Institute for Sociology and Demography, University of Rostock, Ulmenstr. 69, 18057, Rostock, Germany.
BMC Public Health. 2024 Sep 27;24(1):2584. doi: 10.1186/s12889-024-20156-x.
Education has been shown to be positively associated with cognitive performance. However, the pathways via lifestyle-related disease through which education is related to cognitive performance have not been sufficiently explored. Diabetes is an important lifestyle-related disease with increasing prevalence worldwide. Low education is associated with an increased risk of developing diabetes, while diabetes may also lead to a deterioration in cognitive performance. This study aims to explore if the associations between education and cognitive function is mediated by the diabetes status among older adults.
The data utilized in this study were derived from the first two waves of the Dutch Lifelines Cohort Study (2006-2015). The analyzed sample included 26,131 individuals aged 50 years or above at baseline. The baseline assessment included measurements of educational attainment (exposure) and the potential mediator diabetes. The outcome of cognitive function was assessed using age-standardized reaction times from the psychomotor function and attention tasks, as measured by the Cogstate Brief Battery. The Cogstate Brief Battery was only conducted at the follow-up assessment, not at the baseline assessment. Faster reaction times correspond to higher cognitive performance. The study employed linear and logistic regression models, in addition to a causal mediation approach which estimated the average causal mediation effect (ACME).
Higher education was associated with a lower risk of diabetes (b= -0.1976, 95%CI= -0.3354; -0.0597) compared to low or middle education as well as with faster reaction times (b= -0.2023, 95%CI= -0.2246; -0.1798), implying better cognitive function. Diabetes was associated with slower reaction times (b = 0.0617, 95%CI = 0.0162; 0.1072). Most importantly, the mediation approach identified a significant indirect effect of education on cognitive function via the diabetes status (ACME= -0.00061, 95%CI= -0.00142; -0.00011).
The findings emphasize the potentially importance of diabetes in explaining the role of education in promoting healthy cognitive function and mitigating the risk of cognitive decline. Early detection and treatment of diabetes may be particularly beneficial for individuals with low or middle levels of education in order to maintain good levels of cognitive function.
教育与认知表现呈正相关。然而，通过与生活方式相关的疾病来研究教育与认知表现之间的关系的途径还没有得到充分的探索。糖尿病是一种重要的与生活方式相关的疾病，其在全球的患病率正在不断上升。受教育程度较低与患糖尿病的风险增加有关，而糖尿病也可能导致认知表现恶化。本研究旨在探讨在老年人中，糖尿病的患病状况是否在教育与认知功能之间的关联中起中介作用。
本研究的数据来自荷兰 Lifelines 队列研究的前两个波次（2006-2015 年）。分析的样本包括 26131 名基线时年龄在 50 岁及以上的个体。基线评估包括教育程度（暴露因素）和潜在的中介变量糖尿病的测量。认知功能的结果使用 Cogstate 简明电池的精神运动功能和注意力任务的年龄标准化反应时间来评估。Cogstate 简明电池仅在随访评估中进行，而不在基线评估中进行。较快的反应时间对应较高的认知表现。本研究采用了线性和逻辑回归模型，以及因果中介分析方法来估计平均因果中介效应（ACME）。
与低或中等教育相比，较高的教育程度与较低的糖尿病患病风险（b=-0.1976，95%CI=-0.3354；-0.0597）和较快的反应时间（b=-0.2023，95%CI=-0.2246；-0.1798）相关，提示更好的认知功能。糖尿病与较慢的反应时间（b=0.0617，95%CI=0.0162；0.1072）相关。最重要的是，中介分析方法确定了教育程度通过糖尿病状况对认知功能的显著间接影响（ACME=-0.00061，95%CI=-0.00142；-0.00011）。
这些发现强调了糖尿病在解释教育促进健康认知功能和降低认知能力下降风险中的作用的重要性。早期发现和治疗糖尿病可能对受教育程度较低的个体尤其有益，以保持良好的认知功能水平。
