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      Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults Translated title: Associação entre baixa escolaridade, desempenho cognitivo reduzido, incapacidade funcional e fragilidade em idosos

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          ABSTRACT.

          Limited formal education is still common in ageing populations. Although limited formal education seems to be independently and negatively associated with cognition, functional abilities and frailty in ageing, no studies have examined whether the gradient of limited formal education has an impact on health in later life.

          Objective:

          to examine the relationship of limited formal education with cognitive status, functional abilities, and frailty status.

          Methods:

          a cross-sectional study was conducted involving 540 older adults stratified into groups: no formal education, 12-24 months of education, and 25-48 months of education. Cognitive screening (MMSE), functional abilities (Lawton Index), and frailty (CHS criteria) were measured. Regression analyses were performed.

          Results:

          27% had no formal education, 21% had 12-24 months of formal education, and 55% had 25-48 months of formal education. Limited formal education has a clear gradient of negative impact: No formal education was associated with scoring below MMSE cut-off scores (OR = 7.9), being totally/partially dependent for IADLs (OR = 2.5) and frail (OR = 2.0). Having 12-24 months of education was associated with scoring below MMSE cut-off scores (OR = 5.2) and with being frail (OR = 2.0). The No formal education group was 10.1 times more likely to have worse cognitive scores, worse functional abilities and frailty/pre-frailty status concomitantly (CCoFF), while older adults who had 12-24 months of education had a 4.6 times greater chance of having CCoFF.

          Conclusion:

          limited education had a gradient association with cognitive performance, functional disability and frailty. These findings clearly emphasize the importance of prevention through education from childhood to older age.

          RESUMO.

          A baixa escolaridade ainda é comum na população idosa. Embora a limitação na educação formal pareça estar independentemente e negativamente associada à cognição, habilidades funcionais e fragilidade no envelhecimento, nenhum estudo examinou a associação entre baixa escolaridade e um impacto futuro na saúde.

          Objetivo:

          esse estudo examinou a relação entre baixa escolaridade e o status cognitivo, habilidades funcionais e fragilidade.

          Métodos:

          estudo transversal com 540 idosos divididos em grupos: sem educação formal, 12-24 meses de escolaridade e 25-48 meses de escolaridade. Informações da triagem cognitiva (MEEM), habilidades funcionais (Índice de Lawton); a fragilidade (critérios do CHS) foram coletadas. Análises de regressão foram realizadas.

          Resultados:

          27% não tinham educação formal, 21% tinham entre 12-24 meses de educação formal e 55% tinham entre 25-48 meses de educação formal. Baixa escolaridade apresentou um impacto negativo e gradiente: nenhuma educação formal foi associada à pontuação abaixo do escore do MEEM (OR = 7,9), à dependência total/parcialmente em AIVD (OR = 2,5) e fragilidade (OR = 2,0). Ter 12-24 meses de escolaridade foi associado à pontuação abaixo do escore do MEEM (OR = 5,2) e a ser frágil (OR = 2,0). O grupo sem educação formal foi 10,1 vezes mais provável de apresentar piores escores cognitivos, pior capacidade funcional e fragilidade/pré-fragilidade concomitante (CCoFF), enquanto adultos idosos que tinham entre 12-24 meses de escolaridade tiveram 4,6 vezes maior chance de apresentar CCoFF.

          Conclusão:

          a baixa escolaridade apresentou associação com desempenho cognitivo, limitações funcionais e fragilidade. Os achados enfatizam claramente a importância da prevenção através da educação desde a infância à velhice.

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          Most cited references37

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          [Suggestions for utilization of the mini-mental state examination in Brazil].

          Mini-metal state examination (MMSE) is a screening test to detect cognitive impairment. The objectives of the present study are to describe some adaptations for use of MMSE in Brazil and to propose rules for its uniform application. We evaluated 433 healthy subjects using the MMSE and verified the possible influence of demographic variables on total scores. Educational level was the main factor that influenced performance, demonstrated by ANOVA: F(4,425) = 100.45, p<0.0001. The median values for educational groups were: 20 for illiterates; 25 for 1 to 4 yrs; 26.5 for 5 to 8 yrs; 28 for 9 to 11 yrs and 29 for higher levels. The MMSE is an excellent screening instrument and definitive rules are necessary for comparison purposes.
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            Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study

            Summary Background Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. Methods We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3–5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. Findings 12 887 participants were interviewed at baseline. 11 718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34 718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4–2·7 times higher than were those for DSM-IV dementia (9·9–15·7 per 1000 person-years). Mortality hazards were 1·56–5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4–19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56–1·79), female sex (0·72; 0·61–0·84), and low education (0·89; 0·81–0·97), but not with occupational attainment (1·04; 0·95–1·13). Interpretation Our results provide supportive evidence for the cognitive reserve hypothesis, showing that in middle-income countries as in high-income countries, education, literacy, verbal fluency, and motor sequencing confer substantial protection against the onset of dementia. Funding Wellcome Trust Health Consequences of Population Change Programme, WHO, US Alzheimer's Association, FONACIT/ CDCH/ UCV
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              Relationship between cognition and frailty in elderly: A systematic review

              Objective The aim of this study was to analyze the relationship between cognition and frailty in the elderly. Methods A systematic review on the currently existing literature concerning the subject was carried out. The search strategy included LILACS, SCOPUS, SciELO, PsycINFO, PubMed and Web of Science databases. Results A total of 19 studies were selected for review, from which 10 (52.6%) were cross-sectional and 9 (47.4%) longitudinal, and the majority Brazilian. All of the studies established a link between cognition and frailty. There was a relationship between components of frailty and the cognitive domains. Risk of Mild Cognitive Impairment (MCI), dementia and mortality were all evidenced in the relationship between frailty and cognitive impairment. Conclusion The theory remains limited, but results show the variables that appear to be linked to cognition and frailty in elderly. This data can help in implementing actions to improve the quality of life among elderly.
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                Author and article information

                Journal
                Dement Neuropsychol
                Dement Neuropsychol
                dn
                Dementia & Neuropsychologia
                Associação de Neurologia Cognitiva e do Comportamento
                1980-5764
                Apr-Jun 2019
                Apr-Jun 2019
                : 13
                : 2
                : 216-224
                Affiliations
                [1 ]Nursing Post Graduate Program, Federal University of São Carlos, SP, Brazil.
                [2 ]Department of Gerontology, Federal University of São Carlos, SP, Brazil.
                [3 ]Gerontology, School of Arts, Sciences and Humanities, University of São Paulo, SP, Brazil.
                [4 ]School of Health Sciences, University of East Anglia, Norwich, UK.
                Author notes
                Eneida Mioshi. School of Health Sciences / University of East Anglia - Norwich Research Park - Norwich NR4 7TJ - United Kingdom. E-mail: e.mioshi@ 123456uea.ac.uk

                Disclosure: The authors report no conflicts of interest.

                Authors contribution. Design of the study: AGB, SCI, and EM. Analysis of the data: AGB, SCI, EM. Intellectual contribution to the writing of the manuscript: AGB, TSA, KI, MSY, SCI and EM.

                Article
                10.1590/1980-57642018dn13-020011
                6601310
                31285797
                cd201580-6468-4402-88f7-6c848f39d777

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 January 2019
                : 02 March 2019
                Categories
                Original Article

                cognition,instrumental activities of daily living,frailty,education,developing countries,cognição,atividades instrumentais da vida diária,fragilidade,educação,países em desenvolvimento

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