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The Presence of Alzheimer's Disease in a Community Population-Reply

Denis A. Evans, MD; Marilyn S. Albert, PhD; Paul A. Scherr, PhD, ScD; Marilyn J. Chown, MPH; Liesi E. Hebert, ScD; H. Harris Funkenstein, MD; Nancy R. Cook, ScD; Charles H. Hennekens, MD; James O. Taylor, MD
JAMA. 1990;263(18):2448-2449. doi:10.1001/jama.1990.03440180045023.
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In Reply.—  Dr Bowden notes that educational attainment may influence rates of dementia. We strongly agree with the importance of understanding the possible relation of education to cognitive decline and dementia. This understanding is necessary to measure cognitive function in an unbiased fashion in individuals with different levels of education. Even more important, it is essential to defining whether low education is a risk factor for Alzheimer's disease or other dementing illnesses.1 East Boston residents older than 65 years have lower educational attainment2 than the US average for this age group.3 Therefore, if education were demonstrated to influence rates of disease, the East Boston estimates would require adjustment for this factor, if projected to the US population as a whole.Kokmen and colleagues note some of the difficulties in the clinical diagnosis of Alzheimer's disease, especially in a community-based study. Diagnosis in our study conformed to the

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