Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York.
Community and Public Health Promotion, Health and Physical Education Department, Rhode Island College, Providence, Rhode Island.
J Gerontol B Psychol Sci Soc Sci. 2020 Aug 13;75(7):e151-e160. doi: 10.1093/geronb/gbz053.
The objective of this study was to examine the association between education and incidence of accelerated cognitive decline.
Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N = 28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer's disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister studies. Life expectancy ratios (LER) and 95% confidence intervals (CIs) were reported.
This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER = 1.031 95% CI = [1.013-1.015], p < 1E-06). Replication analyses using data from 14 countries identified similar results.
These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
本研究旨在探讨教育程度与认知加速衰退发生率之间的关系。
对美国居民全国代表性前瞻性队列研究——健康与退休研究（HRS）的数据进行二次分析（N=28417）。采用 Cox 比例风险生存模型与纵向混合效应模型相结合，对健康认知老化和与临床前阿尔茨海默病及相关痴呆（ADRD）一致的认知加速衰退发生率进行联合研究。在 HRS 姐妹研究的另一个数据库中进行了复制分析，该数据库包括 62485 名额外的受访者。报告了预期寿命比（LER）和 95%置信区间（CI）。
本研究复制了研究结果，表明教育程度与基线认知能力呈正相关。与单独使用随机斜率模型相比，生存方法的模型拟合度有所提高。对 HRS 数据的分析表明，较高的教育程度与认知加速衰退的发病延迟相关（LER=1.031 95%CI=[1.013-1.015]，p<1E-06）。使用来自 14 个国家的数据进行的复制分析得出了类似的结果。
这些结果与认知储备理论一致，表明教育程度降低了 ADRD 模式认知衰退的风险。后续工作应努力区分涉及的特定痴呆类型，并考虑潜在的机制。
