Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies

© 2017 the Alzheimer's Association. Introduction: This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. Methods: Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. Results: Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. Discussion: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.

van den Hout, Ardo (author)
Machado, Robson J.M. (author)
Bennett, David A. (author)
Čukić, Iva (author)
Deary, Ian J. (author)
Hofer, Scott M. (author)
Hoogendijk, Emiel O. (author)
Huisman, Martijn (author)
Johansson, BooGothenburg University,Göteborgs universitet,Centrum för åldrande och hälsa (AgeCap),Centre for Ageing and Health (Agecap)(Swepub:gu)xjoboo (author)
Koval, Andriy V. (author)
van der Noordt, Maaike (author)
Piccinin, Andrea M. (author)
Rijnhart, Judith J.M. (author)
Singh-Manoux, Archana (author)
Skoog, Johan,1985Gothenburg University,Göteborgs universitet,Centrum för åldrande och hälsa (AgeCap),Psykologiska institutionen,Centre for Ageing and Health (Agecap),Department of Psychology(Swepub:gu)xskjoh (author)
Skoog, Ingmar,1954Gothenburg University,Göteborgs universitet,Centrum för åldrande och hälsa (AgeCap),Institutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi,Centre for Ageing and Health (Agecap),Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry(Swepub:gu)xskooi (author)
Starr, John (author)
Vermunt, Lisa (author)
Clouston, Sean (author)
Muniz Terrera, Graciela (author)
Göteborgs universitetCentrum för åldrande och hälsa (AgeCap) (creator_code:org_t)

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