Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors

Authors

Chelsea Liu, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Yuan Ma, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Albert Hofman, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Reem Waziry, Department of Neurology, Columbia University Irving Medical Center, Columbia University, NY, New York, USA.
Silvia Koton, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
James R. Pike, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
B Gwen Windham, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Melinda C. Power, Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
A Richey Sharrett, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Rebecca F. Gottesman, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD, USA.

Document Type

Journal Article

Publication Date

3-26-2023

Journal

Annals of neurology

DOI

10.1002/ana.26647

Abstract

INTRODUCTION: Lower education is associated with higher burden of vascular risk factors in mid-life and higher risk of dementia in late life. We aim to understand the causal mechanism through which vascular risk factors potentially mediate the relationship between education and dementia. METHODS: In a cohort of 13,368 Black and White older adults in the Atherosclerosis Risk in Communities Study, we assessed the relationship between education (grade school, high school without graduation, high school graduate or equivalent, college, graduate/professional school) and dementia among all participants and among those with incident stroke. Cox models were adjusted for age, race-center (a variable stratified by race and field center), sex, APOE ε4 genotype, and family history of cardiovascular disease. Causal mediation models assessed mediation by mid-life systolic blood pressure, fasting blood glucose, body mass index and smoking. RESULTS: More education was associated with 8-44% lower risk of dementia compared to grade school-level education in a dose-response pattern, while the relationship between education and post-stroke dementia was not statistically significant. Up to 25% of the association between education and dementia was mediated through mid-life vascular risk factors, with a smaller percentage mediated for lower levels of education. INTERPRETATION: A substantial proportion of the relationship between education and dementia was mediated through mid-life vascular risk factors. However, risk factor modification is unlikely to fully address the large educational disparities in dementia risk. Prevention efforts must also address disparities in socioeconomic resources leading to divergent early-life education and other structural determinants of mid-life vascular risk factors. This article is protected by copyright. All rights reserved.

APA Citation

Liu, Chelsea; Ma, Yuan; Hofman, Albert; Waziry, Reem; Koton, Silvia; Pike, James R.; Windham, B Gwen; Power, Melinda C.; Sharrett, A Richey; and Gottesman, Rebecca F., "Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors" (2023). GW Authored Works. Paper 2540.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2540

Department

Epidemiology