Cognitive Decline in Adulthood: An 11.5-Year Follow-Up of the Baltimore Epidemiologic Catchment Area Study

Lyketsos, Constantine G.; Chen, Li Shiun; Anthony, James C.

doi:10.1176/ajp.156.1.58

Cited by 190 publications

(179 citation statements)

References 35 publications

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“…For example, a higher risk of Alzheimer's disease is consistently observed among those with low education levels (Evans et al 1993(Evans et al , 1997a(Evans et al , 1997bGeerlings et al 1999;Graham et al 1998;Gurland et al 1999;Hall et Prencipe et al 1996;Wiederholt et al 1993). Low education is also a predictor of cognitive decline, even in subjects < 60 years of age (Farmer et al 1995;Lyketsos et al 1999). Growing evidence indicates that various environmental influences, including traumatic injury, oxidative stress, neurotoxicants, and medications, interact with endogenous biologic factors to influence cognitive function and risk of Alzheimer's disease (Small 1998).…”

Section: Discussionmentioning

confidence: 99%

Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study.

Schwartz

Glass

Bolla

et al. 2004

Environ Health Perspect

129

146

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The Baltimore Memory Study is a cohort study of the multilevel determinants of cognitive decline in 50-70-year-old randomly selected residents of specific city neighborhoods. Prior studies have demonstrated that cognitive function differs by race/ethnicity, with lower scores in minorities than in whites, but the underlying basis for these differences is not understood. Studies have differed in the rigor with which they evaluated and controlled for such important confounding variables as socioeconomic status (SES), health-related behaviors, comorbid illnesses, and factors in the physical environment. The goal of this study was to describe differences in neurobehavioral test scores by race/ethnicity, before and after control for a four-dimensional measure of SES and health-related behaviors and health conditions, in a cross-sectional analysis of first visit data. Random samples of households in the study area were selected until enrollment goals were reached. Among the 2,351 persons on whom eligibility was determined, 60.8% were scheduled for an enrollment visit; of these, 1,140 (81.3%) were enrolled and tested. These study participants were 34.3% male and 65.7% female and were from 65 Baltimore, Maryland, neighborhoods. After adjustment for age, sex, and testing technician, there were large and statistically significant differences in neurobehavioral test scores by race/ethnicity, with African-American scores lower than those for whites, for both men and women. After adjustment for individual SES (educational status, household income, household assets, and occupational status), the average difference declined by 25.8%. After additional adjustment for SES, health-related behaviors and health conditions, and blood lead, the average difference declined another 10%, but large differences persisted; African Americans had test scores that averaged 0.43 standard deviation lower than those for whites across all neurobehavioral tests. These differences were present in all cognitive domains, including tests that would not be characterized as susceptible to differential item functioning by race/ethnicity, suggesting that the results are not due to race/ethnicity-associated measurement error.

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Section: Discussionmentioning

confidence: 99%

Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study.

Schwartz

Glass

Bolla

et al. 2004

Environ Health Perspect

129

146

View full text Add to dashboard Cite

show abstract

“…There is also evidence for a role of education in age-related cognitive decline, with several studies of normal aging reporting slower cognitive and functional decline in individuals with higher educational attainment [32][33][34][35][36][37][38][39]. These studies suggest that the same education-related factors that delay the onset of dementia also allow individuals to cope more effectively with brain changes encountered in normal aging.…”

Section: Educationmentioning

confidence: 99%

Cognitive reserve: Implications for diagnosis and prevention of Alzheimer’s disease

Scarmeas

Stern

2004

Curr Neurol Neurosci Rep

210

132

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Epidemiologic evidence suggests that higher occupational attainment and education, as well as increased participation in intellectual, social, and physical aspects of daily life, are associated with slower cognitive decline in healthy elderly and may reduce the risk of incident Alzheimer's disease (AD). There is also evidence from structural and functional imaging studies that patients with such life experiences can tolerate more AD pathology before showing signs of clinical dementia. It has been hypothesized that such aspects of life experience may result in functionally more efficient cognitive networks and, therefore, provide a cognitive reserve that delays the onset of clinical manifestations of dementia. In this article, we review some of the relevant literature of the noted associations between markers of cognitive reserve and AD and discuss the possible mechanisms that may explain these associations.

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“…Epidemiological studies have shown lower prevalence or incidence of dementia in elder population with high level of education (see Meng andD"Arcy, 2012 andValenzuela et al, 2006 for a review and meta-analysis). Furthermore, neuropsychological studies have reported better cognitive test performance (Plassman et al, 1995;Wilson et al, 2009) and reduced rate of cognitive decline (Albert et al, 1995;Alvarado et al, 2002;Anstey et al, 2003;Christensen et al, 1997;Evans et al, 1993;Farmer et al, 1995;Lyketsos et al, 1999;White et al, 1994) in elders with higher levels of education. These investigations suggest that education affects the risk of late life dementia by its positive association with level of cognition or through its association with decreased rate of cognitive decline in aging.…”

Section: Introductionmentioning

confidence: 99%

Relationships between years of education and gray matter volume, metabolism and functional connectivity in healthy elders

et al. 2013

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More educated elders are less susceptible to age-related or pathological cognitive changes. We aimed at providing a comprehensive contribution to the neural mechanism underlying this effect thanks to a multimodal approach. Thirtysix healthy elders were selected based on neuropsychological assessments and cerebral amyloid imaging, i.e. as presenting normal cognition and a negative florbetapir-PET scan. All subjects underwent structural MRI, FDG-PET and resting-state functional MRI scans. We assessed the relationships between years of education and i) gray matter volume, ii) gray matter metabolism and iii) functional connectivity in the brain areas showing associations with both volume and metabolism. Higher years of education were related to greater volume in the superior temporal gyrus, insula and anterior cingulate cortex and to greater metabolism in the anterior cingulate cortex. The latter thus showed both volume and metabolism increases with education. Seed connectivity analyses based on this region showed that education was positively related to the functional connectivity between the anterior cingulate cortex and the hippocampus as well as the inferior frontal lobe, posterior cingulate cortex and angular gyrus. Increased connectivity was in turn related with improved cognitive performances. Reinforcement of the connectivity of the anterior cingulate cortex with distant cortical areas of the frontal, temporal and parietal lobes appears as one of the mechanisms underlying education-related reserve in healthy elders.

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Cognitive Decline in Adulthood: An 11.5-Year Follow-Up of the Baltimore Epidemiologic Catchment Area Study

Cited by 190 publications

References 35 publications

Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study.

Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study.

Cognitive reserve: Implications for diagnosis and prevention of Alzheimer’s disease

Relationships between years of education and gray matter volume, metabolism and functional connectivity in healthy elders

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