Contador Israel, Del Ser Teodoro, Llamas Sara, Villarejo Alberto, Benito-León Julián, Bermejo-Pareja Félix
a Department of Basic Psychology , Psychobiology and Methodology of Behavioral Science, University of Salamanca , Salamanca , Spain.
b Alzheimer Project Research Unit, Fundación CIEN , Madrid , Spain.
J Clin Exp Neuropsychol. 2017 Mar;39(2):112-119. doi: 10.1080/13803395.2016.1204992. Epub 2016 Aug 2.
The effect of different educational indices on clinical diagnosis of dementia requires more investigation.
We compared the differential influence of two educational indices (EIs): years of schooling and level of education (i.e., null/low literacy, can read and write, primary school, and secondary school) on global cognition, functional performance, and the probability of having a dementia diagnosis.
A total of 3,816 participants were selected from the population-based study of older adults "Neurological Disorders in Central Spain" (NEDICES). The 37-item version of the Mini-Mental State Examination (MMSE-37) and the Pfeffer's questionnaire were applied to assess cognitive and functional performance, respectively. The diagnosis of dementia was performed by expert neurologists according to Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria. Logistic regression models adjusted for potential confounders were carried out to test the association between the two EIs and dementia diagnosis.
Both EIs were significantly associated with cognitive and functional scores, but individuals with null/low literacy performed significantly worse on MMSE-37 than literates when these groups were compared in terms of years of schooling. The two EIs were also related to an increased probability of dementia diagnosis in logistic models, but the association's strength was stronger for level of education than for years of schooling.
Literacy predicted cognitive performance over and above the years of schooling. Lower education increases the probability of having a dementia diagnosis but the impact of different EIs is not uniform.
不同教育指标对痴呆症临床诊断的影响需要更多研究。
我们比较了两个教育指标（EI）：受教育年限和教育水平（即无识字能力/低识字能力、能读写、小学和中学）对整体认知、功能表现以及痴呆症诊断概率的差异影响。
从基于人群的老年人研究“西班牙中部神经系统疾病”（NEDICES）中选取了3816名参与者。分别应用简易精神状态检查表（MMSE - 37）的37项版本和 Pfeffer问卷来评估认知和功能表现。痴呆症的诊断由专家神经科医生根据《精神疾病诊断与统计手册》第四版（DSM - IV）标准进行。进行了针对潜在混杂因素进行调整的逻辑回归模型，以检验两个EI与痴呆症诊断之间的关联。
两个EI均与认知和功能评分显著相关，但在受教育年限方面进行比较时，无识字能力/低识字能力的个体在MMSE - 37上的表现明显比有识字能力的个体差。在逻辑模型中，两个EI也与痴呆症诊断概率增加有关，但教育水平的关联强度比受教育年限更强。
识字能力在受教育年限之外还能预测认知表现。较低的教育水平会增加痴呆症诊断的概率，但不同EI的影响并不一致。
