Influence of education and occupation on the incidence of Alzheimer's disease.
Influence of education and occupation on the incidence of Alzheimer's disease.
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DOI：
10.1001/jama.1994.03510370056032
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发表时间：
1994-04
期刊：
影响因子：
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通讯作者：
Y. Stern;B. Gurland;T. Tatemichi;M. Tang;D. Wilder;R. Mayeux
中科院分区：
文献类型：
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作者：
Y. Stern;B. Gurland;T. Tatemichi;M. Tang;D. Wilder;R. Mayeux
目的：一些横断面研究发现阿尔茨海默病（AD）和有限的教育经验之间的关联。很难确定教育经历是否是AD的风险因素，因为教育程度会影响诊断测试的表现。本研究旨在确定有限的教育水平和职业成就是否是痴呆事件的危险因素。设计队列发病率研究。设置一般社区。参与者共593名年龄在60岁或以上的非痴呆个体，他们被列入纽约州北曼哈顿痴呆风险个体登记处，并被确定和随访。干预我们重新检查受试者1至4年后，相同的标准化神经和神经心理学的措施。主要观察指标痴呆发生率。结果：我们使用考克斯比例风险模型，调整年龄和性别，估计与低教育和职业成就相关的痴呆事件的相对危险度（RR）。在593名受试者中，有106人患上了痴呆症;除了5人外，所有人都符合AD的研究标准。痴呆的风险增加，无论是受教育程度低（RR，2.02; 95%置信区间[CI]，1.33至3.06）或低终身职业成就（RR，2.25; 95% CI，1.32至3.84）。低学历和低终身职业成就的受试者风险最大（RR，2.87; 95%CI，1.32至3.84）。结论：数据表明，增加教育和职业成就可能会降低AD事件的风险，无论是通过降低AD的临床检测的难易程度，还是通过提供延迟临床表现发作的储备。
OBJECTIVE Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. DESIGN Cohort incidence study. SETTING General community. PARTICIPANTS A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. INTERVENTIONS We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. MAIN OUTCOME MEASURES Incident dementia. RESULTS We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [Cl], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% Cl, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% Cl, 1.32 to 3.84). CONCLUSIONS The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations.