<![CDATA[Introduction: The prevalence of lower education elderly in Indonesia is still high, while low education is one of the significant risk factors in cognitive decline. Besides, many other factors are still controversial with cognitive decline. Aim: This study focuses on religious activities, vascular risk, apolipoprotein E (APOE) ε4, and their association with cognitive decline in the elderly who already have a vital risk factor: low education. Methods: This was a cohort study. There were 154 participants of lower education elderly, with the median follow up 2-3 years. The independent variables were religious activity, vascular risk, APOE ε4, and demographic characteristics. The dependent variable was cognitive decline, defined by lowered MMSE score ≥2 compared to the baseline data. Results: The mean age of the participants was 70.5±7.9 years old, with the majority being female (73.4%). Religious activity and cholesterol level had a significant association with cognitive decline in lower education elderly (p<0.05; RR=1.6; RR=1.5), other factors, such as APOE ε4, gender, age, marital status, hypertension, body mass index, diabetes mellitus, smoking, and depression showed no significant association (p>0,05). In multivariate analysis, cholesterol level and religious activity were associated with cognitive decline with a relative risk of 2.97 and 2.3, respectively. Discussion: High cholesterol level (≥200 mg/dL) and participation in religious activity were protective factors for cognitive decline in lower education elderly.]]>
