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Vol. 26, No. 2, 2006
Issue release date: February 2006
Free Access
Neuroepidemiology 2006;26:93–101
(DOI:10.1159/000090254)

The Relation of Education and Income to Cognitive Function among Professional Women

Lee S.a · Buring J.E.b-d · Cook N.R.b · Grodstein F.c-e
aDepartment of Health and Behavioral Sciences, University of Colorado at Denver and Health Sciences Center, Denver, Colo., bDepartment of Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, cDepartment of Epidemiology, Harvard School of Public Health, dDivision of Aging and eChanning Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass., USA
email Corresponding Author

Abstract

We investigated the relation of educational attainment and annual household income to cognitive function and cognitive decline in community-dwelling women aged 66 years or older. Subjects were 6,314 health professionals participating in the Women’s Health Study, among whom information on education and income was self-reported. From 1998 to 2000, we administered five cognitive tests, measuring general cognition, episodic memory and verbal fluency, using a validated telephone interview. Second cognitive assessments were conducted approximately 2 years later; information was complete for 5,573 women at the time of analysis, with 94% follow-up. We used linear and logistic regression to calculate multivariate-adjusted mean differences as well as odds of cognitive impairment (defined as worst 10% of test distribution) and of substantial decline in performance (worst 10% of distribution), across various levels of education and income. After adjusting for numerous potential confounding factors, we found strong trends of increasing mean cognitive performance with increasing level of education (p trend < 0.0005 on all cognitive measures). Odds of cognitive impairment also consistently decreased with increasing education. For income, we found significant trends of increasing mean cognitive performance with increasing income on the summary score and on episodic memory (p trends < 0.0001). Results were generally similar for cognitive decline over 2 years, although slightly weaker. Thus, in these well-educated, professional women, educational attainment and income both predicted cognitive function and decline.


 goto top of outline Key Words

  • Educational attainment
  • Income
  • Cognitive function
  • Cognitive decline

 goto top of outline Abstract

We investigated the relation of educational attainment and annual household income to cognitive function and cognitive decline in community-dwelling women aged 66 years or older. Subjects were 6,314 health professionals participating in the Women’s Health Study, among whom information on education and income was self-reported. From 1998 to 2000, we administered five cognitive tests, measuring general cognition, episodic memory and verbal fluency, using a validated telephone interview. Second cognitive assessments were conducted approximately 2 years later; information was complete for 5,573 women at the time of analysis, with 94% follow-up. We used linear and logistic regression to calculate multivariate-adjusted mean differences as well as odds of cognitive impairment (defined as worst 10% of test distribution) and of substantial decline in performance (worst 10% of distribution), across various levels of education and income. After adjusting for numerous potential confounding factors, we found strong trends of increasing mean cognitive performance with increasing level of education (p trend < 0.0005 on all cognitive measures). Odds of cognitive impairment also consistently decreased with increasing education. For income, we found significant trends of increasing mean cognitive performance with increasing income on the summary score and on episodic memory (p trends < 0.0001). Results were generally similar for cognitive decline over 2 years, although slightly weaker. Thus, in these well-educated, professional women, educational attainment and income both predicted cognitive function and decline.

Copyright © 2006 S. Karger AG, Basel


 goto top of outline References
  1. Farmer ME, Kittner SJ, Rae DS, Bartko JJ, Regier DA: Education and change in cognitive function. Ann Epidemiol 1995;5:1–7.
  2. Evans DA, Beckett LA, Albert MS, Hebert LE, Scherr PA, Funkenstein HH, Taylor JO: Level of education and change in cognitive function in a community population of older persons. Ann Epidemiol 1993;3:71–77.
  3. Lyketsos CG, Chen L-S, Anthony JC: Cognitive decline in adulthood: an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area Study. Am J Psychiatry 1999;156:58–65.
  4. Gallacher JE, Elwood PC, Hopkinson C, Patrick MA, Rabbitt PMA, Stollery BT, Sweetnam PM, Brayne C, Huppert FA: Cognitive function in the Caerphilly study: associations with age, social class, education and mood. Eur J Epidemiol 1999;15:161–169.
  5. Cagney KA, Lauderdale DS: Education, wealth, and cognitive function in later life. J Gerontol Psychol Sci 2002;57B:163–172.
  6. Scherr P, Albert M, Funkenstein H, Cook N, Hennekens C, Branch L, White L, Taylor J, Evans D: Correlates of cognitive function in an elderly community population. Am J Epidemiol 1988;128:1084–1101.
  7. Alvarado BE, Zunzunegui M-V, Del Ser T, and Beland F: Cognitive decline is related to education and occupation in a Spanish elderly cohort. Aging Clin Exp Res 2002;14:132–142.
  8. Lee S, Kawachi I, Berkman LF, Grodstein F: Education, other socioeconomic indicators, and cognitive function in older women. Am J Epidemiol 2003;157:712–720.
  9. Seeman TE, Huang M, Bretsky P, Crimmins E, Launer L, Guralnik JM: Education and APOE-e4 in longitudinal cognitive decline: MacArthur Studies of Successful Aging. J Gerontol B Psychol Sci Soc Sci 2005;60:P74–P83.
  10. Buring JE, Hennekens CH: The Women’s Health Study: Summary of the Study Design. J Myocardial Ischemia 1992;4:27–29.
  11. Brandt J, Spencer M, Folstein MF: The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1988;1:111–117.
  12. Mufson EJ, Chen E-Y, Cochran EJ, Beckett LA, Bennett DA, Kordower JH: Entorhinal cortex beta-amyloid load in individuals with mild cognitive impairment. Exp Neurol 1999;158:469–490.
  13. Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C: The consortium to establish a registry for Alzheimer’s disease (CERAD). Part 1. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989;39:1159–1165.
  14. Ganguli M: The use of screening instruments for the detection of dementia. Neuroepidemiology 1997;16:271–280.
  15. Albert MS: How does education affect cognitive function? Ann Epidemiol 1995;5:76–78.
  16. Dufouil C, Alperovitch A, Tzourio C: Influence of education on the relationship between white matter lesions and cognition. Neurology 2003;60:831–836.
  17. Bennett DA, Wilson RS, Schneider JA, Evans DA, Mendes de Leon CF, Arnold SE, Barnes LL, Bienias JL: Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60:1909–1915.
  18. Scarmeas N, Zarahn E, Andersen KE, Habeck CG, Hilton J, Flynn J, Marmot MG, Bell KL, Sackeim HA, Van Heertum RL, Moeller JR, Stern Y: Association of life activities with cerebral blood flow in Alzheimer disease. Arch Neurol 2003;60:359–365.
  19. Wilson RS, Bennett DA, Beckett LA, Morris MC, Gilley DW, Bienias JL, Scherr PA, Evans DA: Cognitive activity in older persons from a geographically defined population. J Gerontol B Psychol Sci Soc Sci 1999;54:P155–P160.
  20. Kliegel M, Zimprich D, Rott C: Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study. Aging Men Health 2004;8:430–437.
  21. Wang H, Karp A, Winbald B, Fratiglioni L: Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen Project. Am J Epidemiol 2002;155:1081–1087.
  22. Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslansky G, Ambrose AF, Sliwinski M, Buschke H: Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003;348:2508–2516.

 goto top of outline Author Contacts

Sunmin Lee, ScD
Department of Health and Behavioral Sciences, University of Colorado at Denver and Health Sciences Center, Campus Box 188, PO Box 173364
Denver, CO 80217-3364 (USA)
Tel. +1 303 556 6793, Fax +1 303 556 8501, E-Mail sunmin.lee@cudenver.edu


 goto top of outline Article Information

Published online: December 13, 2005
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 5, Number of References : 22


 goto top of outline Publication Details

Neuroepidemiology

Vol. 26, No. 2, Year 2006 (Cover Date: February 2006)

Journal Editor: Román, G.C. (San Antonio, Tex.)
ISSN: 0251–5350 (print), 1423–0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

We investigated the relation of educational attainment and annual household income to cognitive function and cognitive decline in community-dwelling women aged 66 years or older. Subjects were 6,314 health professionals participating in the Women’s Health Study, among whom information on education and income was self-reported. From 1998 to 2000, we administered five cognitive tests, measuring general cognition, episodic memory and verbal fluency, using a validated telephone interview. Second cognitive assessments were conducted approximately 2 years later; information was complete for 5,573 women at the time of analysis, with 94% follow-up. We used linear and logistic regression to calculate multivariate-adjusted mean differences as well as odds of cognitive impairment (defined as worst 10% of test distribution) and of substantial decline in performance (worst 10% of distribution), across various levels of education and income. After adjusting for numerous potential confounding factors, we found strong trends of increasing mean cognitive performance with increasing level of education (p trend < 0.0005 on all cognitive measures). Odds of cognitive impairment also consistently decreased with increasing education. For income, we found significant trends of increasing mean cognitive performance with increasing income on the summary score and on episodic memory (p trends < 0.0001). Results were generally similar for cognitive decline over 2 years, although slightly weaker. Thus, in these well-educated, professional women, educational attainment and income both predicted cognitive function and decline.



 goto top of outline Author Contacts

Sunmin Lee, ScD
Department of Health and Behavioral Sciences, University of Colorado at Denver and Health Sciences Center, Campus Box 188, PO Box 173364
Denver, CO 80217-3364 (USA)
Tel. +1 303 556 6793, Fax +1 303 556 8501, E-Mail sunmin.lee@cudenver.edu


 goto top of outline Article Information

Published online: December 13, 2005
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 5, Number of References : 22


 goto top of outline Publication Details

Neuroepidemiology

Vol. 26, No. 2, Year 2006 (Cover Date: February 2006)

Journal Editor: Román, G.C. (San Antonio, Tex.)
ISSN: 0251–5350 (print), 1423–0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Farmer ME, Kittner SJ, Rae DS, Bartko JJ, Regier DA: Education and change in cognitive function. Ann Epidemiol 1995;5:1–7.
  2. Evans DA, Beckett LA, Albert MS, Hebert LE, Scherr PA, Funkenstein HH, Taylor JO: Level of education and change in cognitive function in a community population of older persons. Ann Epidemiol 1993;3:71–77.
  3. Lyketsos CG, Chen L-S, Anthony JC: Cognitive decline in adulthood: an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area Study. Am J Psychiatry 1999;156:58–65.
  4. Gallacher JE, Elwood PC, Hopkinson C, Patrick MA, Rabbitt PMA, Stollery BT, Sweetnam PM, Brayne C, Huppert FA: Cognitive function in the Caerphilly study: associations with age, social class, education and mood. Eur J Epidemiol 1999;15:161–169.
  5. Cagney KA, Lauderdale DS: Education, wealth, and cognitive function in later life. J Gerontol Psychol Sci 2002;57B:163–172.
  6. Scherr P, Albert M, Funkenstein H, Cook N, Hennekens C, Branch L, White L, Taylor J, Evans D: Correlates of cognitive function in an elderly community population. Am J Epidemiol 1988;128:1084–1101.
  7. Alvarado BE, Zunzunegui M-V, Del Ser T, and Beland F: Cognitive decline is related to education and occupation in a Spanish elderly cohort. Aging Clin Exp Res 2002;14:132–142.
  8. Lee S, Kawachi I, Berkman LF, Grodstein F: Education, other socioeconomic indicators, and cognitive function in older women. Am J Epidemiol 2003;157:712–720.
  9. Seeman TE, Huang M, Bretsky P, Crimmins E, Launer L, Guralnik JM: Education and APOE-e4 in longitudinal cognitive decline: MacArthur Studies of Successful Aging. J Gerontol B Psychol Sci Soc Sci 2005;60:P74–P83.
  10. Buring JE, Hennekens CH: The Women’s Health Study: Summary of the Study Design. J Myocardial Ischemia 1992;4:27–29.
  11. Brandt J, Spencer M, Folstein MF: The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1988;1:111–117.
  12. Mufson EJ, Chen E-Y, Cochran EJ, Beckett LA, Bennett DA, Kordower JH: Entorhinal cortex beta-amyloid load in individuals with mild cognitive impairment. Exp Neurol 1999;158:469–490.
  13. Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C: The consortium to establish a registry for Alzheimer’s disease (CERAD). Part 1. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989;39:1159–1165.
  14. Ganguli M: The use of screening instruments for the detection of dementia. Neuroepidemiology 1997;16:271–280.
  15. Albert MS: How does education affect cognitive function? Ann Epidemiol 1995;5:76–78.
  16. Dufouil C, Alperovitch A, Tzourio C: Influence of education on the relationship between white matter lesions and cognition. Neurology 2003;60:831–836.
  17. Bennett DA, Wilson RS, Schneider JA, Evans DA, Mendes de Leon CF, Arnold SE, Barnes LL, Bienias JL: Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60:1909–1915.
  18. Scarmeas N, Zarahn E, Andersen KE, Habeck CG, Hilton J, Flynn J, Marmot MG, Bell KL, Sackeim HA, Van Heertum RL, Moeller JR, Stern Y: Association of life activities with cerebral blood flow in Alzheimer disease. Arch Neurol 2003;60:359–365.
  19. Wilson RS, Bennett DA, Beckett LA, Morris MC, Gilley DW, Bienias JL, Scherr PA, Evans DA: Cognitive activity in older persons from a geographically defined population. J Gerontol B Psychol Sci Soc Sci 1999;54:P155–P160.
  20. Kliegel M, Zimprich D, Rott C: Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study. Aging Men Health 2004;8:430–437.
  21. Wang H, Karp A, Winbald B, Fratiglioni L: Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen Project. Am J Epidemiol 2002;155:1081–1087.
  22. Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslansky G, Ambrose AF, Sliwinski M, Buschke H: Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003;348:2508–2516.