To the Editor: Dr Yaffe and colleagues recently reported that lower levels of plasma β-amyloid 42/40 were related to worse rates of cognitive decline.1 A major finding was the observation of an interaction between cognitive reserve (as measured by education, literacy, or apolipoprotein E [APOE] ε4 status) and plasma β-amyloid 42/40. Although this finding is intriguing, and the consistency of the interaction across all 3 measures of cognitive reserve is suggestive, nonetheless caution is warranted. Yaffe et al1 found little association between β-amyloid 42/40 levels and cognitive decline in those with at least a high school education.
However, in a previous study,2 we found strong relations between plasma β-amyloid 42/40 (measured at mid life and again in later life) and subsequent cognitive decline among participants in the Nurses' Health Study, all of whom had more than a high school education (ie, associate degree and above). In addition, while Yaffe et al1 reported that women with less education had a lower baseline ratio of β-amyloid 42/40, we found that women with the lowest ratio of β-amyloid 42/40 had the highest educational attainment (master's or doctoral degree).2 It would be interesting for cohorts with information on β-amyloid level to reassess their data with respect to educational attainment or other markers of cognitive reserve.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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