Original report
Education and change in cognitive function: The Epidemiologic Catchment Area Study

https://doi.org/10.1016/1047-2797(94)00047-WGet rights and content

Abstract

The association between educational attainment and decline in cognitive function over an interval of 1 year was examined for 14,883 subjects 18 years and older in the National Institute of Mental Health Epidemiologic Catchment Area Study. Cognitive function was assessed at both time points by the Mini-Mental State Examination (MMSE); cognitive decline was coded as a dichotomous variable and was defined as 1 if the subject's score had declined 3 or more points from the baseline MMSE score at the 1-year follow-up interview and as 0 otherwise. The association between educational attainment and decline in cognitive function over 1 year was examined in logistic regression models that were stratified by age group (< 65 years, ⩾ 65 years) and by baseline MMSE level (MMSE > 23, MMSE ⩽ 23). Covariates included age, baseline MMSE score, ethnicity, residence, lifetime diagnosis of abuse of alcohol or other drugs, and gender. In those with baseline MMSE > 23, education was a significant predictor of cognitive decline, not only in the elderly but also in younger subjects. Among those with baseline MMSE ⩽ 23, education was not a significant predictor of cognitive decline. The fact that education provides protection against cognitive decline even in those younger than 65 years, in whom the prevalence and incidence of dementia are very low, would seem to indicate that education or its correlates provides protection against processes other than dementia that might produce a decline in test performance in young persons.

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    The Epidemiologic Catchment Area program is a series of five epidemiologic research studies performed by independent research teams in collaboration with staff of the Division of Biometry and Epidemiology—reorganized in 1985 and in 1992 with components now in the Division of Epidemiology and Services Research—of the National Institute of Mental Health (NIMH), Rockville, MD. The NIMH Principal Collaborators are Darrel A. Regier, MD, MPH, Ben Z. Locke, MSPH, William W. Eaton (1978–1983), and Jack D. Burke, Jr., MD, MPH (1983–1991); the NIMH Project Officer was Carl A. Taube (1978–1985) and is now William Huber (starting in 1985). The Principal Investigators and co-investigators from the five sites are as follows: Yale University, New Haven, CT, UO1 MH 34224: Jerome K. Myers, PhD, Myrna M. Weissman, PhD, and Gary L. Tischler, MD; the Johns Hopkins University, Baltimore, MD, UO1 MH 33870: Morton Kramer, ScD, Ernest Gruenberg, MD, and Sam Shaprio, MS; Washington University St. Louis, MO, UO1 MH 33883: Lee N. Robins, PhD, and John Helzer, MD; Duke University, Durham, NC, UO1 MH 35386: Linda George, PhD, and Dan Blazer, MD; and University of California, Los Angeles, CA, UO1 MH 35865: Marvin Karoo, MD, Richard L. Hough, PhD, Javier I. Escobar, MD, M. Audrey Burnam, PhD, and Diane M. Timbers, PhD.

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