios (LER) and 95% confidence intervals (CIs) were reported. RESULTS: This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER = 1.031 95% CI = [1.013-1.015], p < 1E-06). Replication analyses using data from 14 countries identified similar results. CONCLUSIONS: These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
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