title: Childhood school performance, education and occupational complexity: a life-course study of dementia in the Kungsholmen Project.
abstract: Cognitive reserve hypothesis predicts that intellectually demanding activities over the life course protect against dementia. We investigate if childhood school performance remains associated with dementia once education and occupational complexity are taken into account.
  
  
  
  A cohort of 440 individuals aged 75+ from the Kungsholmen Project was followed up for 9 years to detect dementia. To measure early-life contributors to reserve, we used grades at age 9-10 extracted from the school archives. Data on formal education and occupational complexity were collected at baseline and first follow-up. Dementia was ascertained through comprehensive clinical examination. Cox models estimated the relationship between life-course cognitive reserve measures and dementia.
  
  
  
  Dementia risk was elevated [hazard ratio (HR): 1.54, 95% confidence interval (CI): 1.03 to 2.29] in individuals with low early-life school grades after adjustment for formal educational attainment and occupational complexity. Secondary education was associated with a lower risk of dementia (HR: 0.72, 95% CI: 0.50 to 1.03), although the effects of post-secondary and university degrees were indistinguishable from baseline. Occupational complexity with data and things was not related to dementia. However, an association was found between high occupational complexity with people and dementia, albeit only in women (HR: 0.39, 95% CI: 0.14 to 0.99). The pattern of results remained unchanged after adjustment for genetic susceptibility, comorbidities and depressive symptoms.
  
  
  
  Low early-life school performance is associated with an elevated risk of dementia, independent of subsequent educational and occupational attainment.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, serhiy.dekhtyar@ki.se.
authors.forename: Serhiy
authors.initials: S
authors.lastname: Dekhtyar
authors.affiliation: Schoolof Public Health, Zhengzhou University, Zhengzhou, Henan, China and.|Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Hui-Xin
authors.initials: HX
authors.lastname: Wang
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Laura
authors.initials: L
authors.lastname: Fratiglioni
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Herlitz
mesh_terms: D000073978:Academic Performance; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003704:Dementia / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009790:Occupations; D016016:Proportional Hazards Models; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
keywords: Cognitive reserve; dementia; longitudinal studies