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Contribution of cognitive performance and cognitive decline to associations between socioeconomic factors and dementia: A cohort study.

Abstract Socioeconomic disadvantage is a risk factor for dementia, but longitudinal studies suggest that it does not affect the rate of cognitive decline. Our objective is to understand the manner in which socioeconomic disadvantage shapes dementia risk by examining its associations with midlife cognitive performance and cognitive decline from midlife to old age, including cognitive decline trajectories in those with dementia.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos medicine
Publication Year Start




PMID- 28650972
OWN - NLM
STAT- In-Process
DA  - 20170626
LR  - 20170626
IS  - 1549-1676 (Electronic)
IS  - 1549-1277 (Linking)
VI  - 14
IP  - 6
DP  - 2017 Jun
TI  - Contribution of cognitive performance and cognitive decline to associations
      between socioeconomic factors and dementia: A cohort study.
PG  - e1002334
LID - 10.1371/journal.pmed.1002334 [doi]
AB  - BACKGROUND: Socioeconomic disadvantage is a risk factor for dementia, but
      longitudinal studies suggest that it does not affect the rate of cognitive
      decline. Our objective is to understand the manner in which socioeconomic
      disadvantage shapes dementia risk by examining its associations with midlife
      cognitive performance and cognitive decline from midlife to old age, including
      cognitive decline trajectories in those with dementia. METHODS AND FINDINGS: Data
      are drawn from the Whitehall II study (N = 10,308 at study recruitment in 1985), 
      with cognitive function assessed at 4 waves (1997, 2002, 2007, and 2012).
      Sociodemographic, behavioural, and cardiometabolic risk factors from 1985 and
      chronic conditions until the end of follow-up in 2015 (N dementia/total =
      320/9,938) allowed the use of inverse probability weighting to take into account 
      data missing because of loss to follow-up between the study recruitment in 1985
      and the introduction of cognitive tests to the study in 1997. Generalized
      estimating equations and Cox regression were used to assess associations of
      socioeconomic markers (height, education, and midlife occupation categorized as
      low, intermediate, and high to represent hierarchy in the socioeconomic marker)
      with cognitive performance, cognitive decline, and dementia (N dementia/total =
      195/7,499). In those with dementia, we examined whether retrospective
      trajectories of cognitive decline (backward timescale) over 18 years prior to
      diagnosis differed as a function of socioeconomic markers. Socioeconomic
      disadvantage was associated with poorer cognitive performance (all p < 0.001).
      Using point estimates for the effect of age, the differences between the high and
      low socioeconomic groups corresponded to an age effect of 4, 15, and 26 years,
      for height, education, and midlife occupation, respectively. There was no
      evidence of faster cognitive decline in socioeconomically disadvantaged groups.
      Low occupation, but not height or education, was associated with risk of dementia
      (hazard ratio [HR] = 2.03 [95% confidence interval (CI) 1.23-3.36]) in an
      analysis adjusted for sociodemographic factors; the excess risk was unchanged
      after adjustment for cognitive decline but was completely attenuated after
      adjustment for cognitive performance. In further analyses restricted to those
      with dementia, retrospective cognitive trajectories over 18 years prior to
      dementia diagnosis showed faster cognitive decline in the high education (p =
      0.006) and occupation (p = 0.001) groups such that large differences in cognitive
      performance in midlife were attenuated at dementia diagnosis. A major limitation 
      of our study is the use of electronic health records rather than comprehensive
      dementia ascertainment. CONCLUSIONS: Our results support the passive or threshold
      cognitive reserve hypothesis, in that high cognitive reserve is associated with
      lower risk for dementia because of its association with cognitive performance,
      which provides a buffer against clinical expression of dementia.
FAU - Rusmaully, Jennifer
AU  - Rusmaully J
AD  - INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hopital
      Paul Brousse, Villejuif, France.
FAU - Dugravot, Aline
AU  - Dugravot A
AD  - INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hopital
      Paul Brousse, Villejuif, France.
FAU - Moatti, Jean-Paul
AU  - Moatti JP
AD  - Institut de recherche pour le developpement, Marseille, France.
FAU - Marmot, Michael G
AU  - Marmot MG
AD  - Department of Epidemiology and Public Health, University College London, London, 
      United Kingdom.
FAU - Elbaz, Alexis
AU  - Elbaz A
AUID- ORCID: http://orcid.org/0000-0001-9724-5490
AD  - INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hopital
      Paul Brousse, Villejuif, France.
FAU - Kivimaki, Mika
AU  - Kivimaki M
AD  - Department of Epidemiology and Public Health, University College London, London, 
      United Kingdom.
FAU - Sabia, Severine
AU  - Sabia S
AUID- ORCID: http://orcid.org/0000-0003-3109-9720
AD  - INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hopital
      Paul Brousse, Villejuif, France.
AD  - Department of Epidemiology and Public Health, University College London, London, 
      United Kingdom.
FAU - Singh-Manoux, Archana
AU  - Singh-Manoux A
AUID- ORCID: http://orcid.org/0000-0002-1244-5037
AD  - INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hopital
      Paul Brousse, Villejuif, France.
AD  - Department of Epidemiology and Public Health, University College London, London, 
      United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20170626
PL  - United States
TA  - PLoS Med
JT  - PLoS medicine
JID - 101231360
EDAT- 2017/06/27 06:00
MHDA- 2017/06/27 06:00
CRDT- 2017/06/27 06:00
PHST- 2017/01/03 [received]
PHST- 2017/05/24 [accepted]
AID - 10.1371/journal.pmed.1002334 [doi]
AID - PMEDICINE-D-17-00016 [pii]
PST - epublish
SO  - PLoS Med. 2017 Jun 26;14(6):e1002334. doi: 10.1371/journal.pmed.1002334.
      eCollection 2017 Jun.

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