Illiteracy, dementia risk, and cognitive trajectories among older adults with low education

Abstract

ObjectiveTo investigate whether illiteracy was associated with greater risk of prevalent and incident dementia and more rapid cognitive decline among older adults with low education.MethodsAnalyses included 983 adults (≥65 years old, ≤4 years of schooling) who participated in a longitudinal community aging study. Literacy was self-reported (“Did you ever learn to read or write?”). Neuropsychological measures of memory, language, and visuospatial abilities were administered at baseline and at follow-ups (median [range] 3.49 years [0–23]). At each visit, functional, cognitive, and medical data were reviewed and a dementia diagnosis was made using standard criteria. Logistic regression and Cox proportional hazards models evaluated the association of literacy with prevalent and incident dementia, respectively, while latent growth curve models evaluated the effect of literacy on cognitive trajectories, adjusting for relevant demographic and medical covariates.ResultsIlliterate participants were almost 3 times as likely to have dementia at baseline compared to literate participants. Among those who did not have dementia at baseline, illiterate participants were twice as likely to develop dementia. While illiterate participants showed worse memory, language, and visuospatial functioning at baseline than literate participants, literacy was not associated with rate of cognitive decline.ConclusionWe found that illiteracy was independently associated with higher risk of prevalent and incident dementia, but not with a more rapid rate of cognitive decline. The independent effect of illiteracy on dementia risk may be through a lower range of cognitive function, which is closer to diagnostic thresholds for dementia than the range of literate participants.

Perspective on the “African American participation in Alzheimer disease research: Effective strategies” workshop, 2018

“…Additionally, reading and literacy levels are powerful independent predictors of dementia risk 32 . When looking at racial disparities, literacy level was a stronger predictor of cognitive function than stroke, APOE , and years in school 31 .…”

Early Segmental White Matter Fascicle Microstructural Damage Predicts the Corresponding Cognitive Domain Impairment in Cerebral Small Vessel Disease Patients by Automated Fiber Quantification

“…As our results suggested, such functionally relevant WM impairments can be sensitively detected and quantified by the AFQ. Education is efficacious on global cognition, select cognitive domains, and psychosocial functioning in people with CI (Kessels et al, 2017 ; Arce Renteria and Vonk, 2019 ). The positive effect of education on cognition shows a kind of cognitive reserve function.…”

Addressing Neurocognitive Disorders, Dementias, and Alzheimer’s Disease in Colonias of the Lower Rio Grande Valley: Establishing a Research Foundation Using Promotores

“…Noé Garza, DDS, MPH, DPH 1,2,3 ; Marucela Uscamayta-Ayvar, MSc 1,4 ; Gladys E. Maestre, MD, PhD 1,3,4,5 Several Texas communities along the Mexican border, including the Lower Rio Grande Valley (LRGV), are home to low-income Hispanic populations, many of whom live in underserved communities known as colonias. These areas have high incidences of neurocognitive disorders, dementia, and Alzheimer's disease (AD); health care strategies that are culturally and linguistically appropriate for the area are needed.…”

“…2 In the United States, 28.2% of the population aged ≥25 years has a college degree or higher (26.1% in Texas), but only 5.5% of the colonias residents do. 2 Years in school and quality of education affect cognition across lifespan, particularly in older individuals, 3 suggesting that school attrition, educational opportunities, and educational quality are important risk factors for dementia and Alzheimer's disease (AD) in colonias, thus they are also key targets for prevention of cognitive deterioration.…”