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

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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.date.issued2020
dc.date.updated2021-08-01T08:23:40Z
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.en_AU
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn0167-4943en_AU
dc.identifier.urihttp://hdl.handle.net/1885/269911
dc.language.isoen_AUen_AU
dc.publisherElsevier BVen_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/1093083en_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/973302en_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/179805en_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/157125en_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/1002160en_AU
dc.rights© 2020 The authorsen_AU
dc.sourceArchives of Gerontology and Geriatricsen_AU
dc.subjectCognitive declineen_AU
dc.subjectEducationen_AU
dc.subjectAgeingen_AU
dc.subjectSexen_AU
dc.subjectAgeen_AU
dc.subjectEthnicityen_AU
dc.titleEducation and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairmenten_AU
dc.typeJournal articleen_AU
local.bibliographicCitation.lastpage11en_AU
local.bibliographicCitation.startpage1en_AU
local.contributor.affiliationMakkar, Steve, The Sax Instituteen_AU
local.contributor.affiliationLipnicki, Darren, University of New South Walesen_AU
local.contributor.affiliationCrawford, John, University of New South Walesen_AU
local.contributor.affiliationKochan, Nicole A, University of New South Walesen_AU
local.contributor.affiliationCastro-Costa, Erico, Instituto Rene Rachou da Fundacao Oswaldo Cruzen_AU
local.contributor.affiliationLima-Costa, Maria Fernanda, Rene Rachou Research Institute, Oswaldo Cruz Foundationen_AU
local.contributor.affiliationSatler Diniz, Breno, University Torontoen_AU
local.contributor.affiliationBrayne, Carol, Cambridge Universityen_AU
local.contributor.affiliationStephan, Blossom CM, Newcastle Universityen_AU
local.contributor.affiliationLlibre-Rodriguez, Juan J., Medical University of Havanaen_AU
local.contributor.affiliationAnstey, Kaarin, College of Health and Medicine, ANUen_AU
local.contributor.affiliationCherbuin, Nicolas, College of Health and Medicine, ANUen_AU
local.contributor.authoremailu4038535@anu.edu.auen_AU
local.contributor.authoruidAnstey, Kaarin, u4038535en_AU
local.contributor.authoruidCherbuin, Nicolas, u3184049en_AU
local.description.embargo2099-12-31
local.description.notesImported from ARIESen_AU
local.identifier.absfor420301 - Aged health careen_AU
local.identifier.ariespublicationa383154xPUB14650en_AU
local.identifier.citationvolume91en_AU
local.identifier.doi10.1016/j.archger.2020.104112en_AU
local.identifier.uidSubmittedBya383154en_AU
local.publisher.urlhttps://www.sciencedirect.com/en_AU
local.type.statusPublished Versionen_AU

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