Features associated with cognitive impairment and dementia in a community-based sample of illiterate elderly aged 75+ years: The Pietà study

Guimarães, Henrique Cerqueira; Cascardo, Jorge Luiz; Beato, Rogério Gomes; Barbosa, Maira Tonidandel; Machado, Thais Helena; Almeida, Mariana Alves de; Ritter, Simone Rios Fonseca; Borges, Karina Braga Gomes; Teixeira, Antonio Lucio; Caramelli, Paulo

doi:10.1590/S1980-57642014DN82000007

ABSTRACT

A higher level of educational attainment constitutes a protective factor against cognitive decline in the elderly. Nevertheless, the elements underpinning this association are yet not fully understood.

Objective:

The primary aim of this study was to compare cognitively impaired illiterate elderly subjects with cognitively preserved counterparts, according to demographics, comorbidities, lifetime habits and APOE genotype.

Methods:

This is a cross-sectional analysis of the illiterate subset of participants (n=174) from the Pietà study, a community-based survey of successful brain aging conducted in Caeté (MG), Brazil. Subjects were categorized into three diagnostic groups: cognitively normal (CN), cognitive impairment no-dementia (CIND) and dementia. The groups were then compared according to selected variables.

Results:

Subjects with dementia were older and had an increased prevalence of reported stroke or transient ischemic attack. The three groups did not differ in relation to demographics, prevalence of comorbidities, socioeconomic level, previous occupation profile and APOE-e4 allele frequency. Qualitatively evaluated lifetime habits, such as alcohol consumption, smoking and physical activity engagement were also similar across groups.

Conclusion:

No associations were found between cognitive impairment/dementia and the variables evaluated in this community-based sample of illiterate elderly.

Key words
aging; cognitive impairment; dementia; elderly; illiteracy

RESUMO

Um alcance educacional mais elevado constitui um fator protetivo contra o declínio cognitivo em idosos. Todavia, os elementos subjacentes a esta associação ainda são pouco compreendidos.

Objetivo:

O principal objetivo deste estudo foi comparar indivíduos analfabetos com comprometimento cognitivo com analfabetos cognitivamente normais, de acordo com aspectos demográficos, morbidades, hábitos de vida e genótipo APOE.

Métodos:

Este é um estudo transversal da amostra de participantes analfabetos (n=174) do Estudo Pietà, um levantamento de base comunitária sobre envelhecimento cerebral bem sucedido, conduzido em Caeté (MG), Brasil. Os sujeitos foram categorizados em três grupos diagnósticos: cognitivamente normais, comprometimento cognitivo não demência e demência. Os grupos foram então comparados conforme variáveis selecionadas.

Resultados:

Indivíduos com demência eram mais idosos e apresentaram uma maior prevalência de relato de acidente vascular encefálico ou ataque isquêmico transitório. Os três grupos não se mostraram diferentes em relação à demografia, prevalência de comorbidades, nível socioeconômico, perfil ocupacional prévio e frequência do alelo APOE-e4. A avaliação qualitativa de hábitos de vida, como o consumo de bebida alcoólica, fumo e engajamento em atividade física também foi semelhante entre os grupos.

Conclusão:

Não encontramos associações entre comprometimento cognitivo/demência e as variáveis investigadas nesta amostra comunitária de idosos analfabetos.

Palavras-chave
envelhecimento; comprometimento cognitivo; demência; idoso; analfabetismo

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Full text available only in PDF format.

REFERENCES

¹
Nitrini R, Bottino CM, Alballa C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630.
²
Bennett DA, Wilson RS, Schneider JA, et al. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60:1909-1915.
³
Mortamais M, Protet F, Brickman AM, et al. Education modulates the impact of white matter lesions on the risk of mild cognitive impairment and dementia. Am J Geriatr Psychiatry 2013 [Epub ahead of print]
⁴
Wang HX, Gustafson DR, Kivipelto M, et al. Education halves the risk of dementia due to apolipoprotein 4 allele a collaborative study from the Swedish brain power initiative. Neurobiol Aging 2012;33:1007e.1-7.
⁵
Roe CM, Xiong CJ, Miller JP, Morris JC. Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. Neurology 2007;68:223-228
⁶
Farfel JM, Nitrini R, Suemoto CK, et al. Very low levels of education and cognitive reserve: a clinicopathologic study. Neurology 2013;81:650-657.
⁷
Caramelli P, Barbosa MT, Sakurai E, et al. The Pietà Study: epidemiological investigation in successful brain aging in Caeté (MG), Brazil. Methods and baseline cohort characteristics. Arq Neuropsiquatr 2011;69:579-584.
⁸
Apolinario D, Brucki SM, Ferretti RE, et al. Estimating premorbid cognitive abilities in low-educated populations. PLoS One 2013;8:e60084.
⁹
Takada LT, Caramelli P, Flichman HC, et al. Comparison of two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr 2006; 64:35-40.
¹⁰
Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord 2007;21:65-67.
¹¹
Herrera Jr. E, Caramelli P, Silveira ASB, Nitrini R. Epidemiological survey of dementia in a community-dwelling Brazilian population. Alz Dis Assoc Disord 2002;16:103-108.
¹²
Caramelli P, Herrera Jr E, Nitrini R. Education-adjusted normative values for the mini-mental state examination (MMSE) in a large elderly cohort. Dement Neuropsychol 2007;1(Suppl 2):18.
¹³
Teng E, Becker BW, Woo E, Knopman DS, Cummings JL, Lu PH. Utility of the functional activities questionnaire for distinguishing mild cognitive impairment from very mild Alzheimer's disease. Alzheimer Dis Assoc Disord 2010;24:348-353.
¹⁴
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM). 4th ed. Washington, DC: American Psychiatric Association, 1994.
¹⁵
Scazufca M, Almeida OP, Menezes PR. The role of literacy, occupation and income in dementia prevention: the São Paulo Ageing & Health Study (SPAH). Int Psychogeriatr 2010;22:1209-1215.
¹⁶
Morais P, Pinto JA, Lopes MA, Litvoc J, Bottino CM. Impact of sociodemographic and health variables on mini-mental state examination in a community-based sample of older people Eur Arch Psychiatry Clin Neurosci 2010;260:535-542.
¹⁷
Corley J, Gow AJ, Starr JM, Deary IJ. Smoking, childhood IQ, and cognitive function in old age. J Psychosom Res 2012;73:132-138.
¹⁸
Corley J, Jia X, Kyle JA, et al. Caffeine consumption and cognitive function at age 70: the Lothian Birth Cohort 1936 study. Psychosom Med 2010;72:206-214.
¹⁹
Deary IJ, Pattie A, Starr JM. The stability of intelligence from age 11 to age 90 years:the Lothian birth cohort of 1921. Psychol Sci 2013;24: 2362-2368.
²⁰
Rusanen M, Kivipelto M, Quesenberry CP Jr, Zhou J, Whitmer RA. Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia. Arch Intern Med 2011;171:333-339.
²¹
Kummer A, Harsányi E, Dias FM, et al. Depression impairs executive functioning in Parkinson disease patients with low educational level. Cogn Behav Neurol 2009;22:167-172.
²²
Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. N Engl J Med 2005;352:245-253.
²³
Kesse-Guyot E, Andreeva VA, Jeandel C, et al. Alcohol consumption in midlife and cognitive performance assessed 13 years later in the SU.VI.MAX 2 cohort. PLoS One 2012;7:52311.
²⁴
Sabia S, Elbaz A, Britton A, et al. Alcohol consumption and elderly decline in early old age. Neurology 2014;82:332-339.

Publication Dates

Publication in this collection
Apr-Jun 2014

History

Received
21 Feb 2014
Accepted
26 Apr 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Nitrini R, Bottino CM, Alballa C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630.

[2] ²
Bennett DA, Wilson RS, Schneider JA, et al. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60:1909-1915.

[3] ³
Mortamais M, Protet F, Brickman AM, et al. Education modulates the impact of white matter lesions on the risk of mild cognitive impairment and dementia. Am J Geriatr Psychiatry 2013 [Epub ahead of print]

[4] ⁴
Wang HX, Gustafson DR, Kivipelto M, et al. Education halves the risk of dementia due to apolipoprotein 4 allele a collaborative study from the Swedish brain power initiative. Neurobiol Aging 2012;33:1007e.1-7.

[5] ⁵
Roe CM, Xiong CJ, Miller JP, Morris JC. Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. Neurology 2007;68:223-228

[6] ⁶
Farfel JM, Nitrini R, Suemoto CK, et al. Very low levels of education and cognitive reserve: a clinicopathologic study. Neurology 2013;81:650-657.

[7] ⁷
Caramelli P, Barbosa MT, Sakurai E, et al. The Pietà Study: epidemiological investigation in successful brain aging in Caeté (MG), Brazil. Methods and baseline cohort characteristics. Arq Neuropsiquatr 2011;69:579-584.

[8] ⁸
Apolinario D, Brucki SM, Ferretti RE, et al. Estimating premorbid cognitive abilities in low-educated populations. PLoS One 2013;8:e60084.

[9] ⁹
Takada LT, Caramelli P, Flichman HC, et al. Comparison of two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr 2006; 64:35-40.

[10] ¹⁰
Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord 2007;21:65-67.

[11] ¹¹
Herrera Jr. E, Caramelli P, Silveira ASB, Nitrini R. Epidemiological survey of dementia in a community-dwelling Brazilian population. Alz Dis Assoc Disord 2002;16:103-108.

[12] ¹²
Caramelli P, Herrera Jr E, Nitrini R. Education-adjusted normative values for the mini-mental state examination (MMSE) in a large elderly cohort. Dement Neuropsychol 2007;1(Suppl 2):18.

[13] ¹³
Teng E, Becker BW, Woo E, Knopman DS, Cummings JL, Lu PH. Utility of the functional activities questionnaire for distinguishing mild cognitive impairment from very mild Alzheimer's disease. Alzheimer Dis Assoc Disord 2010;24:348-353.

[14] ¹⁴
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM). 4th ed. Washington, DC: American Psychiatric Association, 1994.

[15] ¹⁵
Scazufca M, Almeida OP, Menezes PR. The role of literacy, occupation and income in dementia prevention: the São Paulo Ageing & Health Study (SPAH). Int Psychogeriatr 2010;22:1209-1215.

[16] ¹⁶
Morais P, Pinto JA, Lopes MA, Litvoc J, Bottino CM. Impact of sociodemographic and health variables on mini-mental state examination in a community-based sample of older people Eur Arch Psychiatry Clin Neurosci 2010;260:535-542.

[17] ¹⁷
Corley J, Gow AJ, Starr JM, Deary IJ. Smoking, childhood IQ, and cognitive function in old age. J Psychosom Res 2012;73:132-138.

[18] ¹⁸
Corley J, Jia X, Kyle JA, et al. Caffeine consumption and cognitive function at age 70: the Lothian Birth Cohort 1936 study. Psychosom Med 2010;72:206-214.

[19] ¹⁹
Deary IJ, Pattie A, Starr JM. The stability of intelligence from age 11 to age 90 years:the Lothian birth cohort of 1921. Psychol Sci 2013;24: 2362-2368.

[20] ²⁰
Rusanen M, Kivipelto M, Quesenberry CP Jr, Zhou J, Whitmer RA. Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia. Arch Intern Med 2011;171:333-339.

[21] ²¹
Kummer A, Harsányi E, Dias FM, et al. Depression impairs executive functioning in Parkinson disease patients with low educational level. Cogn Behav Neurol 2009;22:167-172.

[22] ²²
Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. N Engl J Med 2005;352:245-253.

[23] ²³
Kesse-Guyot E, Andreeva VA, Jeandel C, et al. Alcohol consumption in midlife and cognitive performance assessed 13 years later in the SU.VI.MAX 2 cohort. PLoS One 2012;7:52311.

[24] ²⁴
Sabia S, Elbaz A, Britton A, et al. Alcohol consumption and elderly decline in early old age. Neurology 2014;82:332-339.

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