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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.
1st Asia Pacific Forum on Quality Improvement in Health Care Three day conference Wednesday 19 to Friday 21 September 2001 Sydney, Australia
We are delighted to announce this forthcoming conference in Sydney. Authors are invited to submit papers (call for papers closes on Friday 6 April), and delegate enquiries are welcome.
The themes of the Forum are:
Improving patient safety
Leadership for improvement
Consumers driving change
Building capacity for change: measurement, education and human resources
The context: incentives and barriers for change
Improving health systems
The evidence and scientific basis for quality improvement.
Presented to you by the BMJ Publishing Group (London, UK) and Institute for Healthcare Improvement (Boston, USA), with the support of the the Commonweatlh Department of Health and Aged Care (Australia), Safety and Quality Council (Australia), NSW Health (Australia) and Ministry of Health (New Zealand).
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