TY - JOUR
T1 - Transitions across cognitive states and death among older adults in relation to education
T2 - A multistate survival model using data from six longitudinal studies
AU - Robitaille, Annie
AU - van den Hout, Ardo
AU - Machado, Robson J.M.
AU - Bennett, David A.
AU - Čukić, Iva
AU - Deary, Ian J.
AU - Hofer, Scott M.
AU - Hoogendijk, Emiel O.
AU - Huisman, Martijn
AU - Johansson, Boo
AU - Koval, Andriy V.
AU - van der Noordt, Maaike
AU - Piccinin, Andrea M.
AU - Rijnhart, Judith J.M.
AU - Singh-Manoux, Archana
AU - Skoog, Johan
AU - Skoog, Ingmar
AU - Starr, John
AU - Vermunt, Lisa
AU - Clouston, Sean
AU - Muniz Terrera, Graciela
N1 - Funding Information:
Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number P01AG043362, Integrative Analysis of Longitudinal Studies of Aging and Dementia. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The OCTO-Twin study was funded by the National Institute on Aging at the National Institutes of Health (Grant number AG08861), The Swedish Council for Working Life and Social Research, The Adlerbertska Foundation, The Hjalmar Svensson Foundation, The Knut and Alice Wallenberg Foundation, The Wenner-Gren Foundations, The Wilhelm and Martina Lundgrens Foundation, and the Swedish Brain Power Consortium. The Lothian Birth Cohort 1921 (LBC1921) was supported by grants from the Biotechnology and Biological Sciences Research Council (BBSRC: Wave 1: SR176), Chief Scientist Office (CSO: Wave 3: CYB/4/505; Wave 4: ETM/55), and the Medical Research Council (MRC: Wave 5: R42550). Ethics permission for the Lothian Birth Cohort 1921 (LBC1921) was obtained from the Lothian Research Ethics Committee (Wave 1: LREC/1998/4/183; Wave 2: LREC/2003/7/23; Wave 3: LREC1702/98/4/183) and the Scotland A Research Ethics Committee (Wave 4: 10/S1103/6; Wave 5: 10/MRE00/87). The Longitudinal Aging Study Amsterdam (LASA) is largely supported by a grant from the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care. The Whitehall II study is supported by grants from the US National Institutes on Aging (R01AG013196; R01AG034454), the UK Medical Research Council (MRC K013351), and British Heart Foundation (RG/13/2/30098). The H70 studies was supported by The Swedish Research Council (11267, 825-2007-7462, 825-2012-5041, 2013-8717, 2015-0283), Swedish Research Council for Health, Working Life and Welfare (no 2001-2849, 2005-0762, 2008-1210, 2001-2835, AGECAP 2013-2300, 2013-2496, Epilife 2006-1506), Alzheimer's Association (IIRG-03-6168), Eivind och Elsa K:son Sylvans stiftelse, Stiftelsen Söderström-Königska Sjukhemmet, Stiftelsen för Gamla Tjänarinnor, Handlaren Hjalmar Svenssons Forskningsfond, Sahlgrenska University Hospital (ALF), Fredrik and Rosa von Malmborgs Foundation for Brain Research, Swedish Brain Power, and Riksbankens Jubileumsfond (P14-0824:1). Rush Alzheimer's Disease Center (RADC) is supported by grants from the National Institute on Aging: R01AG17917, R01AG15819, R01AG22018, R01AG24480, R01AG24871, R01AG26916, R01AG33678, R01AG34374, R21AG30765, K23AG23040, the Illinois Department of Public Health, the Elsie Heller Brain Bank Endowment Fund, and the Robert C. Borwell Chair of Neurological Sciences.
Publisher Copyright:
© 2017 the Alzheimer's Association
PY - 2018/4
Y1 - 2018/4
N2 - Introduction: This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. Methods: Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. Results: Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. Discussion: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.
AB - Introduction: This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. Methods: Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. Results: Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. Discussion: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.
KW - Cognition
KW - Dementia
KW - Education
KW - Life expectancy
KW - Multistate modeling
KW - Socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85040911992&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040911992&partnerID=8YFLogxK
U2 - 10.1016/j.jalz.2017.10.003
DO - 10.1016/j.jalz.2017.10.003
M3 - Article
C2 - 29396108
AN - SCOPUS:85040911992
SN - 1552-5260
VL - 14
SP - 462
EP - 472
JO - Alzheimer's and Dementia
JF - Alzheimer's and Dementia
IS - 4
ER -