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

TitleBelow 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, A, Langa, KM, Yaffe, K, Moody-Ayers, S, Williams, B, Covinsky, KE
JournalAlzheimer's and dementia
Call Numbernewpubs20101112_Mehta.pdf
KeywordsDemographics, Health Conditions and Status, Risk Taking

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.

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Endnote Keywords

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

Endnote ID


Citation Key7408
PubMed ID19751917
PubMed Central IDPMC2787515