Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment

被引：10

作者：

Makkar, Steve R. ^{[1
]}

Lipnicki, Darren M. ^{[1
]}

Crawford, John D. ^{[1
]}

Kochan, Nicole A. ^{[1
]}

Castro-Costa, Erico ^{[2
]}

Lima-Costa, Maria Fernanda ^{[2
]}

Diniz, Breno Satler ^{[3
,4
]}

Brayne, Carol ^{[5
]}

Stephan, Blossom ^{[6
]}

Matthews, Fiona ^{[6
]}

Llibre-Rodriguez, Juan J. ^{[7
]}

Llibre-Guerra, Jorge J. ^{[8
,9
]}

Valhuerdi-Cepero, Adolfo J. ^{[10
]}

Lipton, Richard B. ^{[11
,12
,13
]}

Katz, Mindy J. ^{[11
]}

Zammit, Andrea ^{[11
]}

Ritchie, Karen ^{[14
,15
,16
]}

Carles, Sophie ^{[17
,18
,19
]}

Carriere, Isabelle ^{[14
,15
]}

Scarmeas, Nikolaos ^{[20
,21
]}

Yannakoulia, Mary ^{[22
]}

Kosmidis, Mary ^{[23
]}

Lam, Linda ^{[24
]}

Fung, Ada ^{[25
]}

Chan, Wai Chi ^{[26
]}

Guaita, Antonio ^{[27
]}

Vaccaro, Roberta ^{[27
]}

Davin, Annalisa ^{[27
]}

Kim, Ki Woong ^{[28
,29
,30
]}

Han, Ji Won ^{[28
]}

Suh, Seung Wan ^{[28
]}

Riedel-Heller, Steffi G. ^{[31
]}

Roehr, Susanne ^{[31
]}

Pabst, Alexander ^{[31
]}

Ganguli, Mary ^{[32
]}

Hughes, Tiffany F. ^{[33
]}

Jacobsen, Erin P. ^{[32
]}

Anstey, Kaarin J. ^{[34
,35
,36
]}

Cherbuin, Nicolas ^{[36
]}

Haan, Mary N. ^{[37
]}

Aiello, Allison E. ^{[38
,39
]}

Dang, Kristina ^{[37
]}

Kumagai, Shuzo ^{[40
]}

Narazaki, Kenji ^{[41
]}

Chen, Sanmei ^{[42
]}

Ng, Tze Pin ^{[43
]}

Gao, Qi ^{[43
]}

Nyunt, Ma Shwe Zin ^{[43
]}

Meguro, Kenichi ^{[44
]}

Yamaguchi, Satoshi ^{[44
]}

机构：

[1] Univ New South Wales, Ctr Hlth Brain Ageing, Sydney, NSW, Australia

[2] Inst Rene Rachou Fundacao Oswaldo Cruz, Rio De Janeiro, Brazil

[3] Fac Med Univ, Dept Psychiat, Toronto, ON, Canada

[4] Ctr Addict & Mental Hlth, Geriatr Psychiat Div, Toronto, ON, Canada

[5] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England

[6] Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne, Tyne & Wear, England

[7] Med Univ Havana, Finlay Albarrcin Fac Med Sci, Havana, Cuba

[8] Inst Neurol & Neurosurg Havana, Havana, Cuba

[9] UCSF San Francisco, Memory & Aging Ctr, San Francisco, CA USA

[10] Med Univ Matanzas, Matanzas, Cuba

[11] Yeshiva Univ, Albert Einstein Coll Med, Saul R Korey Dept Neurol, New York, NY USA

[12] Yeshiva Univ, Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, New York, NY USA

[13] Yeshiva Univ, Albert Einstein Coll Med, Dept Psychiat & Behav Med, New York, NY USA

[14] La Colombiere Hosp, Neuropsychiat Epidemiol & Clin Res U1061, Inserm, Montpellier 5, France

[15] Univ Montpellier, Montpellier, France

[16] Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland

[17] Inserm, Epidemiol & Biostat Sorbonne Paris Cite Ctr CRESS, UMR1153, F-75014 Paris, France

[18] Paris Descartes Univ, Paris, France

[19] Univ Paris Sud, Villejuif, France

[20] Natl & Kapodistrian Univ Athens, Aiginit Hosp, Med Sch, Dept Neurol 1, Athens, Greece

[21] Columbia Univ, Gertrude H Sergievsky Ctr, Taub Inst Res Alzheimers Dis & Aging Brain, Dept Neurol, New York, NY USA

[22] Harokopio Univ, Dept Nutr & Dietet MY, Athens, Greece

[23] Aristotle Univ Thessaloniki, Sch Psychol, Lab Cognit Neurosci, Thessaloniki, Greece

[24] Chinese Univ Hong Kong, Dept Psychiat, Hong Kong, Peoples R China

[25] Hong Kong Polytech Univ, Dept Appl Social Sci, Hong Kong, Peoples R China

[26] Hong Kong Polytech Univ, Dept Psychiat, Hong Kong, Peoples R China

[27] Golgi Cenci Fdn, Corso San Martino 10, I-20081 Abbiategrasso, Italy

[28] Seoul Natl Univ Bundang Hosp, Dept Neuropsychiat, Seongnam, South Korea

[29] Seoul Natl Univ, Coll Med, Dept Psychiat, Seoul, South Korea

[30] Seoul Natl Univ, Dept Brain & Cognit Sci, Coll Nat Sci, Seoul, South Korea

[31] Univ Leipzig, Med Fac, Inst Social Med Occupat Hlth & Publ Hlth ISAP, Leipzig, Germany

[32] Univ Pittsburgh, Sch Med, Dept Psychiat, Pittsburgh, PA USA

[33] Youngstown State Univ, Dept Sociol Anthropol & Gerontol, Youngstown, OH USA

[34] Univ New South Wales, Sch Psychol, Sydney, NSW, Australia

[35] Neurosci Res Australia, Sydney, NSW, Australia

[36] Australian Natl Univ, Coll Hlth & Med, Ctr Res Ageing Hlth & Wellbeing, Canberra, ACT, Australia

[37] Univ Calif Los Angeles, Sch Med, Dept Epidemiol & Biostat, Los Angeles, CA USA

[38] Univ N Carolina, Dept Epidemiol, Gillings Sch Global Publ Hlth, Chapel Hill, NC USA

[39] Carolina Populat Ctr, Chapel Hill, NC USA

[40] Kyushu Univ, Ctr Hlth Sci & Counseling, 6-1 Kasuga Kouen, Kasuga, Fukuoka 8168580, Japan

[41] Fukuoka Inst Technol, Fac Socioenvironm Studies, Dept Socioenvironm Studies, Higashi Ku, 3-30-1 Wajiro Higashi, Fukuoka 8110295, Japan

[42] Natl Ctr Global Hlth & Med, Ctr Clin Sci, Dept Epidemiol & Prevent, Shinjyuku Ku, 1-21-1 Toyama, Tokyo 1628655, Japan

[43] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Psychol Med, Gerontol Res Programme, Singapore, Singapore

[44] Tohoku Univ, Geriatr Behav Neurol, Sendai, Miyagi, Japan

[45] Inst Invest Sanitaria Aragon, Zaragoza, Spain

[46] Univ Zaragoza, Ctr Invest Biomed Red Salud Mental CIBERSAM, Zaragoza, Spain

[47] Univ New South Wales, Dementia Collaborat Res Ctr, Sydney, NSW, Australia

[48] Univ New South Wales, Sch Psychiat, Dept Dev Disabil Neuropsychiat, Kensington, NSW, Australia

来源：

ARCHIVES OF GERONTOLOGY AND GERIATRICS | 2020年 / 91卷

基金：

美国国家卫生研究院; 英国医学研究理事会; 英国惠康基金;

关键词：

Cognitive decline; Education; Ageing; Sex; Age; Ethnicity; MINI-MENTAL-STATE; ALZHEIMERS-DISEASE; SOCIOECONOMIC-STATUS; RACIAL-DIFFERENCES; MEMORY DECLINE; BRAIN RESERVE; FOLLOW-UP; DEMENTIA; METAANALYSIS; ASSOCIATION;

D O I：

10.1016/j.archger.2020.104112

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

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.

引用

页数：11

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