title: Impact of differential attrition on the association of education with cognitive change over 20 years of follow-up: the ARIC neurocognitive study.
abstract: Studies of long-term cognitive change should account for the potential effects of education on the outcome, since some studies have demonstrated an association of education with dementia risk. Evaluating cognitive change is more ideal than evaluating cognitive performance at a single time point, because it should be less susceptible to confounding. In this analysis of 14,020 persons from a US cohort study, the Atherosclerosis Risk in Communities (ARIC) Study, we measured change in performance on 3 cognitive tests over a 20-year period, from ages 48-67 years (1990-1992) through ages 70-89 years (2011-2013). Generalized estimating equations were used to evaluate the association between education and cognitive change in unweighted adjusted models, in models incorporating inverse probability of attrition weighting, and in models using cognitive scores imputed from the Telephone Interview for Cognitive Status for participants not examined in person. Education did not have a strong relationship with change in cognitive test performance, although the rate of decline was somewhat slower among persons with lower levels of education. Methods used to account for selective dropout only marginally changed these observed associations. Future studies of risk factors for cognitive impairment should focus on cognitive change, when possible, to allow for reduction of confounding by social or cultural factors.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Andreea M
authors.initials: AM
authors.lastname: Rawlings
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.forename: Marilyn
authors.initials: M
authors.lastname: Albert
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Karen
authors.initials: K
authors.lastname: Bandeen-Roche
authors.forename: Laura H
authors.initials: LH
authors.lastname: Coker
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: David J
authors.initials: DJ
authors.lastname: Couper
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: David S
authors.initials: DS
authors.lastname: Knopman
authors.forename: Mehul D
authors.initials: MD
authors.lastname: Patel
authors.forename: Alan D
authors.initials: AD
authors.lastname: Penman
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Power
authors.forename: Ola A
authors.initials: OA
authors.lastname: Selnes
authors.forename: Andrea L C
authors.initials: AL
authors.lastname: Schneider
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagenknecht
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wruck
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009483:Neuropsychological Tests; D010352:Patient Dropouts; D012307:Risk Factors; D013997:Time Factors
keywords: aging; cognition; cognitive decline; cognitive reserve; education