Vascular Risk Factors and Cognitive Function: Associations Modified by Level of Education in a Community Dwelling Elders with Cognitive Impairment

ABSTRACT

OBJECTIVE: Level of education has been reported to modify the associations between vascular risk factors and cognitive impairment. This study aimed to test this hypothesis in a community dwelling Korean elders with relative cognitive impairment. METHOD: The study group consisted of 341 participants with the Korean version of Mini-Mental State Examination (MMSE-K) scores of 24 or below. The cognitive impairment was categorized into mild (MMSE-K 21-24) or moderate to severe (MMSE-K <21). For each participant, diagnoses for vascular risk factors were ascertained, and resting blood pressure and non-fasting blood glucose and serum cholesterol levels were examined. RESULTS: In the total sample, after adjustment for age, past occupation, physical activities of daily living and cholesterol levels, the worse cognitive function (MMSE-K <21) was associated with raised systolic blood pressure and the diagnosis of diabetes. However, the stratified analyses according to education level revealed that these associations were only significant in those with no formal education. In addition, the higher level of non-fasting blood glucose was significantly associated with the worse cognitive function only for those with no formal education CONCLUSION: Older Koreans with low levels of education may be particularly vulnerable to cognitive impairment associated with risk factors for cerebrovascular disease. This has an important implication for public health strategies regarding the prevention of dementia.