Lower Levels of Education Are Associated with Cognitive Impairment in the Old Order Amish

Jairo Ramos, Aneesa R. Chowdhury, Laura J. Caywood, Michael Prough, M. Denise Fuzzell, Sarada Fuzzell, Kristy Miskimen, Patrice L. Whitehead, Larry D. Adams, Renee Laux, Yeunjoo Song, Paula Ogrocki, Alan J. Lerner, Jeffery M. Vance, Jonathan L. Haines, William K. Scott, Margaret A. Pericak-Vance, Michael L. Cuccaro

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Lower education has been reported to be associated with dementia. However, many studies have been done in settings where 12 years of formal education is the standard. Formal schooling in the Old Order Amish communities (OOA) ends at 8th grade which, along with their genetic homogeneity, makes it an interesting population to study the effect of education on cognitive impairment. Objective: The objective of this study was to examine the association of education with cognitive function in individuals from the OOA. We hypothesized that small differences in educational attainment at lower levels of formal education were associated with risk for cognitive impairment. Methods: Data of 2,426 individuals from the OOA aged 54-99 were analyzed. The Modified Mini-Mental State Examination (3MS-R) was used to classify participants as CI or normal. Individuals were classified into three education categories: <8, 8, and >8 years of education. To measure the association of education with cognitive status, a logistic regression model was performed adding age and sex as covariates. Results: Our results showed that individuals who attained lowest levels of education (<8 and 8) had a higher probability of becoming cognitvely impaired compared with people attending >8 years (OR = 2.96 and 1.85). Conclusion: Even within a setting of low levels of formal education, small differences in educational attainment can still be associated with the risk of cognitive impairment. Given the homogeneity of the OOA, these results are less likely to be biased by differences in socioeconomic backgrounds.

Original languageEnglish (US)
Pages (from-to)451-458
Number of pages8
JournalJournal of Alzheimer's Disease
Issue number1
StatePublished - 2021


  • Amish
  • Modified Mini-Mental State Examination (3MS)
  • cognitive function
  • cognitive impairment
  • dementia
  • education
  • logistic regression

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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