Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment

Steve R. Makkar*, Darren M. Lipnicki, John D. Crawford, Nicole A. Kochan, Erico Castro-Costa, Maria Fernanda Lima-Costa, Breno Satler Diniz, Carol Brayne, Blossom Stephan, Fiona Matthews, Juan J. Llibre-Rodriguez, Jorge J. Llibre-Guerra, Adolfo J. Valhuerdi-Cepero, Richard B. Lipton, Mindy J. Katz, Andrea Zammit, Karen Ritchie, Sophie Carles, Isabelle Carriere, Nikolaos ScarmeasMary Yannakoulia, Mary Kosmidis, Linda Lam, Ada Fung, Wai Chi Chan, Antonio Guaita, Roberta Vaccaro, Annalisa Davin, Ki Woong Kim, Ji Won Han, Seung Wan Suh, Steffi G. Riedel-Heller, Susanne Roehr, Alexander Pabst, Mary Ganguli, Tiffany F. Hughes, Erin P. Jacobsen, Kaarin J. Anstey, Nicolas Cherbuin, Mary N. Haan, Allison E. Aiello, Kristina Dang, Shuzo Kumagai, Kenji Narazaki, Sanmei Chen, Tze Pin Ng, Qi Gao, Ma Shwe Zin Nyunt, Kenichi Meguro, Satoshi Yamaguchi, Hiroshi Ishii, Antonio Lobo, Elena Lobo-Escolar, Concepción de la Cámara, Henry Brodaty, Julian N. Trollor, Yvonne Leung, Jessica W. Lo, Perminder S. Sachdev, Cohort Studies of Memory in an International Consortium (COSMIC)

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

8 Citations (Scopus)

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).i 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.

Original languageEnglish
Article number104112
JournalArchives of Gerontology and Geriatrics
Volume91
Early online date13 Jul 2020
DOIs
Publication statusPublished - Nov 2020

Scopus Subject Areas

  • Health(social science)
  • Ageing
  • Gerontology
  • Geriatrics and Gerontology

User-Defined Keywords

  • Age
  • Ageing
  • Cognitive decline
  • Education
  • Ethnicity
  • Sex

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