The Differential Effect of Schooling and Physical Activity on Dementia in Older Women and Men from Brazil: Implications for Policymaking

Article type: Research Article

Authors: Souza, Melyssa Alves^{a; b} | Peres Bomfim, Larissa Gomes^a | de Barros, Vinicius Lúcio^a | Medeiros Jr, Reinaldo Coelho^a | Ginsicke, Danielle Cristine^a | Colovati, Mileny Esbravatti Stephano^a | Daly, Timothy^c | Zanesco, Angelina^{a; *}

Affiliations: [a] Medical School, Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil | [b] Department of Biosciences, Institute of Health and Society, Federal University of Sao Paulo (UNIFESP), Santos, SP, Brazil | [c] Sorbonne Université, Science Norms Democracy, UMR 8011, Paris, France

Correspondence: [*] Correspondence to: Angelina Zanesco, Medical School, Avenida Francisco Glicério, 8 –Encruzilhada, Santos (SP), Brazil. E-mail: [email protected].

Abstract: Background:Modifiable risk factors exert crucial impact on dementia. Objective:We sought to answer the question: do two modifiable risk factors, schooling level and physical activity (PA), affect cognitive function similarly in each sex? Methods:This cross-sectional study was conducted in 2019 and 2021, and the survey was applied to the residents of the metropolitan area of Santos, a seashore of Sao Paulo State. Four hundred and twenty-two participants (women = 254 and men = 168) were eligible. Baecke questionnaire for the elderly was applied for the classification as physically inactive (PI) or active (PA). Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Participants were also stratified by schooling status for both sexes. Results:Higher education had a sex-independent positive influence on MMSE and CDR (p < 0.001). PA influences positively MMSE in older women (PI: 25±5 and PA: 27±3, p < 0.03), but has no effect in older men (26±5 and 25±5, p > 0.05). Concordantly, older women who were PA (1.7 and 0 %) showed a lower prevalence of dementia compared with PI (6.2 and 2.1%), for mild and moderate respectively. Active older women had higher odds of improving the MMSE score (OR: 1.093; 95% CI: 1.008–1.186) than men (OR: 0.97 (95% CI: 0.896–1.051). Conclusion:Education affects cognitive function equally in Brazilian elderly whereas older women are more responsive to the beneficial effects of PA for dementia than men.

Keywords: Cognitive function, physical activity, schooling status, sex difference

DOI: 10.3233/JAD-220517

Journal: Journal of Alzheimer's Disease, vol. 90, no. 2, pp. 859-867, 2022