{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T19:42:29Z","timestamp":1770234149128,"version":"3.49.0"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2009,9,1]],"date-time":"2009-09-01T00:00:00Z","timestamp":1251763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["NIA\u2010K\u201001AG025444\u201001A1"],"award-info":[{"award-number":["NIA\u2010K\u201001AG025444\u201001A1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30\u2010AG\u201015272"],"award-info":[{"award-number":["P30\u2010AG\u201015272"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K08\u2010AG019180"],"award-info":[{"award-number":["K08\u2010AG019180"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01\u2010AG027010"],"award-info":[{"award-number":["R01\u2010AG027010"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["NIA\u2010U01AG009740"],"award-info":[{"award-number":["NIA\u2010U01AG009740"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["U01\u2010AG009740"],"award-info":[{"award-number":["U01\u2010AG009740"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self\u2010assessed school performance is associated with AD beyond the effects of educational level alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants were drawn from the population\u2010representative Aging, Demographics, and Memory Study (ADAMS, 2000\u20102002). The ADAMS participants were asked about their performance in school. Possible response options included \u201cabove average,\u201d \u201caverage,\u201d or \u201cbelow average.\u201d The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 725 participants (mean age, 81.8 years; 59% female; 16% African\u2010American) varied in self\u2010assessed educational performance: 29% reported \u201cabove average,\u201d 64% reported \u201caverage,\u201d and 7% reported \u201cbelow average\u201d school performance. Participants with a lower self\u2010assessed school performance had higher proportions of AD: 11% of participants with \u201cabove average\u201d self\u2010assessed performance had AD, as opposed to 12% of participants with \u201caverage\u201d performance and 26% of participants with \u201cbelow average\u201d performance (<jats:italic>P<\/jats:italic> &lt; 0.001). After controlling for subjects' years in school, a literacy test score (Wide\u2010Range Achievement Test), age, sex, race\/ethnicity, apolipoprotein E\u2010\u025b4 status, socioeconomic status, and self\u2010reported comorbidities, respondents with \u201cbelow average\u201d self\u2010assessed school performance were four times more likely to have AD compared with those of \u201caverage\u201d performance (odds ratio, 4.0; 95% confidence interval, 1.2\u201314). \u201cAbove average\u201d and \u201caverage\u201d self\u2010assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5\u20131.7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We suggest an association between \u201cbelow average\u201d self\u2010assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jalz.2009.07.039","type":"journal-article","created":{"date-parts":[[2009,9,13]],"date-time":"2009-09-13T04:09:38Z","timestamp":1252814978000},"page":"380-387","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["\u201cBelow average\u201d self\u2010assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study"],"prefix":"10.1002","volume":"5","author":[{"given":"Kala M.","family":"Mehta","sequence":"first","affiliation":[{"name":"Division of Geriatric Medicine University of California at San Francisco San Francisco CA USA"},{"name":"San Francisco Veterans Affairs Medical Center San Francisco CA USA"},{"name":"Medical Effectiveness Research Center for Diverse Populations University of California at San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita L.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Medical Effectiveness Research Center for Diverse Populations University of California at San Francisco San Francisco CA USA"},{"name":"Institute for Health and Aging University of California at San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth M.","family":"Langa","sequence":"additional","affiliation":[{"name":"Division of General Medicine Department of Medicine and the Institute for Social Research University of Michigan Ann Arbor MI USA"},{"name":"Veterans Affairs Center for Practice Management and Outcomes Research Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine","family":"Yaffe","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Medical Center San Francisco CA USA"},{"name":"Department of Psychiatry Department of Neurology and Department of Epidemiology University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Moody\u2010Ayers","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine University of California at San Francisco San Francisco CA USA"},{"name":"Department of Psychiatry Department of Neurology and Department of Epidemiology University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brie A.","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine University of California at San Francisco San Francisco CA USA"},{"name":"Department of Psychiatry Department of Neurology and Department of Epidemiology University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth E.","family":"Covinsky","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine University of California at San Francisco San Francisco CA USA"},{"name":"Department of Psychiatry Department of Neurology and Department of Epidemiology University of California, San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,9]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1159\/000093378"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410270412"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988705281869"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20637"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617702813248"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.5.1238"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1017\/S135561779953302X"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/59.4.M390"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52575.x"},{"key":"e_1_2_7_11_2","unstructured":"UNESCO.EFA global monitoring report. Understanding educational quality2005"},{"key":"e_1_2_7_12_2","volume-title":"Institute for Social Research","author":"Heeringa S.G.","year":"2006"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-148-6-200803180-00005"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1159\/000109998"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/52B.Special_Issue.37"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.2307\/146277"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1159\/000087448"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/13803390802375557"},{"key":"e_1_2_7_19_2","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/aje\/kwm185","article-title":"Childhood social and economic well\u2010being and health in older age","volume":"166","author":"Moody\u2010Ayers S.","year":"2007","journal-title":"Am J Epidemiol"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.15.1701"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000069923.64550.9F"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1076\/jcen.25.5.680.14579"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1746-1561.2002.tb03561.x"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2004.06.019"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53361.x"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.10.1455"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.wad.0000201854.62116.d7"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2004.04.010"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200107000-00007"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2001.49269.x"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)90082-5"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(90)90035-N"},{"key":"e_1_2_7_33_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700008412"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1991.tb01617.x"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700024375"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)00159-N"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.69.5.797"},{"key":"e_1_2_7_38_2","doi-asserted-by":"publisher","DOI":"10.1353\/dem.2007.0003"},{"key":"e_1_2_7_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(95)00507-2"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2000.tb03877.x"}],"container-title":["Alzheimer's &amp; Dementia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1552526009021293?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1552526009021293?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.jalz.2009.07.039","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.jalz.2009.07.039","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.jalz.2009.07.039","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.jalz.2009.07.039","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T14:47:25Z","timestamp":1759934845000},"score":1,"resource":{"primary":{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/10.1016\/j.jalz.2009.07.039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,9]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2009,9]]}},"alternative-id":["10.1016\/j.jalz.2009.07.039"],"URL":"https:\/\/doi.org\/10.1016\/j.jalz.2009.07.039","archive":["Portico"],"relation":{},"ISSN":["1552-5260","1552-5279"],"issn-type":[{"value":"1552-5260","type":"print"},{"value":"1552-5279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,9]]},"assertion":[{"value":"2009-09-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}