Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies.
Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies.
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DOI：
10.1016/s2468-2667(20)30258-9
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Sabia S
中科院分区：
文献类型：
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作者：
Bloomberg M;Dugravot A;Dumurgier J;Kivimaki M;Fayosse A;Steptoe A;Britton A;Singh-Manoux A;Sabia S
先前的研究表明，女性患阿尔茨海默病和相关痴呆症的风险过高。教育被认为与痴呆症的发病有因果关系。我们的目的是调查教育在影响认知老化的性别差异中的作用。我们分析了英国两项前瞻性队列研究的数据：英国老龄化纵向研究（艾尔莎）和白厅II研究，以评估出生队列（出生年份1930-38，1939-45或1946-55），教育调整前后，以及高和低教育水平的认知表现和认知能力下降的性别差异。使用即时回忆评估记忆，其数据可从艾尔莎（2002-14）和白厅II（1997-2015）研究的所有波中获得。使用基于动物命名任务的语义流畅性测试评估流畅性，数据来自白厅II研究的所有波和艾尔莎研究的波1至5（2002-10）和波7（2014）。在每项研究中，认知评分分别标准化，基于50-59岁中等教育参与者相应测试的平均值和标准差。 两项研究共纳入15924名受试者。在汇总分析中，在所有出生队列中，女性的记忆力评分均优于男性，不考虑教育调整（例如，在60岁时，出生队列1930-38，性别间平均差异[男性评分减去女性评分] -0统计25 SD [95% CI -0统计32至-0统计19]，经教育调整后），并且在两个教育水平组中。男性的记忆力下降速度快于女性（60岁时，1946-55年出生队列，13年变化的平均差异为-0 statis 15 SD [-0 statis 20至-0 statis 09];调整教育后为-0 statis 14 SD [-0 statis 20至-0 statis 08]）。在较早出生的群体和低教育水平的群体中，男性的流畅性得分高于女性（60岁时，出生队列1930-38，平均差异0.20 SD [95% CI 0.05 - 0.36]）;但在晚育组和高学历组中，女性的流畅度得分高于男性（60岁时，出生队列1946-55，平均差异-0统计17 SD [-0统计24至-0统计10]）。流畅性下降没有观察到性别差异。我们的研究结果表明，由于教育机会的长期增加，教育中的性别差异减少，可能会削弱未来痴呆风险和认知能力下降的性别差异。美国国立卫生研究院国家老龄化研究所;英国医学研究理事会;英国心脏基金会;和国家健康研究所。
Previous studies have shown an excess risk of Alzheimer's disease and related dementias among women. Education is thought to have a causal association with dementia onset. We aimed to investigate the role of education in influencing sex differences in cognitive ageing. We analysed data from two prospective cohort studies in the UK; the English Longitudinal Study of Ageing (ELSA) and the Whitehall II study, to assess sex differences in cognitive performance and cognitive decline by birth cohort (birth year 1930–38, 1939–45, or 1946–55), before and after adjustment for education, and by high and low education level. Memory was assessed using immediate recall, for which data were available from all waves of the ELSA (2002–14) and Whitehall II (1997–2015) studies. Fluency was assessed using a semantic fluency test based on an animal naming task, with data available from all waves of the Whitehall II study and waves one to five (2002–10) and wave seven (2014) of the ELSA study. Cognitive scores were standardised separately in each study based on the mean and SD of the corresponding test among participants aged 50–59 years with secondary education. 15 924 participants were included from the two studies. In pooled analyses, women had better memory scores than men in all birth cohorts, irrespective of adjustment for education (eg, at age 60 years, birth cohort 1930–38, mean difference between sexes [male scores minus female scores] –0·25 SDs [95% CI –0·32 to –0·19] after adjustment for education), and in both education level groups. Memory decline was faster in men than in women (at age 60 years, birth cohort 1946–55, mean difference in 13-year change –0·15 SDs [–0·20 to –0·09]; after adjustment for education –0·14 SDs [–0·20 to –0·08]). Men had better fluency scores than women in earlier birth cohorts and in the low education group (at age 60 years, birth cohort 1930–38, mean difference 0·20 SDs [95% CI 0·05 to 0·36]); but women had better fluency scores than men in later birth cohorts and in the high education group (at age 60 years, birth cohort 1946–55, mean difference –0·17 SDs [–0·24 to –0·10]). No sex differences were observed for fluency decline. Our findings suggest that decreasing disparities between sexes in education, due to secular increases in educational opportunities, could attenuate sex differences in dementia risk and cognitive decline in the future. National Institute on Aging, National Institutes of Health; UK Medical Research Council; British Heart Foundation; and National Institute for Health Research.