The Influence of Education on Clinically Diagnosed Dementia Incidence and Mortality Data From the Kungsholmen Project

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Abstract
THE RELATIONSHIP between education and Alzheimer disease (AD) or dementia has been widely examined over the past decade and the evidence obtained is mixed.1,2 An inverse association between educational level and the risk of AD or dementia has been reported in some cross-sectional3-8 and case-control studies,9,10 but not in others.11-14 Retrospective studies are subject to a number of biases, such as information and selection biases, that may result in an overestimation or underestimation of the association between education and dementia.15,16 Several incidence studies6,17-21 and pooled incidence data from Europe22 also demonstrate an inverse association between education and AD or dementia. In contrast, other incidence studies23-25 as well as autopsy-verified studies26-28 have failed to find any evidence for this reverse relationship. In addition, the effects of potential confounders, such as cognitive functioning prior to dementia, vascular diseases, and socioeconomic status, have been largely neglected by most previous studies addressing this issue.