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

Makkar, Steve; Lipnicki, Darren; Crawford, John; Kochan, Nicole A; Castro-Costa, Erico; Lima-Costa, Maria Fernanda; Satler Diniz, Breno; Brayne, Carol; Stephan, Blossom CM; Llibre-Rodriguez, Juan J.; Anstey, Kaarin; Cherbuin, Nicolas

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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...[Show more]

dc.contributor.authorMakkar, Steve
dc.contributor.authorLipnicki, Darren
dc.contributor.authorCrawford, John
dc.contributor.authorKochan, Nicole A
dc.contributor.authorCastro-Costa, Erico
dc.contributor.authorLima-Costa, Maria Fernanda
dc.contributor.authorSatler Diniz, Breno
dc.contributor.authorBrayne, Carol
dc.contributor.authorStephan, Blossom CM
dc.contributor.authorLlibre-Rodriguez, Juan J.
dc.contributor.authorAnstey, Kaarin
dc.contributor.authorCherbuin, Nicolas
dc.date.accessioned2022-07-25T05:15:27Z
dc.identifier.issn0167-4943
dc.identifier.urihttp://hdl.handle.net/1885/269911
dc.description.abstractBackground: 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.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherElsevier BV
dc.rights© 2020 The authors
dc.sourceArchives of Gerontology and Geriatrics
dc.subjectCognitive decline
dc.subjectEducation
dc.subjectAgeing
dc.subjectSex
dc.subjectAge
dc.subjectEthnicity
dc.titleEducation and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume91
dc.date.issued2020
local.identifier.absfor420301 - Aged health care
local.identifier.ariespublicationa383154xPUB14650
local.publisher.urlhttps://www.sciencedirect.com/
local.type.statusPublished Version
local.contributor.affiliationMakkar, Steve, The Sax Institute
local.contributor.affiliationLipnicki, Darren, University of New South Wales
local.contributor.affiliationCrawford, John, University of New South Wales
local.contributor.affiliationKochan, Nicole A, University of New South Wales
local.contributor.affiliationCastro-Costa, Erico, Instituto Rene Rachou da Fundacao Oswaldo Cruz
local.contributor.affiliationLima-Costa, Maria Fernanda, Rene Rachou Research Institute, Oswaldo Cruz Foundation
local.contributor.affiliationSatler Diniz, Breno, University Toronto
local.contributor.affiliationBrayne, Carol, Cambridge University
local.contributor.affiliationStephan, Blossom CM, Newcastle University
local.contributor.affiliationLlibre-Rodriguez, Juan J., Medical University of Havana
local.contributor.affiliationAnstey, Kaarin, College of Health and Medicine, ANU
local.contributor.affiliationCherbuin, Nicolas, College of Health and Medicine, ANU
local.description.embargo2099-12-31
dc.relationhttp://purl.org/au-research/grants/nhmrc/1093083
dc.relationhttp://purl.org/au-research/grants/nhmrc/973302
dc.relationhttp://purl.org/au-research/grants/nhmrc/179805
dc.relationhttp://purl.org/au-research/grants/nhmrc/157125
dc.relationhttp://purl.org/au-research/grants/nhmrc/1002160
local.bibliographicCitation.startpage1
local.bibliographicCitation.lastpage11
local.identifier.doi10.1016/j.archger.2020.104112
dc.date.updated2021-08-01T08:23:40Z
CollectionsANU Research Publications

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