• Posted February 14, 2023

Poorer Schools Could Bring Higher Dementia Rates Many Decades Later

What do race and early education have to do with dementia risk among seniors?

Quite a bit, a new study suggests.

Researchers spent decades tracking the onset of dementia among nearly 21,000 U.S. seniors, before reaching two main conclusions.

The first is that seniors who, as kids, were educated in states that generally had shorter school years, larger classes, and lower attendance rates had a higher risk for dementia after age 65, compared with seniors raised in states offering a "high quality" education, meaning more school days, smaller classes and better attendance.

And the second is that Black seniors are much more likely to have been raised in a "low quality"educational environment than their white peers, putting them at much higher risk of dementia.

So does that mean that dementia risk owes to poorer education or to deeply rooted racism?

"In a sense, it'd be both,"said lead author Yenee Soh, a postdoctoral research fellow at Kaiser Permanente Northern California in Oakland.

"Worse educational quality is associated with higher risk of dementia, but if Black individuals are more exposed to worse educational quality, [then] there's a larger population burden of dementia among Black individuals,"she explained.

And that added dementia burden among Black people, Soh added, likely sources back "to unequal investments in high quality education due to systemic racism."

To examine links between childhood education, race and dementia, the researchers focused on Kaiser Permanente patients who had both completed an optional health survey at some point between 1964 and 1972 and were at least 65 years old and were dementia-free in 1996. Everyone included in the analysis was born between 1902 and 1931.

About 57% of the patients were women. Roughly 1 in 5 patients was Black, the rest were white. About 4 in 10 had not completed high school.

Researchers also assessed the quality of education that each participant would likely have received in their state at 6 years of age. Quality was graded on the basis of student-teacher ratios, school-term length, and attendance figures.

In all, between 21% and 23% of white seniors grew up in states that offered 6-year-olds the "lowest quality"education.

Among Black seniors, those figures shot up dramatically, to between 76% and 86%.

After reviewing records of new dementia diagnoses between 1997 and 2019, the team found that those seniors who grew up in the lowest quality educational environment were significantly more likely to end up with dementia, compared to those from states with the best schooling.

Soh stressed that the findings only highlight an "association"between education, race and dementia risk, and are not clear proof of cause and effect.

As to why inferior education might boost dementia risk, she pointed to several potential factors.

Those included the possibility that kids with such backgrounds have less access to health care overall, as well as a higher risk for obesity, smoking and high blood pressure.

"Identifying those who have experienced worse state-level educational quality may help understand how to target efforts in addressing these factors,"Soh noted.

She said the findings suggest that "state-level investments in education do matter for dementia risk, and that it may be important to address systemic factors that contribute to unequal distribution of such investments in racial and ethnic minority groups."

Andrea Roberts, a senior research scientist at the Harvard University T.H. Chan School of Public Health, said the findings were not surprising, including researchers' observation that state differences in education quality do not affect Americans equally.

"Although we can't be sure this association is causal, the findings suggest that working to increase attendance, making sure the school year is long enough, and keeping student-teacher ratios low could protect against dementia as well as other related health problems,"said Roberts, who was not involved in the study.

Still, on a positive note, Roberts did suggest that even with a history of low quality education, some things can be done to reduce long-term dementia risk.

"For example, getting enough physical activity, eating a diet rich in whole grains, fruits, vegetables, and nuts, getting enough sleep, increasing social connections, and treating symptoms of depression may reduce risk of dementia, even for people whose education quality was not ideal,"she said.

The findings were published Feb. 13 in JAMA Neurology.

More information

There's more on race, ethnicity and dementia risk at the Alzheimer's Association.

SOURCES: Yenee Soh, ScD, SM, postdoctoral research fellow, Kaiser Permanente Northern California, Oakland; Andrea Roberts, PhD, MPH, senior research scientist, Harvard University T.H. Chan School of Public Health, Boston; JAMA Neurology, Feb. 13, 2023