Abstract
BackgroundEducation has been robustly associated with cognitive reserve and dementia, but not with the rate of cognitive aging, resulting in some confusion about the mechanisms of cognitive aging. This study uses longitudinal data to differentiate between trajectories indicative of healthy versus pathologic cognitive aging. MethodsParticipants included 9401 Health and Retirement Study respondents aged ≥55 years who completed cognitive testing regularly over 17.3 years until most recently in 2012. Individual-specific random change-point modeling was used to identify age of incident pathologic decline; acceleration is interpreted as indicating likely onset of pathologic decline when it is significant and negative. ResultsThese methods detect incident dementia diagnoses with specificity/sensitivity of 89.3%/44.3%, 5.6 years before diagnosis. Each year of education was associated with 0.09 (95% confidence interval [CI], 0.087–0.096; P < .001) standard deviation higher baseline cognition and delayed onset of cognitive pathology (hazard ratio, 0.98; 95% CI, 0.96–0.99; P = .006). ConclusionsLongitudinal random change-point modeling was able to reliably identify incident dementia. Accounting for incident cognitive pathology, we find that education predicts cognitive capability and delayed onset pathologic declines.
Highlights
Dementia affects as many as 5 million Americans living with the disease and 15.5 million engaged in caring for friends or family [1]
We differentiate “healthy” from “pathologic” aging to examine the role of education on cognitive aging and find preliminary support for the view that education is associated with cognitive aging
We found some support for the documented association between education and baseline capability and further found a strong association with delayed onset of cognitive pathology
Summary
Dementia affects as many as 5 million Americans living with the disease and 15.5 million engaged in caring for friends or family [1]. Dementia is characterized by rapid changes in individual capabilities and behaviors [2] but most commonly affects domains of “fluid cognition” including memory, executive functioning, fluency, and mental status [3]. Sociologic theory suggests that social factors should influence healthy aging because they determine access to resources, including for instance knowledge or money, that are known to broadly influence health and disease [8,9]. Education is further associated with “cognitive reserve,” the brain’s ability to maintain healthy functioning into old age despite increasing neuropathology [10], which is believed to be attained in part through an association with higher cognitive capability [11,12] and associated brain functional efficiency [10]. Education modifies access to many resources commonly implicated in maintenance of cognitive reserve over an entire life course [3,13]
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