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BACKGROUND: higher educational attainment and less midlife cardiovascular risk factors are related to better old-age cognition. Whether education moderates the association between cardiovascular risk factors and late-life cognition is not known. We studied if higher education provides resilience against the deteriorative effects of higher middle-age body mass index (BMI) and a combination of midlife cardiovascular risk factors on old-age cognition. METHODS: the study population is the older Finnish Twin Cohort (n = 4,051, mean age standard deviation, SD = 45.5 years 6.5). Cardiovascular risk factors and education were studied at baseline with questionnaires in 1975, 1981 and/or 1990 (participation rates of 89, 84 and 77%, respectively). Cognition was evaluated with telephone interviews (participation rate 67%, mean age SD =73.4 2.9 years, mean follow-up SD = 27.8 6.0 years) in 1999-2017. We studied the main and interactive effects of education and BMI/dementia risk score on late-life cognition with linear regression analysis. The study design was formulated before the pre-defined analyses. RESULTS: years of education moderated the association between BMI with old-age cognition (among less educated persons, BMI-cognition association was stronger B = -0.24 points per BMI unit, 95% CI -0.31, -0.18 than among more educated persons B = -0.06 points per BMI unit, 95% CI -0.16, 0.03, Pinteraction < 0.01). There was a similar moderating effect of education on dementia risk score consisting of cardiovascular risk factors (P < 0.001). CONCLUSIONS: our results support the cognitive reserve hypothesis. Those with higher education may tolerate the deteriorative effects of midlife cardiovascular risk factors on old-age cognition better than those with lower education.
Iso‐Markku et al. (Fri,) studied this question.