Cited by 176Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCognitive Abilities and Testing

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The effect of education and occupational complexity on rate of cognitive decline in Alzheimer's patients

ANDEL, ROSS, VIGEN, CHERYL, MACK, WENDY J., CLARK, LINDA J., GATZ, MARGARET·2006·Journal of the International Neuropsychological Society

DOI 10.1017/s1355617706060206

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Abstract

We explored the effect of education and occupational complexity on the rate of cognitive decline (as measured by the Mini-Mental State Examination) in 171 patients with a confirmed Alzheimer's disease (AD) diagnosis. Complexity was measured as substantive complexity of work and complexity of work with data, people, and things. Average lifetime occupational complexity was calculated based on years at each occupation. Participants were followed for an average of 2.5 years and 3.7 visits. In multivariate mixed-effects models, high education, high substantive complexity, and high complexity of work with data and people predicted faster rates of cognitive decline, controlling for age, gender, native language, dementia severity, and entry into the analyses at initial versus follow-up testing. These results provide support for the concept of cognitive reserve according to which greater reserve may postpone clinical onset of AD but also accelerate cognitive decline after the onset. (JINS, 2006, 12, 147–152.)

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“However, the role of schooling after dementia onset is controversial [6, 7, 38, 40].”
Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial
Cheng, S., Chow, P. K. Y., Song, Y., Yu, E. C. S., & Lam, J. (2014) · International Psychogeriatrics · doi:10.1017/s1041610213002524 · Cited by 43
“The effect of education appeared to be consistent with the observation that those with better cognitive reserve have a compressed pathology and tend to show more rapid decline after the emergence of symptoms (Andel et al., 2006; Bruandet et al., 2008).”
Result
Do economic recessions during early and mid-adulthood influence cognitive function in older age?
Leist, A. K., Hessel, P., & Avendaño, M. (2013) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2013-202843 · Cited by 41
“A possible explanation is that macro-economic conditions shape mid-life working conditions associated with late-life cognitive function.[2-10] However, our results suggest that men's susceptibility to macro-economic shocks may be larger at relatively late stages of the working career, while women are more susceptible…”
Background
Cognitive Dysfunction Among Adults With Type 2 Diabetes Mellitus in Karnataka, India
Yerrapragada, D. B., Rao, C. R., Karunakaran, K., & Lee, H. S. E. (2019) · Ochsner Journal · doi:10.31486/toj.18.0160 · Cited by 42
The effect of education on rCBF changes in Alzheimer’s disease: a longitudinal SPECT study
Hanyu, H., Sato, T., Shimizu, S., Kanetaka, H., Iwamoto, T., & Koizumi, K. (2008) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-008-0848-4 · Cited by 38
“Thirdly, we should consider the effect of other associated conditions, including occupational attainment [4, 7], medical comorbid diseases [41, 42], socioeconomic status [43], and life activities [44], on the clinical severity and course of AD.”
Domains of cognitive function in early old age: which ones are predicted by pre-retirement psychosocial work characteristics?
Sabbath, E. L., Andel, R., Zins, M., Goldberg, M., & Berr, C. (2016) · Occupational and Environmental Medicine · doi:10.1136/oemed-2015-103352 · Cited by 37
Self-citation
[Cognitive reserve: evidence, limitations and future research lines].
Díaz-Orueta, U., Buiza-Bueno, C., & Yanguas-Lezaun, J. (2010) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2009.12.007 · Cited by 33
Concepts of Mental Demands at Work That Protect Against Cognitive Decline and Dementia: A Systematic Review
Hussenoeder, F. S., Riedel-Heller, S. G., Conrad, I., & Rodriguez, F. S. (2019) · American Journal of Health Promotion · doi:10.1177/0890117119861309 · Cited by 37
“While the protective effect of complexity is also reflected in the work of authors that use different complexity measures,(21,25) there is also evidence that links complexity with data and people to more pronounced cognitive decline after the diagnosis of Alzheimer.(15) Seventy-five percent of studies analyzing comple…”
Background
The relationship between cognitive decline and a genetic predictor of educational attainment
Ding, X., Barban, N., Tropf, F. C., & Mills, M. C. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112549 · Cited by 34
¿Previene la actividad intelectual el deterioro cognitivo? Relaciones entre reserva cognitiva y deterioro cognitivo ligero
Lojo‐Seoane, C., Facal-Mayo, D., & Juncos‐Rabadán, O. (2012) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2012.02.006 · Cited by 38
“secundarios (2), superior o universitario (3)”
Effects of Cognitive Reserve in Alzheimer’s Disease and Cognitively Unimpaired Individuals
Lee, D. H., Seo, S. W., Roh, J. H., Oh, M., Oh, J. S., Oh, S. J., Kim, J. S., & Jeong, Y. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.784054 · Cited by 35
“In disease stage showing CR-related accelerated progression, education (Andel et al., 2006; Scarmeas et al., 2006; Hall et al., 2007), occupational complexity (Andel et al.”
Social enrichment on the job: Complex work with people improves episodic memory, promotes brain reserve, and reduces the risk of dementia
Coleman, M. E., Roessler, M., Peng, S., Roth, A. R., Risacher, S. L., Saykin, A. J., Apostolova, L. G., & Perry, B. L. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13035 · Cited by 33
Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors
Fujishiro, K., Hajat, A., Landsbergis, P. A., Meyer, J. D., Schreiner, P. J., & Kaufman, J. D. (2017) · SSM - Population Health · doi:10.1016/j.ssmph.2017.05.010 · Cited by 31
Simultaneous modeling of Alzheimer's disease progression via multiple cognitive scales
Kühnel, L., Berger, A., Markussen, B., & Rakêt, L. L. (2021) · Statistics in Medicine · doi:10.1002/sim.8932 · Cited by 29
“15 There exist a range of models for analyzing disease progression in AD.”
Early cognitive stimulation compensates for memory and pathological changes in Tg2576 mice
Gereñu, G., Dobarro, M., Ramírez, M. J., & Gil-Bea, F. J. (2013) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2013.02.018 · Cited by 29
“Epidemiological studies have determined education [2], cognitively complex occupations [3,4], leisure activities [5], and to a lesser extent, physical activity [6], as the”
Background
Education protects against cognitive changes associated with multiple sclerosis
Scarpazza, C., Braghittoni, D., Casale, B., Malagù, S., Mattioli, F., di Pellegrino, G., & Làdavas, E. (2013) · Restorative Neurology and Neuroscience · doi:10.3233/rnn-120261 · Cited by 28
Mediators of cognitive impairment in cerebral amyloid angiopathy
Durrani, R., Wang, M., Cox, E., Irving, E., Saad, F., McCreary, C. R., Beaudin, A. E., Gee, M., Nelles, K., Sajobi, T. T., et al. (2022) · International Journal of Stroke · doi:10.1177/17474930221099352 · Cited by 27
Grit in adolescence is protective of late-life cognition: non-cognitive factors and cognitive reserve
Rhodes, E., Devlin, K. N., Steinberg, L. D., & Giovannetti, T. (2016) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2016.1210079 · Cited by 26
Activity-Induced Amyloid-β Oligomers Drive Compensatory Synaptic Rearrangements in Brain Circuits Controlling Memory of Presymptomatic Alzheimer's Disease Mice
Pignataro, A., Meli, G., Pagano, R., Fontebasso, V., Battistella, R., Conforto, G., Ammassari‐Teule, M., & Middei, S. (2018) · Biological Psychiatry · doi:10.1016/j.biopsych.2018.10.018 · Cited by 27
Educational attainment, Aβ, tau, and structural brain reserve in Alzheimer's disease
Cai, Y. Q., Fang, L., Li, A., Yang, J., Zhou, X. Y., He, Z., Sun, P., Wang, Q., Guo, T., & Initiative, A. D. N. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.14400 · Cited by 22
“Some studies have shown that higher EA is associated with accelerated decline in certain cognitive domains, such as executive function and memory, 16,17 while others have reported slower cognitive decline 18,36 or no correlation with cognitive changes.”
Complexity of Work and Incident Cognitive Impairment in Puerto Rican Older Adults
Andel, R., Dávila-Roman, A., Grotz, C., Small, B. J., Markides, K. S., & Crowe, M. G. (2017) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbx127 · Cited by 22
Self-citation
Predictores del deterioro cognitivo en ancianos
López, Á. G., & Calero, M. D. (2009) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2009.03.006 · Cited by 23
Cognitive reserve: a multidimensional protective factor in Parkinson’s disease related cognitive impairment
Ciccarelli, N., Colombo, B., Pepe, F., Magni, E., Antonietti, A., & Silveri, M. (2021) · Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition · doi:10.1080/13825585.2021.1892026 · Cited by 18
“…premorbid intelligence, and brain volume could explain individual tolerance and response to cognitive difficulties due to age or brain pathologies as Alzheimer’s disease (AD) or PD (Andel et al., 2006; Colombo, Piromalli et al., 2019; Hindle et al., 2014; Richards & Deary, 2005; Stern, 2012).”
Background
Inequality of educational opportunity at time of schooling predicts cognitive functioning in later adulthood
Leist, A. K., Bar-Haim, E., & Chauvel, L. (2021) · SSM - Population Health · doi:10.1016/j.ssmph.2021.100837 · Cited by 28
“…exposure to or engagement in cognitively stimulating activities such as education, occupational level, or occupational complexity have been shown to be associated with higher levels of cognitive functioning at older ages (Andel et al., 2006; Ritchie & Tucker-Drob, 2018; Singh-Manoux et al., 2011).”
Background
Longitudinal Analysis of Brain-Predicted Age in Amnestic and Non-amnestic Sporadic Early-Onset Alzheimer's Disease
Gautherot, M., Kuchcinski, G., Bordier, C., Sillaire, A. R., Delbeuck, X., Leroy, M., Leclerc, X., Pruvo, J., Pasquier, F., & Lopes, R. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.729635 · Cited by 22
“, 2019), it could be related to more severe brain atrophy and accelerated cognitive decline in advanced AD stages (Wilson et al., 2000; Scarmeas, 2005; Andel et al., 2006; Bracco et al., 2007; Hall et al., 2007; Yoon et al., 2015; Myung et al., 2016; Soldan et al., 2017).”
Background
Work Demands and Cognitive Health Inequities by Race and Ethnicity: A Scoping Review
Gonzales, E. G., Whetung, C., Lee, Y. J., & Kruchten, R. (2022) · The Gerontologist · doi:10.1093/geront/gnac025 · Cited by 22
Predicting cognitive decline and conversion to Alzheimer’s disease in older adults using the NAB List Learning test
Gavett, B. E., Ozonoff, A., DOKTOR, V., Palmisano, J. N., Nair, A. K., Green, R. C., Jefferson, A. L., & Stern, R. A. (2010) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617710000421 · Cited by 22
More than Education: Openness to Experience Contributes to Cognitive Reserve in Older Adulthood
Williams, S. R. T. P. (2013) · Journal of Aging Science · doi:10.4172/2329-8847.1000109 · Cited by 22
“This is consistent with literature supporting links between higher intelligence [17], higher education [77], and delayed onset and/or progression of cognitive decline in dementia.”
Result
Social class, dementia and the fourth age
Jones, I. R. (2017) · Sociology of Health & Illness · doi:10.1111/1467-9566.12520 · Cited by 22
“Within such a model education is seen as a strong predictor of a later age at onset of dementia symptoms but a faster rate of decline once these are present (Andel et al. 2006, Esiri and Chance 2012).”
Background
The Influences of Community-Enriched Environment on the Cognitive Trajectories of Elderly People
Yu, S., & Wei, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168866 · Cited by 21
Life course engagement in enriching activities: When and how does it matter for cognitive aging?
Frank, C. C., Mundy, L. M., & Smith, J. (2023) · Psychology and Aging · doi:10.1037/pag0000744 · Cited by 23
Relationship between Cognitive Reserve and Cognitive Impairment in Autonomous and Institutionalized Older Adults
Sánchez, M. W., Bonete-López, B., Cabaco, A. S., Litago, J. D. U., & Afonso, R. M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17165777 · Cited by 21
“The results are in the line of others studies that [33] supporting the hypothesis that CR influences the delay of the manifestation of symptoms of cognitive”
Result
Higher education affects accelerated cortical thinning in Alzheimer's disease: a 5-year preliminary longitudinal study
Cho, H., Jeon, S., Kim, C., Ye, B. S., Kim, G. H., Noh, Y., Kim, Y. J., Yoon, C. W., Kim, Y. J., Kim, J., et al. (2014) · International Psychogeriatrics · doi:10.1017/s1041610214001483 · Cited by 20
“Moreover, after the clinical onset of AD, HE-AD experienced more rapid cognitive decline than LE-AD (Stern et al., 1999; Andel et al., 2006; Scarmeas et al., 2006; Bruandet et al., 2008).”
Background
Memory rehabilitation in older adults
Glisky, E. L., & Glisky, M. L. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9781316529898.037 · Cited by 20
Age differences and educational attainment across the life span on three generations of Wechsler adult scales
Kaufman, A. S., Salthouse, T. A., Scheiber, C., & Chen, H. (2016) · Journal of Psychoeducational Assessment · doi:10.1177/0734282915619091 · Cited by 20
The influence of cognitive reserve on neuropsychological functioning following coronary artery bypass grafting (CABG)☆
Ropacki, S., Bert, A. A., Ropacki, M. T., ROGERS, B., & Stern, R. A. (2006) · Archives of Clinical Neuropsychology · doi:10.1016/j.acn.2006.11.001 · Cited by 18
“In Alzheimer’s disease and other neurodegenerative disorders (e.g., Andel, Vigen, Mack, Clark, & Gatz, 2006; Le Carret et al., 2005; Qiu, Backman, Winblad, Aguero-Torres, & Fratiglioni, 2001; Scarmeas et al., 2003; Stern, Albert, Tang, & Tsai, 1999), HIV/AIDS (Satz et al., 1993; Stern, Silva, Chaisson, & Evans, 1996),…”
Neuronal injury biomarkers for assessment of the individual cognitive reserve in clinically suspected Alzheimer's disease
Beyer, L., Schnabel, J., Kazmierczak, P. M., Ewers, M., Schönecker, S., Prix, C., Meyer-Wilmes, J., Unterrainer, M., Catak, C., Pogarell, O. M., et al. (2019) · NeuroImage Clinical · doi:10.1016/j.nicl.2019.101949 · Cited by 18
Gender as a Moderator of the Effect of Education and Acculturation on Cognitive Function: A Study of Older Korean Immigrants
Choi, E. Y., Jang, Y., & Chiriboga, D. A. (2020) · Journal of Aging and Health · doi:10.1177/0898264320950554 · Cited by 17
“Education not only promotes cognitive development early in life but also exerts cognitive health benefits over the life course by enhancing socioeconomic status, health behaviors, and engagement in activities associated with cognitive reserve (Andel et al., 2006; Jefferson et al., 2011).”
Background
[Cognitive reserve and neuronal changes associated with aging].
Villeneuve, S., & Belleville, S. (2010) · Psychologie and NeuroPsychiatrie du Vieillissement · doi:10.1684/pnv.2010.0214 · Cited by 16
“Bien que la réserve retarde l’apparition des signes cliniques, des travaux ontmis en évidence qu’après leur apparition le fonctionnement cognitif des patients dont la réserve est supérieure se détériore plus rapidement que chez ceux dont la réserve est inférieure [25, 55-63].”
Background
Duration of subjective poverty in relation to subsequent cognitive performance and decline among adults aged ≥64 in China, 2005–2018
Yu, X., Zhang, W., & Kobayashi, L. C. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114188 · Cited by 17
The Association Between Cognitive Reserve and Cognitive Trajectories Among Older Adults
Khalaila, R., Dintica, C. S., & Yaffe, K. S. (2024) · Innovation in Aging · doi:10.1093/geroni/igae014 · Cited by 16
“…findings showed conflicting results on the association between individual CR indicators and cognitive decline, as found in previous studies (Andel et al., 2006; Li et al., 2021; Lövd é n et al., 2020; Mousavi-Nasab et al., 2014; Opdebeeck et al., 2016; Zahodne et al., 2011), although, in…”
MethodResult
Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment
Makkar, S. R., Lipnicki, D. M., Crawford, J. D., Kochan, N. A., Costa, E., Lima‐Costa, M. F., Diniz, B. S., Brayne, C., Stephan, B. C. M., Matthews, F. E., et al. (2020) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2020.104112 · Cited by 17
“Each of these factors is associated with reduced dementia incidence (Andel et al., 2006; Russ et al., 2013; Sharp & Gatz, 2011).”
Background
Nivel de independencia en la vida diaria y plasticidad cognitiva en la vejez
González, E. N., García, M. D. C., Pérez-Díaz, Á. G. L., Ceballos, A. L. G., Carbonell, I. T., & García, M. J. C. (2008) · Escritos de Psicología / Psychological Writings · doi:10.24310/espsiescpsi.v2i1.13361 · Cited by 16
Life course linkages between enriching early-life activities and later life cognition: Evidence from the Wisconsin Longitudinal Study
Greenfield, E. A., Reynolds, A., & Moorman, S. M. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114673 · Cited by 15
Gene by Environment Interplay in Cognitive Aging
Reynolds, C. A., Finkel, D., & Zavala, C. (2013) · Springer eBooks · doi:10.1007/978-1-4614-7447-0_6 · Cited by 14

Authors: ANDEL, R., VIGEN, C., MACK, W. J., CLARK, L. J., & GATZ, M.
Affiliations: University of South Florida (US)
University of Southern California (US)
ORCID: ANDEL, ROSS
VIGEN, CHERYL
MACK, WENDY J.
GATZ, MARGARET
Venue: Journal of the International Neuropsychological Society
Publisher: Cambridge University Press (CUP)
Published: 2006-01
Volume: 12
Issue: 1
Pages: 147-152
ISSN: 1355-6177 (ISSN-L)
1469-7661
DOI: 10.1017/s1355617706060206
OpenAlex: W2031572198
Cited by: 176
References: 17
Citations by year: 2026: 2 · 2025: 5 · 2024: 8 · 2023: 10 · 2022: 6 · 2021: 16 · 2020: 10 · 2019: 11 · 2018: 6 · 2017: 8 · 2016: 8 · 2015: 7 · 2014: 10 · 2013: 15 · 2012: 7
FWCI: 5.95
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified, 22 d)
Locations: Journal of the International Neuropsychological Society (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Aging (P30 AG17265, P50-AG05142, P50AG005142, P30AG017265)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
Keywords: Alzheimer's disease, cognitive decline, educational attainment, occupational complexity, cognitive reserve, job complexity, Mini-Mental State Examination, dementia progression
MeSH terms: Aged, Alzheimer Disease, Cognition, Education, Female, Humans, Longitudinal Studies, Male, Models, Psychological, Occupations, Age of Onset

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The effect of education and occupational complexity on rate of cognitive decline in Alzheimer's patients

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