Education, but not occupation, is associated with cognitive impairment: The role of cognitive reserve in a sample from a low-to-middle-income country

Abstract

Introduction: Education, and less frequently occupation, has been associated with lower dementia risk in studies from high-income countries. We aimed to investigate the association of cognitive impairment with education and occupation in a low-middle-income country sample.

Methods: In this cross-sectional study, cognitive function was assessed by the Clinical Dementia Rating sum of boxes (CDR-SOB). We investigated the association of occupation complexity and education with CDR-SOB using adjusted linear regression models for age, sex, and neuropathological lesions.

Results: In 1023 participants, 77% had < 5 years of education, and 56% unskilled occupations. Compared to the group without education, those with formal education had lower CDR-SOB (1-4 years: $\beta$ = -0.99, 95% confidence interval [CI] = -1.85; -0.14, P = .02; ≥5 years: $\beta$ = -1.42, 95% CI = -2.47; -0.38, P = .008). Occupation complexity and demands were unrelated to cognition.

Discussion: Education, but not occupation, was related to better cognitive abilities independent of the presence of neuropathological insults.

Keywords: cognitive impairment; developing countries; education; occupation.