Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies

Robitaille, Annie; Hout, Ardo van den; Machado, Robson; Bennett, David A.; Čukić, Iva; Deary, Ian J.; Hofer, Scott M.; Hoogendijk, Emiel O.; Huisman, Martijn; Johansson, Boo; Koval, Andriy V.; Noordt, Maaike van der; Piccinin, Andrea M.; Rijnhart, Judith J. M.; Singh‐Manoux, Archana; Skoog, Johan; Skoog, Ingmar; Starr, John M.; Vermunt, Lisa; Clouston, Sean; Muniz‐Terrera, Graciela

doi:10.1016/j.jalz.2017.10.003

Cited by 66 publications

(65 citation statements)

References 56 publications

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“…Multistate models facilitate a better understanding of transitions between health states and death among the oldest old. Recent developments in multistate modeling make it possible to study the role of risk factors, such as sex, in transitions between these states [11]. Moreover, based on multistate models, overall, healthy, and unhealthy life expectancies (LEs) may be estimated for specific groups [12].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study

Hoogendijk

Noordt

Deeg

et al. 2019

Experimental Gerontology

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Objectives: Little is known about sex differences in healthy life expectancy among the oldest old, the fastest growing segment of the older population. This study examines sex differences in total, healthy and unhealthy life expectancy among nonagenarians. Methods: Longitudinal data of 884 older adults aged 90 and over participating in the Vitality 90+ study (Tampere, Finland) were used, including 2,501 observations (health or death states) from 5 measurement waves between 2001 and 2014. Using the MSM and ELECT packages in R, multistate survival models were performed to estimate the transition probabilities of older adults through the different health states and to calculate life expectancies. The analyses were done separately for two health indicators (disability and multimorbidity) to see whether patterns were consistent. Results: Women had higher total life expectancies than men (about 8 months), but also higher unhealthy life expectancies. Men had a higher disability-free life expectancy between the age of 90 and 95 compared to women. For multimorbidity, no sex differences in healthy life expectancy were found. Conclusions: This study showed that the male-female health-survival paradox remains at very old age. Women aged 90+ live longer than men, and spend more time in poor health.

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Section: Introductionmentioning

confidence: 99%

Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study

Hoogendijk

Noordt

Deeg

et al. 2019

Experimental Gerontology

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“…According to the theory, individuals with high CR remain clinically normal in the early stage of AD, but the rate of decline in cognitive performance is more rapid than in those with low CR in the late stage of AD [34]. Indeed, there is a considerable amount of evidence supports that higher levels of CR protect against progression of from SCD to MCI [35,36], and diagnostic conversion for normal cognition [37,38]. In this sense, our ndings from this study are consistent with the theory of CR.…”

Section: Discussionmentioning

confidence: 99%

“…It was estimated that low educational attainment has the highest population-attributable risk (PAR) of AD worldwide (19.1%, 95% CI 12.3-25.6) [7]. Conversely, higher level of education has been shown to prevent or delay the onset of dementia [8,9].…”

Section: Introductionmentioning

confidence: 99%

Beneficial impact of education on cognition in amyloid-positive individuals with subjective cognitive decline: The SILCODE study

Chen

Liu

Yang

et al. 2020

Preprint

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Background: Previous studies suggest that education is associated with a decreased risk of dementia in individuals with subjective cognitive decline (SCD). However, the influence of education on cognition in amyloid-positive SCD subjects is not clear.Methods: We performed a cross-sectional study that involved 43 amyloid-negative and 29 amyloid-positive SCD subjects from the Sino Longitudinal Study on Cognitive Decline (SILCODE) project. Cognitive assessment included episodic memory, executive function, language, and general cognitive function. Multiple linear regression model was used to assess the association of education on cognitive performance.Results: Multiple linear regression analysis suggested that education has a protective effect on executive function, language for the amyloid-negative SCD group and language, global cognition for the amyloid-positive SCD group.Conclusions: The present study indicated that education has the potential to delay disease progression in amyloid-positive SCD subjects.

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“…Factors contributing to the construction of an adequate cognitive reserve will help delay the arrival of senile dementia, while, a lack of these factors constitutes increasing risks. In addition to genetic factors [6], a growing number of modifiable factors have been related to senile dementia, such as occupational complexity [7][8][9], educational attainment [10][11][12], marital status [13], socioeconomic status [14], and social networks [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…Just recently, a data analysis report integrating six longitudinal studies demonstrated that older individuals with high educational attainment and high socioeconomic status have remarkably longer non-cognitively impaired life expectancies as opposed to those with low educational attainment and low socioeconomic status [19]. This observation suggests that education and socioeconomic status are synergistic resilience factors against the onset of senile dementia.…”

Section: Introductionmentioning

confidence: 99%

Education and marriage synergistically protect oldest old against severe cognitive impairment

Sun

Jia

Guo

et al. 2019

Preprint

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Background It is hypothesized that education and marriage are resilience factors protective against senile dementia.Methods We investigated the resilience of elderly persons from dementia by considering the interactions between educational levels and marriage status. Four sociodemographic variables (age, sex, educational level, and marital status) were collected from 1177 elderly Chinese participants, for whom the mini-mental state examination score (MMSE score) was measured and severe cognitive impairment (MMSE score = 0) was identified.Results Lower educational level coupled with being widowed caused a greater risk of severe cognitive impairment (relative risk [RR] 1.48; 95% confidence interval [CI] 1.20-1.82; p < 0.001) for high-age elderly participants (age range: ≥80) than those low-age counterparts (age range: ≥60 and <80). By contrast, higher educational level coupled with being married leveled this age-related risk of cognitive loss (RR 0.91; 95% CI 0.65-1.27; p = 0.62). Further findings suggest that synergistically cognitive protection effect for education and marriage was only observed among high-age elderly persons, instead of among low-age ones.Conclusions Being well-educated and being married synergistically protected delayed cognitive function for elderly people. However, longevity is a prerequisite for realizing this benefit.

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Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies

Abstract: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.

Cited by 66 publications

References 56 publications

Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study

Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study

Beneficial impact of education on cognition in amyloid-positive individuals with subjective cognitive decline: The SILCODE study

Education and marriage synergistically protect oldest old against severe cognitive impairment

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