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Educational attainment and cognitive decline in old age

From Rush Alzheimer’s Disease Center (R.S.W., L.L.B.), Rush Institute for Healthy Aging (L.E.H., C.F.M.d.L., D.A.E.), and Departments of Neurological Sciences (R.S.W., L.L.B., D.A.E.), Behavioral Sciences (R.S.W., L.L.B.), and Internal Medicine (L.E.H., C.F.M.d.L., D.A.E.), Rush University Medical Center, Chicago, IL; and National Center for Chronic Disease Prevention and Health Promotion (P.A.S.), Centers for Disease Control and Prevention, Atlanta, GA.

Address correspondence and reprint requests to Dr. Robert S. Wilson, Rush Alzheimer’s Disease Center, Rush University Medical Center, 600 South Paulina Avenue, Suite 1038, Chicago, IL 60612 rwilson{at}rush.edu

Background: Level of education is a well-established risk factor for Alzheimer disease but its relation to cognitive decline, the principal clinical manifestation of the disease, is uncertain.

Methods: More than 6,000 older residents of a community on the south side of Chicago were interviewed at approximately 3-year intervals for up to 14 years. The interview included administration of four brief tests of cognitive function from which a previously established composite measure of global cognition was derived. We estimated the associations of education with baseline level of cognition and rate of cognitive change in a series of mixed-effects models.

Results: In an initial analysis, higher level of education was related to higher level of cognition at baseline, but there was no linear association between education and rate of change in cognitive function. In a subsequent analysis with terms to allow for nonlinearity in education and its relation to cognitive decline, rate of cognitive decline at average or high levels of education was slightly increased during earlier years of follow-up but slightly decreased in later years in comparison to low levels of education. Findings were similar among black and white participants. Cognitive performance improved with repeated test administration, but there was no evidence that retest effects were related to education or attenuated education’s association with cognitive change.

Conclusions: The results suggest that education is robustly associated with level of cognitive function but not with rate of cognitive decline and that the former association primarily accounts for education’s correlation with risk of dementia in old age.

Abbreviations: AD = Alzheimer disease.

Supported by National Institute on Aging grants AG 11101 and AG10161 and by National Institute of Environmental Health Sciences grant ES 10902.

Disclosure: The authors report no disclosures.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Received June 25, 2008. Accepted in final form October 23, 2008.

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