scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Relationship between education and dementia: an updated systematic review.

01 Oct 2011-Alzheimer Disease & Associated Disorders (Alzheimer Dis Assoc Disord)-Vol. 25, Iss: 4, pp 289-304
TL;DR: It seemed that a more consistent relationship with dementia occurred when years of education reflected cognitive capacity, suggesting that the effect of education on risk for dementia may be best evaluated within the context of a lifespan developmental model.
Abstract: Objective The purpose of this study was to review the relationship between education and dementia.
Citations
More filters
Journal ArticleDOI
16 Mar 2012-Cell
TL;DR: Investigative and drug development efforts should be diversified to fully address the multifactoriality of Alzheimer's disease.

1,558 citations


Cites background from "Relationship between education and ..."

  • ...Potential environmental risk factors for late-onset AD include head injury, low educational levels, hyperlipidemia, hypertension, homocysteinemia, diabetes mellitus, and obesity (Barnes and Yaffe, 2011; Rosendorff et al., 2007; Sharp and Gatz, 2011; Van Den Heuvel et al., 2007)....

    [...]

Journal ArticleDOI
04 Jun 2012-PLOS ONE
TL;DR: This systematic review and meta-analyses covering a wide range of observational studies and diverse settings provides robust support for the CR hypothesis and suggests several avenues for dementia prevention.
Abstract: Background Cognitive reserve (CR) or brain reserve capacity explains why individuals with higher IQ, education, or occupational attainment have lower risks of developing dementia, Alzheimer’s disease (AD) or vascular dementia (VaD). The CR hypothesis postulates that CR reduces the prevalence and incidence of AD or VaD. It also hypothesizes that among those who have greater initial cognitive reserve (in contrast to those with less reserve) greater brain pathology occurs before the clinical symptoms of disease becomes manifest. Thus clinical disease onset triggers a faster decline in cognition and function, and increased mortality among those with initial greater cognitive reserve. Disease progression follows distinctly separate pathological and clinical paths. With education as a proxy we use meta-analyses and qualitative analyses to review the evidence for the CR hypothesis. Methodology/Principal Findings We searched PubMed, PsycoINFO, EMBASE, HealthStar, and Scopus databases from January 1980 to June 2011 for observational studies with clear criteria for dementia, AD or VaD and education. One hundred and thirty-three articles with a variety of study designs met the inclusion criteria. Prevalence and incidence studies with odds ratios (ORs), relative risks or original data were included in the meta-analyses. Other studies were reviewed qualitatively. The studies covered 437,477 subjects. Prevalence and incidence studies with pooled ORs of 2.61 (95%CI 2.21–3.07) and 1.88 (95%CI 1.51–2.34) respectively, showed low education increased the risk of dementia. Heterogeneity and sensitivity tests confirmed the evidence. Generally, study characteristics had no effect on conclusions. Qualitative analyses also showed the protective effects of higher education on developing dementia and with clinical disease onset hastening a decline in cognition and function, and greater brain pathology. Conclusion/Significance This systematic review and meta-analyses covering a wide range of observational studies and diverse settings provides robust support for the CR hypothesis. The CR hypothesis suggests several avenues for dementia prevention.

659 citations


Cites methods from "Relationship between education and ..."

  • ...The most recent review by Sharp and Gatz [23] is also limited in scope and did not use meta-analyses techniques so no pooled estimates of effect are provided....

    [...]

Journal ArticleDOI

568 citations

Journal ArticleDOI
TL;DR: There are a substantial number of people with dementia worldwide and these numbers will continue to increase mainly in LMIC, producing a wide range of impacts, and it is important to make dementia a national public health and social care priority worldwide.

380 citations

References
More filters
Journal ArticleDOI
TL;DR: The criteria proposed are intended to serve as a guide for the diagnosis of probable, possible, and definite Alzheimer's disease; these criteria will be revised as more definitive information becomes available.
Abstract: Clinical criteria for the diagnosis of Alzheimer's disease include insidious onset and progressive impairment of memory and other cognitive functions. There are no motor, sensory, or coordination deficits early in the disease. The diagnosis cannot be determined by laboratory tests. These tests are important primarily in identifying other possible causes of dementia that must be excluded before the diagnosis of Alzheimer's disease may be made with confidence. Neuropsychological tests provide confirmatory evidence of the diagnosis of dementia and help to assess the course and response to therapy. The criteria proposed are intended to serve as a guide for the diagnosis of probable, possible, and definite Alzheimer's disease; these criteria will be revised as more definitive information become available.

26,847 citations

Journal ArticleDOI
TL;DR: The Clinical Dementia Rating (CRD) was developed for a prospective study of mild senile dementia—Alzheimer type (SDAT), and was found to distinguish unambiguously among older subjects with a wide range of cognitive function.
Abstract: Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia--Alzheimer type (SDAT) Reliability, validity, and correlational data are discussed The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired

6,428 citations

Journal ArticleDOI
06 Apr 1994-JAMA
TL;DR: Increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations.
Abstract: Objective. —Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. Design. —Cohort incidence study. Setting. —General community. Participants. —A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. Interventions. —We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. Main Outcome Measure. —Incident dementia. Results. —We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [CI], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% CI, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% CI, 1.32 to 3.84). Conclusions. —The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations. (JAMA. 1994;271:1004-1010)

1,402 citations

Journal ArticleDOI
TL;DR: Regular physical activity could be an important component of a preventive strategy against Alzheimer's disease and many other conditions, and use of nonsteroidal anti-inflammatory drugs, wine consumption, coffee consumption, and regular physical activity were associated with a reduced risk of Alzheimer's Disease.
Abstract: A prospective analysis of risk factors for Alzheimer's disease was a major objective of the Canadian Study of Health and Aging, a nationwide, population-based study. Of 6,434 eligible subjects aged 65 years or older in 1991, 4,615 were alive in 1996 and participated in the follow-up study. All participants were cognitively normal in 1991 when they completed a risk factor questionnaire. Their cognitive status was reassessed 5 years later by using a similar two-phase procedure, including a screening interview, followed by a clinical examination when indicated. The analysis included 194 Alzheimer's disease cases and 3,894 cognitively normal controls. Increasing age, fewer years of education, and the apolipoprotein E epsilon4 allele were significantly associated with increased risk of Alzheimer's disease. Use of nonsteroidal anti-inflammatory drugs, wine consumption, coffee consumption, and regular physical activity were associated with a reduced risk of Alzheimer's disease. No statistically significant association was found for family history of dementia, sex, history of depression, estrogen replacement therapy, head trauma, antiperspirant or antacid use, smoking, high blood pressure, heart disease, or stroke. The protective associations warrant further study. In particular, regular physical activity could be an important component of a preventive strategy against Alzheimer's disease and many other conditions.

1,240 citations


Additional excerpts

  • ...In keeping with the observation that differences in level and quality of educational opportunities available to minorities in the older cohorts may change the meaning of education, some researchers have suggested that literacy or reading level may be a better indicator of what education is thought to represent than years of education in minority groups.89 In an entirely African American sample in Indianapolis, Indiana, Hall et al90 found that the combination of low education and rural residence until 19 years of age greatly increased risk for AD....

    [...]

  • ...AD: Of the 13 studies that analyzed the relationship between low education and risk for AD, 7 studies reported significant effects such that lower education was associated with an increased risk for AD.54,55,57,66,69,72,83 In contrast, 6 other studies reported no significant relationship.55,65,70,71,74,81 Total Dementia: Of the 15 studies that examined whether low education was associated with an increased risk for Total Dementia, 8 studies reported significant effects for low education on risk for Total Dementia.60,64,67,75–78 In contrast, 7 studies reported no significant association.50–53,77,80,85 Both Outcomes: Of the remaining 14 incidence studies that examined both the dementia outcomes, 7 studies found a significant relationship for both the outcomes,56,59,61–63,79,84 a total of 5 reported no significant relationship for either outcome,16,25,58,68,82 and 2 reported only 1 of the outcomes to be significant (1 AD and 1 Total Dementia).58,73...

    [...]

  • ...AD: Of the 13 studies that analyzed the relationship between low education and risk for AD, 7 studies reported significant effects such that lower education was associated with an increased risk for AD.(54,55,57,66,69,72,83) In contrast, 6 other studies reported no significant relationship....

    [...]

  • ...Two studies included in this review were conducted in Israel and reported an effect of low education on risk for AD48 and Total Dementia.49 One study conducted in Nigeria, Africa, did not find a significant association between no education and risk for AD.33 Figure 4 illustrates the results across prevalence and incidence studies within each geographical region....

    [...]

  • ...Across the 31 European studies, 19 studies reported significant associations between education and a dementia outcome,21–24,26,29,54–64 whereas 12 studies reported no significant association.18–20,25,27,50–53,55,58 Of the 27 North American studies, 17 studies reported significant effects of education on dementia risk,30–34,36,37,66,67,69,72,75–79 whereas 10 studies reported no significant associations.16,34,35,65,68,70,71,73,74,77 Of the 18 studies conducted in Asia, 8 studies reported significant associations between education and a dementia outcome,2,38,41–44,83,84 whereas 10 studies reported no significant associations.15,39,40,45,80–82 Of the 9 Latin American studies, 5 reported significant associations between education and a Total Dementia,45–47 whereas 4 studies reported no significant associations.45,85 No studies in Latin America reported on risk for AD....

    [...]