title: Is Educational Attainment Associated with Increased Risk of Mortality in People with Dementia? A Population-based Study.
abstract: The association between higher education and increased mortality in Alzheimer's disease (AD) is controversial. Further it is unknown whether education predicts survival in all dementia subtypes. We assessed mortality rates and death causes of persons with dementia compared to participants without dementia.
  
  
  
  Participants derive from the Neurological Disorders in Central Spain, a prospective population- based cohort study of older adults. We compared 269 persons with dementia to 2944 participants without dementia. We carried out Cox regression models to predict the risk of mortality dependent on the educational attainment adjusting for covariates. Reasons of death were obtained from the National Population Register.
  
  
  
  During a median follow-up of 5.4 years, 400 individuals died (171 with dementia, 229 without dementia). Among the participants with dementia, those with higher educational attainment had an increased risk of death than those with lower education; the adjusted hazard ratio (HRa) was 1.40 (95% confidence interval [CI], 1.01 to 1.94). When the analysis was restricted to patients with AD the HRa increased to 1.51 (95% CI = 1.01-2.24). By contrast, educational attainment was not associated with increased mortality among participants without dementia (HRa = 0.92, 95% CI = 0.71-1.20, p = 0.55), whereas education did not influence mortality in QD.
  
  
  
  Our findings suggest that high educational attainment is associated with increased mortality risk in people with dementia. This observation implies that neuropathology is more advanced in patients with higher education at any level of clinical severity, leading these individuals to an earlier death after diagnosis.
authors.affiliation: Facultad de Psicología, Universidad de Salamanca, Avda. de la Merced 109-131, Postal code: ES-37005; Salamanca. Spain.
authors.forename: Israel
authors.initials: I
authors.lastname: Contador
authors.affiliation: Cognitive Neuroscience Division, The Taub Institute, and Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10027. United States.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.affiliation: Research Institute of Hospital "12 de Octubre" (i+12), Madrid. Spain.
authors.forename: Felix
authors.initials: F
authors.lastname: Bermejo-Pareja
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; and Centro Integral de Neurociencias A.C., Móstoles, Madrid. Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sanchez-Ferro
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid. Spain.
authors.forename: Julian
authors.initials: J
authors.lastname: Benito-Leon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia / Q000401:mortality*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models
keywords: Alzheimer's disease; Education; cognitive reserve; dementia; mortality; population-based study