Impact of differential attrition on the association of education with cognitive change over 20 years of follow-up

Rebecca F. Gottesman, Andreea M. Rawlings, A. Richey Sharrett, Marilyn Albert, Alvaro Alonso, Karen Bandeen-Roche, Laura H. Coker, Josef Coresh, David J. Couper, Michael E. Griswold, Gerardo Heiss, David S. Knopman, Mehul D. Patel, Alan D. Penman, Melinda C. Power, Ola A. Selnes, Andrea L.C. Schneider, Lynne E. Wagenknecht, B. Gwen Windham, Lisa M. WruckThomas H. Mosley

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


Studies of long-term cognitive change should account for the potential effects of education on the outcome, since some studies have demonstrated an association of education with dementia risk. Evaluating cognitive change is more ideal than evaluating cognitive performance at a single time point, because it should be less susceptible to confounding. In this analysis of 14,020 persons from a US cohort study, the Atherosclerosis Risk in Communities (ARIC) Study, we measured change in performance on 3 cognitive tests over a 20-year period, from ages 48-67 years (1990-1992) through ages 70-89 years (2011-2013). Generalized estimating equations were used to evaluate the association between education and cognitive change in unweighted adjusted models, in models incorporating inverse probability of attrition weighting, and in models using cognitive scores imputed from the Telephone Interview for Cognitive Status for participants not examined in person. Education did not have a strong relationship with change in cognitive test performance, although the rate of decline was somewhat slower among persons with lower levels of education. Methods used to account for selective dropout only marginally changed these observed associations. Future studies of risk factors for cognitive impairment should focus on cognitive change, when possible, to allow for reduction of confounding by social or cultural factors.

Original languageEnglish (US)
Pages (from-to)956-966
Number of pages11
JournalAmerican journal of epidemiology
Issue number8
StatePublished - Apr 15 2014


  • aging
  • cognition
  • cognitive decline
  • cognitive reserve
  • education


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