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Childhood Cognitive Ability and Incident Dementia: The 1932 Scottish Mental Survey Cohort into their 10th Decade.

ABSTRACT: The prevention of dementia is a global priority but its etiology is poorly understood. Early life cognitive ability has been linked to subsequent dementia risk but studies to date have been small and none has examined sex differences.In the 1932 Scottish Mental Survey cohort, we related intelligence test scores at age 11 years in 16,370 boys and 16,097 girls (born in 1921) to incident dementia ages ?65 years as ascertained using probabilistic linkage to electronic health records up to the age of 92 years (1,231 cases in men, 2,163 in women; median follow-up 15 years).Compared with the highest intelligence group (IQ ?115), dementia risk was raised in the lowest-scoring category (<85) and these associations were stronger for women (hazard ratio; 95% confidence interval: 1.51; 1.29, 1.76) than men (1.19; 0.98, 1.44; P value for interaction by gender: 0.054). There was evidence of a dose-response association between childhood IQ and dementia in women (IQ 100-114.9 compared with ?115: 1.18; 1.03, 1.34; IQ 85-99.9: 1.32; 1.15, 1.51; P value for trend <0.001) but not in men (1.05; 0.89, 1.24 and 1.01; 0.85, 1.21; 0.44).Childhood intelligence is related to subsequent dementia risk but this association is not the same in men and women. See video abstract at, http://links.lww.com/EDE/B184.

SUBMITTER: Russ TC

PROVIDER: S-EPMC5381709 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Childhood Cognitive Ability and Incident Dementia: The 1932 Scottish Mental Survey Cohort into their 10th Decade.

Russ Tom C TC Hannah Jean J Batty G David GD Booth Christopher C CC Deary Ian J IJ Starr John M JM

Epidemiology (Cambridge, Mass.) 20170501 3

<h4>Background</h4>The prevention of dementia is a global priority but its etiology is poorly understood. Early life cognitive ability has been linked to subsequent dementia risk but studies to date have been small and none has examined sex differences.<h4>Methods</h4>In the 1932 Scottish Mental Survey cohort, we related intelligence test scores at age 11 years in 16,370 boys and 16,097 girls (born in 1921) to incident dementia ages ≥65 years as ascertained using probabilistic linkage to electro ...[more]

PMID: 28151744

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Project description:ImportanceHigher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities.ObjectiveTo evaluate the association between state-level educational quality during childhood and dementia risk.Design, setting, and participantsThis cohort study analyzed longitudinal data collected from January 1, 1997, through December 31, 2019 (23-year follow-up period). The sample comprised members of Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, who completed an optional survey during 1964-1972. Eligible individuals were US born; non-Hispanic Black or non-Hispanic White; aged 65 years or older as of January 1, 1996; were still alive; and did not have a dementia diagnosis or lapse in KPNC membership greater than 90 days between January 1 and December 31, 1996.ExposuresHistorical state-level administrative indicators of school quality (school term length, student-teacher ratio, and attendance rates) linked to participants using birth state and birth year (with a 6-year lag) and divided into tertiles using the pooled sample.Main outcomes and measuresDementia diagnoses from electronic health records between 1997 and 2019 were analyzed between March 1 and August 31, 2022. The associations of educational quality with incident dementia were estimated using Cox proportional hazards regression models.ResultsAmong 21 450 KPNC members who participated in the optional survey, individuals born before availability of educational quality records (n = 87) and missing educational attainment (n = 585) were excluded. The final analytic sample was 20 778 individuals (56.5% women, 43.5% men; mean [SD] age, 74.7 [6.5] years; 18.8% Black; 81.2% White; 41.0% with less than high school education). Among Black individuals, 76.2% to 86.1% (vs 20.8%-23.3% of White individuals) attended schools in states in the lowest educational quality tertiles. Highest (vs lowest) educational quality tertiles were associated with lower dementia risk (student-teacher ratio: hazard ratio [HR], 0.88 [95% CI, 0.83-0.94]; attendance rates: HR, 0.80 [95% CI, 0.73-0.88]; term length: HR, 0.79 [95% CI, 0.73-0.86]). Effect estimates did not differ by race and were not attenuated by adjustment for educational attainment.Conclusions and relevanceIn this cohort study, lower state-average educational quality was more common among Black individuals and associated with higher dementia risk. Differential investment in high-quality education due to structural racism may contribute to dementia disparities.

Project description:Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether some admissions of persons with dementia might be potentially preventable.To determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay.Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system. All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis. Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned February 1, 1994, to December 31, 2007.Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs.Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group. After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P < .001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P < .001). Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia.Among our cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.

Dataset Information

Childhood Cognitive Ability and Incident Dementia: The 1932 Scottish Mental Survey Cohort into their 10th Decade.

Publications

Childhood Cognitive Ability and Incident Dementia: The 1932 Scottish Mental Survey Cohort into their 10th Decade.

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