All ETDs from UAB

Advisory Committee Chair

Michael G Crowe

Advisory Committee Members

Virginia Bradley Wadley

Olivio J Clay

Document Type


Date of Award


Degree Name by School

Master of Arts (MA) College of Arts and Sciences


In general, greater years of education is associated with reduced risk of cognitive impairment in older adulthood, but the strength of this association has been found to differ by study population. Additionally, quality of education is understudied, despite evidence that quality of education and, in turn, literacy, may be additional indicators of cognitive reserve. This thesis examined years of education, literacy, and childhood quality of education indicators in relation to late-life cognitive outcomes in an older Puerto Rican population. We hypothesized that greater years of education, literacy, and quality of childhood education would be positively associated with each other, as well as with reduced cognitive decline and impairment in late life. Baseline and four-year follow-up data were collected for a population-based sample of community dwelling Puerto Rican adults aged 60 years and over for the Puerto Rican Elderly: Health Conditions (PREHCO) study. Cognitive impairment and decline were our main outcomes and were determined using the minimental Cabαn (MMC). Years of education and literacy were self-reported at baseline. Quality of education was based on historical education and Census records and included school year length, student-teacher ratio, school attendance, and literacy rates by municipality of childhood residence. Childhood health status, child and adult SES, vascular risk factors, and depressive symptoms were used as covariates in linear regression models for cognitive decline and logistic regression models for cognitive impairment as the outcome. Years of education, literacy, quality of education, and cognitive performance were all positively and significantly associated with each other. In models adjusted for demographic covariates, years of education, literacy and a composite variable for quality of education were each significantly related to lower cognitive decline and incident cognitive impairment. However, years of education explained much of the associations between cognitive outcomes and quality of education indicators. This study provides further evidence that years of education, literacy, and quality of education are all interrelated and are important factors for cognitive functioning in older age, although years of education may be sufficient for capturing potential effects of quality of education in this population of older Puerto Ricans.



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