Education As A Protective Factor

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In the Shanghai survey of dementia, the 27% of the subjects in the sample of 5500 who had received no formal education had approximately twice the

Figure 2.2. Incidence of age-specific dementia (as log of incidence of age-defined population per annum) plotted against age. The regression line is calculated from data from the Eurodem incidence analysis (Launer et al., 1999) and the Canadian Study of Health and Aging (2000). Sites of other studies include Baltimore (Kawas et al., 2000); Bronx (Aronson et al., 1991); Cambridge, England (Paykel et al., 1994); East Boston, Massachusetts (Hebert et al., 1995); Hisayama, Japan (Yoshitake et al., 1995); Mannheim, Germany (Bickel and Cooper, 1994), Monongahela, Pennsylvania (Ganguli et al., 2000); North London (Boothby et al., 1994); Nottingham (Morgan et al., 1992); Rochester, Minnesota (Rocca et al., 1998); and Shanghai, China (E. Yu, in preparation, based upon Zhang et al., 1998). (Updated from Katzman and Kawas, 1999, reproduced by permission of Lippincott, Williams and Wilkins.)

Figure 2.2. Incidence of age-specific dementia (as log of incidence of age-defined population per annum) plotted against age. The regression line is calculated from data from the Eurodem incidence analysis (Launer et al., 1999) and the Canadian Study of Health and Aging (2000). Sites of other studies include Baltimore (Kawas et al., 2000); Bronx (Aronson et al., 1991); Cambridge, England (Paykel et al., 1994); East Boston, Massachusetts (Hebert et al., 1995); Hisayama, Japan (Yoshitake et al., 1995); Mannheim, Germany (Bickel and Cooper, 1994), Monongahela, Pennsylvania (Ganguli et al., 2000); North London (Boothby et al., 1994); Nottingham (Morgan et al., 1992); Rochester, Minnesota (Rocca et al., 1998); and Shanghai, China (E. Yu, in preparation, based upon Zhang et al., 1998). (Updated from Katzman and Kawas, 1999, reproduced by permission of Lippincott, Williams and Wilkins.)

age-specific prevalence of dementia compared with subjects with at least some secondary education (Zhang et al., 1990). Similar results were obtained in the large study carried out in Bordeaux. Incidence data are now available. Again, lack of education is a risk factor for late-life dementia in Shanghai and in Europe (Katzman et al., 1997; Schmand et al., 1997), but in the Eurodem analysis the protective effect of education against incident dementia has been found to be greater in women (Letenneur et al., 2000). An evident explanation of the protective effect of education is that education increases cognitive reserve, thus delaying the onset of the clinical symptoms of dementia (Katzman and Kawas, 1999). This hypothesis has received support from studies of head circumference (Graves et al., 1996b), brain volume (Coffey et al., 1999) and rate of decline once dementia begins (Stern et al., 1999). However, in Indianapolis, Hall et al. (2000) found that lack of education is of greater importance in reducing dementia in African Americans who grew up in rural areas, not in those who grew up in cities. This remains an intriguing area for investigation.

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