Level of education and change in cognitive function in a community population of older persons

Evans, Denis A.; Beckett, Laurel A.; Albert, Marilyn; Hebert, Liesi E.; Scherr, Paul A.; Funkenstein, H. Harris; Taylor, James O.

doi:10.1016/1047-2797(93)90012-s

Cited by 295 publications

(247 citation statements)

References 23 publications

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“…However, lower incidence of dementia in subjects with higher education has been reported by at least eight cohorts from France [26], Sweden [27], Finland [12], China [28], and the United States [14,15,20,29]. Similar associations emerged in a pooled analysis of four European population-based prospective studies of individuals 65 years and older [30].…”

Section: Educationmentioning

confidence: 55%

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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Section: Educationmentioning

confidence: 55%

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

Scarmeas

Stern

2004

Curr Neurol Neurosci Rep

210

132

View full text Add to dashboard Cite

show abstract

“…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).…”

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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“…2,3 General intelligence as a risk factor for dementia onset has been explained using a concept called 'brain reserve capacity' (BRC). 25 This concept implicates the presence of a threshold that needs to be exceeded before disease symptoms become evident.…”

Section: Discussionmentioning

confidence: 99%

“…1 General intelligence is an important risk factor for the incidence and prevalence of dementia and also the rate of cognitive decline in the nondemented elderly. 2,3 Cognitive impairment affects approximately 10% of community-dwelling people aged 65 years and over, and accounts for 35% with disability in England and Wales. 4 In an increasingly long-lived population, the identification and early treatment of individuals at risk from cognitive impairment will have profound social and economic implications.…”

Section: Introductionmentioning

confidence: 99%

Cathepsin D exon 2 polymorphism associated with general intelligence in a healthy older population

et al. 2003

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General intelligence is a heritable trait that is a risk factor for both the onset of dementia and the rate of cognitive decline in community-dwelling older persons. Previous studies screening for quantitative trait loci (QTLs) that influence general intelligence in healthy individuals have identified four loci, two of which are located within the genes insulin-like growth factor 2 receptor (IGF2R) and the Msx1 homeobox. Here, we report the finding of another QTL associated with general intelligence that is located within exon 2 of the cathepsin D (CTSD) gene. A group of 767 healthy adults with a follow-up period of over 15 years have been analyzed for cross-sectional and longitudinal trends in cognitive change using the Heim intelligence test score (AH4-1). We observed a significant association (P ¼ 0.01) between a functional C4T (Ala4Val) transition within exon 2 of the CTSD gene that increases the secretion of pro-CTSD from the cell, and the AH4-1 score at initial testing on entry to the longitudinal study. Interestingly, CTSD is transported by IGF2R from the trans Golgi network to the lysosome.

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Level of education and change in cognitive function in a community population of older persons

Cited by 295 publications

References 23 publications

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

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

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

Cathepsin D exon 2 polymorphism associated with general intelligence in a healthy older population

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