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From the Aging Research Center (ARC) (T.N., E.v.S., B.W., M.K.), Karolinska Institutet, Stockholm, Sweden; Departments of Neuroscience and Neurology (T.N., H.S., M.K.) and Public Health and General Practice (E.-L.L.), University of Kuopio, Finland; Division of Geriatric Medicine (B.W., M.K.), Karolinska University Hospital, Huddinge, Sweden; Department of Epidemiology and Health Promotion (A.N., J.T.), National Public Health Institute, Helsinki; Department of Public Health (J.T.), University of Helsinki, Finland; and South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland.
Address correspondence and reprint requests to Dr. Tiia Ngandu, Aging Research Center, Karolinska Institutet, Gävlegatan 16, 11330 Stockholm, Sweden
Background: Low education seems to be associated with an increased risk of dementia and Alzheimer disease (AD). People with low education have unhealthier lifestyles and more cardiovascular risk factors, but it is unclear how this affects the association between education and dementia.
Methods: Participants of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study were derived from random, population-based samples previously studied in a survey in 1972, 1977, 1982, or 1987. After an average follow-up of 21 years, 1,449 individuals (72%) aged 65 to 79 participated in a re-examination in 1998.
Results: Compared to individuals with formal education of 5 years or less, those with 6 to 8 years of education had OR of 0.57 (95% CI 0.29 to 1.13), and those with 9 years of education or more had OR of 0.16 (95% CI 0.06 to 0.41) for dementia. The corresponding ORs for AD were 0.49 (0.24 to 1.00) and 0.15 (0.05 to 0.40). The associations remained unchanged after adjustments for several demographic, socioeconomic, vascular, and lifestyle characteristics. The results were similar among both men and women. ApoE4 did not modify the association, but the risk of dementia and AD was very low among ApoE4 noncarriers with high education.
Conclusions: The association between low education and dementia is probably not explained by the unhealthy lifestyles of the less educated compared with higher educated persons. Higher educated persons may have a greater cognitive reserve that can postpone the clinical manifestation of dementia. Unhealthy lifestyles may independently contribute to the depletion of this reserve or directly influence the underlying pathologic processes.
GLOSSARY: AD = Alzheimer disease; CAIDE = Cardiovascular Risk Factors, Aging and Dementia; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; MMSE = Mini-Mental State Examination; NINCDS-ADRDA = National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association; SBP = systolic blood pressure.
Supported by the Alzheimer Association, USA, the Aging Program of the Academy of Finland, and EVO-grants of Kuopio University Hospital, Finland (5772708, 5772720). Dr. Ngandu was supported by the Helsingin Sanomain 100-vuotissäätiö. Dr. Kivipelto was supported by Academy of Finland grants 103334 and 206951, Swedish Council for Working Life and Social Research, and the Gamla Tjänarinnor Foundation.
Disclosure: The authors report no conflicts of interest.
Received June 20, 2006. Accepted in final form April 27, 2007.
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