Lower Levels of Education Are Associated with Cognitive Impairment in the Old Order Amish

Article type: Research Article

Authors: Ramos, Jairo^a | Chowdhury, Aneesa R.^a | Caywood, Laura J.^a | Prough, Michael^a | Denise Fuzzell, M.^b | Fuzzell, Sarada^b | Miskimen, Kristy^b | Whitehead, Patrice L.^a | Adams, Larry D.^a | Laux, Renee^b | Song, Yeunjoo^b | Ogrocki, Paula^c | Lerner, Alan J.^c | Vance, Jeffery M.^{a; d} | Haines, Jonathan L.^{b; e} | Scott, William K.^{a; d} | Pericak-Vance, Margaret A.^{a; d} | Cuccaro, Michael L.^{a; d; *}

Affiliations: [a] John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA | [b] Case Western Reserve University School of Medicine, Cleveland, OH, USA | [c] University Hospitals Cleveland Medical Center, Cleveland, OH, USA | [d] The Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA | [e] Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA

Correspondence: [*] Correspondence to: Michael Cuccaro, PhD, 1501 NW 10th Avenue, BRB 306, Miami, FL 33136, USA. Tel.: +1 305 243 2366; Fax: +1 305 243 2396; E-mail: MCuccaro@med.miami.edu.

Abstract: Background:Lower education has been reported to be associated with dementia. However, many studies have been done in settings where 12 years of formal education is the standard. Formal schooling in the Old Order Amish communities (OOA) ends at 8th grade which, along with their genetic homogeneity, makes it an interesting population to study the effect of education on cognitive impairment. Objective:The objective of this study was to examine the association of education with cognitive function in individuals from the OOA. We hypothesized that small differences in educational attainment at lower levels of formal education were associated with risk for cognitive impairment. Methods:Data of 2,426 individuals from the OOA aged 54–99 were analyzed. The Modified Mini-Mental State Examination (3MS-R) was used to classify participants as CI or normal. Individuals were classified into three education categories: <8, 8, and >8 years of education. To measure the association of education with cognitive status, a logistic regression model was performed adding age and sex as covariates. Results:Our results showed that individuals who attained lowest levels of education (<8 and 8) had a higher probability of becoming cognitvely impaired compared with people attending >8 years (OR = 2.96 and 1.85). Conclusion:Even within a setting of low levels of formal education, small differences in educational attainment can still be associated with the risk of cognitive impairment. Given the homogeneity of the OOA, these results are less likely to be biased by differences in socioeconomic backgrounds.

Keywords: Amish, cognitive function, cognitive impairment, dementia, education, logistic regression, Modified Mini-Mental State Examination (3MS)

DOI: 10.3233/JAD-200909

Journal: Journal of Alzheimer's Disease, vol. 79, no. 1, pp. 451-458, 2021