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Socioeconomic Inequalities in the Onset of Cognitive Pathology

Sun, August 13, 2:30 to 4:10pm, Palais des congrès de Montréal, Floor: Level 5, 515B

Abstract

Dementia affects more than 5.4 million Americans and is the sixth most common cause of death. Social theories suggest that education should predict later onset of cognitive pathology. Yet, cognitive aging models and clinical models deviate about the role of education in predicting the rate of cognitive decline. This paper suggests that one reason for such a deviation may be divergence in theories about how declines progress. Analyses used data from a nationally representative prospective cohort study (N=30,336) to model acceleration in cognitive decline as an indicator of cognitive pathology. Longitudinal models leveraged acceleration in cognitive decline by layering a Logistic-Gompertz-Makeham survival model over a longitudinal mixed-effects model to jointly model cognitive aging and incidence of cognitive pathology. Results found that education was associated with a later onset of accelerated cognitive decline. Results also suggested that education was associated with higher baseline capability, and with more rapid accelerated declines, consistent with cognitive reserve theory. Together, this study suggests that models interrogating cognitive reserve but ignoring accelerated declines in cognition may be biased. This study found support for the hypothesis that education is associated with higher lifetime cognitive capability as well as with later onset of cognitive pathology.

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