Department of Clinical Neuroscience, Section of Psychology, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Am J Geriatr Psychiatry. 2015 Sep;23(9):885-96. doi: 10.1016/j.jagp.2015.02.002. Epub 2015 Feb 11.
To test a life-course model of cognitive reserve in dementia and examine if school grades around age 10 years, formal educational attainment, and lifetime occupational complexity affect the risk of dementia in old age.
7,574 men and women from the Uppsala Birth Cohort Multigenerational Study were followed for 21 years. Information on school performance, formal education, and occupational attainment was collected prospectively from elementary school archives and population censuses. Dementia diagnosis was extracted from the two Swedish registers. Discrete-time Cox proportional hazard models were estimated.
Dementia was diagnosed in 950 individuals (12.5%). Dementia risk was lower among individuals with higher childhood school grades (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.68 to 0.93) and was lower among individuals in data-complex occupations (HR: 0.77; 95% CI: 0.64 to 0.92). Professional/university education predicted lower risk of dementia in minimally adjusted models (HR: 0.74; 95% CI: 0.60 to 0.91), although the effect faded with adjustment for occupational complexity. Lowest risk was found in the group with both higher childhood school performance and high occupational complexity with data (HR: 0.61; 95% CI: 0.50 to 0.75). Importantly, high occupational complexity could not compensate for the effect of low childhood grades. In contrast, dementia risk was reduced in those with higher school grades, irrespective of occupational complexity.
Higher childhood school performance is protective of dementia risk, particularly when preserved through complex work environments in adulthood, although it will remain protective even in the absence of later-life educational or occupational stimulation.
检验认知储备的毕生模型在痴呆症中的作用，并探讨 10 岁左右的在校成绩、正规教育程度和终生职业复杂性是否会影响老年痴呆症的发病风险。
乌普萨拉出生队列多代研究中的 7574 名男性和女性参与者随访了 21 年。在校成绩、正规教育和职业成就的信息通过小学档案和人口普查进行前瞻性收集。痴呆症的诊断从两个瑞典登记处提取。使用离散时间 Cox 比例风险模型进行估计。
950 名参与者（12.5%）被诊断为痴呆症。在校成绩较高的个体患痴呆症的风险较低（风险比 [HR]：0.79；95%置信区间 [CI]：0.68 至 0.93），从事数据复杂职业的个体的风险较低（HR：0.77；95% CI：0.64 至 0.92）。在最小调整模型中，接受专业/大学教育可预测痴呆症风险较低（HR：0.74；95% CI：0.60 至 0.91），尽管在校成绩较高的个体的职业复杂性调整后，这种影响会减弱。在校成绩较高且职业数据复杂的个体风险最低（HR：0.61；95% CI：0.50 至 0.75）。重要的是，高职业复杂性不能弥补低儿童成绩的影响。相比之下，无论职业复杂性如何，在校成绩较高都能降低痴呆症的发病风险。
较高的儿童在校成绩可预防痴呆症的发病风险，尤其是在成年后保持复杂的工作环境时，尽管即使没有以后的教育或职业刺激，也会保持保护作用。
