Australian researchers report that a greater proportion of a group of older people who participated in university studies for at least 12 months over a four-year period performed better on measures of cognitive capacity, or cognitive reserve, which is associated with reduced risk of dementia, than a control group who didn’t participate in university studies (92% vs. 56%). The authors note that those in the control group likely did their own versions of mentally stimulating activities, as they self-selected by enrolling in a study on the topic. The differences between the groups may have been greater had participants been somehow blinded to the intent of the study.
While this American Psychological Association news release is informative overall and mostly avoids the hyperbole that we often find in descriptions of similar studies, there were some missed opportunities to inform. Notably, the release doesn’t help readers interpret the magnitude of the benefit observed (was it clinically significant?), misses some key limitations, and is a bit careless with its use of language — leading to overstatement of the results.
The older segments of the population are the fastest growing ones in many parts of the world, especially developed countries. As age is the biggest risk factor for dementia, rates of dementia are expected to burgeon in the coming decades. A variety of drug, activity, and psychosocial interventions are being explored to try to mitigate some of the risk.
Prior studies have indicated that intellectual and social stimulation (and physical exercise) have positive effects of cognitive function, and several observational studies have indicated that higher levels of education are associated with protection against dementia.
This Australian study is the first to examine university study in an older population prospectively, and it’s one of the longer term studies looking at intellectual or cognitive stimulation as a way of preserving brain health.
Costs were not mentioned in the article and we think that they should have been. Although costs for tuition in Australia are fixed, the lowest tier is approximately $5,000 US dollars annually. That is a considerable sum for elderly retirees.
The authors report the proportions in each group for whom cognitive capacity, or actually “cognitive reserve” improved. It’s difficult, though, to evaluate the magnitude of the change from either the news release or the article. It would have been helpful if the author of the news release pressed one of the scientists to translate this into English. We also don’t know whether the increase the scientists measured has any clinical significance. Contrary to what the title of the press release implies, the findings are a long way from saying dementia risk may be reduced by the university studies intervention. The scientific article authors make this clear by saying in their last paragraph that this question is one for further study.
No harms were noted in the news release or the paper, and its hard to envision any, so we’ll rate this Not Applicable.
The news release provides limited information about the study design. It is clear that 459 subjects participated but it is unclear how they were chosen or if they were provided with the results of the cognitive testing prior to making a choice about college entry. The demographics of the participants are not provided other than a statement about age. Were the subjects who chose college rather than control more educated than those who chose to be controls? This would be an important piece of information.
The release does get at some limitations, including that the control group likely “studied” themselves, which could have affected the results. But the scale tips toward Not Satisfactory for the release’s use of language. Since this was an observational study incapable of demonstrating cause and effect, we think the release should have avoided the use of active verbs which indicate a causal relationship between college studies and dementia risk. Examples:
College studies were “associated with” reduced risk, but we can’t say that they “may reduce” risk based on this evidence. It’s an important distinction.
Funding sources weren’t noted, nor conflicts (which could have been covered if just noted that it was a largely government-funded study). The published article is also silent on the matter. Given the subject, it is difficult to identify any meaningful potentials for a conflict of interest. But we think all news releases should discuss funding as a matter of course. That’s our line in the sand.
The release refers to other studies including those that have utilized other methods not involving formal education.
Not noted explicitly but university courses are widely available especially at community colleges. This is suggested by the release so we’ll give the benefit of the doubt.
The news release noted that this study was the first to report the effect of college coursework over time in older adults.
Apart from the overly optimistic title and some inappropriate use of active verbs (already noted above), the release provides information in a clear and a reasonable fashion without the use of hyperbole.
Systematic, Criteria-Driven
We’ve written about the hype of liquid biopsies for years (see link in comment below). And now this…. https://www.statnews.com/2022/01/12/medicare-shouldnt-cover-liquid-biopsies-early-cancer-detection/
Case counts still matter. “(There) are stories that may not be told adequately if only hospitalizations and deaths are emphasized.” @garyschwitzer interviewed by @dbauder of @AP. https://apnews.com/article/omicron-changing-news-outlets-covid-data-da9272f7c4c8a109c3bfb56bed9e9c76
My friend Gary @garyschwitzer wrote to his city council representative in a Minnesota town about a Viva Las Vegas event scheduled for January.
The response he got seems to perfectly capture where we are now.
https://www.healthnewsreview.org/2021/12/2021-ends-with-covid-craziness-in-sports-and-politics/
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