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Increased Risk of Mortality in Alzheimer's Disease Patients with More Advanced Educational and Occupational Attainment

Yaakov Stern; Mingxin Tang; Jean Denaro; Richard Paul Mayeux

Title:
Increased Risk of Mortality in Alzheimer's Disease Patients with More Advanced Educational and Occupational Attainment
Author(s):
Stern, Yaakov
Tang, Mingxin
Denaro, Jean
Mayeux, Richard Paul
Date:
Type:
Articles
Department(s):
Neurology
Volume:
37
Persistent URL:
Book/Journal Title:
Annals of Neurology
Abstract:
A reserve hypothesis suggests that clinical symptoms of Alzheimer's disease (AD) begin earlier in individuals with less education. Therefore, patients with less education might survive longer after diagnosis than those with more education. Two hundred forty-six subjects with probable AD were following for 1 to 4 years. There were 78 deaths; 30 deaths occurred in the 127 patients whose education was ≤8 years, while 48 deaths occured in the 119 patients with <8 years of education. Cox proportional hazards models adjusted for age, gender, and clinical dementia rating (CDR) showed that patients with more education had increased mortality (continuous variable: RR = 1.06 for each years of education; 95% confidence interval {CI}, 1.01-1.11; dichotomous variable at 8 yr: RR = 1.76; CI, 1.11-2.77). This observation might at first seem counterintuitve, since groups with lower socioeconomic status are often at greater mortality risk. It implies that at any level of assessed clinical severity, the underlying pathology of AD is more advanced in patients with more education, resulting in shorter duration of diagnosed disease before death. These findings suggest either that education systematically influences global ratings of disease severity or that education provides a reserve against the clinical manifestation of AD pathology.
Subject(s):
Neurology
Alzheimer's disease--Patients
Mortality
Dementia
Education
Publisher DOI:
https://doi.org/10.1002/ana.410370508
Item views
18
Metadata:
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Suggested Citation:
Yaakov Stern, Mingxin Tang, Jean Denaro, Richard Paul Mayeux, , Increased Risk of Mortality in Alzheimer's Disease Patients with More Advanced Educational and Occupational Attainment, Columbia University Academic Commons, .

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