title: Education and risk of incident dementia during the premotor and motor phases of essential tremor (NEDICES).
abstract: Individuals with late-onset essential tremor (ET) (e.g., older adults) seem to have an increased prevalence of mild cognitive impairment and dementia, and a higher risk of incident dementia. It is well-known that education has a protective role against dementia in individuals without a pre-existing neurologic disorder, but evidence regarding the maintenance of this effect during the premotor and motor phases of ET is unknown. Our aim was to determine the influence of education on the risk of dementia in a population-based cohort of ET patients and controls. In a prospective study (Neurological Disorders in Central Spain), participants ≥65 years old were evaluated twice: at baseline (1994-1995) and at follow-up (1997-1998). There were 3 groups: premotor (i.e., participants first diagnosed with incident ET at follow-up), prevalent ET (i.e., participants diagnosed with ET at baseline and at follow-up), and controls. Participants were stratified into lower education (≤primary studies) versus higher education (≥secondary studies) categories. Dementia risk was estimated using Cox proportional-hazards models (higher education control group = reference category). Among the participants, 3878 had a mean duration of follow-up of 3.2 years. Eight (16.7%) of 48 lower education premotor ET patients developed incident dementia versus 1 (3.3%) of 30 higher education premotor ET patients, 9 (7.1%) of 126 lower education prevalent ET patients, 7 (8.8%) of 80 higher education prevalent ET patients, and 92 (4.9%) of 1892 lower education controls (P < 0.001). In comparison to the higher education controls, the adjusted hazard ratios for incident dementia were 5.84 (lower education premotor ET, P < 0.001); 1.36 (higher education premotor ET, P = 0.76); 2.13 (lower education prevalent ET, P = 0.04); 2.79 (higher education prevalent ET, P = 0.01); and 1.66 (lower education controls, P = 0.01). Our results suggest that a higher educational attainment may ameliorate the risk of incident dementia during the premotor phase of ET, but not in the motor phase.
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain Department of Medicine, Complutense University, Madrid, Spain Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain Department of Neurology, Yale School of Medicine Department of Chronic Disease Epidemiology, Yale School of Public Health Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine and Yale School of Public Health, New Haven, CT Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center Taub Institute for Research on Alzheimer's Disease and the Aging Brain Department of Neurology, Columbia University Medical Center, New York, NY.
authors.forename: Julián
authors.initials: J
authors.lastname: Benito-León
authors.forename: Israel
authors.initials: I
authors.lastname: Contador
authors.forename: Elan D
authors.initials: ED
authors.lastname: Louis
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cosentino
authors.forename: Félix
authors.initials: F
authors.lastname: Bermejo-Pareja
mesh_terms: D000368:Aged; D003704:Dementia / Q000209:etiology*; D004522:Educational Status; D020329:Essential Tremor / Q000150:complications*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors