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. 2011 Oct-Dec;25(4):289-304.
doi: 10.1097/WAD.0b013e318211c83c.

Relationship between education and dementia: an updated systematic review

Emily Schoenhofen Sharp  1 , Margaret Gatz
Affiliations

Relationship between education and dementia: an updated systematic review

Emily Schoenhofen Sharp et al. Alzheimer Dis Assoc Disord. 2011 Oct-Dec.

Abstract

Objective: The purpose of this study was to review the relationship between education and dementia.

Methods: A systematic literature review was conducted of all published studies examining the relationship between education and dementia listed in the PubMed and PsycINFO databases from January 1985 to July 2010. The inclusion criteria were a measure of education and a dementia diagnosis by a standardized diagnostic procedure. Alzheimer disease and Total Dementia were the outcomes.

Results: A total of 88 study populations from 71 studies met inclusion criteria. Overall, 51 studies (58%) reported significant effects of lower education on risk for dementia, whereas 37 studies (42%) reported no significant relationship. A relationship between education and risk for dementia was more consistent in developed regions compared with developing regions. Age, sex, race/ethnicity, and geographical region moderated the relationship.

Conclusions: Lower education was associated with a greater risk for dementia in many but not all studies. The level of education associated with risk for dementia varied by study population and more years of education did not uniformly attenuate the risk for dementia. It seemed that a more consistent relationship with dementia occurred when years of education reflected cognitive capacity, suggesting that the effect of education on risk for dementia may be best evaluated within the context of a lifespan developmental model.

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Figures

FIGURE 1
FIGURE 1
Pattern of Study Results by Study Type (Prevalence or Incidence). Note. Each study is counted once. If a study analyzed both outcomes, the result for Total Dementia is shown.
FIGURE 2
FIGURE 2
Reported Effect Size (OR) and 95% Confidence Interval from Analysis of Lower Education and Risk for Dementia Prevalence. Note. OR indicates Odds Ratio. All studies are presented without differentiation. Studies vary in how education was defined, sample size, and model covariates.
FIGURE 3
FIGURE 3
Reported Effect Size (OR/RR/HR) and 95% Confidence Interval from Analysis of Lower Education and Risk for Dementia Incidence. Note. OR indicates Odds Ratio, RR, Relative Risk, and HR, Hazard Ratio. All studies are presented without differentiation. Studies vary in how education was defined, sample size, and model covariates.
FIGURE 4
FIGURE 4
Pattern of Study Results by Prevalence and Incidence within Geographical Regions. Note. P = Prevalence; I= Incidence. Each study is counted once. If a study analyzed both dementia outcomes, the result for Total Dementia is shown.
FIGURE 5
FIGURE 5
Pattern of Study Results for Developed and Developing Regions. Note. Each study is counted once. If a study analyzed both dementia outcomes, the result for Total Dementia is shown.
FIGURE 6
FIGURE 6
Lifespan Developmental Model for a Relationship between Education and Dementia. (Note. Adapted from Deary IJ, Whiteman MC, Starr JM, et al. The impact of childhood intelligence on later life: following up the Scottish mental surveys of 1932 and 1947. J Pers Soc Psychol. 2004;86:130–147 Copyright 2004 by the American Psychological Association)
See this image and copyright information in PMC

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