Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment
Steve R Makkar
(1)
,
Darren M Lipnicki
(1)
,
John D Crawford
(1)
,
Nicole A Kochan
(1)
,
Erico Castro-Costa
(2)
,
Maria Fernanda Lima-Costa
(2)
,
Breno Satler Diniz
(3)
,
Carol Brayne
(4)
,
Blossom Stephan
(5)
,
Fiona Matthews
(5)
,
Juan J Llibre-Rodriguez
(6)
,
Jorge J Llibre-Guerra
(7)
,
Adolfo J Valhuerdi-Cepero
(8)
,
Richard B Lipton
(9)
,
Mindy J Katz
(9)
,
Andrea Zammit
(9)
,
Karen Ritchie
(10, 11)
,
Sophie Carles
(12)
,
Isabelle Carriere
(10, 13)
,
Nikolaos Scarmeas
(14, 15)
,
Mary Yannakoulia
(16)
,
Mary Kosmidis
(17)
,
Linda Lam
(18)
,
Ada Fung
(19)
,
Wai Chi Chan
(20)
,
Antonio Guaita
(21)
,
Roberta Vaccaro
(21)
,
Annalisa Davin
(21)
,
Ki Woong Kim
(22)
,
Ji Won Han
(23)
,
Seung Wan Suh
(23)
,
Steffi G Riedel-Heller
(24)
,
Susanne Roehr
(24)
,
Alexander Pabst
(24)
,
Mary Ganguli
(25)
,
Tiffany F Hughes
(26)
,
Erin P Jacobsen
(25)
,
Kaarin J Anstey
(27)
,
Nicolas Cherbuin
(27)
,
Mary N Haan
(28)
,
Allison E Aiello
(29)
,
Kristina Dang
(28)
,
Shuzo Kumagai
(30)
,
Kenji Narazaki
(31)
,
Sanmei Chen
(32)
,
Tze Pin Ng
(33)
,
Qi Gao
(33)
,
Ma Shwe Zin Nyunt
(33)
,
Kenichi Meguro
(34)
,
Satoshi Yamaguchi
(34)
,
Hiroshi Ishii
(34)
,
Antonio Lobo
(35)
,
Elena Lobo Escolar
(35)
,
Concepción de La Cámara
(35)
,
Henry Brodaty
(1)
,
Julian N Trollor
(1)
,
Yvonne Leung
(1)
,
Jessica W Lo
(1)
,
Perminder Sachdev
(1)
1
UNSW -
University of New South Wales [Sydney]
2 Fiocruz Minas - René Rachou Research Center / Instituto René Rachou [Belo Horizonte, Brésil]
3 University of Toronto
4 CAM - University of Cambridge [UK]
5 Newcastle University [Newcastle]
6 UH - University of Havana = Universidad de la Habana
7 UC San Francisco - University of California [San Francisco]
8 Universidad de Matanzas
9 Albert Einstein College of Medicine [New York]
10 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
11 Edin. - University of Edinburgh
12 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
13 Hôpital la Colombière [CHU Montpellier]
14 Columbia University [New York]
15 NKUA - National and Kapodistrian University of Athens
16 Harokopio University of Athens
17 Aristotle University of Thessaloniki
18 CUHK - The Chinese University of Hong Kong [Hong Kong]
19 POLYU - The Hong Kong Polytechnic University [Hong Kong]
20 HKU - The University of Hong Kong
21 Golgi Cenci Foundation
22 Seoul National University College of Natural Sciences
23 SNUBH - Seoul National University Bundang Hospital
24 Leipzig University / Universität Leipzig
25 University of Pittsburgh School of Medicine
26 YSU - Youngstown State University
27 ANU - Australian National University
28 UC - University of California
29 UNC - University of North Carolina [Chapel Hill]
30 Kyushu University
31 FIT - Fukuoka Institute of Technology
32 NCGM - National Center for Global Health and Medicine [Japan]
33 NUS - National University of Singapore
34 Tohoku University [Sendai]
35 Universidad de Zaragoza = University of Zaragoza [Saragossa University] = Université de Saragosse
2 Fiocruz Minas - René Rachou Research Center / Instituto René Rachou [Belo Horizonte, Brésil]
3 University of Toronto
4 CAM - University of Cambridge [UK]
5 Newcastle University [Newcastle]
6 UH - University of Havana = Universidad de la Habana
7 UC San Francisco - University of California [San Francisco]
8 Universidad de Matanzas
9 Albert Einstein College of Medicine [New York]
10 PSNREC - Neuropsychiatrie : recherche épidémiologique et clinique
11 Edin. - University of Edinburgh
12 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
13 Hôpital la Colombière [CHU Montpellier]
14 Columbia University [New York]
15 NKUA - National and Kapodistrian University of Athens
16 Harokopio University of Athens
17 Aristotle University of Thessaloniki
18 CUHK - The Chinese University of Hong Kong [Hong Kong]
19 POLYU - The Hong Kong Polytechnic University [Hong Kong]
20 HKU - The University of Hong Kong
21 Golgi Cenci Foundation
22 Seoul National University College of Natural Sciences
23 SNUBH - Seoul National University Bundang Hospital
24 Leipzig University / Universität Leipzig
25 University of Pittsburgh School of Medicine
26 YSU - Youngstown State University
27 ANU - Australian National University
28 UC - University of California
29 UNC - University of North Carolina [Chapel Hill]
30 Kyushu University
31 FIT - Fukuoka Institute of Technology
32 NCGM - National Center for Global Health and Medicine [Japan]
33 NUS - National University of Singapore
34 Tohoku University [Sendai]
35 Universidad de Zaragoza = University of Zaragoza [Saragossa University] = Université de Saragosse
John D Crawford
- Fonction : Auteur
- PersonId : 811551
- ORCID : 0000-0001-5141-0673
Erico Castro-Costa
- Fonction : Auteur
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- ORCID : 0000-0003-0792-5439
Carol Brayne
- Fonction : Auteur
- PersonId : 766057
- ORCID : 0000-0001-5307-663X
Blossom Stephan
- Fonction : Auteur
- PersonId : 778033
- ORCID : 0000-0002-1235-360X
Jorge J Llibre-Guerra
- Fonction : Auteur
- PersonId : 811552
- ORCID : 0000-0002-2137-7750
Sophie Carles
- Fonction : Auteur
- PersonId : 749166
- IdHAL : sophiecarles
- ORCID : 0000-0003-0792-1104
Nikolaos Scarmeas
- Fonction : Auteur
- PersonId : 761369
- ORCID : 0000-0001-6453-8908
Ji Won Han
- Fonction : Auteur
- PersonId : 798924
- ORCID : 0000-0003-2418-4257
Susanne Roehr
- Fonction : Auteur
- PersonId : 803840
- ORCID : 0000-0001-9385-0669
Alexander Pabst
- Fonction : Auteur
- PersonId : 794546
- ORCID : 0000-0003-0432-5681
Kaarin J Anstey
- Fonction : Auteur
- PersonId : 807421
- ORCID : 0000-0002-9706-9316
Mary N Haan
- Fonction : Auteur
- PersonId : 811553
- ORCID : 0000-0001-9312-4501
Tze Pin Ng
- Fonction : Auteur
- PersonId : 798951
- ORCID : 0000-0001-9585-855X
Antonio Lobo
- Fonction : Auteur
- PersonId : 803841
- ORCID : 0000-0002-9098-655X
Elena Lobo Escolar
- Fonction : Auteur
- PersonId : 812183
- ORCID : 0000-0002-1252-2397
Yvonne Leung
- Fonction : Auteur
- PersonId : 798952
- ORCID : 0000-0001-9110-7054
Perminder Sachdev
- Fonction : Auteur
- PersonId : 778032
- ORCID : 0000-0002-9595-3220
- IdRef : 076727041
Résumé
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.
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