Synergistic influence of education and marriage on the risk for cognition loss among the older people in China

Abstract Background The study was aim to prove that both rationality and emotion are indispensable for older people to maintain their ability to live independently during the twilight of their lives. Methods The resilience of older people to dementia were investigated by considering the interactions between educational levels and marriage status. Four sociodemographic variables (age, sex, educational level, and marital status) were collected from 1177 older Chinese participants, whose mini-mental state examination scores (MMSE scores) were measured. Results A lower educational level coupled with being widowed caused a greater risk for severe cognitive impairment (relative risk [RR] 1.48; 95% confidence interval [CI] 1.20–1.82; p < 0.001) for high-aged older participants (age range: ≥80) than for their low-aged counterparts (age range: ≥60 and < 80). In contrast, a higher educational level coupled with being married leveled this age-related risk for cognitive loss (RR 0.91; 95% CI 0.65–1.27; p = 0.62). Conclusions Further findings suggest that the synergistic influence of education and marriage was observed only among high-aged older people .Being both well-educated and married is associated with a delayed cognitive function for older people. However, longevity is a prerequisite for realizing this benefit.

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Education and marriage synergistically protect oldest old against severe cognitive impairment

10.21203/rs.2.16104/v1 ◽

2019 ◽

Author(s):

Ning Sun ◽

Rangcheng Jia ◽

Chunyan Guo ◽

Tongda Sun ◽

Xiaoxin Dong ◽

...

Keyword(s):

Cognitive Impairment ◽

Educational Level ◽

Mmse Score ◽

Oldest Old ◽

Elderly Persons ◽

Severe Cognitive Impairment ◽

Age Related ◽

Related Risk ◽

High Age ◽

Age Range

Abstract Background It is hypothesized that education and marriage are resilience factors protective against senile dementia.Methods We investigated the resilience of elderly persons from dementia by considering the interactions between educational levels and marriage status. Four sociodemographic variables (age, sex, educational level, and marital status) were collected from 1177 elderly Chinese participants, for whom the mini-mental state examination score (MMSE score) was measured and severe cognitive impairment (MMSE score = 0) was identified.Results Lower educational level coupled with being widowed caused a greater risk of severe cognitive impairment (relative risk [RR] 1.48; 95% confidence interval [CI] 1.20-1.82; p < 0.001) for high-age elderly participants (age range: ≥80) than those low-age counterparts (age range: ≥60 and <80). By contrast, higher educational level coupled with being married leveled this age-related risk of cognitive loss (RR 0.91; 95% CI 0.65-1.27; p = 0.62). Further findings suggest that synergistically cognitive protection effect for education and marriage was only observed among high-age elderly persons, instead of among low-age ones.Conclusions Being well-educated and being married synergistically protected delayed cognitive function for elderly people. However, longevity is a prerequisite for realizing this benefit.

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Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

10.21203/rs.2.17884/v1 ◽

2019 ◽

Author(s):

Carlota Grossi ◽

Kathryn Richardson ◽

George Savva ◽

Chris Fox ◽

Antony Arthur ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Older People ◽

Mini Mental State Examination ◽

Medication Use ◽

Anticholinergic Medication ◽

Older Population ◽

Clinically Significant ◽

State Examination ◽

Anticholinergic Burden

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality. The characteristics of the population who use anticholinergic medication are not known. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects. Key words: cognitive impairment, anticholinergic burden, polypharmacy

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Adjusting Mini-Mental State Examination Scores for Age and Educational Level to Screen for Dementia: Correcting Bias or Reducing Validity?

International Psychogeriatrics ◽

10.1017/s1041610298005134 ◽

1998 ◽

Vol 10 (1) ◽

pp. 43-51 ◽

Cited By ~ 37

Author(s):

Helena Chmura Kraemer ◽

Deborah J. Moritz ◽

Jerome Yesavage

Keyword(s):

Mental State ◽

Educational Level ◽

Mini Mental State Examination ◽

Decision Procedures ◽

Screening Procedure ◽

Educational Levels ◽

State Examination ◽

Clinical Populations

The question of whether Mini-Mental State Examination scores should be adjusted for age and educational levels to screen for dementia in clinical populations is reexamined in the results of a recent study supporting adjustment. If the criterion is to identify the most accurate screening procedure for each sociodemographic subgroup, the evidence indicates that the unadjusted scores are preferable. Other criteria might lead to different conclusions. The validities of some of these criteria are questionable because they have the flaw that they are easily satisfied by using random decision procedures.

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Educational level differences on the Mini-Mental State: the role of test bias

Psychological Medicine ◽

10.1017/s0033291700008424 ◽

1988 ◽

Vol 18 (3) ◽

pp. 727-731 ◽

Cited By ~ 76

Author(s):

A. F. Jorm ◽

R. Scott ◽

A. S. Henderson ◽

D. W. K. Kay

Keyword(s):

Cognitive Impairment ◽

Elderly People ◽

Mental State ◽

Educational Level ◽

Mini Mental State Examination ◽

Community Sample ◽

Test Bias ◽

Level Difference ◽

State Examination

SynopsisLess educated elderly people are commonly found to perform more poorly on the Mini-Mental State Examination (MMSE). This educational level difference has been attributed by some research workers to test bias. To assess whether the MMSE is biased against the poorly educated, its validity was assessed separately in the more- and less-educated members of a community sample. No evidence was found to indicate that the test is a biased measure of cognitive impairment.

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APOE Variant (rs405509) might Modulate the Effect of Sex and Educational Level on Cognitive Impairment Risk in a Taiwanese Population

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101732 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1732 ◽

Cited By ~ 1

Author(s):

Tsui-Wen Hsu ◽

Disline Manli Tantoh ◽

Pang-Li Liu ◽

Pei-Hsin Chen ◽

Oswald Ndi Nfor ◽

...

Keyword(s):

High School ◽

Cognitive Impairment ◽

Junior High School ◽

Educational Level ◽

Mini Mental State Examination ◽

Mmse Score ◽

Taiwanese Population ◽

Educational Group ◽

University Level ◽

State Examination

Education, sex, and the APOE-rs405509 variant are associated with Alzheimer’s disease and cognitive performance. We investigated if the rs405509 TT, TG, and GG genotypes modulate the effect of sex and education on cognitive impairment in Taiwanese adults. Data on cognitive health (defined by Mini-Mental State Examination (MMSE) scores) and rs405509 were from Taiwan Biobank. Participants included 2105 men and 2027 women with a mean age of 64 years. Education below university level was significantly associated with lower MMSE scores. The odds ratios (ORs) were 1.82; 95% confidence interval (CI) 1.38–2.41 for senior high school, 3.39; 95% CI 2.50–4.59 for junior high school, and 11.94; 95% CI 9.91–15.50 for elementary school and below (p-trend < 0.05). The association between MMSE score and sex was significant only in the lowest educational group (elementary and below), with lower odds of having a low MMSE score in men compared to women (OR = 0.51; 95% CI 0.34–0.77). After stratification by rs405509 genotypes, this association was significant only among TT genotype carriers (OR = 0.481; CI = 0.253–0.915). In conclusion, a significant association between MMSE score and sex was observed in the lowest educational group, especially among carriers of rs405509 TT genotypes.

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Risk Factors of Cognitive Impairment Post Ischemic Stroke

Jurnal Kesehatan Masyarakat ◽

10.15294/kemas.v15i2.16845 ◽

2019 ◽

Vol 15 (2) ◽

pp. 295-302

Author(s):

Rr Rizqi Saphira Nurani ◽

Santi Martini ◽

Fanni Marzela

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Cognitive Impairment ◽

Cigarette Smoke ◽

Educational Level ◽

Mini Mental State Examination ◽

Medication Compliance ◽

Sleep Pattern ◽

History Of ◽

State Examination

The aim of this research was to analyze the risk factors of cognitive impairment post-ischemic stroke. This research was case control design, consisted of 38 cases and 38 control. Mini Mental State Examination (MMSE) and the Pittsburg Sleep Quality Index (PSQI) were tools to obtain data. Independent variables were age, gender, educational level, history of hypertension, exposure to cigarette smoke, medication compliance, and sleep pattern. The risk factors were age (OR = 3,43; 95% CI = 1,08<OR<10,89), sex (OR = 2,67; 95% CI = 1.05<OR<6,83), educational level (OR = 4,17; 95% CI = 1,60<OR<10,86), history of hypertension (OR = 1,60; 95% CI = 0,62<OR<4,17), exposure to cigarette smoke (OR = 1,24; 95% CI = 0,50<OR<3,04), medication compliance (OR = 6,59; 95% CI = 2,23<OR<19,43), and sleep pattern (OR = 8,125; 95% CI = 2,88<OR<22,93). It is suggested for ischemic stroke’s patient to maintain medication compliance and sleep pattern.

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GENDER DIFFERENCES IN THE PREVALENCE AND INCIDENCE OF COGNITIVE IMPAIRMENT: DOES IMMIGRATION MATTER?

Innovation in Aging ◽

10.1093/geroni/igz038.3003 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S814-S815

Author(s):

Fengyan Tang ◽

Ke Li ◽

Iris Chi ◽

XinQi Dong

Keyword(s):

Cognitive Impairment ◽

Mini Mental State Examination ◽

Chinese Women ◽

Future Research ◽

Research Needs ◽

Related Factors ◽

Men And Women ◽

Baseline Incidence ◽

Older Chinese ◽

State Examination

Abstract Using two waves of the PINE data, this study examined gender difference in the associations between immigration-related factors and cognitive impairment (CI). CI was assessed by the Chinese Mini-Mental State Examination (C-MMSE). CI prevalence was determined by C-MMSE < 18 at baseline; incidence was the percentage of the respondents whose C-MMSE > 18 at baseline but dropped below 18 at Wave 2. We found 7.62% CI prevalence and 5.12% incidence rate. Women were more likely than men to have CI, consisting of 77.06% and 75.20% among persons with CI at two time points. Older Chinese women were generally disadvantaged in cognition and overall health compared with older men. Yet immigration experience does not link to CI for both men and women after controlling the well-established effects of age and education. Future research needs to investigate what biological and contextual factors earlier in life are predictive of late-life CI risk.

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The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population

International Psychogeriatrics ◽

10.1017/s1041610209990822 ◽

2009 ◽

Vol 22 (1) ◽

pp. 72-81 ◽

Cited By ~ 55

Author(s):

Francisco Franco-Marina ◽

Jose Juan García-González ◽

Fernando Wagner-Echeagaray ◽

Joseph Gallo ◽

Oscar Ugalde ◽

...

Keyword(s):

Cognitive Impairment ◽

Mental State ◽

Educational Level ◽

Mini Mental State Examination ◽

Community Sample ◽

Epidemiological Studies ◽

Cognitive Test ◽

Ceiling Effects ◽

Floor Effects ◽

State Examination

ABSTRACTBackground: The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education.Methods: MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects.Results: Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model.Conclusion: Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

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Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

10.21203/rs.2.17884/v3 ◽

2020 ◽

Author(s):

Carlota Grossi ◽

Kathryn Richardson ◽

George Savva ◽

Chris Fox ◽

Antony Arthur ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Older People ◽

Mental State ◽

Mini Mental State Examination ◽

Medication Use ◽

Anticholinergic Medication ◽

Older Population ◽

Clinically Significant ◽

State Examination

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

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Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

10.21203/rs.2.17884/v2 ◽

2020 ◽

Author(s):

Carlota Grossi ◽

Kathryn Richardson ◽

George Savva ◽

Chris Fox ◽

Antony Arthur ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Older People ◽

Mental State ◽

Mini Mental State Examination ◽

Medication Use ◽

Anticholinergic Medication ◽

Older Population ◽

Clinically Significant ◽

State Examination

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

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