title: Effects of education on very mild dementia among Chinese people in Hong Kong: potential mediators in the Cantonese Mini-Mental State Examination tasks.
abstract: BACKGROUND
  In Hong Kong, older Chinese adults generally have a low level of education. This study examined the effect of education on very mild Alzheimer's disease (AD), as quantified by Clinical Dementia Rating (CDR) scale (CDR 0.5 versus 0), in a Chinese community. The Cantonese version of the Mini-Mental State Examination (C-MMSE) was used to estimate cognitive abilities that were related to the level of education, and that in turn serve as protective factors for AD.
  
  
  METHODS
  A total of 788 community-dwelling older adults (383 CDR 0 and 405 CDR 0.5) were recruited in this cross-sectional study, which was derived from a population-based prevalence project. The participants' number of years of education and C-MMSE scores were used to predict their CDR scores using logistic regression and the mediation effects of C-MMSE scores were analyzed.
  
  
  RESULTS
  Consistent with previous studies, the chance of being rated as having very mild AD increased with age, but decreased with years of education, among the older adult community of Hong Kong. The effect of education on very mild dementia was weakened substantially when C-MMSE scores were included as mediating variables.
  
  
  CONCLUSIONS
  The findings indicate that the protective effects of education on dementia were mediated by an enhancement of older adults' performance on some C-MMSE items, including attention and orientation to time and place.
authors.affiliation: Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China. cstse@cuhk.edu.hk
authors.forename: C S
authors.initials: CS
authors.lastname: Tse
authors.forename: J F
authors.initials: JF
authors.lastname: Chang
authors.forename: Grace T Y
authors.initials: GT
authors.lastname: Leung
authors.forename: Ada W T
authors.initials: AW
authors.lastname: Fung
authors.forename: K T
authors.initials: KT
authors.lastname: Hau
authors.forename: Helen F K
authors.initials: HF
authors.lastname: Chiu
authors.forename: Linda C W
authors.initials: LC
authors.lastname: Lam
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D003072:Cognition Disorders / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data*; D009483:Neuropsychological Tests; D011159:Population Surveillance; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012112:Residential Facilities; D012720:Severity of Illness Index