Home › Research › Prevention and risk
Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors
Liu C, Ma Y, Hofman A, Waziry R, Koton S, Pike JR, et al.. Annals of Neurology, 2023-04-27
Topic: Risk, prevention and care in population studies
Introduction Lower education is associated with higher burden of vascular risk factors in mid-life and higher risk of dementia in late life. We aim to understand the causal mechanism through which vascular risk factors potentially mediate the relationship between education and dementia. Methods In a cohort of 13,368 Black and White older adults in the Atherosclerosis Risk in Communities Study, we assessed the relationship between education (grade school, high school without graduation, high school graduate or equivalent, college, graduate/professional school) and dementia among all participants and among those with incident stroke. Cox models were adjusted for age, race-center (a variable stratified by race and field center), sex, apolipoprotein E (APOE) ε4 genotype, and family history of cardiovascular disease. Causal mediation models assessed mediation by mid-life systolic blood pressure, fasting blood glucose, body mass index, and smoking. Results More education was associated with 8 to 44% lower risk of dementia compared to grade school-level education in a dose-response pattern, while the relationship between education and post-stroke dementia was not statistically significant. Up to 25% of the association between education and dementia was mediated through mid-life vascular risk factors, with a smaller percentage mediated for lower levels of education. Interpretation A substantial proportion of the relationship between education and dementia was mediated through mid-life vascular risk factors. However, risk factor modification is unlikely to fully address the large educational disparities in dementia risk. Prevention efforts must also address disparities in socioeconomic resources leading to divergent early-life education and other structural determinants of mid-life vascular risk factors. ANN NEUROL 2023;94:13-26.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Liu, C., Ma, Y., Hofman, A., Waziry, R., Koton, S., Pike, JR., et al. (2023). Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors. Annals of Neurology. https://doi.org/10.1002/ana.26647
Vancouver
Liu C, Ma Y, Hofman A, Waziry R, Koton S, Pike JR, et al. Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors. Annals of Neurology. 2023. doi:10.1002/ana.26647. PMID: 36966451.
BibTeX
@article{liu2023-36966451,
author = {Liu, C. and Ma, Y. and Hofman, A. and Waziry, R. and Koton, S. and Pike, JR. and others},
title = {{Educational Attainment and Dementia: Mediation by Mid-Life Vascular Risk Factors}},
journal = {Annals of Neurology},
year = {2023},
doi = {10.1002/ana.26647},
pmid = {36966451},
url = {https://doi.org/10.1002/ana.26647}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- Introduction Lower education is associated with higher burden of vascular risk factors in mid-life and higher risk of dementia in late life.
- Results More education was associated with 8 to 44% lower risk of dementia compared to grade school-level education in a dose-response pattern, while the relationship between education and post-stroke dementia was not statistically significant.
Why it matters
This cohort study of 13,368 older adults found that more education was associated with 8 to 44% lower risk of dementia in a dose-response pattern, with up to 25% of the association mediated through mid-life vascular risk factors. It suggests that education and mid-life vascular health may be linked to lower dementia risk, but it does not show a treatment or cure.
New to this subject? Start with our plain-English guide: Prevention →
Study details
- Study designcohort
- Participants13,368
- Effect size8-44% lower dementia risk with higher education vs grade school; up to 25% mediated by midlife vascular risk factors
- Evidence strengthModerate
Limitations
Observational; two US regions and two racial groups; mediation estimates depend on modelling assumptions.
How this study scored 66/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 65 of the 98 points we could judge it on, which is 66 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Annals of Neurology) |
| Journal's citation record | 3 / 4 | Annals of Neurology: journal h-index 437 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 13,368 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 26 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 5.2 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 3 / 6 | Cited 4.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 26 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Rebecca F. Gottesman: h-index 92 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 9 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 36966451) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 65 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 65 of the 98 points we could judge it on is 66 out of 100. |
| Total | 66 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Related
Studies in the library that share something with this one. The line above each title says what.
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here. Showing 12 of 16.
Later studies that cite this one
2 studies in the alzhub library list this one in their references.
Related studies in Prevention and risk
Also tagged “incidence”
1,084 studies in the library carry the topic tag “incidence”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 1,084 tagged studies.