Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies
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Introduction: This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini‐Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. Methods: Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. Results: Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. Discussion: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.
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Multi-state modeling can estimate Alzheimer's disease duration from stage progression and mortality rates without requiring very long follow-up.
“We estimated disease duration by applying a multi-state modeling approach, which has been previously used in AD research [22-25], and can offer an estimate of disease duration based on stage progression and mortality rates in the absence of very long follow-up duration.”
From Duration of preclinical, prodromal, and dementia stages of Alzheimer's disease in relation to age, sex, and <i>APOE</i> genotype (2019) · cites this paper as [23]
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- Authors
- Robitaille, A., van den Hout, A., Machado, R. J. M., Bennett, D. A., Čukić, I., Deary, I. J., Hofer, S. M., Hoogendijk, E. O., Huisman, M., Johansson, B., Koval, A. V., van der Noordt, M., Piccinin, A. M., Rijnhart, J. J. M., Singh‐Manoux, A., Skoog, J., Skoog, I., Starr, J., Vermunt, L., Clouston, S., & Muniz Terrera, G.
- Affiliations
- University of Victoria (CA)
- Department of Statistical Science University College London London UK
- University College London (GB)
- Rush University Medical Center (US)
- University of Edinburgh (GB)
- Oregon Health & Science University (US)
- Amsterdam Public Health (NL)
- University of Gothenburg (SE)
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute VU University Medical Center Amsterdam The Netherlands
- Inserm (FR)
- Alzheimer Scotland (GB)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Stony Brook University (US)
- Department of Psychology University of Victoria Victoria BC Canada
- Corresponding author
- Robitaille, Annie
- ORCID
- Venue
- Alzheimer's & Dementia
- Publisher
- Wiley
- Published
- 2018-02-03
- Volume
- 14
- Issue
- 4
- Pages
- 462-472
- ISSN
- 1552-5260 (ISSN-L)
- 1552-5279
- PMC
- PMC6377940
- OpenAlex
- W2785983352
- Cited by
- 77
- References
- 60
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 8 · 2023: 2 · 2022: 11 · 2021: 25 · 2020: 10 · 2019: 7 · 2018: 3
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alzheimer s & Dementia (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- National Institutes of Health (P01AG043362, AG08861)
- Forskningsrådet för Arbetsliv och Socialvetenskap
- Adlerbertska Stiftelserna
- Stiftelsen Handlanden Hjalmar Svenssons
- Knut och Alice Wallenbergs Stiftelse
- Wenner-Gren Stiftelserna
- Stiftelserna Wilhelm och Martina Lundgrens
- Swedish Brain Power
- Biotechnology and Biological Sciences Research Council (Wave 1: SR176)
- Chief Scientist Office (Wave 3: CYB/4/505, Wave 4: ETM/55)
- Medical Research Council (Wave 5: R42550)
- British Heart Foundation (RG/13/2/30098)
- Vetenskapsrådet (11267, 825‐2007‐7462, 825‐2012‐5041, 2013‐8717, 2015‐0283)
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd (2001‐2849, 2005‐0762, 2008‐1210, 2001‐2835, AGECAP 2013‐2300, 2013‐2496, Epilife 2006‐1506)
- Alzheimer's Association (IIRG‐03‐6168)
- Stiftelsen Söderström Königska Sjukhemmet
- Stiftelsen för Gamla Tjänarinnor
- Sahlgrenska Universitetssjukhuset
- Riksbankens Jubileumsfond (P14‐0824:1)
- National Institute on Aging (R01AG17917, R01AG15819, R01AG22018, R01AG24480, R01AG24871, R01AG26916, R01AG33678, R01AG34374, R21AG30765, K23AG23040)
- Illinois Department of Public Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
- Keywords
- educational attainment, cognitive reserve
- MeSH terms
- Cognitive Aging, Aged, Aged, 80 and over, Cognition, Dementia, Educational Status, Female, Humans, Longitudinal Studies, Male, Mental Status Schedule, Risk Factors, Survival Analysis, Cognitive Reserve, Cognitive Dysfunction, Protective Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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