 |
 |
 |
 |
 |
 |
Sains Malaysiana 45(9)(2016):
1371–1380 Relationship between Education and Cognitive
Performance among Healthy Malay Adults (Hubungan antara Pendidikan dan Prestasi
Kognitif dalam Kalangan Dewasa Melayu Sihat) A.I.Z.
AMIR
HAMZAH1,
Z.H.
ABU
BAKAR1,
N.F.
ABDUL
SANI1,
J-K.
TAN1,
M.H.
AHMAD
DAMANHURI1,
K.N.
NOR
ARIPIN2,
M.D.
MOHD
RANI2,
N.A.
NOH2,
R.
RAZALI14,
M.
MOHAMAD3,
S.
MAKPOL1,
M.
MAZLAN5,
H.
ABDUL
HAMID6
& W.Z. WAN
NGAH1* 1Department of Biochemistry, Hospital
Chancellor Tuanku Mukhriz, Universiti Kebangsaan Malaysia Medical
Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala
Lumpur, Federal Territory, Malaysia 2Faculty of Medicine and Health Sciences,
Universiti Sains Islam Malaysia, 55100 Kuala Lumpur, Federal Territory,
Malaysia 4Department of Psychiatry, Hospital
Chancellor Tuanku Mukhriz, Universiti Kebangsaan Malaysia Medical
Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala
Lumpur, Federal Territory, Malaysia 5Faculty of Medicine, Universiti
Teknologi MARA, 47000 Sungai Buloh, Selangor Darul Ehsan Malaysia 6Department of Radiology, Hospital
Chancellor Tuanku Mukhriz, Universiti Kebangsaan Malaysia Medical
Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala
Lumpur, Federal Territory, Malaysia Received:
18 December 2015/Accepted: 7 May 2016 ABSTRACT Higher level of education is
associated with better cognitive performance and lower risk of developing
dementia. However, the effect of education on cognitive performance
varies across different cognitive domains and in different populations.
The aim of this study was to determine the relationship between
education and performance of different cognitive domains among healthy
Malay adults. A total of 53 individuals aged 29 to 77 years participated
in a battery of neurophysiological tests consisting of Mini-Mental
State Examination, Montreal Cognitive Assessment, digit span, visual
reproduction and digit symbol speed test (DSST).
Blood test was performed for each participant to obtain their biochemical
profile. Educational level was divided into level 1 (PMR),
level 2 (SPM), level 3 (STPM), level 4 (Diploma) and level
5 (Degree). Simple linear regression indicated that years of education
was positively associated with scores of delayed visual reproduction
(b=1.348,
p=0.002) and DSST (b=3.257, p=0.012).
However, scores of all the tests were not significantly different
among different levels of education after controlling for age, gender
and blood test profile by ANCOVA. Multiple linear regression analysis showed that
MMSE
score was associated with red cell distribution width
(b=-0.628, p=0.005), age (b=-0.119, p<0.001)
and there was interaction between high density lipoprotein (HDL)
with age (b=0.047, p<001). MoCA score
was associated with age (b=-0.121, p<0.001), gender
(male compared to female, b=1.870, p=0.020) and HDL (b=1.681,
p=0.047). Age was associated with backward digit span (b=-0098,
p<0.001) and immediate visual reproduction (b=-0.348,
p<0.001), resp. Delayed visual reproduction was associated
with age (b=-0.323, p<0.001) and potassium level
(b=-4.471, p=0.016). DSST was
associated with age (b=-0.911, p<0.001) and alanine
aminotransferase (b=-0.754, p=0.002). The lack of
association between educational level and cognitive performance
after adjusting for confounders in this study maybe due to multiple
factors influencing cognitive performance and further studies with
a larger sample size are needed to further identify the factors
involved. Keywords: Cognitive performance;
education; healthy Malay adults ABSTRAK Tahap pendidikan yang tinggi
telah dikaitkan dengan prestasi kognitif yang lebih baik dan risiko
perkembangan dementia yang lebih rendah. Namun, kesan pendidikan
terhadap prestasi kognitif berbeza antara domain kognitif dan populasi
yang berlainan. Kajian ini bertujuan untuk menentukan hubungan antara
pendidikan dengan prestasi pada domain kognitif yang berlainan pada
individu dewasa Melayu yang sihat. Seramai 53 individu yang berumur
antara 29 hingga 77 tahun telah menyertai ujian neuropsikologi yang
terdiri daripada Pemeriksaan Keadaan Mental Mini, Penilaian Kognitif
Montreal, digit span, penghasilan semula visual dan ujian kelajuan
simbol digit (DSST). Tahap pendidikan dibahagikan kepada
tahap 1 (PMR), tahap 2 (SPM),
tahap 3 (STPM), tahap 4 (Diploma) dan tahap 5 (Ijazah Sarjana Muda).
Regresi linear mudah menunjukkan bahawa tahap pendidikan berhubung
kait secara positif dengan penghasilan semula visual tertunda (b=1.348,
p=0.002) dan DSST (b=3.257, p=0.012).
Namun, semua skor ujian menjadi tidak berbeza antara tahap pendidikan
yang berbeza selepas mengambil kira kesan konpengasas dengan menggunakan
ANCOVA.
Regresi linear berganda menunjukkan bahawa skor MMSE berhubung
kait dengan lebar taburan sel merah (b=-0.628, p=0.005),
umur (b=-0.119, p<0.001) dan interaksi antara lipoprotein
ketumpatan tinggi (HDL)
dan umur (b=0.047, p<001). MoCA didapati
berhubung kait dengan umur (b=-0.121, p<0.001),
jantina (lelaki berbanding perempuan, b=1.870, p=0.020)
dan HDL
(b=1.681, p=0.047). Umur juga berhubung
kait dengan digit span ke belakang (b=-0098, P<0.001)
dan penghasilan semula visual segera (b=-0.348, p<0.001).
Penghasilan semula visual tertunda berhubung kait dengan umur (b=-0.323,
p<0.001) dan tahap kalium (b=-4.471, p=0.016).
DSST
berhubung kait dengan umur (b=-0.911, p<0.001)
dan alanin aminotransferase (b=-0.754, p=0.002). Hubungan
antara tahap pendidikan dan prestasi kognitif tidak dikesan selepas
mengambil kira kesan konpengasas yang mencadangkan bahawa prestasi
kognitif mungkin dipengaruhi oleh pelbagai faktor dan kajian lanjut
dengan bilangan sampel yang lebih besar diperlukan untuk mengenal
pasti faktor ini. Kata kunci: Dewasa Melayu sihat; pendidikan; prestasi kognitif REFERENCES Alley,
D., Suthers, K. & Crimmins, E. 2007. Education and cognitive
decline in older Americans: Results from the AHEAD sample. Res.
Aging 29(1): 73-94. Anstey,
K. & Christensen, H. 2000. Education, activity, health, blood
pressure and apolipoprotein E as predictors of cognitive change
in old age: A review. Gerontology 46(3): 163-177. Ardila,
A., Rosselli, M. & Rosas, P. 1989. Neuropsychological assessment
in illiterates: Visuospatial and memory abilities. Brain &
Cognition 11(2): 147-166. Awang,
M.I. 2009. Dependability dan model ujian pencapaian matematik KBSM
tingkatan 2 di negeri kedah= Dependability and Form 2 Mathematics
KBSM Achievement Test Model in Kedah. Tesis University of Malaya
(Unpublished). Boone,
K.B., Victor, T.L., Wen, J., Razani, J. & Pontón, M. 2007. The
association between neuropsychological scores and ethnicity, language,
and acculturation variables in a large patient population. Archives
of Clinical Neuropsychology 22(3): 355-365. Brito-Marques,
P.R.d. & Cabral-Filho, J.E. 2004. The role of education in mini-mental
state examination: A study in Northeast Brazil. Arquivos de Neuro-psiquiatria
62(2A): 206-211. Choi,
H.J., Lee, D.Y., Seo, E.H., Jo, M.K., Sohn, B.K., Choe, Y.M., Byun,
M.S., Kim, J.W., Kim, S.G., Yoon, J.C., Jhoo, J.H., Kim, K.W. &
Woo, J.I. 2014. A normative study of the digit span in an educationally
diverse elderly population. Psychiatry Investig. 11(1): 39-43.
Christensen,
H., Korten, A.E., Jorm, A.F., Henderson, A.S., Jacomb, P.A., Rodgers,
B. & Mackinnon, A.J. 1997. Education and decline in cognitive
performance: Compensatory but not protective. International Journal
of Geriatric Psychiatry 12(3): 323-330. Colom,
R., Jung, R.E. & Haier, R.J. 2007. General intelligence and
memory span: Evidence for a common neuroanatomic framework. Cogn.
Neuropsychol. 24(8): 867-878. Combs,
H. & Prosser, R. 1973. C-Ahmed, M-New Paths to Learning:
For Rural Children and Youth. Publications Essex, Connecticut-New
York: International Council for Education Development. Deary,
I.J., Corley, J., Gow, A.J., Harris, S.E., Houlihan, L.M., Marioni,
R.E., Penke, L., Rafnsson, S.B. & Starr, J.M. 2009. Age-associated
cognitive decline. Br. Med. Bull. 92: 135-152. Del
Ser, T., Hachinski, V., Merskey, H. & Munoz, D.G. 1999. An autopsy-verified
study of the effect of education on degenerative dementia. Brain
122(Pt 12): 2309-2319. Dodd,
J.W. 2015. Lung disease as a determinant of cognitive decline and
dementia. Alzheimer’s Research & Therapy 7(1): 1-8. dos
Santos, E.B., Tudesco Ide, S., Caboclo, L.O. & Yacubian, E.M.
2011. Low educational level effects on the performance of healthy
adults on a Neuropsychological Protocol suggested by the Commission
on Neuropsychology of the Liga Brasileira de Epilepsia. Arq.
Neuro- Psiquiatr. 69(5): 778-784. Ganguli,
M., Snitz, B.E., Lee, C.W., Vanderbilt, J., Saxton, J.A. & Chang,
C.C. 2010. Age and education effects and norms on a cognitive test
battery from a population-based cohort: the Monongahela-Youghiogheny
Healthy Aging Team. Aging Ment Health 14(1): 100-107. Gao,
L., Nie, K., Tang, H., Wang, L., Zhao, J., Gan, R., Huang, J., Feng,
S., Zhu, R., Duan, Z., Zhang, Y. & Wang, L. 2015. Sex differences
in cognition among Chinese people with Parkinson’s disease. Journal
of Clinical Neuroscience 22(3): 488-492. Gillum,
R.F. & Obisesan, T.O. 2011. High-density lipoprotein cholesterol,
cognitive function and mortality in a US national cohort. Lipids
in Health & Disease 10(1): 1. Hoyer,
W.J., Stawski, R.S., Wasylyshyn, C. & Verhaeghen, P. 2004. Adult
age and digit symbol substitution performance: A meta-analysis.
Psychology & Aging 19(1): 211-214. Hung,
W.W., Wisnivesky, J.P., Siu, A.L. & Ross, J.S. 2009. Cognitive
decline among patients with chronic obstructive pulmonary disease.
American Journal of Respiratory and Critical Care Medicine 180(2):
134-137. Johari,
S.i.M., Shahar, S., Ng, T.P. & Rajikan, R. 2014. A preliminary
randomized controlled trial of multifaceted educational intervention
for mild cognitive impairment among elderly Malays in Kuala Lumpur.
International Journal of Gerontology 8(2): 74-80. Jonassen,
D.H. 2004. Handbook of Research on Educational Communications
and Technology. New Jersey: Lawrence Erlbaum. Joy,
S., Kaplan, E. & Fein, D. 2004. Speed and memory in the WAIS-III
Digit Symbol-Coding subtest across the adult lifespan. Archives
of Clinical Neuropsychology 19(6): 759- 767. Katzman,
R. 1993. Education and the prevalence of dementia and Alzheimer’s
disease. Neurology 43(1): 13-20. Kim,
W.R., Flamm, S.L., Di Bisceglie, A.M. & Bodenheimer, H.C. 2008.
Serum activity of alanine aminotransferase (ALT) as an indicator
of health and disease. Hepatology 47(4): 1363-1370. Laks,
J., Coutinho, E.S.F., Junger, W., Silveira, H., Mouta, R., Baptista,
E.M.R., Contino, A.L.B., Barca, M.L., Selbaek, G. & Engedal,
K. 2010. Education does not equally influence all the Mini Mental
State Examination subscales and items: Inferences from a Brazilian
community sample. Revista Brasileira de Psiquiatria 32(3):
223-230. Lee,
H.B., Kim, J., Oh, S.H., Kim, S.H., Kim, H.S., Kim, W.C., Kim, S.
& Kim, O.J. 2016. Red
blood cell distribution width is associated with severity of leukoaraiosis.
PloS one 11(2): e0150308. Malek-Ahmadi,
M., Powell, J.J., Belden, C.M., O’Connor, K., Evans, L., Coon, D.W.
& Nieri, W. 2015. Age- and education-adjusted normative data
for the Montreal Cognitive Assessment (MoCA) in older adults age
70-99. Neuropsychology, Development, & Cognition. Section
B: Aging 22(6): 755-761. Matallana, D., de Santacruz, C., Cano, C., Reyes, P., Samper- Ternent,
R., Markides, K., Ottenbacher, K. & Reyes-Ortiz, C.A. 2010.
The relationship between education level and mini-mental state examination
domains among older Mexican Americans. Journal of Geriatric Psychiatry
& Neurology 24(1): 9-18. Mittal, S., Verma, P., Jain, N.,
Khatter, S. & Juyal, A. 2012. Gender based variation in cognitive
functions in adolescent subjects. Ann. Neurosci. 19(4): 165-168.
Murphy, C.F.B., Rabelo, C.M., Silagi,
M.L., Mansur, L.L. & Schochat, E. 2016. Impact of Educational
Level on Performance on Auditory Processing Tests. Front. Neurosci.
doi.org/10.3389/fnins.2016.00097. Ng, T.P., Feng, L., Lim, W.S., Chong,
M.S., Lee, T.S., Yap, K.B., Tsoi, T., Liew, T.M., Gao, Q., Collinson,
S., Kandiah, N. & Yap, P. 2015. Montreal Cognitive Assessment
for screening mild cognitive impairment: variations in test performance
and scores by education in Singapore. Dementia & Geriatric
Cognitive Disorders 39(3-4): 176-185. Ng, T.P., Niti, M., Chiam, P.C.
& Kua, E.H. 2007. Ethnic and educational differences in cognitive
test performance on mini-mental state examination in Asians. Am.
J. Geriatr. Psychiatry 15(2): 130-139. Öztürk, Z.A., Ünal, A., Yiğiter,
R., Yesil, Y., Kuyumcu, M.E., Neyal, M. & Kepekçi, Y. 2013.
Is increased red cell distribution width (RDW) indicating the inflammation
in Alzheimer›s disease (AD)?. Archives of Gerontology & Geriatrics
56(1): 50-54. Park, S. 2007. The effects of acculturation
and education upon intelligence test performances in Korean Americans.
Pacific Graduate School of Psychology. PhD Dissertation. ProQuest
Publication Number 3320949 (Unpublished). Qiu, C., Backman, L., Winblad, B.,
Aguero-Torres, H. & Fratiglioni, L. 2001. The influence of education
on clinically diagnosed dementia incidence and mortality data from
the Kungsholmen Project. Arch. Neurol. 58(12): 2034-2039.
Razali, R., Jean-Li, L., Jaffar,
A., Ahmad, M., Shah, S.A., Ibrahim, N., Din, N.C., Nik Jaafar, N.R.,
Midin, M., Sidi, H. & Ahmad, S. 2014. Is the Bahasa Malaysia
version of the Montreal Cognitive Assessment (MoCA-BM) a better
instrument than the Malay version of the Mini Mental State Examination
(M-MMSE) in screening for mild cognitive impairment (MCI) in the
elderly? Compr. Psychiatry 55(Suppl 1): S70-75. Rossetti, H.C., Lacritz, L.H., Cullum,
C.M. & Weiner, M.F. 2011. Normative data for the Montreal Cognitive
Assessment (MoCA) in a population-based sample. Neurology 77(13):
1272-1275. Salthouse, T.A. 1996. The processing-speed
theory of adult age differences in cognition. Psychol. Rev. 103(3):
403-428. Seo, S.W., Gottesman, R.F., Clark,
J.M., Hernaez, R., Chang, Y., Kim, C., Ha, K.H., Guallar, E. &
Lazo, M. 2016. Nonalcoholic fatty liver disease is associated with
cognitive function in adults. Neurology 86(12): 1136-1142.
Sharp, E.S. & Gatz, M. 2011.
Relationship between education and dementia: An updated systematic
review. Alzheimer Disease & Associated Disorders 25(4):
289-304. Stern, Y. 2002. What is cognitive
reserve? Theory and research application of the reserve concept.
J. Int. Neuropsychol. Soc. 8(3): 448-460. Tervo, S., Kivipelto, M., Hanninen,
T., Vanhanen, M., Hallikainen, M., Mannermaa, A. & Soininen,
H. 2004. Incidence and risk factors for mild cognitive impairment:
A population-based three-year follow-up study of cognitively healthy
elderly subjects. Dementia & Geriatric Cognitive Disorders
17(3): 196-203. Wechsler, D. 1981. Manual for
the Wechsler Adult Intelligence Scale-Revised. New York: Psychological
Corporation. WENR. 2014. Education in Malaysia.
http://wenr.wes. org/2014/12/education-in-malaysia/. Accessed on
29 November 2015. Yeung, P.Y., Wong, L.L., Chan, C.C.,
Leung, J.L. & Yung, C.Y. 2014. A validation study of the Hong
Kong version of Montreal Cognitive Assessment (HK-MoCA) in Chinese
older adults in Hong Kong. Hong Kong Med. J. 20(6): 504-510.
Yu, J., Li, J. & Huang, X. 2012.
The Beijing version of the montreal cognitive assessment as a brief
screening tool for mild cognitive impairment: A community-based
study. BMC Psychiatry 12(1): 156. Zhou, S., Zhu, J., Zhang, N., Wang,
B., Li, T., Lv, X., Ng, T.P., Yu, X. & Wang, H. 2014. The influence
of education on Chinese version of Montreal cognitive assessment
in detecting amnesic mild cognitive impairment among older people
in a Beijing rural community. Scientific World Journal 2014:
689456. *Corresponding author; email: wanzurinah@ppukm.ukm.edu.my
|
|||
|
