Education is a key predictor of cognitive function and dementia. Sensory impairments and social well-being are underexplored modifiable pathways through which education may influence cognitive function. Using longitudinal data from the National Social Life, Health, and Aging Project, we created a latent measure of global sensory impairment (GSI) encompassing all five “classical” senses. We estimated the indirect influence of education on Montreal Cognitive Assessment (MoCA) scores—our primary measure of cognitive function—through GSI, loneliness, and social isolation. Positive dementia screening was a secondary outcome. GSI accounted for 5.32% and social isolation for 3.79% of college attendance’s influence on MoCA scores. For years of education, GSI accounted for 3.87% and social isolation for 2.85% of its influence on MoCA scores. Loneliness accounted for smaller percentages. Sensory impairments and social isolation may be targets for public health interventions aimed at reducing educational disparities in cognitive function and improving older adults’ quality of life.
AgrawalY.PlatzE. A.NiparkoJ. K. (2008). Prevalence of hearing loss and differences by demographic characteristics among US adults: Data from the national health and nutrition examination survey, 1999-2004. Archives of Internal Medicine, 168(14), 1522–1530. https://doi.org/10.1001/archinte.168.14.1522
2.
AjmaniG. S.SuhH. H.PintoJ. M. (2016). Effects of ambient air pollution exposure on olfaction: A review. Environmental Health Perspectives, 124(11), 1683–1693. https://doi.org/10.1289/EHP136
3.
Alfaro HudakK. M.WittenbornJ. S.LamudaP. A.LundeenE. A.SaaddineJ.ReinD. B. (2023). Association between social determinants of health and examination-based vision loss vs self-reported vision measures. JAMA Ophthalmology, 141(5), 468–476. https://doi.org/10.1001/jamaophthalmol.2023.0723
4.
ArandaM. P.KremerI. N.HintonL.ZissimopoulosJ.WhitmerR. A.HummelC. H.TrejoL.FabiusC. (2021). Impact of dementia: Health disparities, population trends, care interventions, and economic costs. Journal of the American Geriatrics Society, 69(7), 1774–1783. https://doi.org/10.1111/jgs.17345
5.
BauldryS. (2015). Variation in the protective effect of higher education against depression. Society and Mental Health, 5(2), 145–161. https://doi.org/10.1177/2156869314564399
6.
ChaumE.WinbornC. S.BhattacharyaS. (2015). Genomic regulation of senescence and innate immunity signaling in the retinal pigment epithelium. Mammalian Genome, 26(5), 210–221. https://doi.org/10.1007/s00335-015-9568-9
7.
ChintaS. J.LieuC. A.DeMariaM.LabergeR.-M.CampisiJ.AndersenJ. K. (2013). Environmental stress, ageing and glial cell senescence: A novel mechanistic link to Parkinson’s disease?Journal of Internal Medicine, 273(5), 429–436. https://doi.org/10.1111/joim.12029
8.
ChouC.-F.BecklesG. L. A.ZhangX.SaaddineJ. B. (2015). Association of socioeconomic position with sensory impairment among US working-aged adults. American Journal of Public Health, 105(6), 1262–1268. https://doi.org/10.2105/AJPH.2014.302475
9.
CorreiaC.LopezK. J.WroblewskiK. E.Huisingh-ScheetzM.KernD. W.ChenR. C.SchummL. P.DaleW.McClintockM. K.PintoJ. M. (2016). Global sensory impairment in older adults in the United States. Journal of the American Geriatrics Society, 64(2), 306–313. https://doi.org/10.1111/jgs.13955
10.
CrimminsE. M.SaitoY.KimJ. K.ZhangY. S.SassonI.HaywardM. D. (2018). Educational differences in the prevalence of Dementia and life expectancy with Dementia: Changes from 2000 to 2010. The Journals of Gerontology: Series B, 73(Suppl_1), S20–S28. https://doi.org/10.1093/geronb/gbx135
11.
CroyI.NordinS.HummelT. (2014). Olfactory disorders and quality of life—an updated review. Chemical Senses, 39(3), 185–194. https://doi.org/10.1093/chemse/bjt072
12.
CzakóC.KovácsT.UngvariZ.CsiszarA.YabluchanskiyA.ConleyS.CsipoT.LipeczA.HorváthH.SándorG. L.IstvánL.LoganT.NagyZ. Z.KovácsI. (2020). Retinal biomarkers for Alzheimer’s disease and vascular cognitive impairment and dementia (VCID): Implication for early diagnosis and prognosis. GeroScience, 42(6), 1499–1525. https://doi.org/10.1007/s11357-020-00252-7
13.
DeckersK.CadarD.van BoxtelM. P. J.VerheyF. R. J.SteptoeA.KöhlerS. (2019). Modifiable risk factors explain socioeconomic inequalities in dementia risk: Evidence from a population-based prospective cohort study. Journal of Alzheimer’s Disease, 71(2), 549–557. https://doi.org/10.3233/JAD-190541
Fuller-ThomsonE.NowaczynskiA.MacNeilA. (2022). The association between hearing impairment, vision impairment, dual sensory impairment, and serious cognitive impairment: Findings from a population-based study of 5.4 million older adults. Journal of Alzheimer’s Disease Reports, 6(1), 211–222. https://doi.org/10.3233/ADR-220005
16.
Garcia MoralesE. E.ReedN. S.ZhouY.AssiS.VaradarajV.LinF. R.EhrlichJ. R.DealJ. A. (2024). Population prevalence of dual sensory loss in community-dwelling US adults 71 years and older: Evidence from the national health and aging trends study. Journal of the American Geriatrics Society, 72(2), 536–543. https://doi.org/10.1111/jgs.18648
17.
HaywardM. D.FarinaM. P.ZhangY. S.KimJ. K.CrimminsE. M. (2021). The importance of improving educational attainment for dementia prevalence trends from 2000 to 2014, among older non-Hispanic Black and white Americans. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 76(9), 1870–1879. https://doi.org/10.1093/geronb/gbab015
18.
HongS.BaekS.-H.LaiM. K. P.ArumugamT. V.JoD.-G. (2024). Aging-associated sensory decline and Alzheimer’s disease. Molecular Neurodegeneration, 19(1), 93. https://doi.org/10.1186/s13024-024-00776-y
19.
KarlsonK. B.HolmA.BreenR. (2012). Comparing regression coefficients between same-sample nested models using logit and probit: A new method. Sociological Methodology, 42(1), 286–313. https://doi.org/10.1177/0081175012444861
20.
KlinenbergE. (2018). Palaces for the people: How social infrastructure can help fight inequality, polarization, and the decline of civic life. Crown.
21.
KotwalA. A.KimJ.WaiteL.DaleW. (2016). Social function and cognitive status: Results from a US Nationally Representative Survey of older adults. Journal of General Internal Medicine, 31(8), 854–862. https://doi.org/10.1007/S11606-016-3696-0
22.
LangaK. M.LarsonE. B.CrimminsE. M.FaulJ. D.LevineD. A.KabetoM. U.WeirD. R. (2017). A comparison of the prevalence of Dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 177(1), 51–58. https://doi.org/10.1001/jamainternmed.2016.6807
23.
LenehanM. E.SummersM. J.SaundersN. L.SummersJ. J.VickersJ. C. (2015). Relationship between education and age-related cognitive decline: A review of recent research. Psychogeriatrics, 15(2), 154–162. https://doi.org/10.1111/psyg.12083
24.
LivingstonG.HuntleyJ.LiuK. Y.CostafredaS. G.SelbækG.AlladiS.AmesD.BanerjeeS.BurnsA.BrayneC.FoxN. C.FerriC. P.GitlinL. N.HowardR.KalesH. C.KivimäkiM.LarsonE. B.NakasujjaN.RockwoodK.MukadamN. (2024). Dementia prevention, intervention, and care: 2024 report of the lancet standing commission. The Lancet, 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
25.
LövdénM.FratiglioniL.GlymourM. M.LindenbergerU.Tucker-DrobE. M. (2020). Education and cognitive functioning across the life span. Psychological Science in the Public Interest, 21(1), 6–41. https://doi.org/10.1177/1529100620920576
26.
MajokaM. A.SchimmingC. (2021). Effect of social determinants of health on cognition and risk of alzheimer disease and related dementias. Clinical Therapeutics, 43(6), 922–929. https://doi.org/10.1016/j.clinthera.2021.05.005
27.
MasalaC.CavazzanaA.SannaF.CecchiniM. P.ZaniniA.GasperiF.MenghiL.EndrizziI.BorgognoM.DragoS.CantoneE.CiofaloA.MacchiA.MontiG.ParmaV.PiochiM.PinnaI.TorriL.CabrinoG.HummelT. (2022). Correlation between olfactory function, age, sex, and cognitive reserve index in the Italian population. European Archives of Oto-Rhino-Laryngology, 279(10), 4943–4952. https://doi.org/10.1007/s00405-022-07311-z
28.
MedelV.DelanoP. H.BelkhiriaC.LeivaA.De GaticaC.VidalV.NavarroC. F.MartínS. S.MartínezM.GierkeC.GarcíaX.CerdaM.VergaraR.DelgadoC.FaríasG. A. (2024). Cochlear dysfunction as an early biomarker of cognitive decline in normal hearing and mild hearing loss. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 16(1), Article e12467. https://doi.org/10.1002/dad2.12467
29.
MengX.D’ArcyC. (2012). Education and dementia in the context of the cognitive reserve Hypothesis: A systematic review with meta-analyses and qualitative analyses. PLOS ONE, 7(6), Article e38268. https://doi.org/10.1371/journal.pone.0038268
30.
MoonK. A.SolK.SimoneS. M.ZaheedA. B.KrasnovaA.AndrewsR. M.VonkJ. M. J.WidamanK. F.ArmstrongN. M. (2024). Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline. International Journal of Geriatric Psychiatry, 39(7), Article e6123. https://doi.org/10.1002/gps.6123
31.
Office of the Surgeon General (OSG). (2023). Our epidemic of loneliness and isolation: The U.S. surgeon general’s advisory on the healing effects of social connection and community. US Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK595227/
32.
PengS.RothA. R.ApostolovaL. G.SaykinA. J.PerryB. L. (2022). Cognitively stimulating environments and cognitive reserve: The case of personal social networks. Neurobiology of Aging, 112, 197–203. https://doi.org/10.1016/J.NEUROBIOLAGING.2022.01.004
33.
PenninkilampiR.CaseyA.-N.SinghM. F.BrodatyH. (2018). The association between social engagement, loneliness, and risk of dementia: A systematic review and meta-analysis. Journal of Alzheimer’s Disease, 66(4), 1619–1633. https://doi.org/10.3233/JAD-180439
34.
PintoJ. M.WroblewskiK. E.Huisingh-ScheetzM.CorreiaC.LopezK. J.ChenR. C.KernD. W.SchummP. L.DaleW.McClintockM. K. (2017). Global sensory impairment predicts morbidity and mortality in older U.S. adults. Journal of the American Geriatrics Society, 65(12), 2587–2595. https://doi.org/10.1111/jgs.15031
35.
PintoJ. O.VieiraI.BarrosoB. C. R.PeixotoM.PontesD.PeixotoB.DoresA. R.BarbosaF. (2024). Inventory of sensory, emotional, and cognitive reserve (SECri): Proposal of a new instrument and preliminary data. Applied Neuropsychology: Adult, 1–13. https://doi.org/10.1080/23279095.2024.2407462
36.
ReubenD. B.MuiS.DamesynM.MooreA. A.GreendaleG. A. (1999). The prognostic value of sensory impairment in older persons. Journal of the American Geriatrics Society, 47(8), 930–935. https://doi.org/10.1111/j.1532-5415.1999.tb01286.x
37.
SalinasJ.O’DonnellA.KojisD. J.PaseM. P.DeCarliC.RentzD. M.BerkmanL. F.BeiserA.SeshadriS. (2021). Association of social support with brain volume and cognition. JAMA Network Open, 4(8), e2121122. https://doi.org/10.1001/JAMANETWORKOPEN.2021.21122
38.
SharpE. S.GatzM. (2011). Relationship between education and dementia: An updated systematic review. Alzheimer Disease & Associated Disorders, 25(4), 289–304. https://doi.org/10.1097/WAD.0b013e318211c83c
39.
ShegaJ. W.SunkaraP. D.KotwalA.KernD. W.HenningS. L.McClintockM. K.SchummP.WaiteL. J.DaleW. (2014). Measuring cognition: The Chicago cognitive function measure in the national social life, health and aging project, wave 2. The Journals of Gerontology: Series B, 69(Suppl_2), S166–S176. https://doi.org/10.1093/GERONB/GBU106
40.
SorokowskaA.DrechslerE.KarwowskiM.HummelT. (2017). Effects of olfactory training: A meta-analysis. Rhinology, 55(1), 17–26. https://doi.org/10.4193/Rhino16.195
41.
SteptoeA.ZaninottoP. (2020). Lower socioeconomic status and the acceleration of aging: An outcome-wide analysis. Proceedings of the National Academy of Sciences, 117(26), 14911–14917. https://doi.org/10.1073/pnas.1915741117
42.
TerrierC.Greco-VuilloudJ.CaveliusM.ThevenetM.MandaironN.DidierA.RichardM. (2024). Long-term olfactory enrichment promotes non-olfactory cognition, noradrenergic plasticity and remodeling of brain functional connectivity in older mice. Neurobiology of Aging, 136, 133–156. https://doi.org/10.1016/j.neurobiolaging.2024.01.011
43.
TurcotteV.PotvinO.DadarM.HudonC.DuchesneS.FeinkohlI. (2022). Birth cohorts and cognitive reserve influence cognitive performances in older adults. Journal of Alzheimer’s Disease, 85(2), 587–604. https://doi.org/10.3233/JAD-215044
44.
WaiteL. J.LaumannE. O.LevinsonW.LindauS. T.O’MuircheartaighC. A. (2014). National social life, health, and aging Project (NSHAP): Wave 1. ICPSR20541-v6. Inter-university Consortium for Political and Social Research [distributor]. [Dataset]. https://doi.org/10.3886/ICPSR20541.v6
45.
Welge-LüssenA. (2009). Ageing, neurodegeneration, and olfactory and gustatory loss. B-ENT, 5(Suppl 13), 129–132.
46.
YorgasonJ. B.TannerC. T.RichardsonS.HillM. M. Y. S.StaggB.WettsteinM.EhrlichJ. R. (2022). The longitudinal association of late-life visual and hearing difficulty and cognitive function: The role of social isolation. Journal of Aging and Health, 34(6-8), 765–774. https://doi.org/10.1177/08982643211063338
47.
YoshidaY.HiratsukaY.UmeyaR.OnoK.NakaoS. (2025). The association between dual sensory impairment and dementia: A systematic review and meta-analysis. Journal of Alzheimer's Disease: JAD, 103(3), 637–648. https://doi.org/10.1177/13872877241304127
48.
ZhangN. K.ZhangS. K.ZhangL. I.TaoH. W.ZhangG.-W. (2023). Sensory processing deficits and related cortical pathological changes in Alzheimer’s disease. Frontiers in Aging Neuroscience, 15, Article 1213379. https://doi.org/10.3389/fnagi.2023.1213379
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