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Article
November 9, 1994

Education, Occupation, and Alzheimer's Disease-Reply

Author Affiliations

College of Physicians and Surgeons of Columbia University New York, NY

JAMA. 1994;272(18):1406. doi:10.1001/jama.1994.03520180029018
Abstract

In Reply.  —We thank Dr Devitt and Dr Cohen for their comments. We agree that education and occupation serve as a marker for lower socioeconomic status. Thus, poverty-related conditions including malnutrition, lifestyle, health care, and environmental factors including exposure to pollutants could impact on the developing or mature brain to produce a reduction in reserve against AD. Still, there are suggestions in our data that this is not the entire explanation for the increased risk of incident dementia in individuals with less educational and occupational attainment.None of our subjects were demented at the initial visit, which eliminates many of the potential disparities that might be introduced by gross neurological insult. Even when the subject cohort was restricted to those who performed relatively well on our examinations (by eliminating those with "borderline" dementia), the education/occupation effects remained, again arguing against the idea that one group was simply more impaired than

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