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

Journal article
Authors Annie Robitaille
Ardo van den Hout
Robson J.M. Machado
David A. Bennett
Iva Čukić
Ian J. Deary
Scott M. Hofer
Emiel O. Hoogendijk
Martijn Huisman
Boo Johansson
Andriy V. Koval
Maaike van der Noordt
Andrea M. Piccinin
Judith J.M. Rijnhart
Archana Singh-Manoux
Johan Skoog
Ingmar Skoog
John Starr
Lisa Vermunt
Sean Clouston
Graciela Muniz Terrera
Published in Alzheimer's and Dementia
Volume 14
Issue 4
Pages 462-472
ISSN 15525260
Publication year 2018
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Department of Psychology
Centre for Ageing and Health (Agecap)
Pages 462-472
Language en
Keywords Cognition, Dementia, Education, Life expectancy, Multistate modeling, Socioeconomic status
Subject categories Psychology, Older people and ageing


© 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.

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