Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Feb;66(2):177–183. doi: 10.1136/jnnp.66.2.177

Are sex and educational level independent predictors of dementia and Alzheimer's disease? Incidence data from the PAQUID project

L Letenneur 1, V Gilleron 1, D Commenges 1, C Helmer 1, J Orgogozo 1, J Dartigues 1
PMCID: PMC1736218  PMID: 10071096

Abstract

OBJECTIVES—To examine the age specific risk of Alzheimer's disease according to sex, and to explore the role of education in a cohort of elderly community residents aged 65 years and older.
METHODS—A community based cohort of elderly people was studied longitudinally for 5 years for the development of dementia. Dementia diagnoses were made according to the DSM III R criteria and Alzheimer's disease was assessed using the NINCDS-ADRDA criteria. Among the 3675 non-demented subjects initially included in the cohort, 2881participated in the follow up. Hazard ratios of dementia were estimated using a Cox model with delayed entry in which the time scale is the age of the subjects.
RESULTS—During the 5 year follow up, 190 incident cases of dementia, including 140 cases of Alzheimer's disease were identified. The incidence rates of Alzheimer's disease were 0.8/100 person-years in men and 1.4/100 person-years in women. However, the incidence was higher in men than in women before the age of 80 and higher in women than in men after this age. A significant interaction between sex and age was found. The hazard ratio of Alzheimer's disease in women compared with men was estimated to be 0.8 at 75 years and 1.7 at 85 years. The risks of dementia and Alzheimer's disease were associated with a lower educational attainment (hazard ratio=1.8, p<0.001). The increased risk of Alzheimer's disease in women was not changed after adjustment for education.
CONCLUSION—Women have a higher risk of developing dementia after the age of 80 than men. Low educational attainment is associated with a higher risk of Alzheimer's disease. However, the increased risk in women is not explained by a lower educational level.



Full Text

The Full Text of this article is available as a PDF (109.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander G. E., Furey M. L., Grady C. L., Pietrini P., Brady D. R., Mentis M. J., Schapiro M. B. Association of premorbid intellectual function with cerebral metabolism in Alzheimer's disease: implications for the cognitive reserve hypothesis. Am J Psychiatry. 1997 Feb;154(2):165–172. doi: 10.1176/ajp.154.2.165. [DOI] [PubMed] [Google Scholar]
  2. Aronson M. K., Ooi W. L., Geva D. L., Masur D., Blau A., Frishman W. Dementia. Age-dependent incidence, prevalence, and mortality in the old old. Arch Intern Med. 1991 May;151(5):989–992. doi: 10.1001/archinte.151.5.989. [DOI] [PubMed] [Google Scholar]
  3. Bachman D. L., Wolf P. A., Linn R. T., Knoefel J. E., Cobb J. L., Belanger A. J., White L. R., D'Agostino R. B. Incidence of dementia and probable Alzheimer's disease in a general population: the Framingham Study. Neurology. 1993 Mar;43(3 Pt 1):515–519. doi: 10.1212/wnl.43.3_part_1.515. [DOI] [PubMed] [Google Scholar]
  4. Barberger-Gateau P., Chaslerie A., Dartigues J. F., Commenges D., Gagnon M., Salamon R. Health measures correlates in a French elderly community population: the PAQUID study. J Gerontol. 1992 Mar;47(2):S88–S95. doi: 10.1093/geronj/47.2.s88. [DOI] [PubMed] [Google Scholar]
  5. Beard C. M., Kokmen E., Offord K. P., Kurland L. T. Lack of association between Alzheimer's disease and education, occupation, marital status, or living arrangement. Neurology. 1992 Nov;42(11):2063–2068. doi: 10.1212/wnl.42.11.2063. [DOI] [PubMed] [Google Scholar]
  6. Bickel H., Cooper B. Incidence and relative risk of dementia in an urban elderly population: findings of a prospective field study. Psychol Med. 1994 Feb;24(1):179–192. doi: 10.1017/s0033291700026945. [DOI] [PubMed] [Google Scholar]
  7. Bonaiuto S., Rocca W. A., Lippi A., Giannandrea E., Mele M., Cavarzeran F., Amaducci L. Education and occupation as risk factors for dementia: a population-based case-control study. Neuroepidemiology. 1995;14(3):101–109. doi: 10.1159/000109785. [DOI] [PubMed] [Google Scholar]
  8. Brayne C., Gill C., Huppert F. A., Barkley C., Gehlhaar E., Girling D. M., O'Connor D. W., Paykel E. S. Incidence of clinically diagnosed subtypes of dementia in an elderly population. Cambridge Project for Later Life. Br J Psychiatry. 1995 Aug;167(2):255–262. doi: 10.1192/bjp.167.2.255. [DOI] [PubMed] [Google Scholar]
  9. Chandra V., Philipose V., Bell P. A., Lazaroff A., Schoenberg B. S. Case-control study of late onset "probable Alzheimer's disease". Neurology. 1987 Aug;37(8):1295–1300. doi: 10.1212/wnl.37.8.1295. [DOI] [PubMed] [Google Scholar]
  10. Cobb J. L., Wolf P. A., Au R., White R., D'Agostino R. B. The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham Study. Neurology. 1995 Sep;45(9):1707–1712. doi: 10.1212/wnl.45.9.1707. [DOI] [PubMed] [Google Scholar]
  11. Commenges D., Letenneur L., Joly P., Alioum A., Dartigues J. F. Modelling age-specific risk: application to dementia. Stat Med. 1998 Sep 15;17(17):1973–1988. doi: 10.1002/(sici)1097-0258(19980915)17:17<1973::aid-sim892>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  12. Commenges D., Letenneur L., Joly P. Re: "Serum transferrin saturation, stroke incidence, and mortality in women and men. The NHANES I Epidemiologic Followup Study". Am J Epidemiol. 1997 Oct 15;146(8):683–684. doi: 10.1093/oxfordjournals.aje.a009339. [DOI] [PubMed] [Google Scholar]
  13. Copeland J. R., Davidson I. A., Dewey M. E., Gilmore C., Larkin B. A., McWilliam C., Saunders P. A., Scott A., Sharma V., Sullivan C. Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. Br J Psychiatry. 1992 Aug;161:230–239. doi: 10.1192/bjp.161.2.230. [DOI] [PubMed] [Google Scholar]
  14. Dartigues J. F., Gagnon M., Michel P., Letenneur L., Commenges D., Barberger-Gateau P., Auriacombe S., Rigal B., Bedry R., Alpérovitch A. Le programme de recherche Paquid sur l'épidémiologie de la démence. Méthodes et résultats initiaux. Rev Neurol (Paris) 1991;147(3):225–230. [PubMed] [Google Scholar]
  15. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  16. Fratiglioni L., Grut M., Forsell Y., Viitanen M., Grafström M., Holmén K., Ericsson K., Bäckman L., Ahlbom A., Winblad B. Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology. 1991 Dec;41(12):1886–1892. doi: 10.1212/wnl.41.12.1886. [DOI] [PubMed] [Google Scholar]
  17. Fratiglioni L., Viitanen M., von Strauss E., Tontodonati V., Herlitz A., Winblad B. Very old women at highest risk of dementia and Alzheimer's disease: incidence data from the Kungsholmen Project, Stockholm. Neurology. 1997 Jan;48(1):132–138. doi: 10.1212/wnl.48.1.132. [DOI] [PubMed] [Google Scholar]
  18. Gussekloo J., Heeren T. J., Izaks G. J., Ligthart G. J., Rooijmans H. G. A community based study of the incidence of dementia in subjects aged 85 years and over. J Neurol Neurosurg Psychiatry. 1995 Nov;59(5):507–510. doi: 10.1136/jnnp.59.5.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hachinski V. C., Iliff L. D., Zilhka E., Du Boulay G. H., McAllister V. L., Marshall J., Russell R. W., Symon L. Cerebral blood flow in dementia. Arch Neurol. 1975 Sep;32(9):632–637. doi: 10.1001/archneur.1975.00490510088009. [DOI] [PubMed] [Google Scholar]
  20. Isaacs B., Akhtar A. J. The set test: a rapid test of mental function in old people. Age Ageing. 1972 Nov;1(4):222–226. doi: 10.1093/ageing/1.4.222. [DOI] [PubMed] [Google Scholar]
  21. Joly P., Commenges D., Letenneur L. A penalized likelihood approach for arbitrarily censored and truncated data: application to age-specific incidence of dementia. Biometrics. 1998 Mar;54(1):185–194. [PubMed] [Google Scholar]
  22. Jorm A. F., Korten A. E., Henderson A. S. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand. 1987 Nov;76(5):465–479. doi: 10.1111/j.1600-0447.1987.tb02906.x. [DOI] [PubMed] [Google Scholar]
  23. Katzman R. Education and the prevalence of dementia and Alzheimer's disease. Neurology. 1993 Jan;43(1):13–20. doi: 10.1212/wnl.43.1_part_1.13. [DOI] [PubMed] [Google Scholar]
  24. Kawas C., Resnick S., Morrison A., Brookmeyer R., Corrada M., Zonderman A., Bacal C., Lingle D. D., Metter E. A prospective study of estrogen replacement therapy and the risk of developing Alzheimer's disease: the Baltimore Longitudinal Study of Aging. Neurology. 1997 Jun;48(6):1517–1521. doi: 10.1212/wnl.48.6.1517. [DOI] [PubMed] [Google Scholar]
  25. Kokmen E., Beard C. M., O'Brien P. C., Offord K. P., Kurland L. T. Is the incidence of dementing illness changing? A 25-year time trend study in Rochester, Minnesota (1960-1984) Neurology. 1993 Oct;43(10):1887–1892. doi: 10.1212/wnl.43.10.1887. [DOI] [PubMed] [Google Scholar]
  26. Korn E. L., Graubard B. I., Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997 Jan 1;145(1):72–80. doi: 10.1093/oxfordjournals.aje.a009034. [DOI] [PubMed] [Google Scholar]
  27. Law C. G., Brookmeyer R. Effects of mid-point imputation on the analysis of doubly censored data. Stat Med. 1992 Sep 15;11(12):1569–1578. doi: 10.1002/sim.4780111204. [DOI] [PubMed] [Google Scholar]
  28. Letenneur L., Commenges D., Dartigues J. F., Barberger-Gateau P. Incidence of dementia and Alzheimer's disease in elderly community residents of south-western France. Int J Epidemiol. 1994 Dec;23(6):1256–1261. doi: 10.1093/ije/23.6.1256. [DOI] [PubMed] [Google Scholar]
  29. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984 Jul;34(7):939–944. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
  30. Mölsä P. K., Marttila R. J., Rinne U. K. Epidemiology of dementia in a Finnish population. Acta Neurol Scand. 1982 Jun;65(6):541–552. doi: 10.1111/j.1600-0404.1982.tb03109.x. [DOI] [PubMed] [Google Scholar]
  31. Orgogozo J. M., Dartigues J. F., Lafont S., Letenneur L., Commenges D., Salamon R., Renaud S., Breteler M. B. Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area. Rev Neurol (Paris) 1997 Apr;153(3):185–192. [PubMed] [Google Scholar]
  32. Ott A., Breteler M. M., van Harskamp F., Claus J. J., van der Cammen T. J., Grobbee D. E., Hofman A. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ. 1995 Apr 15;310(6985):970–973. doi: 10.1136/bmj.310.6985.970. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Paganini-Hill A., Henderson V. W. Estrogen deficiency and risk of Alzheimer's disease in women. Am J Epidemiol. 1994 Aug 1;140(3):256–261. doi: 10.1093/oxfordjournals.aje.a117244. [DOI] [PubMed] [Google Scholar]
  34. Paykel E. S., Brayne C., Huppert F. A., Gill C., Barkley C., Gehlhaar E., Beardsall L., Girling D. M., Pollitt P., O'Connor D. Incidence of dementia in a population older than 75 years in the United Kingdom. Arch Gen Psychiatry. 1994 Apr;51(4):325–332. doi: 10.1001/archpsyc.1994.03950040069009. [DOI] [PubMed] [Google Scholar]
  35. Plassman B. L., Welsh K. A., Helms M., Brandt J., Page W. F., Breitner J. C. Intelligence and education as predictors of cognitive state in late life: a 50-year follow-up. Neurology. 1995 Aug;45(8):1446–1450. doi: 10.1212/wnl.45.8.1446. [DOI] [PubMed] [Google Scholar]
  36. Raskin N. H. Acute and prophylactic treatment of migraine: practical approaches and pharmacologic rationale. Neurology. 1993 Jun;43(6 Suppl 3):S39–S42. [PubMed] [Google Scholar]
  37. Rocca W. A., Hofman A., Brayne C., Breteler M. M., Clarke M., Copeland J. R., Dartigues J. F., Engedal K., Hagnell O., Heeren T. J. Frequency and distribution of Alzheimer's disease in Europe: a collaborative study of 1980-1990 prevalence findings. The EURODEM-Prevalence Research Group. Ann Neurol. 1991 Sep;30(3):381–390. doi: 10.1002/ana.410300310. [DOI] [PubMed] [Google Scholar]
  38. Rorsman B., Hagnell O., Lanke J. Prevalence and incidence of senile and multi-infarct dementia in the Lundby Study: a comparison between the time periods 1947-1957 and 1957-1972. Neuropsychobiology. 1986;15(3-4):122–129. doi: 10.1159/000118254. [DOI] [PubMed] [Google Scholar]
  39. Schoenberg B. S., Kokmen E., Okazaki H. Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features. Ann Neurol. 1987 Dec;22(6):724–729. doi: 10.1002/ana.410220608. [DOI] [PubMed] [Google Scholar]
  40. Shalat S. L., Seltzer B., Pidcock C., Baker E. L., Jr Risk factors for Alzheimer's disease: a case-control study. Neurology. 1987 Oct;37(10):1630–1633. doi: 10.1212/wnl.37.10.1630. [DOI] [PubMed] [Google Scholar]
  41. Snowdon D. A., Kemper S. J., Mortimer J. A., Greiner L. H., Wekstein D. R., Markesbery W. R. Linguistic ability in early life and cognitive function and Alzheimer's disease in late life. Findings from the Nun Study. JAMA. 1996 Feb 21;275(7):528–532. [PubMed] [Google Scholar]
  42. Stern Y., Alexander G. E., Prohovnik I., Mayeux R. Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease. Ann Neurol. 1992 Sep;32(3):371–375. doi: 10.1002/ana.410320311. [DOI] [PubMed] [Google Scholar]
  43. Stern Y., Gurland B., Tatemichi T. K., Tang M. X., Wilder D., Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA. 1994 Apr 6;271(13):1004–1010. [PubMed] [Google Scholar]
  44. Yoshitake T., Kiyohara Y., Kato I., Ohmura T., Iwamoto H., Nakayama K., Ohmori S., Nomiyama K., Kawano H., Ueda K. Incidence and risk factors of vascular dementia and Alzheimer's disease in a defined elderly Japanese population: the Hisayama Study. Neurology. 1995 Jun;45(6):1161–1168. doi: 10.1212/wnl.45.6.1161. [DOI] [PubMed] [Google Scholar]
  45. Zhang M. Y., Katzman R., Salmon D., Jin H., Cai G. J., Wang Z. Y., Qu G. Y., Grant I., Yu E., Levy P. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol. 1990 Apr;27(4):428–437. doi: 10.1002/ana.410270412. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES