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40 Educational Quality vs Years of Education is More Strongly Associated with Neuropsychological Test Performance
- Marilyn J Steinbach, Corey J Bolton, Marissa A Gogniat, Angela L Jefferson, Holly J Westervelt
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 720-721
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Objective:
Education is known to impact neuropsychological test performance, and self-reported years of education is often used in stratifying normative data. However, this variable does not always reflect education quality, particularly among underrepresented populations, and may overestimate cognitive impairment in individuals with low education quality. This cross-sectional study evaluated relative contributions of years of education and reading level to several verbally mediated assessments to improve interpretation of neuropsychological performance.
Participants and Methods:Data was obtained from the Vanderbilt Memory and Aging Project. Cognitively-unimpaired participants (n=175, 72±7 years, 59% male, 87% Non-Hispanic White, 16±2 years of education) completed a comprehensive neuropsychological protocol. Stepwise linear regressions were calculated using education and Wide Range Achievement Test (WRAT)-3 Reading subtest scores as predictors and letter fluency (FAS, CFL), category fluency (Vegetable and Animal Naming), the Boston Naming Test (BNT), and California Verbal Learning Test (CVLT)-II as outcomes to assess increase in variance explained by educational quality. Models covaried for age and sex. The False Discovery Rate (FDR) based on the Benjamini-Hochberg procedure (Benjamini & Hochberg, 1995) was used to correct for multiple comparisons.
Results:The mean WRAT-3 score was 51±4 (range:37-57), indicating post-high school reading level. Education and WRAT-3 scores were moderately correlated (r=0.36, p<0.01). Both WRAT-3 and years of education independently predicted letter fluency (WRAT-3 p<0.001; education p<0.02), category fluency (WRAT-3 p<0.001; education p<0.05), and CVLT-II performance (WRAT-3 p-values<0.005; education p-values<0.02) in single predictor models. On BNT, WRAT-3 (p<0.001), but not education (p=0.06), predicted performance in single predictor models. In combined models with both WRAT-3 and education, WRAT-3 scores remained a significant predictor of FAS (WRAT-3 b=1.21, p<0.001; education b=0.006, p=0.99) and CFL performance (WRAT-3 b=1.02, p<0.001; education b=0.51, p=0.14). Both WRAT-3 (b=0.21, p=0.01) and years of education (b=0.35, p=0.03) predicted Animal Naming, while WRAT-3 (b=0.16,p=0.008), but not years of education (p=0.37), predicted Vegetable Naming. WRAT-3 was a significant predictor of BNT performance (b=0.21, p<0.001) but not years of education (p=0.65). WRAT-3 predicted CVLT-II learning (b=0.32, p=0.04), immediate recall (b=0.16, p=0.005), and delayed recall performances (b=0.15, p=0.005), while education did not (p-values>0.14). All significant results persisted after FDR correction. WRAT-3 scores explained an additional level of variance beyond the covariates and education alone for FAS (AR=18%), CFL (AR=13%), Animal Naming and Vegetable Naming (AR= 3%), BNT (AR=18%), and CVLT-II learning (AR=2%), immediate recall (AR=4%), and delayed recall (AR=3%).
Conclusions:Reading level more strongly associated with performance on several verbally mediated neuropsychological measures than years of education. For all measures, the addition of reading level significantly increased the amount of variance explained by the model compared to covariates and education alone, which aligns with existing research. However, most of this past work looks at individuals with lower levels of educational quality. Because our cohort was highly educated and at the upper end of the reading spectrum, our results suggest that reading level is important to consider even for more highly educated individuals. Therefore, reading level is a critical variable to consider when interpreting verbally mediated neuropsychological measures for individuals across the educational spectrum.
7 P-Tau and Education as Moderators of the Relation between APOE4 and Memory Performance in Older Adults with Varying Cognitive Status
- Kharine Jean, Marissa Gogniat, Talia Robinson, L. Stephen Miller
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 885-886
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Objective:
White matter microstructure (WMM) potentially mediates the relation between APOE4 and memory performance. This study’s purpose was to understand whether p-tau effects this mediation model and whether education level differentially impacts the relations between these genetic and biological biomarkers’ influence on memory.
Participants and Methods:Participants included 161 older adults (M=74 years, 40.4% female, 92% White, 74 e4 non-carriers, 87 e4 carriers) with subjective and objective cognitive impairment from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). A composite memory score created by ADNI was used as the outcome variable. Mean fractional anisotropy (FA) and radial diffusivity (RD) values of white matter tracts within regions of interest (i.e., fornix (FX), hippocampal cingulum (CGH)) were individually used as the measures of WMM. A moderated mediation was run to examine whether p-tau was a moderator of the mediation between APOE4, white matter microstructure, and memory. An exploratory dual moderated mediation analysis examined education as a moderator of the moderated mediation. Indirect effects were tested using bootstrapping procedures.
Results:In the FA moderated mediation model, APOE4 was significantly related to FA of the fornix and memory performance. FA of the CGH and FX were also related to memory performance. With FA of the fornix as the mediator, the conditional indirect effect was not significant (95% CI[-.0009, .0070]). There was a trend suggesting at low (95% CI[-.2421, -.0140]) and average (95% CI[-.1658, -.0083]) levels of p-tau, FA of the fornix was a significant mediator but was non-significant at high levels of p-tau (95% CI [-.1322, .0341]). The RD moderated mediation model was non-significant. The FA and RD exploratory dual moderated mediation models were non-significant. However, the APOE4 x p-tau interaction with FA of the fornix as the mediator suggested a trend. At low levels of p-tau, increased education was related to a significant moderated mediation.
Conclusions:Results suggest that FA of the fornix is a significant mediator between the relation of APOE4 and memory, and this may be dependent upon p-tau levels. When p-tau burden load was high, the path by which APOE4 impacts memory performance was not through white matter microstructure degradation. Additionally, the potential buffering effects of education may be most robust at lower levels of p-tau burden.
3 Area Deprivation Index Interacts with Sex to Predict Atrophy and Cognitive Trajectory Over a 5-Year Follow-Up Period
- Marissa A Gogniat, Brina Ratangee, Omair A Khan, Francis Cambronero, Soumya Vytla, Michelle Houston, Dandan Liu, Timothy J Hohman, Katherine A Gifford, Angela L Jefferson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 870-872
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Objective:
Area Deprivation Index (ADI) is a measurement of neighborhood disadvantage. Evidence suggests that living in a disadvantaged neighborhood has a negative impact on health outcomes independent of socioeconomic status, including increased risk for Alzheimer's disease (AD). However, less is known about the biological mechanisms that drive these associations. We examined how ADI influences structural imaging variables and cognitive performance in community-dwelling older adults. We hypothesized that greater neighborhood disadvantage would predict atrophy and worse cognitive trajectory over time.
Participants and Methods:Participants included the legacy cohort from the Vanderbilt Memory and Aging Project (n=295, 73±7 years of age, 16±3 years of education, 42% female, 85% non-Hispanic White) who lived in the state of Tennessee. T1-weighted and T2-weighted fluid-attenuated inversion recovery brain MRIs and a comprehensive neuropsychological assessment were acquired at baseline, 18-month, 3-year, 5-year and 7-year follow-up time (mean follow-up time=5.2 years). Annual change scores were calculated for all neuropsychological and structural MRI outcome variables. Baseline state ADI was calculated using the University of Wisconsin School of Medicine and Public Health Neighborhood Atlas (Kind & Buckingham, 2018) and was based on deciles where 1 represents the least deprived area and 10 represents the most. Mixed effects regression models related baseline ADI to longitudinal brain structure (volume, thickness, white matter hyperintensities) and neuropsychological trajectory (one test per model). Analyses adjusted for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile score, (apolipoprotein) APOE-e4 status, cognitive status, and intracranial volume (for MRI outcomes). Models were repeated testing interactions with APOE-e4 status, sex, and cognitive status. A false discovery rate (FDR) correction for multiple comparisons was performed.
Results:On average, the sample was from relatively less disadvantaged neighborhoods in Tennessee (ADI state decile=2.4±1.8). Greater neighborhood disadvantage at study entry predicted more thinning of an AD-signature composite over time (ß=-0.002, p=0.005, pFDR=0.06); however, all other models testing MRI and neuropsychological outcomes were null (p-values>0.05, pFDR-values>0.51). Baseline ADI interacted with sex on longitudinal cortical thinning captured on the AD-signature composite (ß=0.004, p=0.006, pFDR=0.08) as well as several longitudinal cognitive outcomes including an executive function composite score (ß=0.033, p<0.001, pFDR=0.01), naming (ß=0.10, p=0.01, pFDR=0.12), visuospatial functioning (ß=0.083, p=0.02, pFDR=0.09), and an episodic memory composite score (ß=0.021, p=0.02, pFDR=0.07). In stratified models by sex, greater ADI predicted greater cortical thinning over time and worse longitudinal neuropsychological performance among men only. All stratified models in women were null except for executive function composite score, which did not survive correction for multiple comparisons (ß=-0.013, p=0.03, pFDR=0.61). Interactions by APOE-e4 and cognitive status were null (p-values>0.06, pFDR-values>0.61).
Conclusions:Among community-dwelling older adults, greater neighborhood disadvantage predicted greater cortical thinning over the mean 5-year follow-up in anatomical regions susceptible to AD-related neurodegeneration. Neighborhood disadvantage also interacted with sex on cortical thickness and several cognitive domains, with stronger effects found among men versus women. By contrast, there were no interactions between neighborhood disadvantage and genetic risk for AD or cognitive status. This study provides valuable evidence for sociobiological mechanisms that may underlie health disparities in aging adults whereby neighborhood deprivation is linked with neurodegeneration over time.