The Differential Effect of Schooling and Physical Activity on Dementia in Older Women and Men from Brazil: Implications for Policymaking

Abstract

Background: Modifiable risk factors exert crucial impact on dementia.

Objective: We sought to answer the question: do two modifiable risk factors, schooling level and physical activity (PA), affect cognitive function similarly in each sex?

Methods: This cross-sectional study was conducted in 2019 and 2021, and the survey was applied to the residents of the metropolitan area of Santos, a seashore of Sao Paulo State. Four hundred and twenty-two participants (women = 254 and men = 168) were eligible. Baecke questionnaire for the elderly was applied for the classification as physically inactive (PI) or active (PA). Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Participants were also stratified by schooling status for both sexes.

Results: Higher education had a sex-independent positive influence on MMSE and CDR (p < 0.001). PA influences positively MMSE in older women (PI: 25±5 and PA: 27±3, p < 0.03), but has no effect in older men (26±5 and 25±5, p > 0.05). Concordantly, older women who were PA (1.7 and 0 %) showed a lower prevalence of dementia compared with PI (6.2 and 2.1%), for mild and moderate respectively. Active older women had higher odds of improving the MMSE score (OR: 1.093; 95% CI: 1.008-1.186) than men (OR: 0.97 (95% CI: 0.896-1.051).

Conclusion: Education affects cognitive function equally in Brazilian elderly whereas older women are more responsive to the beneficial effects of PA for dementia than men.

Keywords: Cognitive function; physical activity; schooling status; sex difference.