title: Education plays a greater role than age in cognitive test performance among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  Brazil has gone through fast demographic, epidemiologic and nutritional transitions and, despite recent improvements in wealth distribution, continues to present a high level of social and economic inequality. The ELSA-Brasil, a cohort study, aimed at investigating cardiovascular diseases and diabetes, offers a great opportunity to assess cognitive decline in this aging population through time-sequential analyses drawn from the same battery of tests over time. The purpose of this study is to analyze the influence of sex, age and education on cognitive tests performance of the participants at baseline.
  
  
  METHODS
  Analyses pertain to 14,594 participants with aged 35 to 74 years, who were functionally independent and had no history of stroke or use of neuroleptics, anticonvulsants, cholinesterase inhibitors or antiparkinsonian agents. Mean age was 52.0 ± 9.0 years and 54.2% of participants were women. Cognitive tests included the word memory tests (retention, recall and recognition), verbal fluency tests (VFT, animals and letter F) and Trail Making Test B. Multivariable linear regression analysis was used to determine the influence of sociodemographic characteristics on the distribution of the final score of each test.
  
  
  RESULTS
  Women had significant and slightly higher scores than men in all memory tests and VFT, but took more time to perform Trail B. Reduced performance in all tests was seen with an increase age and, more importantly, with decrease level of education. The word list and VFT scores decreased at about one word for every 10 years of age; whereas higher-educated participants scored four words more on the word list test, and six or seven more correct words on VFT, when compared to lower-educated participants. Additionally, the oldest and less educated participants showed significant lower response rates in all tests.
  
  
  CONCLUSIONS
  The higher influence of education than age in this Brazilian population reinforce the need for caution in analyzing and diagnosing cognitive impairments based on traditional cognitive tests and the importance of searching for education-free cognitive tests, especially in low and middle-income countries.
authors.affiliation: Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. passos.v@gmail.com.|ELSA Research Center, Hospital Borges da Costa, Universidade Federal de Minas Gerais, Av. Alfredo Balena 100, 30130-100, Belo Horizonte, Brazil. passos.v@gmail.com.
authors.forename: Valéria Maria
authors.initials: VM
authors.lastname: de Azeredo Passos
authors.affiliation: Faculty of Nutrition, Universidade Federal de Ouro Preto, Ouro Preto, Brazil. luana.giatti@gmail.com.
authors.forename: Luana
authors.initials: L
authors.lastname: Giatti
authors.affiliation: Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil. isabensenor@hu.usp.br.
authors.forename: Isabela
authors.initials: I
authors.lastname: Bensenor
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands. h.tiemeier@erasmusmc.nl.
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands. m.a.ikram@erasmusmc.nl.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: Campus Centro Oeste Dona Lindu, Universidade Federal São João del Rey, Belo Horizonte, Brazil. betafigueiredo@yahoo.com.br.
authors.forename: Roberta Carvalho
authors.initials: RC
authors.lastname: de Figueiredo
authors.affiliation: Public Health School, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. dorachor@fiocruz.br.
authors.forename: Dora
authors.initials: D
authors.lastname: Chor
authors.affiliation: Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. maria.schmidt@ufrgs.br.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
authors.affiliation: Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. sandhi.barreto@gmail.com.
authors.forename: Sandhi Maria
authors.initials: SM
authors.lastname: Barreto
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D001938:Brazil; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests