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

Mehta, Kala M.; Stewart, Anita L.; Langa, Kenneth M.; Yaffe, Kristine; Moody-Ayers, Sandra; Williams, Brie A.; Covinsky, Kenneth E.

doi:10.1016/j.jalz.2009.07.039

« Previous Next »Alzheimer's & Dementia: The Journal of the Alzheimer's Association
Volume 5, Issue 5 , Pages 380-387, September 2009

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

Kala M. Mehta
- Division of Geriatric Medicine, University of California at San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Medical Effectiveness Research Center for Diverse Populations, University of California at San Francisco, San Francisco, CA, USA
- Corresponding author. Tel.: 415-221-4810, extension 3984.
Anita L. Stewart
- Medical Effectiveness Research Center for Diverse Populations, University of California at San Francisco, San Francisco, CA, USA
- Institute for Health and Aging, University of California at San Francisco, San Francisco, CA, USA
Kenneth M. Langa
- Division of General Medicine, Department of Medicine and the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA
Kristine Yaffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, Department of Neurology, and Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA
Sandra Moody-Ayers
- Division of Geriatric Medicine, University of California at San Francisco, San Francisco, CA, USA
- Department of Psychiatry, Department of Neurology, and Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA
Brie A. Williams
- Division of Geriatric Medicine, University of California at San Francisco, San Francisco, CA, USA
- Department of Psychiatry, Department of Neurology, and Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA
Kenneth E. Covinsky
- Division of Geriatric Medicine, University of California at San Francisco, San Francisco, CA, USA
- Department of Psychiatry, Department of Neurology, and Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA

Abstract

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-ɛ4 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.

Keywords: Alzheimer's disease, Education, Cognition, Race, Ethnicity