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Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies
Author(s) -
Robitaille Annie,
Hout Ardo,
Machado Robson J.M.,
Bennett David A.,
Čukić Iva,
Deary Ian J.,
Hofer Scott M.,
Hoogendijk Emiel O.,
Huisman Martijn,
Johansson Boo,
Koval Andriy V.,
Noordt Maaike,
Piccinin Andrea M.,
Rijnhart Judith J.M.,
SinghManoux Archana,
Skoog Johan,
Skoog Ingmar,
Starr John,
Vermunt Lisa,
Clouston Sean,
Muniz Terrera Graciela
Publication year - 2018
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 - 10.1016/j.jalz.2017.10.003
Subject(s) - socioeconomic status , cognitive impairment , cognition , psychology , longitudinal study , gerontology , educational attainment , longitudinal data , demography , developmental psychology , medicine , psychiatry , sociology , political science , population , pathology , law
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.