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Cognitive function in the oldest old: women perform better than men
  1. Department of Psychiatry, Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Medical School, 320 EAST Superior Steet, Suite 11–499, Chicago, IL 60611–3010, USA

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    In the paper by van Exel et al in this issue (pp 29–32),1 the authors examine the influence of sex and formal education on cognitive functioning in a community based sample of subjects over the age of 85. Based on the cognitive reserve theory of dementia, the authors hypothesise that women would be expected to score more poorly than men on cognitive tests due to a lower level of formal education.

    Previous studies provide support for the theory that a lower educational level is a risk factor for the development of dementia.2 This relation seems to be more pronounced in female subjects than males,3 although data regarding the influence of sex on cognitive functioning in non-demented persons were not available.

    The results of the current study showed better cognitive performance in the female group, despite their lower level of formal education. One possible explanation raised by the authors was that medical risk factors (for example, atherosclerosis) may be greater in the male group. An alternative, or contributing factor, may be use of formal education as a measure of “cognitive reserve”. Although years of education have traditionally been used to estimate premorbid functioning, some authors have suggested that formal education may be less important than later life experiences, such as primary occupation.4 A follow up to the current study might examine the role of non-educational experiences on cognitive functioning between men and women.

    This paper makes an important and timely contribution to the field of aging research, with the recent emphasis on early diagnosis of dementia. Understanding variables related to cognitive functioning in elderly people, such as the influence of sex, is essential for improving the ability to detect preclinical markers of dementia and identify “at risk” people who could benefit from clinical prevention trials.


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