Cerebral amyloid associated with global cognition is differentially moderated by pulse pressure across education levels in The 90+ Study.

INTRODUCTION: Oldest-old individuals show complex multifactorial etiologies as well as resilience, but there is limited understanding of amyloid burden on cognitive decline in 90+-year-olds. We examine whether education and vascular risk influence the association of amyloid burden and global cognition. METHODS: We investigated a longitudinal design with 296 oldest-old adults (mean age = 92.46 [2.33] years) from The 90+ Study. We measured global cognition with the Clinical Dementia Rating (CDR) scale, amyloid burden with 18F-florbetapir positron emission tomography, vascular risk with pulse pressure (PP), and low/high education levels. Statistical analyses used latent growth modeling, and path and moderation analyses. Sex, education, and clinical diagnosis were included as covariates. RESULTS: Higher amyloid burden was associated with increasing CDR scores (worse performance) longitudinally. This association was only present in those with high PP levels and magnified in those with low levels of education. DISCUSSION: Education and PP impact the association of amyloid burden and global cognition even after age 90.