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Abstract
Objective To assess the contribution of education to cognitive reserve.
Methods Analyses are based on older participants in a longitudinal clinical-pathologic cohort study who had annual cognitive testing (n = 2,899) and subgroups that developed incident dementia (n = 696), died, and underwent a neuropathologic examination from which 10 neurodegenerative and cerebrovascular markers were derived (n = 752), or both (n = 405). Cognitive test scores were converted to a standard scale and averaged to yield composite measures of cognition.
Results Participants had a mean of 16.3 years of education (SD = 3.7, range 0–30). In all participants, education was associated with initial level of global cognition but not rate of cognitive change. In those who developed dementia, rate of global cognitive decline accelerated a mean of 1.8 years before the diagnosis, but education was not related to the onset or rate of accelerated decline. In the deceased, rate of global cognitive decline accelerated a mean of 3.4 years before death, but higher educational attainment was related to earlier (not later) onset of accelerated decline and unrelated to rate of acceleration. Higher education was associated with lower likelihood of gross and microscopic cerebral infarcts but not with other neuropathologic markers. Education was not related to global cognitive change not attributable to neuropathologic burden and did not decrease the association of higher neuropathologic burden with more rapid cognitive decline.
Conclusion The results suggest that the contribution of education to cognitive reserve is limited to its association with level of cognitive function before old age.
Glossary
- AD=
- Alzheimer disease;
- ADRDA=
- Alzheimer's Disease and Related Disorders Association;
- CI=
- credible interval;
- NINCDS=
- National Institute of Neurological and Communicative Disorders and Stroke;
- ROSMAP=
- Religious Orders Study/Memory and Aging Project;
- TDP-43=
- TAR DNA-binding protein 43
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received May 24, 2018.
- Accepted in final form October 29, 2018.
- © 2019 American Academy of Neurology
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