Protective Effect Of Education Research Articles

Longitudinal change of intrinsic capacity and associated factors in older Chinese adults: China Health and Retirement Longitudinal Study

BackgroundAlthough intrinsic capacity (IC) has been constructed in older populations, whether IC retains the same structure over time has not been formally examined, nor have the factors associated with the changes in IC over time been thoroughly investigated. This study aimed to establish that the structure of IC remains unchanged over time by testing its longitudinal measurement invariance and to investigate factors that influence the longitudinal change of IC over time. MethodsData came from 7,271 participants aged 60 and older from the China Health and Retirement Longitudinal Study in 2011 (Wave 1) and 2015 (Wave 3). Bifactor confirmatory factor analysis (CFA) was used to construct IC with its domains, and the longitudinal measurement invariance of IC between Waves was tested. ResultsBifactor CFA fitted the data well at both Waves and showed good construct validity. Partial scalar invariance was supported with non-invariant intercepts for delayed word recall, math, and close vision. Decreases in IC were associated with increasing age, being female (−0.030, 95% CI: −0.045, −0.016), living in rural areas (−0.019, 95% CI: −0.030, −0.009), BMI < 18.5 (−0.019, 95% CI: −0.035, −0.003), and hypertension (−0.012, 95% CI: −0.022, −0.001). Increases in IC were associated with higher education (primary school: 0.012, 95% CI: 0.001, 0.024; lower secondary school: 0.023, 95% CI: 0.005, 0.041) and drinking ≥4/week (0.019, 95% CI: 0.003, 0.034). Stratifying the sample by gender, the protective effect of education was observed only in women. ConclusionsThe bifactor structure of the IC construct was valid and retained its meaning over time. Longitudinal changes in IC were associated with various sociodemographic factors, lifestyle, and health conditions, confirming the need to monitor IC for timely intervention, particularly in those with risk factors for IC decline.

Educational Attainment and Risk of All‐Cause Dementia, Vascular Dementia, and Alzheimer’s Disease – A Population‐Based Twin Study

AbstractBackgroundMost studies on the association between educational attainment and dementia have been conducted in unrelated individuals. Dementia‐discordant twin pairs can inform if the protective effect of education on dementia is evident when controlling for environmental and genetic effects. We investigated the association of educational attainment on all‐cause dementia, vascular dementia (VaD), and Alzheimer’s disease (AD) mortality in a population‐based sample of dizygotic (DZ) and monozygotic (MZ) pairs.MethodParticipants were from a population‐based longitudinal older Finnish Twin Cohort study with baseline questionnaire in 1975 (N = 29,784; mean age = 36.9±14.9years). Education was coded as &lt;12 years versus ≥12 years. Registry‐based cause of death data until year 2020 was based on the International Classification of Diseases. We ran individual‐level cox proportional hazard models with sex as a covariate and conditional within‐twin‐pair models for education predicting all‐cause dementia, VaD, and AD mortality. We report hazard ratios (HR) with 95% confidence intervals (CI).ResultIn individual‐level analyses higher education was associated with a decreased risk of all‐cause dementia (HR = .935, 95%CI = .934;.936, p&lt;.001) and VaD (HR = .638, 95%CI = .637;.640, p&lt;.001), but with an increased risk of AD (HR = 1.276, 95%CI = 1.275;1.277, p&lt;.001). In co‐twin analyses of discordant DZ and MZ twin pairs, co‐twins with higher education had lower – although non‐significant – risk of all‐cause dementia (N = 52, HR = .688, 95%CI = .319;1.481, p = .339) or AD (N = 36, HR = .600, 95%CI: .218;1.651, p = .323). Co‐twin analyses were not done for VaD due to small number of discordant pairs (N = 6).ConclusionThis large population‐based sample showed that higher education is related to lower risk of all‐cause dementia and VaD mortality. Unexpectedly, higher education was related to higher AD mortality, but discordant twin pair analyses were informative regarding this counterintuitive result. This case‐control design, controlling for genetic and environmental effects, did not support any causality from higher education to higher AD risk. Despite the large sample, twin pairs – especially MZ twins – discordant for dementia are rare. Meta‐ or mega‐analysis of multiple large twin studies is needed to clarify if secondary education is related to lower risk of dementia, VaD, and AD mortality when controlling for genetic effects.

Disentangling the causal effects of education and participation bias on Alzheimer’s disease using Mendelian Randomization

AbstractBackgroundHigher education has been associated with reduced risk of Alzheimer’s Disease (AD) based on previous epidemiological research. However, the relationship between education and AD could be influenced by participation bias whereby people with higher education may be more likely to be enrolled in studies. In this study, we use two‐sample Mendelian randomization (MR) to investigate the potential effects of education and participation bias on AD and further investigate their relationship.MethodGenome‐wide association summary (GWAS) statistics were obtained from GWAS’s of educational attainment (n = 1,100,000), participation in an optional mental health questionnaire (MHQ) of the UK Biobank (n = 451,036) and AD (n = 94,437). Independent genome‐wide significant (r2 = 0.001, 10Mb window, p&lt;5×10−8) single nucleotide polymorphisms (SNPs) were extracted from the exposure summary statistics and harmonized with the outcome SNPs. Inverse variance weighted (IVW) meta‐analysis was the primary MR method and sensitivity analyses included MR Egger, Weighted Median and Weighted mode. Cochran’s Q statistic was used to test for heterogeneity, MR Egger intercept for pleiotropy, and radial MR to identify outliers.ResultGenetically predicted higher educational attainment was causally associated with a reduced risk of AD (IVW OR [95% CI]: 0.691 [0.548, 0.832], p = 3.29e‐07). Similarly, participation in the MHQ was also associated with a reduction in AD risk (IVW OR [95% CI]: 0.987 [0.975, 0.998], p = 0.031]. Our analysis showed no evidence of heterogeneity or pleiotropy and radial MR analysis did not identify any significant outliers, indicating that our univariate MR analyses were robust.ConclusionUnivariant MR analyses indicated that education and participation were both associated with a reduced risk of AD. However, further investigation using multivariable MR is necessary to fully evaluate their independent effects on AD through multiple clumping and proxy variant identification steps. This will allow us to see if the protective effect of education on AD is mediated by participation bias.

Intimate partner violence and malnutrition among women of reproductive age in Western Africa: A geostatistical analysis.

Intimate partner violence (IPV) is a public health issue, and the experience varies among population sub-groups in Africa. In the West African sub-region, IPV perpetrated against women remains high and is exacerbated by the pertaining cultural milieu. It affects women's health, wellbeing, and nutritional status. We examined the association between women's lifetime experiences of physical, sexual, and emotional IPV and undernutrition by quantifying the association at smaller geographical settings in West African countries. We used a bivariate probit geostatistical technique to explore the association between IPV and undernutrition, combining data from the latest Demographic and Health Survey conducted in ten Western African countries. Bayesian inference relies on Markov chain Monte Carlo simulation. The findings demonstrate spatial clustering in the likelihood of experiencing IPV and being underweight in the regions of Mali, Sierra Leone, Liberia and neighboring Cote d'Ivoire, Ghana, Togo, Benin, Cameroon, and Nigeria. The pattern of clustering was somewhat similar when physical violence was combined with underweight and emotional violence combined with underweight. The findings also indicate protective effects of education, wealth status, employment status, urban residence, and exposure to mass media. Further, the likelihood of experiencing IPV and the likelihood of being underweight or thin declined with age and age-gap between the woman and her partner. The findings provide insight into the location-specific variations that can aid targeted interventions, and underscore the importance of empowering women holistically, in the domains of education, socio-economic and socio-cultural empowerment, in addressing women's vulnerability to IPV and malnutrition (underweight and thinness). Furthermore, IPV prevention programmes will need to address gender inequality and cultural factors such as male dominance that may heighten women's risk of experiencing IPV.

Educational attainment and anxiety in middle-aged and older Europeans

We examined the relationship between educational attainment (EA) and anxiety symptoms in a sample of 77,792 individuals (median age = 64 years, 55% female) from the Survey of Health, Ageing and Retirement in Europe. Using logistic regression, we estimated odds ratio (OR) with 95% confidence interval (CI) for the association between EA (7 educational levels based on International Standard Classification of Education) and anxiety symptoms (12 or more points from the shortened 5-item version of the Beck Anxiety Inventory), adjusting for sociodemographic and health-related factors. We further explored whether the relationship varied by region, sex and age group. Independent of sociodemographic and health-related factors, higher levels of EA were associated with lower odds of anxiety symptoms. The magnitude of this association plateaued at first stage of tertiary education (OR 0.40; 95% CI 0.35–0.47, p < 0.001). The association was stronger in females, middle-aged individuals and in Central and Eastern Europe while not apparent in Northern Europe. Our findings suggest that individuals with higher education might be protected against anxiety throughout life. The protective effect of education against anxiety symptoms is more pronounced in less egalitarian regions and in females.

Education reduces cognitive dysfunction in Alzheimer's disease by changing regional cerebral perfusion: An in-vivo arterial spin labeling study.

Formal education and other cognitive challenges influence brain structure and improve function. It is believed that cognitive activities create a cognitive reserve (CR) that can slow the decline due to aging and neurodegenerative diseases. This study investigated alterations of regional cerebral blood flow (rCBF) associated with high and low CR in different stages of Alzheimer's disease (AD) and examined whether rCBF alteration mediates the relationship between education and cognitive performance. Patients with AD or amnestic mild cognitive impairment (aMCI) and healthy controls were divided into low cognitive reserve (LCR) and high cognitive reserve (HCR) subgroups according to median of education years (≤ 9 vs. > 9 years). The final study population included 89 AD patients (67 LCR, 22 HCR), 74 aMCI patients (44 LCR, 30 HCR), and 66 healthy controls (29 LCR, 37 HCR). All subjects were examined by arterial spin labeling magnetic resonance imaging and a neurocognitive test battery. rCBF was compared among groups by two-way analysis of variance. Mediation analyses were used to explore the relationships among education, rCBF, and cognitive test scores. There were significant interaction effects of disease state (AD, aMCI, HC) and education level (LCR, HCR) on CBF in right hippocampus, posterior cingulate cortex, and right inferior parietal cortex (R_IPC). Education regulated episodic memory score by influencing right hippocampal CBF in HC_HCR and aMCI_HCR subgroups. Our results indicate that the protective effect of education against cognitive dysfunction in early-stage AD is mediated at least partially by altered CBF in right hippocampus.

RACIAL AND ETHNIC DIFFERENCES IN THE LIFE COURSE INFLUENCES OF SOCIOECONOMIC STATUS ON ADULT SYSTEMIC INFLAMMATION

Abstract Two fundamental causes of health disparities in the U.S. are race and socioeconomic status (SES). Although these disparities emerge early in the life course, there is limited research on how race/ethnicity intersects with SES over the life course to influence later-life systemic inflammation—a key pathogenic process of health for older adults. Moreover, life course studies on systemic inflammation often focus on Black/White differences. Analyzing a sample of Black, White, and Hispanic Americans, this study examined the intersecting influences of childhood SES, race/ethnicity, and adult education on three time points of later-life inflammation levels (measured using C-reactive protein [CRP]). Longitudinal mixed-effects models were estimated using a sample of U.S. men (n=4,137) and women (n=6,187) over age 50 from the Health and Retirement Study during a decade of observation (2006-2016). Black men who experienced low childhood SES had higher levels of CRP than White men with low childhood SES; education did not moderate these associations. Education had a stronger protective effect against systemic inflammation for Hispanic men who experienced childhood socioeconomic disadvantage compared to their White counterparts. For women, the protective effect of education on systemic inflammation was stronger for White women compared to Black and Hispanic women. There were no significant childhood SES interactions for women. Findings indicate that the effects of SES on later-life systemic inflammation are contingent upon race/ethnicity, suggesting that intersectionality operates over the life course to produce health disparities in later-life. However, adult education acts as a leveler of life course inequality for Hispanic men.

Integrating genetic correlation, polygenic risk scores, and Mendelian randomization to identify modifiable risk factors for Alzheimer’s disease

AbstractBackgroundTo reduce the population prevalence of Alzheimer’s disease (AD), it is critical to identify risk factors that modify AD risk. Methods of causal inference that exploit genomic information, such as genetic correlation (rg), polygenic risk scores (PRS) and Mendelian randomization (MR), can overcome some of the limitations of observational studies such as confounding and reverse causation. Here we use rg, PRS, and MR to investigate causal associations between twenty‐two risk factors and eleven AD outcomes.MethodsUsing GWAS summary statistics, rg was estimated using GNOVA and bidirectional MR causal estimates using LHC‐MR. The exposures included alcohol intake, physical activity, lipid traits, blood pressure traits, diabetes, BMI, depression, insomnia, social isolation, smoking, diet, and education. The outcomes included AD, AD age of onset, hippocampal volume, CSF Aβ42, tau, and Ptau181 levels, and amyloid, tau, cerebrovascular neuropathology. PRS for the exposures were constructed using PRSice in ADGC (n = 25,431), ADNI (nmax = 1,718), and ROSMAP (nmax = 1,675), and their association with AD diagnosis, CSF biomarkers, PET imaging, MRI imaging, and neuropathology was evaluated.ResultsAfter accounting for multiple testing, 71, 1, and 38 trait pairs were significant in the rg, PRS, MR models respectively. The only significant trait pair identified across all three methods was a protective effect of higher educational attainment on AD (rg = ‐0.161, p = 3.78e‐14; bPRS [se] = ‐0.07 [0.014], p = 8.88e‐7; bMR [se] = ‐0.21 [0.042], p = 2.43e‐7). Seventeen trait pairs had both significant genetic correlations and causal MR estimates. In particular, increased cortical surface area was positively correlated with higher educational attainment (rg = 0.261, p = 1.46e‐18), with MR indicating that genetically predicted cortical surface area was causally associated with higher education (bMR [se] = 0.27 [0.042], p = 3.21e‐10), but not vice versa (bMR [se] = ‐0.09 [0.072], p = 0.224).ConclusionsWe evaluated causal relationships between risk factors and AD endophenotypes using genomic information. The protective effect of education on AD is supported by genetic correlation, PRS and MR, potentially due to increased cognitive resilience resulting from increased cortical surface area.

Differential returns on education by ethnicity and nativity in a cohort of older white and Asian Americans

AbstractBackgroundAsian Americans generally have lower risk of dementia than white Americans. Education likely protects against dementia via direct development of cognitive reserve and indirectly via income and material resources. However, the protective effects of education may be weaker among Asian Americans due to lower income returns among the foreign‐born. We hypothesized that: (1) the effects of education may be weaker among Asians than whites; (2) the effects of education are weaker among foreign‐born than US‐born individuals.MethodWe followed a cohort of 5,974 Chinese, 4,601 Filipino, 3,071 Japanese, and 131,762 white Kaiser Permanente Northern California members for incident dementia (2002‐2020). We estimated hazard ratios (HRs) with age‐ and sex‐adjusted Cox proportional hazards models to examine whether estimated effects of college education (versus less than college degree) on dementia incidence differed by race/ethnicity (Asian versus white) and nativity (US‐ versus foreign‐born). Models were run for Asian ethnicities pooled and separately due to potential subgroup heterogeneity.ResultMean baseline age was 71.3 years (standard deviation, SD 7.7), and mean follow‐up time was 9.5 years (SD 4.6). The estimated effect of college education appeared slightly more protective against dementia incidence among Asian Americans than whites (HR 0.84 95% CI [0.76‐0.92] in Asian Americans, 0.89 [0.86‐0.91] in whites; Figure). There was heterogeneity across Asian groups. The estimated effect of college education (versus less than college) was most protective in Chinese individuals (0.73 [0.62‐0.85]) and Filipinos (0.80 [0.67‐0.95]), but null in Japanese (1.02 [0.84‐1.23]). College education also appeared more protective in foreign‐born vs. US‐born Asian Americans but not whites. Nativity results were also driven by strong effect modification among Chinese participants; other Asian ethnic group estimates were imprecise.ConclusionContrary to expectations, college education may confer slightly greater protection against dementia for Asian than white Americans, driven by differences among foreign‐born. Due to devaluing of education among immigrants, it is unlikely that social/material resources conferred by high education explain the greater protective effect in Asian Americans. However, there is substantial heterogeneity by Asian ethnicity, and additional work on the mechanisms driving differences by ethnicity and nativity (e.g. bilingualism, selective migration) is needed.

Educational attainment, structural brain reserve and Alzheimer's disease: a Mendelian randomization analysis.

Higher educational attainment is observationally associated with lower risk of Alzheimer's disease. However, the biological mechanisms underpinning this association remain unclear. The protective effect of education on Alzheimer's disease may be mediated via increased brain reserve. We used two-sample Mendelian randomization to explore putative causal relationships between educational attainment, structural brain reserve as proxied by MRI phenotypes and Alzheimer's disease. Summary statistics were obtained from genome-wide association studies of educational attainment (n = 1 131 881), late-onset Alzheimer's disease (35 274 cases, 59 163 controls) and 15 measures of grey or white matter macro- or micro-structure derived from structural or diffusion MRI (nmax = 33 211). We conducted univariable Mendelian randomization analyses to investigate bidirectional associations between (i) educational attainment and Alzheimer's disease; (ii) educational attainment and imaging-derived phenotypes; and (iii) imaging-derived phenotypes and Alzheimer's disease. Multivariable Mendelian randomization was used to assess whether brain structure phenotypes mediated the effect of education on Alzheimer's disease risk. Genetically proxied educational attainment was inversely associated with Alzheimer's disease (odds ratio per standard deviation increase in genetically predicted years of schooling = 0.70, 95% confidence interval 0.60, 0.80). There were positive associations between genetically predicted educational attainment and four cortical metrics (standard deviation units change in imaging phenotype per one standard deviation increase in genetically predicted years of schooling): surface area 0.30 (95% confidence interval 0.20, 0.40); volume 0.29 (95% confidence interval 0.20, 0.37); intrinsic curvature 0.18 (95% confidence interval 0.11, 0.25); local gyrification index 0.21 (95% confidence interval 0.11, 0.31)]; and inverse associations with cortical intracellular volume fraction [-0.09 (95% confidence interval -0.15, -0.03)] and white matter hyperintensities volume [-0.14 (95% confidence interval -0.23, -0.05)]. Genetically proxied levels of surface area, cortical volume and intrinsic curvature were positively associated with educational attainment [standard deviation units change in years of schooling per one standard deviation increase in respective genetically predicted imaging phenotype: 0.13 (95% confidence interval 0.10, 0.16); 0.15 (95% confidence interval 0.11, 0.19) and 0.12 (95% confidence interval 0.04, 0.19)]. We found no evidence of associations between genetically predicted imaging-derived phenotypes and Alzheimer's disease. The inverse association of genetically predicted educational attainment with Alzheimer's disease did not attenuate after adjusting for imaging-derived phenotypes in multivariable analyses. Our results provide support for a protective causal effect of educational attainment on Alzheimer's disease risk, as well as potential bidirectional causal relationships between education and brain macro- and micro-structure. However, we did not find evidence that these structural markers affect risk of Alzheimer's disease. The protective effect of education on Alzheimer's disease may be mediated via other measures of brain reserve not included in the present study, or by alternative mechanisms.

Protective effects of education on the cognitive decline in a mental rotation task using real models: a pilot study with middle and older aged adults

Mental rotation is the ability to rotate objects in one’s mind. Large age-related decreases in accuracy and processing time are often found in studies using paper-and-pencil or computerized mental rotation tests. For older participants, these tests are often too difficult. In the present study, real models consisting of cube figures were used to assess the mental rotation performance of middle and older aged adults. It should be investigated whether these tests were comparable to paper-and-pencil or chronometric tests and if very old participants were able to solve them. Eighty-four participants (49 females) between 40 and 90 years took part and were divided into middle (40–68 years) and older aged (69–90 years) and groups with higher (with college degree) and lower education (without college degree). For accuracy, main effects of gender and age group as well as interactions of age group and education were found. Younger participants outperformed older ones only in the group with lower education. For processing time, a main effect of age group as well as an interaction of age group and education was found. The age-related cognitive decline in the higher educated group was moderate, while a large effect appeared for the group without college degree. Age and gender effects of our new test with real objects were comparable to paper–pencil and computerized tests. Furthermore, a protective effect of education on the cognitive decline in mental rotation performance is discussed.

Education and Literacy as Risk Factors of Dementia after Stroke and Transient Ischemic Attack: NEDICES Study.

A protective effect of education on cognitive decline after stroke has been claimed, but evidence from prospective population-based cohorts is very limited. The differential role of literacy and education on dementia after stroke remains unexplored. This research addresses the role of education and literacy in dementia incidence after stroke and transient ischemic attack (TIA). 131 participants with stroke or TIA were identified within the population-based NEDICES study (N = 5,278 persons). Participants were fully assessed at baseline (1994-1995) and incident dementia diagnosis was made by expert neurologists (DSM-IV criteria) after a mean follow-up of 3.4 years. Adjusted Cox regression analyses were applied to test the association between education, literacy, and dementia risk. Within the 131 subjects with stroke or TIA, 19 (14%) developed dementia at follow-up. The Cox's regression model (age and sex adjusted) showed that low education (HR = 3.48, 95% CI = 1.28, 9.42, p = 0.014) and literacy (HR = 3.16, 95% CI = 1.08, 9.22, p = 0.035) were significantly associated with a higher dementia risk. Low education was also associated with dementia when main confounders (i.e., cognitive/functional performance) were considered in the Cox's model. However, after including stroke recurrence, only low/null literacy (versus education) remained as significant predictor of dementia. Finally, low/null literacy showed an effect over-and-above education on dementia risk when both factors were introduced in the adjusted Cox's regression. These findings underline the importance of literacy to estimate cognitive decline after stroke in low-educated populations.

The relationship between women\u2019s individual empowerment and the support to female genital cutting continuation: a study on 7 African countries

Female genital mutilation/cutting (FGM/C) is still present in many African countries, as well as a few others. The United Nations has targeted women’s empowerment in terms of both women’s health and gender equality as one of its Sustainable Development Goals. In this paper, we aimed to study the possible link between women’s empowerment and support for the continuation of FGM/C. We used DHS data from seven African countries and considered both the empowerment and FGM/C modules. We selected empowerment variables based on Kabeer’s conceptual framework and used multilevel logistic models to evaluate the putative role of empowerment in support for discontinuing the practice. The multilevel models highlighted the protective effect of education. Other variables, including justification of intimate partner violence (IPV) and having experienced FGM/C, were associated with FGM/C support. The relationship between decision-making and FGM/C support appears complex, while the unmet need for contraception and job conditions do not seem to play a role. Our findings confirm that some aspects of women’s empowerment (education and rejection of IPV) may enhance the discontinuation of FGM/C. However, the relationship between empowerment and support for continuation of FGM/C is complex and should not be treated as self-evident. Thus, using DHS data, we empirically support the UN’s proposal for discontinuing FGM/C through sustaining women’s empowerment.

Education and Cardiovascular Health as Effect Modifiers of APOE ε4 on Dementia: The Atherosclerosis Risk in Communities Study.

Both education and cardiovascular risk factors are strongly associated with dementia risk. However, it is not clear whether these associations persist or vary among individuals with high genetic risk for Alzheimer's disease. We examined the interactive relationship between lifestyle and genetic dementia risk factors in a prospective cohort study. Our data came from the Atherosclerosis Risk in Communities study participants (n = 13 715; baseline age 45-64; 25% Black; 55% female), who were followed for incident dementia from 1987 through 2017. We used Cox proportional hazard models to estimate the risk of dementia (ascertained through in-person examination, telephone cognitive screeners, and/or hospital and death records) associated with baseline education and cardiovascular risk factors (measured using the American Heart Association's "Life Simple 7") among ε4 carriers and non-carriers separately. We also examined differences by race and sex. Two thousand two hundred and twenty-six incident dementia cases occurred over a median 25 years of follow-up. Lower educational attainment and poorer cardiovascular health were associated with greater risk of incident dementia. There was an education by apolipoprotein E (APOE) status interaction (p = .005) whereby the association of education and dementia was weaker for ε4 carriers (HR college graduates vs less than high school: 0.71 [0.59-0.84] than non-carriers (0.54 [0.47-0.63]). There was no interaction between APOE status and cardiovascular health on dementia risk. These relationships did not vary significantly by race or sex. Education and cardiovascular health were associated with lower dementia risk regardless of APOE genotype, though the protective effects of education were somewhat diminished among ε4 carriers.

Curiosity-Based Interventions Increase Everyday Functioning Score But Not Serum BDNF Levels in a Cohort of Healthy Older Adults.

An enriched environment is effective in stimulating learning and memory in animal models as well as in humans. Environmental enrichment increases brain-derived neurotrophic factor (BDNF) in aged rats and reduces levels of Alzheimer-related proteins in the blood, including amyloid-β (Aβ) peptides and misfolded toxic forms of tau. To address whether stimulation of curiosity, which is a form of enrichment, may provide a buffer against Alzheimer’s disease (AD), we measured levels of biomarkers associated with AD at baseline and after a 6-week intervention in older adults (>65 years of age) randomized to one of three different intervention conditions. Specifically, in this pilot study, we tested the effectiveness of a traditional, structured learning environment compared to a self-motivated learning environment designed to stimulate curiosity. There were no significant differences from baseline to post-intervention in any of the groups for Aβ42/Aβ40 ratio or t-tau (total-tau) plasma levels. Serum BDNF levels decreased significantly in the control group. Interestingly, individuals who had the lowest serum BDNF levels at baseline experienced significantly higher increases in BDNF over the course of the 6-week intervention compared to individuals with higher serum BDNF levels at baseline. As expected, older individuals had lower MoCA scores. Years of education correlated negatively with Aβ levels, suggesting a protective effect of education on levels of this toxic protein. ECog scores were negatively correlated with BDNF levels, suggesting that better performance on the ECog questionnaire was associated with higher BDNF levels. Collectively, these findings did not suggest that a 6-week cognitive training intervention focused on curiosity resulted in significant alterations in blood biomarkers but showed interesting correlations between cognitive scores and BDNF levels, further supporting the role of this trophic factor in brain health in older adults.

Social Determinants of Cigarette Smoking among American Women during Pregnancy

Educational attainment is among the most substantial protective factors against cigarette smoking, including during pregnancy. Although Minorities’ Diminished Returns (MDRs) of educational attainment, defined as weaker protective effect of education for racial and ethnic minority groups compared to Non-Hispanic Whites, has been demonstrated in previous studies; such MDRs are not tested for cigarette smoking during pregnancy. To better understand the relevance of MDRs to tobacco use during pregnancy, this study had three aims: firstly, to investigate the association between educational attainment and cigarette smoking in pregnant women; secondly, to compare racial and ethnic groups for the association between educational attainment and cigarette smoking; and thirdly, to explore the mediating effect of poverty status on such MDRs, among American adults during pregnancy. This cross-sectional study explored a nationally representative sample of pregnant American women (n = 338), which was taken from the Population Assessment of Tobacco and Health (PATH; 2013). Current smoking was the outcome. Educational attainment was the independent variable. Region and age were the covariates. Poverty status was the mediator. Race and ethnicity were the effect modifiers. Overall, a higher level of educational attainment (OR = 0.54, p &lt; 0.05) was associated with lower odds of current smoking among pregnant women. Race (OR = 2.04, p &lt; 0.05) and ethnicity (OR = 2.12, p &lt; 0.05) both showed significant interactions with educational attainment on smoking, suggesting that the protective effect of educational attainment against smoking during pregnancy is smaller for Blacks and Hispanics than Non-Hispanic Whites. Poverty status fully mediated the above interactions. In the United States, highly educated pregnant Black and Hispanic women remain at higher risk of smoking cigarettes, possibly because they are more likely to live in poverty, compared to their White counterparts. The results suggest the role that labor market discrimination has in explaining lower returns of educational attainment in terms of less cigarette smoking by racial and ethnic minority pregnant women.

Does the association between cognition and education differ between older adults with gradual or rapid trajectories of cognitive decline?

ABSTRACT Education is associated with improved baseline cognitive performance in older adults, but the association with maintenance of cognitive function is less clear. Education may be associated with different types of active cognitive reserve in those following different cognitive trajectories. We used data on n = 5642 adults aged >60 from the English Longitudinal Study of Aging (ELSA) over 5 waves (8 years). We used growth mixture models to test if the association between educational attainment and rate of change in verbal fluency or immediate recall varied by latent class trajectory. For recall, 91.5% (n = 5164) of participants were in a gradual decline class and 8.5% (n = 478) in a rapid decline class. For fluency, 90.0% (n = 4907) were in a gradual decline class and 10.0% (n = 561) were in a rapid decline class. Educational attainment was associated with improved baseline performance for both verbal fluency and recall. In the rapidly declining classes, educational attainment was not associated with rate of change for either outcome. In the verbal fluency gradual decline class, education was associated with higher (an additional 0.05–0.38 words per 2 years) or degree level education (an additional 0.04–0.42 words per 2 years) when compared to those with no formal qualifications. We identified no evidence of a protective effect of education against rapid cognitive decline. There was some evidence of active cognitive reserve for verbal fluency but not recall, which may reflect a small degree of domain-specific protection against age-related cognitive decline.

Interaction effect of Alzheimer's disease pathology and education, occupation, and socioeconomic status as a proxy for cognitive reserve on cognitive performance: in vivo positron emission tomography study.

Educational attainment, occupation, and socioeconomic status have been regarded as major factors influencing cognitive reserve (CR). This study aimed to investigate the interaction effect of amyloid-β/tau burden and education/occupation/socioeconomic status as a proxy for CR on cognitive performance. We analyzed the datasets of the Alzheimer's Disease Neuroimaging Initiative. We included clinically normal subjects and patients with mild cognitive impairment or Alzheimer's disease who had undergone a florbetapir scan within 1 year of a flortaucipir (AV-1451) scan (n = 127). Partial correlation analysis between the standardized uptake value ratio of florbetapir/AV-1451 and the proxy for CR was performed with the 13-item Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) score as a covariate. Stepwise multiple linear regression analysis was performed to determine the predictors of ADAS-cog performance based on the interaction between the imaging biomarkers and the proxy for CR. We found a significant positive partial correlation between educational level and tau pathology in Braak stage 1/2 areas, and we observed significantly higher tau accumulation among participants with higher education when ADAS-cog score was used as a covariate. The interaction between tau and education was a good predictor of cognitive function, with higher tau accumulation showing a greater association with higher ADAS-cog score among participants with less education than among those with more education. Our findings indicate the protective effect of education against cognitive dysfunction in early-stage Alzheimer's disease pathology and suggest that education may exert a beneficial effect by reducing the adverse cognitive consequences of tau aggregation.

Second-Hand Smoke Exposure at Home in the United States; Minorities' Diminished Returns.

Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. Minorities' Diminished Returns (MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American adults. This cross-sectional study included 18,274 non-smoking adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013). The independent variables were educational attainment and poverty status. The dependent variable was second-hand smoke exposure at home. Age and region of residence were the covariates. Ethnicity was the moderator. Overall, individuals with a higher educational attainment (odds ratio [OR] = 0.76, 95% CI = 0.74-0.79) and those who lived out of poverty (OR = 0.56, 95% CI =0.51-0.62) had lower odds of second-hand smoke exposure at home. Hispanic ethnicity showed significant interactions with both SES indicators, suggesting that the protective effects of education and poverty on second-hand smoke exposure at home are smaller for Hispanics (ORs for interaction with education and poverty status = 1.30 and 1.26, P < 0.05) than for Non-Hispanics. In the US, high SES Hispanics remain at high risk of exposure to second-hand smoke at home despite a high education and income. High SES better reduces environmental exposures for non-Hispanic than for Hispanic individuals.

Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

BackgroundAdolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example.MethodsThis study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS.ResultsThis study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use.ConclusionsIn the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.