"Below average" self-assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study.

Title"Below average" self-assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study.
Publication TypeJournal Article
Year of Publication2009
AuthorsMehta, KM, Stewart, AL, Langa, KM, Yaffe, K, Moody-Ayers, SY, Williams, BA, Covinsky, KE
JournalAlzheimers Dement
Date Published2009 Sep
ISSN Number1552-5279
Call Numbernewpubs20101112_Mehta.pdf
KeywordsAged, Aged, 80 and over, Aging, Alzheimer disease, Apolipoprotein E4, Cognition Disorders, Educational Status, Female, Geriatric Assessment, Humans, Male, Memory, Neuropsychological tests, Risk Factors

BACKGROUND: A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone.

METHODS: Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD.

RESULTS: The 725 participants (mean age, 81.8 years; 59% female; 16% African-American) varied in self-assessed educational performance: 29% reported "above average," 64% reported "average," and 7% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11% of participants with "above average" self-assessed performance had AD, as opposed to 12% of participants with "average" performance and 26% of participants with "below average" performance (P < 0.001). After controlling for subjects' years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5-1.7).

CONCLUSIONS: We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.

URLhttp://www.sciencedirect.com/science?_ob=ArticleURLand_udi=B7W6D-4X6VH7W-7and_user=99318and_coverDate=09 2F30 2F2009and_rdoc=1and_fmt=highand_orig=searchand_origin=searchand_sort=dand_docanchor=andview=cand_acct=C000007678and_version=1and_urlVersion=0and_
User Guide Notes


Endnote Keywords

alzheimer disease/cognition Disorders/educational Status/Geriatric Assessment/neuropsychological Tests/risk Factors

Endnote ID


Alternate JournalAlzheimers Dement
Citation Key7408
PubMed ID19751917
PubMed Central IDPMC2787515
Grant ListK01 AG025444 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
K08 AG019180 / AG / NIA NIH HHS / United States
K01 AG025444-01A1 / AG / NIA NIH HHS / United States
P30 AG015272 / AG / NIA NIH HHS / United States
U01-AG009740 / AG / NIA NIH HHS / United States
R01 AG027010 / AG / NIA NIH HHS / United States
K24 AG029812 / AG / NIA NIH HHS / United States
P30-AG-15272 / AG / NIA NIH HHS / United States
R01-AG027010 / AG / NIA NIH HHS / United States
K-01AG025444-01A1 / AG / NIA NIH HHS / United States
U01AG009740 / AG / NIA NIH HHS / United States
K08-AG019180 / AG / NIA NIH HHS / United States