Steve R Makkar1, Darren M Lipnicki2, John D Crawford2, Nicole A Kochan2, Erico Castro-Costa3, Maria Fernanda Lima-Costa3, Breno Satler Diniz4, Carol Brayne5, Blossom Stephan6, Fiona Matthews6, Juan J Llibre-Rodriguez7, Jorge J Llibre-Guerra8, Adolfo J Valhuerdi-Cepero9, Richard B Lipton10, Mindy J Katz11, Andrea Zammit11, Karen Ritchie12, Sophie Carles13, Isabelle Carriere14, Nikolaos Scarmeas15, Mary Yannakoulia16, Mary Kosmidis17, Linda Lam18, Ada Fung19, Wai Chi Chan20, Antonio Guaita21, Roberta Vaccaro21, Annalisa Davin21, Ki Woong Kim22, Ji Won Han23, Seung Wan Suh23, Steffi G Riedel-Heller24, Susanne Roehr24, Alexander Pabst24, Mary Ganguli25, Tiffany F Hughes26, Erin P Jacobsen25, Kaarin J Anstey27, Nicolas Cherbuin28, Mary N Haan29, Allison E Aiello30, Kristina Dang29, Shuzo Kumagai31, Kenji Narazaki32, Sanmei Chen33, Tze Pin Ng34, Qi Gao34, Ma Shwe Zin Nyunt34, Kenichi Meguro35, Satoshi Yamaguchi35, Hiroshi Ishii35, Antonio Lobo36, Elena Lobo Escolar36, Concepción De la Cámara36, Henry Brodaty37, Julian N Trollor38, Yvonne Leung2, Jessica W Lo2, Perminder Sachdev37. 1. Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia. Electronic address: stevem@unsw.edu.au. 2. Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia. 3. Instituto Rene´ Rachou da Fundaçaõ Oswaldo Cruz, Rio de Janeiro, Brazil. 4. Department of Psychiatry, Faculty of Medicine University, Toronto, Canada; Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto, ON, Canada. 5. Department of Public Health and Primary Care, Cambridge University, UK. 6. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. 7. Finlay-Albarrán Faculty of Medical Sciences, Medical University of Havana, Cuba. 8. Institute of Neurology and Neurosurgery Havana, Cuba, Memory and Aging Center, UCSF San Francisco, United States. 9. Medical University of Matanzas, Cuba. 10. Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States; Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States. 11. Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States. 12. Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France; Université de Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, UK. 13. Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, F-75014 France; Paris Descartes University, Paris, France; Univ Paris-Sud, Villejuif, France. 14. Université de Montpellier, Montpellier, France; Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France. 15. 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H Sergievsky Center, Department of Neurology, Columbia University, New York, NY, United States. 16. Department of Nutrition and Dietetics (M.Y.), Harokopio University, Athens, Greece. 17. Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece. 18. Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong. 19. Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong. 20. Department of Psychiatry, The University of Hong Kong, Hong Kong. 21. Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy. 22. Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea. 23. Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea. 24. Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany. 25. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. 26. Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, OH, United States. 27. School of Psychology, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia. 28. Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia. 29. University of California, School of Medicine, Department of Epidemiology and Biostatistics, CA, United States. 30. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Carolina Population Center, Chapel Hill, NC, United States. 31. Center for Health Science and Counseling, Kyushu University, 6-1 Kasuga kouen, Kasuga City, Fukuoka, 816-8580, Japan. 32. Faculty of Socio-Environmental Studies, Department of Socio-Environmental Studies, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka 811-0295, Japan. 33. Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku-ku, Tokyo 162-8655, Japan. 34. Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 35. Geriatric Behavioral Neurology, Tohoku University, Japan. 36. Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain. 37. Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia. 38. Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Australia.
Abstract
BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Authors: Elena Lobo; Patricia Gracia-García; Antonio Lobo; Pedro Saz; Concepción De-la-Cámara Journal: Int J Environ Res Public Health Date: 2021-07-02 Impact factor: 3.390