Alzheimer’s sufferers are more likely to have jobs that are less mentally challenging than people without Alzheimer’s disease

www.aan.comAug 9 2004

A study published today in the journal of the American Academy of Neurology shows that Alzheimer’s sufferers are more likely to have jobs that are less mentally challenging than people without Alzheimer’s disease.

Alzheimer's is a progressive form of presenile dementia that is similar to senile dementia except that it usually starts in the 40s or 50s; first symptoms are impaired memory which is followed by impaired thought and speech and finally complete helplessness

The study looked at 122 people with Alzheimer’s disease and 235 people without the disease as a control group. All 357 person's were over the age of 60. Information about their occupational history from their 20s through their 50s was collected from the control group directly and from family members of those with Alzheimer’s disease.

Information collected included job and industry types, the duration of their job, and the main activities in the job. The mental, physical, social and fine motor skill demands of their jobs were determined using measures developed by the U.S. Department of Labor.

The researchers found that, on average, people with Alzheimer's disease held jobs with lower mental demands than people in the control group. Looking decade by decade at the jobs held by study participants, the researchers found that people with Alzheimer’s disease and those in the control group had jobs with about the same level of mental demands when they were in their 20s. The level was about 15 percent above the average for all U.S. occupations ranked by the Labor Department. However, those in the control group moved on to jobs with higher mental demands in their 30s, 40s and 50s, increasing the demand level by about 33 percent on average across the decades. The mental demands of occupations for those with Alzheimer’s remained at about the same level in later decades.

The researchers also found that those with Alzheimer’s disease had jobs with more physical demands than those in the control group during their 20s, 40s and 50s. They found no differences across the decades in the social or motor demands of jobs held by those with Alzheimer’s disease and those in the control group.

Because education has been found to be protective against Alzheimer’s disease, the researchers reexamined the data while controlling for education levels, and the results did not change.

The researchers don’t know what the link is between Alzheimer’s disease and less mentally demanding occupations. Several theories exist.

“It could be that the disease has a very early effect on the individual’s capacity to pursue a mentally challenging occupation,” said Kathleen Smyth, PhD, of Case Western Reserve University School of Medicine and the University Hospitals of Cleveland in Ohio. “Or, it could be that higher levels of mental demands result in increased brain cell activity, which may help maintain a ‘reserve’ of brain cells that resists the effects of Alzheimer’s disease.”

Smyth added, “There is also the possibility that jobs with higher mental demands require skills that enhance an individual’s ability to perform well on the tests used to diagnose Alzheimer’s. If this is the case, then the disease may go undetected in these people until the disease is much farther along than in those whose jobs pose lower mental demands.”

One limitation of the study was that researchers did not control for socioeconomic status, Smyth said. “People with higher socioeconomic status generally hold jobs with higher mental demands compared to those with lower socioeconomic status,” she said. “Therefore, variations in income, access to health care, better nutrition, and other factors related to socioeconomic status could be responsible in part for our findings.”

The study also did not factor in environmental demands and exposures of occupations. “There could be possible relationships between these factors and the development of Alzheimer’s disease,” Smyth said.

The study was supported by grants from the National Institutes of Health, the Fullerton Family Foundation, Mandel Foundation, Nickman family, Philip Morris, USA, and American Physicians Fellowship for Medicine in Israel.

The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as multiple sclerosis, restless legs syndrome, Alzheimer’s disease, narcolepsy, and stroke.