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August 08, 2006; 67 (3) Articles

Education and the cognitive decline associated with MRI-defined brain infarct

J. S. Elkins, W. T. Longstreth, T. A. Manolio, A. B. Newman, R. A. Bhadelia, S. C. Johnston
First published August 7, 2006, DOI: https://doi.org/10.1212/01.wnl.0000228246.89109.98
J. S. Elkins
MD
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W. T. Longstreth Jr
MD, MPH
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T. A. Manolio
MD, PhD
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A. B. Newman
MD, MPH
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R. A. Bhadelia
MD
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S. C. Johnston
MD, PhD
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Citation
Education and the cognitive decline associated with MRI-defined brain infarct
J. S. Elkins, W. T. Longstreth, T. A. Manolio, A. B. Newman, R. A. Bhadelia, S. C. Johnston
Neurology Aug 2006, 67 (3) 435-440; DOI: 10.1212/01.wnl.0000228246.89109.98

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Abstract

Objective: To assess whether educational attainment, a correlate of cognitive reserve, predicts the amount of cognitive decline associated with a new brain infarct.

Methods: The Cardiovascular Health Study is a population-based, longitudinal study of people aged 65 years and older. Cognitive function was measured annually using the Modified Mini-Mental State Examination (3MS) and the Digit-Symbol Substitution Test (DSST). The authors tested whether education level modified 1) the cross-sectional association between cognitive performance and MRI-defined infarct and 2) the change in cognitive function associated with an incident infarct at a follow-up MRI.

Results: In cross-sectional analysis (n = 3,660), MRI-defined infarct was associated with a greater impact on 3MS performance in the lowest education quartile when compared with others (p for heterogeneity = 0.012). Among those with a follow-up MRI who had no infarct on initial MRI (n = 1,433), education level was not associated with the incidence, size, or location of new brain infarct. However, a new MRI-defined infarct predicted substantially greater decline in 3MS scores in the lowest education group compared with the others (6.3, 95% CI 4.4- to 8.2-point decline vs 1.7, 95% CI 0.7- to 2.7-point decline; p for heterogeneity < 0.001). Higher education was not associated with smaller declines in DSST performance in the setting of MRI-defined infarct.

Conclusions: Education seems to modify an individual's decline on a test of general cognitive function when there is incident brain infarct. These findings are consistent with the hypothesis that cognitive reserve influences the impact of vascular injury in the brain.

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  • All Cognitive Disorders/Dementia
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  • MRI
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  • Risk factors in epidemiology

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