Abstract
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 language | English |
|---|---|
| Article number | 104112 |
| Journal | Archives of Gerontology and Geriatrics |
| Volume | 91 |
| Early online date | 13 Jul 2020 |
| DOIs | |
| Publication status | Published - 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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In: Archives of Gerontology and Geriatrics, Vol. 91, 104112, 11.2020.
Research output: Contribution to journal › Journal article › peer-review
TY - JOUR
T1 - Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment
AU - Makkar, Steve R.
AU - Lipnicki, Darren M.
AU - Crawford, John D.
AU - Kochan, Nicole A.
AU - Castro-Costa, Erico
AU - Lima-Costa, Maria Fernanda
AU - Diniz, Breno Satler
AU - Brayne, Carol
AU - Stephan, Blossom
AU - Matthews, Fiona
AU - Llibre-Rodriguez, Juan J.
AU - Llibre-Guerra, Jorge J.
AU - Valhuerdi-Cepero, Adolfo J.
AU - Lipton, Richard B.
AU - Katz, Mindy J.
AU - Zammit, Andrea
AU - Ritchie, Karen
AU - Carles, Sophie
AU - Carriere, Isabelle
AU - Scarmeas, Nikolaos
AU - Yannakoulia, Mary
AU - Kosmidis, Mary
AU - Lam, Linda
AU - Fung, Ada
AU - Chan, Wai Chi
AU - Guaita, Antonio
AU - Vaccaro, Roberta
AU - Davin, Annalisa
AU - Kim, Ki Woong
AU - Han, Ji Won
AU - Suh, Seung Wan
AU - Riedel-Heller, Steffi G.
AU - Roehr, Susanne
AU - Pabst, Alexander
AU - Ganguli, Mary
AU - Hughes, Tiffany F.
AU - Jacobsen, Erin P.
AU - Anstey, Kaarin J.
AU - Cherbuin, Nicolas
AU - Haan, Mary N.
AU - Aiello, Allison E.
AU - Dang, Kristina
AU - Kumagai, Shuzo
AU - Narazaki, Kenji
AU - Chen, Sanmei
AU - Ng, Tze Pin
AU - Gao, Qi
AU - Nyunt, Ma Shwe Zin
AU - Meguro, Kenichi
AU - Yamaguchi, Satoshi
AU - Ishii, Hiroshi
AU - Lobo, Antonio
AU - Lobo-Escolar, Elena
AU - de la Cámara, Concepción
AU - Brodaty, Henry
AU - Trollor, Julian N.
AU - Leung, Yvonne
AU - Lo, Jessica W.
AU - Sachdev, Perminder S.
AU - Cohort Studies of Memory in an International Consortium (COSMIC)
N1 - Funding Information: Funding for COSMIC comes from a National Health and Medical Research Council of Australia Program Grant (ID 1093083), the National Institute On Aging of the National Institutes of Health under Award Number RF1AG057531, and philanthropic contributions to The Dementia Momentum Fund (UNSW Project ID PS38235). Funding for each of the contributing studies is as follows: Bambui: The Brazilian Ministry of Health (Department of Science and Technology), the Brazilian Ministry of Science and Technology (National Fund for Scientific and Technological Development, Funding of Studies, Brazilian National Research Council) and the Minas Gerais State Research Foundation; CFAS: Major awards from the Medical Research Council and the Department of Health, UK; CHAS: The Wellcome Trust Foundation (GR066133 and GR08002) and the Cuban Ministry of Public Health; EAS: Supported in part by National Institutes of Health grants NIA 2 P01 AG03949, the Leonard and Sylvia Marx Foundation, and the Czap Foundation; ESPRIT: Novartis; HELIAD: IIRG-09133014 from the Alzheimer’s Association; 189 10276/8/9/2011 from the ESPA-EU program Excellence Grant (ARISTEIA), which is co-funded by the European Social Fund and Greek National resources, and ΔΥ2β/οικ.51657/14.4.2009 from the Ministry for Health and Social Solidarity (Greece); HK-MAPS: The Mei Family Trust; Invece.Ab: Financed with own funds and supported in part by “Federazione Alzheimer Italia”, Milan, Italy; KLOSCAD: The Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea [Grant No. HI09C1379 (A092077)]; LEILA75+: The Interdisciplinary Centre for Clinical Research at the University of Leipzig (Interdisziplinäres Zentrum für Klinische Forschung/IZKF; grant 01KS9504); MoVIES: Grant # R01AG07562 from the National Institute on Aging, National Institutes of Health, United States Department of Health and Human Services; PATH: National Health and Medical Research Council of Australia grants 973302, 179805, 157125 and 1002160; SALSA: NIH grants AG12975, T32 AG049663, ES023451; Carolina Population Center (CPC) Funding: CPC Center grant (the P2C Center grant from NIH): P2C HD050924. CPC NICHD-NRSA Population Research Training (the T32 Training grant from NIH): T32 HD007168, Biosocial Training Grant: T32 HD091058; SGS: JSPS KAKENHI Grant Number JP17K09146; SLASI: Agency for Science Technology and Research (A*STAR) Biomedical Research Council (BMRC) [Grants: 03/1/21/17/214 and 08/1/21/19/567] and the National Medical Research Council [Grant: NMRC/1108/2007]; Sydney MAS: National Health & Medical Research Council of Australia Program Grant (ID 350833); ZARADEMP: Supported by grants from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain (grants 94/1562, 97/1321E, 98/0103, 01/0255, 03/0815, 06/0617, G03/128), and the Fondo Europeo de Desarrollo Regional (FEDER) of the European Union and Gobierno de Aragón, Group #19. Funding Information: Richard B. Lipton Is the Edwin S. Lowe Professor of Neurology at the Albert Einstein College of Medicine in New York. He receives research support from the NIH : 2PO1 AG003949 (mPI), 5U10 NS077308 (PI), RO1 NS082432 (Investigator), 1RF1 AG057531 (Site PI), RF1 AG054548 (Investigator), 1RO1 AG048642 (Investigator), R56 AG057548 (Investigator), K23 NS09610 (Mentor), K23AG049466 (Mentor), 1K01AG054700 (Mentor). He also receives support from the Migraine Research Foundation and the National Headache Foundation . He serves on the editorial board of Neurology, senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from: American Academy of Neurology , Alder , Allergan , American Headache Society , Amgen , Autonomic Technologies , Avanir , Biohaven , Biovision , Boston Scientific , Dr. Reddy’s , Electrocore , Eli Lilly , eNeura Therapeutics , GlaxoSmithKline , Merck , Pernix , Pfizer , Supernus , Teva , Trigemina , Vector , Vedanta . He receives royalties from Wolff’s Headache 7th and 8th Edition , Oxford Press University, 2009 , Wiley and Informa . Henry Brodaty is on the Advisory Committee for Nutricia Australia; Clinincal Advisory Committee, Montefiore Home; Medical Advisory Committee, Cranbrook Care. Nikolaos Scarmeas reports personal fees from Merck Consumer Health and the NIH outside the submitted work. Mary Ganguli was on Biogen Inc.’s “Patient Journey Advisory Group” in 2016 and 2017. Allison E. Aiello is a consultant for Kinsa Inc. and has received an unrestricted gift from Gojo Inc. Henry Brodaty is on the Advisory Board of Nutricia Australia. Funding Information: Richard B. Lipton Is the Edwin S. Lowe Professor of Neurology at the Albert Einstein College of Medicine in New York. He receives research support from the NIH: 2PO1 AG003949 (mPI), 5U10 NS077308 (PI), RO1 NS082432 (Investigator), 1RF1 AG057531 (Site PI), RF1 AG054548 (Investigator), 1RO1 AG048642 (Investigator), R56 AG057548 (Investigator), K23 NS09610 (Mentor), K23AG049466 (Mentor), 1K01AG054700 (Mentor). He also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from: American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy's, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, Vedanta. He receives royalties from Wolff's Headache 7th and 8th Edition, Oxford Press University, 2009, Wiley and Informa. Henry Brodaty is on the Advisory Committee for Nutricia Australia; Clinincal Advisory Committee, Montefiore Home; Medical Advisory Committee, Cranbrook Care. Nikolaos Scarmeas reports personal fees from Merck Consumer Health and the NIH outside the submitted work. Mary Ganguli was on Biogen Inc.?s ?Patient Journey Advisory Group? in 2016 and 2017. Allison E. Aiello is a consultant for Kinsa Inc. and has received an unrestricted gift from Gojo Inc. Henry Brodaty is on the Advisory Board of Nutricia Australia. Publisher Copyright: © 2020 Elsevier B.V.
PY - 2020/11
Y1 - 2020/11
N2 - 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.
AB - 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.
KW - Age
KW - Ageing
KW - Cognitive decline
KW - Education
KW - Ethnicity
KW - Sex
UR - http://www.scopus.com/inward/record.url?scp=85088802035&partnerID=8YFLogxK
U2 - 10.1016/j.archger.2020.104112
DO - 10.1016/j.archger.2020.104112
M3 - Journal article
C2 - 32738518
AN - SCOPUS:85088802035
SN - 0167-4943
VL - 91
JO - Archives of Gerontology and Geriatrics
JF - Archives of Gerontology and Geriatrics
M1 - 104112
ER -