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Examining possible gender differences in the association between education and late‐life cognitive function in the LifeAfter90 Study, a large multiethnic cohort of the oldest‐old
Author(s) -
Gilsanz Paola,
Corrada Maria M,
Mungas Dan M,
Glymour M Maria,
Kawas Claudia H,
Lam Jennifer O,
Vieira Katharine E,
Peterson Rachel L,
Eng Chloe W,
Quesenberry Charles P,
Whitmer Rachel A
Publication year - 2021
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.056194
Subject(s) - cognition , psychology , cohort , dementia , educational attainment , ethnic group , cognitive test , gerontology , neuropsychology , cognitive decline , developmental psychology , medicine , psychiatry , disease , sociology , pathology , anthropology , economics , economic growth
Background Educational attainment predicts late‐life cognitive ability and dementia. Historically, women have had fewer educational opportunities than men. We examine if the association between educational attainment and cognitive level and decline differ by gender. Method LifeAfter90 is an ongoing cohort of long‐time members of an integrated healthcare delivery system ≥90 years old without a dementia diagnosis at recruitment. Interviews and cognitive assessment occurred every six months and included self‐reported education (≤high school, some college, and ≥college graduate (reference)) and Spanish and English Neuropsychological Assessment Scales (SENAS). SENAS encompasses the domains of verbal episodic memory, semantic memory, and executive function. Mixed models with random intercepts estimated possible differences in the association between education and late‐life cognition adjusting for time (years since baseline), baseline age, race/ethnicity, and practice effects. Practice effects were accounted for by using an indicator variable for the first visit. Interactions terms allowed for possible gender differences in the association of education with baseline cognitive scores (i.e. education*male) and cognitive change (i.e., education*male*time). Result The 669 participants were on average 92.8 years of age, 63% were women, 34% were college graduates, and 69% were racial/ethnic minorities (Table 1 and Table 2). Lower levels of education were associated with worse performance on baseline cognitive assessment but not performance over time. Women with ≤high school or some college averaged worse baseline cognition in each domain than women who had completed college (Table 3). There was no significant gender by education interaction for verbal episodic memory (p‐value=0.22) or semantic memory (p‐value=0.26), but the disadvantage in executive function associated with lower education was significantly attenuated in men (some college*male β=0.32, 95% CI=0.08, 0.56; p‐value=0.01). There were no differences across genders in the association between education and any of the domain specific cognitive scores over time. Conclusion The association between education and late‐life cognitive function appears to be similar across genders with the exception of college completion having a larger effect on baseline executive function scores for women than for men. We will continue to explore these differences as additional visits occur in this ongoing cohort of ethnically diverse oldest‐old individuals.