Education, Cognitive Test Scores, and Black-White Differences in Dementia Risk

doi:10.1111/j.1532-5415.2006.00747.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 54 Issue 6, Pages 898 - 905

Published Online: 4 May 2006

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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Education, Cognitive Test Scores, and Black-White Differences in Dementia Risk

Marie-Florence Shadlen, MD ^* , David Siscovick, MD, MPH ^*† , Annette L. Fitzpatrick, PhD ^† , Corinne Dulberg, PhD, MPH ^‡ , Lewis H. Kuller, MD, PhD ^§ , and Sharon Jackson, PhD ^∥

From the Departments of ^*Medicine, ^†Epidemiology, and ^‡Biostatistics, University of Washington, Seattle, Washington; ^§Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ^∥School of Medicine, Wake Forest University, Winston-Salem, North Carolina.

Address correspondence to Marie-Florence Shadlen, MD, Assistant Professor, Division of Gerontology and Geriatric Medicine, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, WA 98104. E-mail: mshadlen@u.washington.edu

KEYWORDS

black • race • education • dementia risk • cognitive test

ABSTRACT

OBJECTIVES: To compare dementia risks of elderly black and white subjects and to determine whether differences in education and cognitive test scores contribute to the inconsistency in reported differences between these groups.

DESIGN: Longitudinal, 6-year follow-up.

PARTICIPANTS: Two thousand seven hundred eighty-six older black and white subjects in the Cardiovascular Health Study.

MEASUREMENTS: Age, education (>10 years vs ≤10 years), Modified Mini-Mental State Examination score (3MS, ≤85 vs >85). Potential confounders were sex, depression, apolipoprotein E4 genotype, vascular disease, and baseline magnetic resonance imaging changes.

RESULTS: White subjects with low education and black subjects with high education had twice the risk of dementia of white subjects with high education (95% confidence interval (CI)=1.5–2.4 and 95% CI=1.4–2.7); black subjects with low education had five times the risk of dementia (95% CI=3.4–7.7). Likewise, for subjects with low 3MSE scores, black subjects had 6.7 times the risk of dementia (95% CI=4.7–9.7) and white subjects had 2.7 times the risk of dementia (95% CI=2.2–3.5) as white subjects with high 3MSE scores. Finally, in Cox models, there was no significant black-white difference in dementia risk after adjustment for all confounders and baseline 3MSE.

CONCLUSION: Black race was associated with greater dementia risk even after adjustment for education and other potential confounders. This black-white difference in dementia risk was markedly attenuated after adjustment for baseline cognitive screening scores. The apparent race effect may reflect gaps in the quality of education or differences in the trajectory of impaired cognitive function experienced by the two groups. Future investigations might take these findings into consideration for the design of studies evaluating black-white differences in dementia risk.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2006.00747.x About DOI