Cobb J L, Wolf P A, Au R, White R, D'Agostino R B
Department of Mathematics, Boston University, MA, USA.
Neurology. 1995 Sep;45(9):1707-12. doi: 10.1212/wnl.45.9.1707.
To evaluate whether low educational attainment is a risk factor for the incidence of dementia and Alzheimer's disease (AD) in the Framingham Study and to determine whether age at onset of dementia is earlier in persons with low educational levels.
A community-based cohort was studied longitudinally for the development of dementia. Diagnosis was made according to strict criteria by two neurologists and a neuropsychologist. Subtype of dementia and year at onset were determined. Incidence rates were compared in three education groups: < grade school, < high school, and > or = high school.
A total of 3,330 men and women aged 55 to 88 years.
During 17 years of follow-up, 258 incident cases of dementia, including 149 AD cases, were identified. Unadjusted incidence rates were significantly elevated (p < 0.05) for dementia and non-AD dementia among the least educated. The age-adjusted relative risk for subjects with a grade school education or less compared with those who earned a high school diploma was 1.31 (95% confidence interval [CI], 0.90 to 1.90) for dementia generally, 1.04 (95% CI, 0.62 to 1.74) for AD, and 1.75 (95% CI, 1.03 to 2.98) for non-AD dementia. Age at onset of dementia did not vary by educational attainment.
After age adjustment, low educational attainment was not a significant risk factor for the incidence of dementia generally or of AD. Low educational attainment was associated with increased risk of non-AD dementia, perhaps because of deleterious smoking habits and other risk factors for stroke in the least-educated individuals. Adequately adjusting for age and examining subtypes of dementia are important in assessing the influence of education on dementia incidence.
在弗雷明汉姆研究中评估低教育程度是否为痴呆症和阿尔茨海默病（AD）发病的危险因素，并确定痴呆症发病年龄在低教育水平人群中是否更早。
对一个基于社区的队列进行纵向研究，以观察痴呆症的发展情况。由两位神经科医生和一位神经心理学家根据严格标准进行诊断。确定痴呆症亚型和发病年份。比较三个教育程度组（小学以下、高中以下、高中及以上）的发病率。
共3330名年龄在55至88岁之间的男性和女性。
在17年的随访期间，共识别出258例痴呆症发病病例，其中包括149例AD病例。未调整的发病率在受教育程度最低的人群中，痴呆症和非AD痴呆症均显著升高（p<0.05）。小学及以下教育程度的受试者与获得高中文凭的受试者相比，痴呆症总体的年龄调整相对风险为1.31（95%置信区间[CI]，0.90至1.90），AD为1.04（95%CI，0.62至1.74），非AD痴呆症为1.75（95%CI，1.03至2.98）。痴呆症发病年龄不受教育程度影响。
年龄调整后，低教育程度一般不是痴呆症或AD发病的显著危险因素。低教育程度与非AD痴呆症风险增加有关，这可能是因为受教育程度最低的个体存在有害吸烟习惯和其他中风危险因素。在评估教育对痴呆症发病率的影响时，充分调整年龄并检查痴呆症亚型很重要。
