TY - JOUR
T1 - Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment
AU - for Cohort Studies of Memory in an International Consortium (COSMIC)
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
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/11/1
Y1 - 2020/11/1
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). 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). 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
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U2 - 10.1016/j.archger.2020.104112
DO - 10.1016/j.archger.2020.104112
M3 - 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 -