The DOI matches its Crossref record; 65 of the 68 references it cites were found in a registry or an index; none of the 9 sources its claims cite is checked for support yet.
Education and rates of cognitive decline in incident Alzheimer's disease
Open accessAbstract
BACKGROUND: Some (but not all) epidemiological studies have noted faster rates of progression in high education patients with Alzheimer's disease (AD), which has been attributed to harbouring/tolerating a higher pathological burden at the time of clinical dementia for subjects with higher education. We wanted to assess the relationship between education and rates of decline in AD. METHODS: During the course of a community based multiethnic prospective cohort study of individuals aged > or = 65 years living in New York, 312 patients were diagnosed with incident AD and were followed overall for 5.6 (up to 13.3) years. The subjects received an average of 3.7 (up to 9) neuropsychological assessments consisting of 12 individual tests. With the aid of a normative sample, a standardised composite cognitive score as well as individual cognitive domain scores were calculated. Generalised estimating equation models were used to examine the association between education and rates of cognitive decline. RESULTS: Composite cognitive performance declined by 9% of a standard deviation per year. Rates of decline before and after AD incidence were similar. For each additional year of education there was 0.3% standard deviation lower composite cognitive performance for each year of follow up. The association between higher education and faster decline was noted primarily in the executive speed (0.6%) and memory (0.5%) cognitive domains and was present over and above age, gender, ethnicity, differential baseline cognitive performance, depression, and vascular comorbidity. CONCLUSIONS: We conclude that higher education AD patients experience faster cognitive decline.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In a multiethnic community cohort of 312 incident Alzheimer's disease patients, higher educational attainment was associated with slightly faster cognitive decline after accounting for baseline cognition and other covariates. The effect was most apparent in executive speed and memory, while pre- and post-diagnosis decline rates were similar.
Key findings
- Composite cognition declined by about 9% of a standard deviation per year (b = −0.09, p < 0.001); pre-incidence and post-incidence slopes were nearly identical (−0.09 vs −0.08 SD/year; interaction p = 0.57).
- Each additional year of education was linked to an extra 0.003 z-score-unit decline per follow-up year on the composite (p = 0.012), described in the abstract as 0.3% of an SD per year. Domain interactions were significant for executive speed (b = −0.006, p = 0.002), memory (b = −0.005, p = 0.002), and abstract reasoning (b = −0.003, p = 0.047), but not visual-spatial or language.
- At baseline, future AD patients scored 0.37 SD below matched controls about 3.8 years before diagnosis, and 0.89 SD below at the incidence visit.
- The education–decline association persisted after adjustment for age, gender, ethnicity, baseline cognition, literacy, vascular risk factors, and depression; no evidence indicated that ethnicity or literacy modified the relationship.
Methods
- Prospective community-based multiethnic cohort in northern Manhattan; 312 incident AD patients (mean age 81.6 years, mean education 7.1 years, 54% Hispanic, 33% black, 12% white) drawn mostly from WHICAP cohorts, followed on average 5.6 years (maximum 13.3) with 3.7 assessments (maximum 9) and 1159 total cognitive evaluations.
- Diagnosis used standardized clinical examination, a neuropsychological battery in English or Spanish, consensus conference, DSM-III-R and NINCDS-ADRDA criteria; composite and domain z-scores were derived from 548 cognitively healthy age-, gender-, and education-matched controls.
- Generalized estimating equation models tested education, time, and an education×time interaction, adjusted for age, gender, ethnicity, and baseline cognitive score; supplementary models examined pre/post incidence, nonlinear time, ethnicity, literacy, vascular comorbidity, and depression.
Limitations
- Stated: clinical diagnosis without biomarkers may misclassify dementia type; the standard criteria had sensitivity around 81% and specificity around 70%.
- Stated: reliance on pre-incidence data and limited post-incidence follow-up (1.8 years) may miss later disease stages; only linear and quadratic time terms were tested; education may be a proxy for unmeasured factors; years of schooling may not capture education quality.
- Evident: post-incidence analyses included only 131 of 312 patients, limiting power; the language domain had a ceiling effect and was skewed; the observational design cannot establish causality.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
49 Own result · 13 Own method · 9 Not checked yet · 6 Own interpretation
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The association between higher education and faster decline was noted primarily in the executive speed (0.6%) and memory (0.5%) cognitive domains and was present over and above age, gender, ethnicity, differential”
- Also stated in: § Education and rates of cognitive decline · plain
“there was an association between education and z score decline for executive speed, memory, and abstract reasoning domains”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Abstract
plaincorrelationaln = 312 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Education and rates of cognitive decline · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, there was no evidence that the relationship between education and cognitive decline varied by ethnicity: time6education6ethnicity: b = 0.03; p = 0.23.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between education and rates of abstract reasoning (b = 20.002;p = 0.191), visual-spatial (b,20.001;p = 0.987), or language (b = 0.002; p = 0.168) decline.”
- Also stated in: § Education and rates of cognitive decline · plain
“there was no association between education and rates of visual-spatial and language decline (table 3; fig 1).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Education and rates of cognitive decline · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between education and rates of abstract reasoning (b = 20.002;p = 0.191), visual-spatial (b,20.001;p = 0.987), or language (b = 0.002; p = 0.168) decline.”
- Also stated in: § Education and rates of cognitive decline · plain
“there was no association between education and rates of visual-spatial and language decline (table 3; fig 1).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Education and rates of cognitive decline · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no evidence of differential rates of decline for different literacy levels: b = 0.01; p = 0.43.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the vascular variables was significant in this model.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no evidence of different rates of decline among ethnicities: time6ethnicity: b = 20.009;p = 0.65.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For each additional year of education there was 0.3% standard deviation lower composite cognitive performance for each year of follow up.”
- Also stated in: § Education and rates of cognitive decline · plain
“In models adjusted for baseline cognitive performance, each additional year of education was associated with an additional decline of 0.003 z score units of the composite cognitive score per year of follow up (table 3; fig 1).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Abstract
plaincorrelationaln = 312- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Education and rates of cognitive decline · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, there was no evidence that the relationship between education and cognitive decline varied by literacy: b = 20.001;p = 0.60.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Composite cognitive performance declined by 9% of a standard deviation per year.”
- Also stated in: § Decline of cognition over time · hedged
“For the composite score, b was 20.09 (p,0.001),indicating a 9% decline in the score per year of follow up.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Abstract
plainn = 312 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Decline of cognition over time · hedged
- Probably not a substantial claim. 15
- It may state two separate claims as one. 19
- The quote only partly states this claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Men performed slightly better than women: mean baseline composite score was -0.35 for men and -0.50 for women (p = 0.03).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results were similar in supplementary analyses that used language domain as the outcome in the form of a recoded four level categorical variable.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Distribution of cognitive scores
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between age and education (r = 0.09, p = 0.14) or between age and baseline composite score (r = 0.10, p = 0.08).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between education and gender (mean years of education 7.2 for males and 7.1 for females; p = 0.86).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, we included baseline scores as covariates in the analyses and the results were unchanged.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In post-hoc Scheffe's tests, Hispanic subjects (mean baseline composite z score -0.57) had significantly lower baseline cognitive performance as compared to black subjects (mean baseline composite z score 20.32) but had similar baseline cognitive performance as compared to white subjects (mean baseline composite z score -0.38).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no differential rates of decline for abstract reasoning (b = 20.002;p = 0.33), visual-spatial (b = 20.001;p = 0.81), and language (b = 20.001;p = 0.78).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Pre-incidence visits only
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between age and education (r = 0.09, p = 0.14) or between age and baseline composite score (r = 0.10, p = 0.08).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The composite z score, and all cognitive domain scores with the exception of the language domain, were normally distributed.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Distribution of cognitive scores
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no significant association between education and LDL, history of heart disease, stroke, or current smoking.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was faster decline for higher education AD patients in the memory (b = 20.004;p = 0.037) and executive speed domains (b = 20.008;p = 0.006).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Pre-incidence visits only
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The association between education and cognitive decline was still noted after controlling for differential cognitive performance at the initial visit and was not accounted for by literacy, vascular comorbidity, or depression.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Results from the Religious Order Study, including clinical and neuropathological data from 130 older Catholic clergy, contested this.57 The association between cognitive function and AD pathology was modified by education: there was less effect of AD pathology on cognitive function for each additional year of education.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites [57] 57. Bennett DA, Wilson RS, Schneider JA, et al. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60(12):1909-15.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinical diagnosis was based on uniform application of widely accepted criteria via a consensus diagnostic conference procedure.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Third, although we examined rates of decline using both linear and non-linear (quadratic) terms, it is possible that other types of non-linear decline may be present.8 9 60 61”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites 8 9 60 61
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“More specifically, there were no differences between the 548 subjects and the 312 incident AD patients regarding gender (x 2 = 0.19; p = 0.67), age tertiles (x 2 = 4.16 = 0.13), or education tertiles (x 2 = 1.53; p = 0.47).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Outcomes
plainn = 548- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Previous reports studied more impaired AD patients (either prevalent cases or patients seeking medical attention) capturing the part of disease course corresponding to more advanced stages, while the design of the present study enables testing of the hypothesis during earlier stages of disease.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming that the progression of AD pathology does not differ as a function of education, this delay in clinical onset may result from differences in rate of cognitive decline, differences in the time when cognitive decline begins (''inflection point''), or a combination of both.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- The authors state this as an assumption: The progression of AD pathology does not differ as a function of education.
In the paper
“The CR hypothesis predicts that among AD patients with similar cognitive status, those with more CR would have (or be able to tolerate) more severe degrees of brain pathology.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites 1 2 43
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We used a comprehensive battery of cognitive assessment, permitting evaluation of a full range of cognitive domains.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data were examined to ensure that the variables included in the models met the model assumptions (that is, normality).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Statistical analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This is one of the largest studies examining this hypothesis and provided sufficient power for detection and more precise calculation of effects of interest as well as the ability to control for potential confounders.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“For the diagnosis of probable or possible AD, the criteria of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association 34 were used.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Sample and procedure
What the sources say
- Not checked yetcites [34] 34. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34(7):939-44.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Evaluations were performed approximately every 1.5 years for an average of 5.6 (and up to 13.3) years, which provides multiple assessments of cognitive performance and therefore permits more accurate slope calculations.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“the criteria used for the diagnosis of dementia as required by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R).33”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Sample and procedure
What the sources say
- Not checked yetcites [33] 33. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Washington, DC: American Psychiatric Association, 1987.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifth, years of schooling cannot completely capture all aspects of educational experience (that is, different quality of education in different educational systems, etc).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, because AD pathology progresses independently of educational attainment (or CR), when pathological burden becomes more severe and widespread, sufficient neural substrate is no londer available and a faster decline may ensue.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Many prospective studies have suggested that higher education is associated with reduced risk of incident AD. 11 20 45-51”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites 11 20 45-51
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The used standard diagnostic criteria have a sensitivity of ,81% with a specificity of ,70%.59”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites [59] 59. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56(9):1143-53.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
Pathological changes of Alzheimer's disease are present in the brain many years before clinical symptoms of dementia appear.
“the pathological changes of AD are present in the brain many years before the onset of clinical symptoms of dementia”
The paper relies on this without support.
Previous studies of education and AD progression usually used clinic-referred patients, which limits generalizability to the general population.
“subjects studied in previous reports were usually clinic referred AD patients, which could limit generalisability to the population.”
The paper relies on this without support.
Previous studies of education and AD progression used prevalent AD patients recruited at various disease stages, so they could not accurately control for disease duration.
“previous studies were of prevalent AD patients who were recruited at various stages of their disease.Time of disease onset could only be estimated retrospectively or inferred by cognitive performance status.Therefore, previous studies could not accurately control for duration of disease.”
The paper relies on this without support.
Most previous investigations used limited neuropsychological measures that do not assess many cognitive domains and can suffer from floor and ceiling effects.
“most previous investigations have used limited neuropsychological measures that do not assess many cognitive domains and can suffer from floor and ceiling effects resulting in inadequately assessed cognitive performance.”
The paper relies on this without support.
Most previous reports did not adequately control for education-related differences in baseline cognitive performance.
“most previous reports did not adequately control for the potential effect on rates of cognitive decline of education related differences in baseline cognitive performance.”
The authors state this as an assumption.
The progression of AD pathology does not differ as a function of education.
“Assuming that the progression of AD pathology does not differ as a function of education”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“We replicated this observation in patients with incident AD28 and also found more rapid decline in cognitive function in AD patients who engaged in more leisure activities prior to dementia onset29.”
From Cognitive reserve in ageing and Alzheimer's disease (2012) · cites this paper as [28]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The rate of decline is more rapid in individuals with high reserve than those with low reserve, even when accounting for a multitude of other factors that may contribute to disease course27, 28, 46.”
From Cognitive reserve in ageing and Alzheimer's disease (2012) · cites this paper as [28]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
“the postincidence follow up was relatively limited (1.8 years)”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
“| After incidence (n = 131) | | | | Years from incidence to | 3.9 (2.39) | 0.9-11.1 | | last evaluation | | |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Education and rates of cognitive decline in incident Alzheimer's disease > RESULTS
“Overall, the 312 included AD subjects had 1159 separate cognitive assessments.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > RESULTS
“More specifically, 110 (35%) had two evaluations, 47 (15%) had three, 60 (19%) had four, 40 (13%) had five, 37 (12%) had six, 14 (5%) had seven, three (1%) had eight, and one (0.3%) had nine.”
Citations
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984) · Neurology · doi:10.1212/wnl.34.7.939 · Cited by 27,915
Hirono, N., Mori, E., Ikejiri, Y., Imamura, T., Shimomura, T., Hashimoto, M., Yamashita, H., & Ikeda, M. (1997) · PubMed · Cited by 21,012
Kok, J. S., Berg, I. J., & Scherder, E. J. A. (2013) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000353441 · Cited by 20,589
Older Adults' Reasons for Using Technology while Aging in Place
Peek, S. T. M., Luijkx, K. G., Rijnaard, M. D., Nieboer, M. E., van der Voort, C. S., Aarts, S., van Hoof, J., Vrijhoef, H. J., & Wouters, E. (2015) · Gerontology · doi:10.1159/000430949 · Cited by 19,852
Sensitivity and False Alarm Rate of a Fall Sensor in Long-Term Fall Detection in the Elderly
Kangas, M., Korpelainen, R., Vikman, I., Nyberg, L., & Jämsä, T. J. (2014) · Gerontology · doi:10.1159/000362720 · Cited by 19,007
Longitudinal data analysis using generalized linear models
LIANG, K.-Y., & ZEGER, S. L. (1986) · Biometrika · doi:10.1093/biomet/73.1.13 · Cited by 18,550
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. L., & Stadlan, E. (2011) · Neurology · doi:10.1212/01.wnl.0000400650.92875.cf · Cited by 9,882
Blessed, G., Tomlinson, B. E., & Roth, M. (1968) · British Journal of Psychiatry · doi:10.1192/bjp.114.512.797 · Cited by 4,117
What is cognitive reserve? Theory and research application of the reserve concept
STERN, Y. (2002) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617702813248 · Cited by 3,951
Research works printed but not linked: 4
- [3]3. Mortimer JA, Ebbitt BJ, Jun SP. Neuropsychological and behavioral predictors of decline in Alzheimer's disease. J Clin Exp Neuropsychol 1991;13:109.
- [32]32. Schwab J, England A. Projection technique for evaluating surgery in Parkinson's disease. In: Gillinghan FS, Donaldson MN, eds. Third Symposium on Parkinson's Disease. Edinburgh, Scotland: E & S Livingstone, 1969:152-7.
- [33]33. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Washington, DC: American Psychiatric Association, 1987.
- [61]61. Liu X, Tsai WY, Stern Y. A functional decline model for prevalent cohort data. Stat Med 1996;15(10):1023-32.
Cited by
Sorted by citations
Cognitive reserve in ageing and Alzheimer's disease
Stern, Y. (2012) · The Lancet Neurology · doi:10.1016/s1474-4422(12)70191-6 · Cited by 3,557
Stern, Y. (2009) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2009.03.004 · Cited by 2,943
“Study 8 Scarmeas et al. (2003b) 17 youngf, 19 oldg Nonverbal serial recognition GLM Identify voxels where the change in PET”
Hertzog, C., Kramer, A. F., Wilson, R. S., & Lindenberger, U. (2008) · Psychological Science in the Public Interest · doi:10.1111/j.1539-6053.2009.01034.x · Cited by 1,495
“, 2000) and education (Bruandet et al., 2008; Hall et al., 2007; Scarmeas et al., 2006; Teri, McCurry, Edland, Kulkull, & Larson, 1995; Wilson, Li, et al., 2004).”
Education and cognitive functioning across the life span
Lövdén, M., Fratiglioni, L., Glymour, M. M., Lindenberger, U., & Tucker-Drob, E. M. (2020) · Psychological Science in the Public Interest · doi:10.1177/1529100620920576 · Cited by 1,224
Mediterranean diet and risk for Alzheimer's disease
Scarmeas, N., Stern, Y., Tang, M., Mayeux, R., & Luchsinger, J. A. (2006) · Annals of Neurology · doi:10.1002/ana.20854 · Cited by 1,103
“WHICAP 1999 cohort, N (%) 395 (55) 508 (55) 312 (54) 0.”
Self-citationEpidemiology of Alzheimer DiseasePreprint
Mayeux, R. P., & Stern, Y. (2012) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a006239 · Cited by 1,127
“Similarly , higher educational or occupational attainment (Stern et al. 1999; Scarmeas et al. 2006a), increased engagement in leisure activities (Helzner et al. 2007), and greater lifetime cognitive activity (Wilson et al. 2010) have each been associated with more rapid cognitive decline in…”
InfluentialBilingualism as a protection against the onset of symptoms of dementia
Bialystok, E., Craik, F. I. M., & Freedman, M. (2007) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2006.10.009 · Cited by 967
“Finally, there is evidence that patients with higher education catch up with their less-educated peers by exhibiting faster rates of cognitive decline in the 5 years after diagnosis ( Scarmeas, Albert, Manly & Stern, 2006 ).”
BackgroundPhysical Activity, Diet, and Risk of Alzheimer Disease
Scarmeas, N. (2009) · JAMA · doi:10.1001/jama.2009.1144 · Cited by 916
Self-citationThe bilingual adaptation: How minds accommodate experience
Bialystok, E. (2017) · Psychological Bulletin · doi:10.1037/bul0000099 · Cited by 906
Cognitive Reserve and Alzheimer Disease
Stern, Y. (2006) · Alzheimer Disease & Associated Disorders · doi:10.1097/01.wad.0000213815.20177.19 · Cited by 838
Durga, J., van Boxtel, M. P., Schouten, E. G., Kok, F. J., Jolles, J., Katan, M. B., & Verhoef, P. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60109-3 · Cited by 758
Detecting Dementia With the Mini-Mental State Examination in Highly Educated Individuals
O’Bryant, S. E., Humphreys, J. D., Smith, G. E., Ivnik, R. J., Graff‐Radford, N. R., Petersen, R. C., & Lucas, J. A. (2008) · Archives of Neurology · doi:10.1001/archneur.65.7.963 · Cited by 653
“13 This literature demonstrates that oncediagnosed,patientswithprobableAlz-heimerdiseasewhohavehigherlevelsof educationtendtodemonstrateasteeper slopeofdecline 14,15 and earlier mortality rates.”
BackgroundM. Tucker, A., & Stern, Y. (2011) · Current Alzheimer Research · doi:10.2174/156720511795745320 · Cited by 561
“A further limitation of this model is that it cannot explain why those with higher IQ and more education decline more quickly once Alzheimer’s is diagnosed and progress to death sooner [21-27].”
BackgroundKurtz, M. M., & Gerraty, R. T. (2009) · Neuropsychology · doi:10.1037/a0016277 · Cited by 433
Defining Cognitive Reserve and Implications for Cognitive Aging
Pettigrew, C. A., & Soldan, A. (2019) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-019-0917-z · Cited by 484
Solé‐Padullés, C., Bartrés‐Faz, D., Junqué, C., Vendrell, P., Rami, L., Clemente, I. C., Bosch, B., Villar, A., Bargalló, N., Jurado, M. Á., et al. (2007) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2007.10.008 · Cited by 387
Langa, K. M., Larson, E. B., Karlawish, J. H., Cutler, D., Kabeto, M. U., Kim, S. Y. H., & Rosen, A. B. (2008) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2008.01.001 · Cited by 388
Educational attainment and cognitive decline in old age
Wilson, R. S., Hebert, L. E., Scherr, P. A., Barnes, L. L., Mendes de Leon, C. F., & Evans, D. A. (2009) · Neurology · doi:10.1212/01.wnl.0000341782.71418.6c · Cited by 354
Contribution of Vascular Risk Factors to the Progression in Alzheimer Disease
Helzner, E., Luchsinger, J. A., Scarmeas, N., Cosentino, S., Brickman, A. M., Glymour, M. M., & Stern, Y. (2009) · Archives of Neurology · doi:10.1001/archneur.66.3.343 · Cited by 338
“The z scores were averaged within cognitive domains, which were subsequently averaged to produce the composite cognitive score.(24) The outcome measure was the rate of change in the composite score from diagnosis onward.”
MethodSelf-citationMediterranean diet and Alzheimer disease mortality
Scarmeas, N., Luchsinger, J. A., Mayeux, R. P., & Stern, Y. (2007) · Neurology · doi:10.1212/01.wnl.0000277320.50685.7c · Cited by 324
Self-citationLong-term Cognitive and Psychological Outcomes in the Awakening and Breathing Controlled Trial
Jackson, J. C., Girard, T. D., Gordon, S. M., Thompson, J. L., Shintani, A., Thomason, J. W. W., Pun, B. T., Canonico, A. E., Dunn, J., Bernard, G. R., et al. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200903-0442oc · Cited by 255
“composite cognitive score, which has been employed in a variety of investigations (25-27), minimizes floor and ceiling effects and reduces the risk of type I error when multiple cognitive tests are used (28,29).”
MethodModifiable lifestyle factors and cognitive reserve: a systematic review of current evidence
Song, S., Stern, Y., & Gu, Y. (2022) · Ageing Research Reviews · doi:10.1016/j.arr.2021.101551 · Cited by 248
Kemppainen, N. M., Aalto, S., Karrasch, M., Någren, K., Savisto, N., Oikonen, V., Viitanen, M., Parkkola, R., & Rinne, J. O. (2008) · Annals of Neurology · doi:10.1002/ana.21212 · Cited by 239
“However, after AD incident faster decline in memory and executive speed is associated with higher education.(23) The lower incidence of AD in high-educated populations has been shown in several epidemiological studies, but the protective mechanism of education against the disease is still unclear.”
BackgroundMediterranean Diet, Inflammatory and Metabolic Biomarkers, and Risk of Alzheimer's Disease
Gu, Y., Luchsinger, J. A., Stern, Y., & Scarmeas, N. (2010) · Journal of Alzheimer s Disease · doi:10.3233/jad-2010-100897 · Cited by 253
“Cognitive performance at baseline A composite cognitive Z-score was developed to summarize cognitive performance as previously described [28–32].”
MethodSelf-citationCognitive Reserve and Alzheimer’s Disease
Xu, W., Yu, J., Tan, M., & Tan, L. (2014) · Molecular Neurobiology · doi:10.1007/s12035-014-8720-y · Cited by 251
Sex and age differences in atrophic rates: an ADNI study with n=1368 MRI scans
Hua, X., Hibar, D. P., Lee, S., Toga, A. W., Jack, C. R., Weiner, M. W., & Thompson, P. M. (2010) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2010.04.033 · Cited by 234
Fotenos, A. F., Mintun, M. A., Snyder, A. Z., Morris, J. C., & Buckner, R. L. (2008) · Archives of Neurology · doi:10.1001/archneurol.2007.27 · Cited by 226
“c 26/5 35/5 28/1 Hollingshead, mean (SD) [range] 35 (4) [29-43] 22 (3) [18-27] 13 (2) [11-15] MMSE score, mean (SD) [range] 29 (1) [25-30] 29 (1) [26-30] 29 (1) [26-30] Medications, mean (SD) [range], No.”
Incidence of Mild Cognitive Impairment: A Systematic Review
Luck, T., Luppa, M., Briel, S., & Riedel-Heller, S. G. (2010) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000272424 · Cited by 213
“A high level of education was also found to be associated with a decreased risk for incident Alzheimer’s disease (AD) yet with a faster cognitive decline in clinically manifest AD [”
BackgroundKim, B.-K., Noh, G. O., & Kim, K. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02109-w · Cited by 221
APOE ε4 allele predicts faster cognitive decline in mild Alzheimer disease
Cosentino, S., Scarmeas, N., Helzner, E., Glymour, M. M., Brandt, J., Albert, M., Blacker, D., & Stern, Y. (2008) · Neurology · doi:10.1212/01.wnl.0000304038.37421.cc · Cited by 214
Self-citationGildner, T. E., Liebert, M. A., Kowal, P. R., Chatterji, S., & Snodgrass, J. J. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3782 · Cited by 217
“In accordance with other cognitive studies, composite z-scores were calculated to facilitate the comparison of cognitive test performance between individuals (Grodstein et al., 2003; Scarmeas et al., 2006).”
MethodSubramaniapillai, S., Almey, A., Rajah, M. N., & Einstein, G. (2020) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2020.100879 · Cited by 215
Cognitive reserve and long-term change in cognition in aging and preclinical Alzheimer's disease
Soldan, A., Pettigrew, C. A., Cai, Q., Wang, J., Wang, M., Moghekar, A., Miller, M. I., & Albert, M. (2017) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2017.09.002 · Cited by 221
“…Stern model, a number of previous studies of individuals with dementia have reported greater rates of cognitive decline (e.g., Roselli et al., 2009; Scarmeas et al., 2006; Stern et al., 1999) or functional decline (de Oliveira et al., 2015) among those with more education compared to those with…”
ResultBilingualism delays clinical manifestation of Alzheimer's disease
Woumans, E., Santens, P., Sieben, A., Versijpt, J. J., Stevens, M., & Duyck, W. (2014) · Bilingualism Language and Cognition · doi:10.1017/s136672891400087x · Cited by 190
“This may seem counterintuitive, but note that faster AD progression with higher education has also been reported earlier (Scarmeas et al., 2006).”
Desjardins, R., & Warnke, A. J. (2012) · OECD education working papers · doi:10.1787/5k9csvw87ckh-en · Cited by 206
Effects of education on cognition at older ages: Evidence from China's Great Famine
Huang, W., & Zhou, Y. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.08.021 · Cited by 181
Dementia of the Alzheimer Type
Jalbert, J. J., Daiello, L. A., & Lapane, K. L. (2008) · Epidemiologic Reviews · doi:10.1093/epirev/mxn008 · Cited by 181
“If patients with higher educational levels also have a higher cognitive reserve, then, when DAT symptoms become apparent, the pathological burden will already be more severe and widespread, and, with the cognitive reserve depleted, the patient would appear to experience cognitive decline at a more rapid rate (45, 109).”
BackgroundDoes cognitive reserve shape cognitive decline?
Singh‐Manoux, A., Marmot, M. G., Glymour, M. M., Sabia, S., Mika Kivimaki, B., & Dugravot, A. (2011) · Annals of Neurology · doi:10.1002/ana.22391 · Cited by 181
“Clinical studies, often on a small number of subjects, assume that cognitive function declines only in the period immediately prior to the diagnosis of dementia.(24,25) However, there is now enough evidence from large scale studies to suggest a much longer period of cognitive decline.”
BackgroundHughes, M. L., Agrigoroaei, S., Jeon, M., Bruzzese, M., & Lachman, M. E. (2018) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617718000425 · Cited by 177
Heterogeneity of cognitive trajectories in diverse older persons.
Mungas, D., Beckett, L. A., Harvey, D. J., Farias, S. T., Reed, B., Carmichael, O. T., Olichney, J., Miller, J. W., & DeCarli, C. S. (2010) · Psychology and Aging · doi:10.1037/a0019502 · Cited by 184
Bosch, B., David Bartrés-faz, A., Rami, L., Arenaza‐Urquijo, E. M., Fernández‐Espejo, D., Junqué, C., Solé‐Padullés, C., Sánchez‐Valle, R., Bargalló, N., Falcón, C., et al. (2009) · Cortex · doi:10.1016/j.cortex.2009.05.006 · Cited by 153
“…bDepartment de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Catalonia, Spain cInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain dRadiology Service, Hospital Clı́nic de Barcelona, Catalonia, Spain eCIBER-BBN, Barcelona, Catalonia, Spain a r…”
BackgroundCognitive reserve and clinical progression in Alzheimer disease
van Loenhoud, A. C., van der Flier, W. M., Wink, A. M., Dicks, E., Groot, C., Twisk, J. W. R., Barkhof, F., Scheltens, P., Ossenkoppele, R., & Initiative, A. D. N. (2019) · Neurology · doi:10.1212/wnl.0000000000007821 · Cited by 159
Hippocampal volume varies with educational attainment across the life-span
Noble, K. G., Grieve, S. M., Korgaonkar, M. S., Engelhardt, L. E., Griffith, E. Y., Williams, L. M., & Brickman, A. M. (2012) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2012.00307 · Cited by 154
“ORIGINAL RESEARCH ARTICLE published: 09 November 2012 doi: 10.3389/fnhum.2012.00307 Hippocampal volume varies with educational attainment across the life-span”
BackgroundInfluentialCognitive and social lifestyle: links with neuropathology and cognition in late life
Bennett, D. A., Arnold, S. E., Valenzuela, M., Brayne, C., & Schneider, J. A. (2013) · Acta Neuropathologica · doi:10.1007/s00401-013-1226-2 · Cited by 148
“Thus, education appears to not only delay the onset of cognitive decline but is also associated with a more rapid progression once decline commences and a greater risk of adverse health outcomes [108, 127].”
BackgroundAdam, S., Bonsang, É., Grotz, C., & Sergio, P. (2013) · Clinical Interventions in Aging · doi:10.2147/cia.s39921 · Cited by 138
“35 Taking into account these potential relationships with age and education, we used stochastic frontier analysis 36 to create a “frontier” corresponding to the optimum cognitive functioning that each individual is expected to achieve given age and level of education.”
Education amplifies brain atrophy effect on cognitive decline: Implications for cognitive reserve
Mungas, D., Gavett, B., Fletcher, E., Farias, S. T., Decarli, C., & Reed, B. (2018) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2018.04.002 · Cited by 131
Bialystok, E., Craik, F. I. M., Binns, M. A., Ossher, L., & Freedman, M. (2013) · Neuropsychology · doi:10.1037/neu0000023 · Cited by 149
“…rate of cognitive decline in older people, but the bulk of the evidence shows that reserve factors such as higher levels of education delay the onset of symptoms but are then followed by a faster rate of decline following diagnosis (Hall et al., 2007, 2009; Scarmeas, Albert, Manly, & Stern, 2006).”
BackgroundLANGUAGE AND DEMENTIA: NEUROPSYCHOLOGICAL ASPECTS
Kempler, D., & Goral, M. (2008) · Annual Review of Applied Linguistics · doi:10.1017/s0267190508080045 · Cited by 105
Perneczky, R. (2006) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.094714 · Cited by 122
“recently showed, for example, that the association between the Alzheimer’s disease pathology and cognitive symptoms shortly before death was attenuated by the number of years of schooling. Better educated patients had more pathology than would have been predicted from their cognitive status. Epidemiological studies th…”
BackgroundMejía-Arango, S., & Gutierrez, L. M. (2011) · Journal of Aging and Health · doi:10.1177/0898264311421199 · Cited by 125
Gross, A. L., Mungas, D., Crane, P. K., Gibbons, L. E., MacKay‐Brandt, A., Manly, J. J., Mukherjee, S., Romero, H., Sachs, B. C., Thomas, M., et al. (2015) · Psychology and Aging · doi:10.1037/pag0000032 · Cited by 130
“Level of educational attainment is strongly associated with cross-sectional cognitive test scores, explaining up to 50% of variance in some studies (Albert et al., 1995; Alley et al., 2007; Atkinson et al., 2005; Early et al., 2013; Manly et al., 2004; Mungas et al., 2000, 2005; Schaie, 1996).”
Dijk, K. R. A. V., Gerven, P. W. M. V., van Boxtel, M. P. J., der Elst, W. V., & Jolles, J. (2008) · Psychology and Aging · doi:10.1037/0882-7974.23.1.119 · Cited by 131
Musicco, M., Palmer, K., Salamone, G., Lupo, F., Perri, R., Mosti, S., Spalletta, G., Iulio, F. D., Pettenati, C., Cravello, L., et al. (2009) · Journal of Neurology · doi:10.1007/s00415-009-5116-4 · Cited by 118
“Lower education has also been found to be associated with slower progression rates in previous studies [22, 33, 36].”
ResultLesuis, S. L., Hoeijmakers, L., Kőrösi, A., de Rooij, S. R., Swaab, D. F., Kessels, H. W. H. G., Lucassen, P. J., & Krugers, H. J. (2018) · Alzheimer s Research & Therapy · doi:10.1186/s13195-018-0422-7 · Cited by 128
Heo, J., Lee, K., Paek, S. H., Kim, M. J., Lee, J., Kim, J.-Y., Cho, S.-Y., Lim, Y. H., Kim, M.-R., Jeong, S. Y., et al. (2008) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2008.06.010 · Cited by 117
“Several studies reported an association between a higher level of education and a more rapid cognitive decline in Alzheimer's disease [46,47].”
Barnabé, A., Whitehead, V., Pilon, R., Arsenault‐Lapierre, G., & Chertkow, H. M. (2012) · Hippocampus · doi:10.1002/hipo.22015 · Cited by 114
“With regards to education, the theory predicts that higher education will delay the inception of rapid cognitive decline, but once cognitive decline has begun, it will be more accelerated in individuals with more education (Scarmeas et al., 2006; Stern, 2009).”
BackgroundRate of MMSE score change in Alzheimer's disease: Influence of education and vascular risk factors
Roselli, F., Tartaglione, B., Federico, F., Lepore, V. L., Defazio, G., & Livrea, P. (2008) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2008.10.006 · Cited by 113
Leisure activity and cognitive decline in incident Alzheimer disease
Helzner, E. P., Scarmeas, N., Cosentino, S., Portet, F., & Stern, Y. (2007) · Archives of Neurology · doi:10.1001/archneur.64.12.1749 · Cited by 112
“This was done to more fully capture the natural course of the disease, since AD-associated neuropathologic conditions and subtle cognitive decline are present many years before diagnosis.(27,28) Also, in this sample, rates of cognitive decline were similar before and after AD diagnosis.”
Self-citationAnthony, M., & Lin, F. (2018) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acx125 · Cited by 109
Spering, C. C., Hobson, V. L., Lucas, J. A., Menon, C. V., Hall, J. R., & O’Bryant, S. E. (2012) · The Journals of Gerontology Series A · doi:10.1093/gerona/gls006 · Cited by 109
Strydom, A., Hassiotis, A., King, M., & Livingston, G. (2008) · Psychological Medicine · doi:10.1017/s0033291708003334 · Cited by 93
“An accelerated decline (Scarmeas et al. 2006) and higher mortality (Geerlings et al. 1999) have been noted when dementia occurs in adults with high ability or educational attainment, giving support to the idea that, in contrast to the present participants, they can tolerate some degree of pathology…”
BackgroundPhysical Activity and Alzheimer Disease Course
Scarmeas, N., Luchsinger, J. A., Brickman, A. M., Cosentino, S., Schupf, N., Xin-Tang, M., Gu, Y., & Stern, Y. (2010) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181eb00a9 · Cited by 112
“Higher education has been associated with faster rates of cognitive decline (25) and increased mortality (37) in AD patients.”
Self-citation‘Normal’ semantic–phonemic fluency discrepancy in Alzheimer's disease? A meta-analytic study
Laws, K. R., Duncan, A. L., & Gale, T. M. (2009) · Cortex · doi:10.1016/j.cortex.2009.04.009 · Cited by 101
Bessi, V., Mazzeo, S., Padiglioni, S., Piccini, C., Nacmias, B., Sorbi, S., & Bracco, L. (2018) · Journal of Alzheimer s Disease · doi:10.3233/jad-171180 · Cited by 103
“These findings have been interpreted by means of the Cognitive Reserve hypothesis [35, 36].”
Noble, K. G., Korgaonkar, M. S., Grieve, S. M., & Brickman, A. M. (2013) · Developmental Science · doi:10.1111/desc.12077 · Cited by 105
Number of children is associated with neuropathology of Alzheimer's disease in women
Beeri, M. S., Rapp, M. A., Schmeidler, J., Reichenberg, A., Purohit, D. P., Perl, D. P., Grossman, H. T., Prohovnik, I., Haroutunian, V. H., & Silverman, J. M. (2008) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2007.11.011 · Cited by 96
Matallana, D., de Santacruz, C., Cano, C. A., Reyes, P. A., Samper‐Ternent, R., Markides, K. S., Ottenbacher, K. J., & Ortíz, C. (2010) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988710373597 · Cited by 96
Targets for the Prevention of Dementia
Middleton, L. E., & Yaffe, K. (2010) · Journal of Alzheimer's Disease · doi:10.3233/jad-2010-091657 · Cited by 94
“In contrast, people who are highly educated may have faster cognitive decline after the onset of AD [12,18–21], though not all studies agree [22].”
BackgroundCognitive Decline and Survival in Alzheimer’s Disease according to Education Level
Bruandet, A., Richard, F., Bombois, S., Maurage, C., Masse, I., Amouyel, P., & Pasquier, F. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000111693 · Cited by 90
“]; these factors may protect the brain from lesions that contribute to dementia [ , , , , ,”
BackgroundEducation Attenuates the Association between Dietary Patterns and Cognition
Akbaraly, T. N., Singh-Manoux, A., Marmot, M. G., & Brunner, E. J. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000199235 · Cited by 90
“Previous research shows that education is linked to dietary behavior [6, 7], the exposure being considered here and cognition [8-11], the outcome.”
BackgroundEffect of Cognitive Reserve Markers on Alzheimer Pathologic Progression
Lo, R. Y., & Jagust, W. J. (2013) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e3182900b2b · Cited by 94
Baldivia, B., Andrade, V. M., & Bueno, O. F. A. (2008) · Dementia & Neuropsychologia · doi:10.1590/s1980-57642009dn20300003 · Cited by 93
Education, cognitive function, and severity of neuropathology in Alzheimer disease
Koepsell, T. D., Kurland, B. F., Harel, O., Johnson, E. A., Zhou, X. H., & Kukull, W. A. (2008) · Neurology · doi:10.1212/01.wnl.0000284603.85621.aa · Cited by 115
Cespón, J., Miniussi, C., & Pellicciari, M. C. (2018) · Ageing Research Reviews · doi:10.1016/j.arr.2018.03.001 · Cited by 93
“Specifically, adherence to specific dietary habits has been associated with a lower risk of developing MCI and AD (Scarmeas et al., 2006).”
Plasma β-Amyloid and Cognitive Decline
Cosentino, S., Stern, Y., Sokolov, E., Scarmeas, N., Manly, J. J., Tang, M. X., Schupf, N., & Mayeux, R. P. (2010) · Archives of Neurology · doi:10.1001/archneurol.2010.189 · Cited by 84
Self-citationMantzorou, M., Vadikolias, Κ., Pavlidou, E., Serdari, A., Vasios, G. K., Tryfonos, C., & Giaginis, C. (2018) · Nutritional Neuroscience · doi:10.1080/1028415x.2018.1486940 · Cited by 86
Statistical Disease Progression Modeling in Alzheimer Disease
Rakêt, L. L., & Initiative, F. T. A. D. N. (2020) · Frontiers in Big Data · doi:10.3389/fdata.2020.00024 · Cited by 78
“It has consistently been found that higher education is associated with increased rate of cognitive decline in incident AD (Teri et al., 1995; Rasmusson et al., 1996; Wilson et al., 2004; Andel et al., 2006; Scarmeas et al., 2006; Musicco et al., 2009; Thomas et al., 2016), with several of these studies also reporting…”
ResultMazzeo, S., Padiglioni, S., Bagnoli, S., Bracco, L., Nacmias, B., Sorbi, S., & Bessi, V. (2019) · Journal of Neurology · doi:10.1007/s00415-018-9164-5 · Cited by 72
Trends in Psychiatry and Psychotherapy
(2020) · Trends in Psychiatry and Psychotherapy · doi:10.47626/2237-6089 · Cited by 70
Zahodne, L. B., Mayeda, E. R., Hohman, T. J., Fletcher, E., Racine, A. M., Gavett, B. E., Manly, J. J., Schupf, N., Mayeux, R. P., Brickman, A. M., et al. (2019) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2019.08.009 · Cited by 72
“Current understanding of the protective effects of education on cognition is complicated by the well-replicated finding that more education is associated with better cognitive outcomes in healthy older adults, but faster cognitive decline in older adults with mild cognitive impairment (MCI) or dementia (Amieva et al.,…”
BackgroundModifiable, Non-Modifiable, and Clinical Factors Associated with Progression of Alzheimer’s Disease
Loeffler, D. A. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-201182 · Cited by 71
Identifying the Functional Brain Network of Motor Reserve in Early Parkinson's Disease
Chung, S. J., Kim, H., Jung, J. H., Lee, P. H., Jeong, Y., & Sohn, Y. H. (2020) · Movement Disorders · doi:10.1002/mds.28012 · Cited by 68
The cost of dementia in an unequal country: The case of Chile
Hojman, D. A., Duarte, F., Ruiz‐Tagle, J., Budnich, M., Delgado, C., & Slachevsky, A. (2017) · PLoS ONE · doi:10.1371/journal.pone.0172204 · Cited by 72
Gildner, T. E., Salinas‐Rodríguez, A., Manrique-Espinoza, B. S., Moreno-Tamayo, K. M., & Kowal, P. R. (2019) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2019.04.014 · Cited by 68
Russ, T. C., Batty, G. D., & Starr, J. M. (2011) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2795 · Cited by 66
“NART-IQ was significantly associated with survival in a model including age and gender—in this study, individuals with lower estimated premorbid IQ declined more rapidly after diagnosis in contrast to the cognitive reserve hypothesis (Stern et al. 1999; Scarmeas et al. 2006).”
ResultValen-Sendstad, A., Engedal, K., Stray‐Pedersen, B., Strobel, C., Barnett, L., Nurminemi, M., & Meyer, N. (2009) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181beaaf4 · Cited by 60
Traumatic brain injury and reserve
Bigler, E. D., & Stern, Y. (2015) · Handbook of clinical neurology · doi:10.1016/b978-0-444-63521-1.00043-1 · Cited by 72
“Higher measured CR has also been associated with more rapid cognitive decline in patients with AD (Stern et al., 1999; Scarmeas et al., 2006).”
BackgroundNeural consequences of bilingualism for cortical and subcortical function
Krizman, J., & Marian, V. (2015) · Cambridge University Press eBooks · doi:10.1017/cbo9781107447257.027 · Cited by 58
Papaioannou, T., Voinescu, A., Petrini, K., & Fraser, D. S. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-210672 · Cited by 67
“…example, although people with higher education are less prone to develop dementia and MCI, when they do develop these conditions, the cognitive decline is greater than for people with lower level of education [39, 40], and therefore cognitive outcomesafterVRtrainingmaybeinfluencedbyedu-cationlevel.”
Stanley, K., Walker, Z., Koopmans, R., & Rosness, T. (2014) · International Psychogeriatrics · doi:10.1017/s1041610214001173 · Cited by 58
Babiloni, C., Lopez, S., Percio, C. D., Noce, G., Pascarelli, M. T., Lizio, R., Teipel, S. J., González‐Escamilla, G., Bakardjian, H., George, N., et al. (2020) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2020.01.012 · Cited by 61
Determinants of cognitive and brain resilience to tau pathology: a longitudinal analysis
Bocancea, D. I., Svenningsson, A. L., van Loenhoud, A. C., Groot, C., Barkhof, F., Strandberg, O. T., Smith, R. A., Initiative, A. D. N., Weiner, M. W., Aisen, P., et al. (2023) · Brain · doi:10.1093/brain/awad100 · Cited by 59
Leoutsakos, J., Forrester, S., Corcoran, C. D., Norton, M. C., Rabins, P. V., Steinberg, M. I., Tschanz, J. T., & Lyketsos, C. G. (2014) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4221 · Cited by 56
“Education was associated with increased odds of membership in class 3 in the univariate analysis; this is consistent with other reports (Stern et al., 1999; Andel et al., 2006; Scarmeas et al., 2006).”
BackgroundResultEffects of education on the progression of early- versus late-stage mild cognitive impairment
Ye, B. S., Seo, S. W., Cho, H., Kim, S. Y., Lee, J., Kim, E., Lee, Y., Back, J. H., Hong, C. H., Choi, S. H., et al. (2012) · International Psychogeriatrics · doi:10.1017/s1041610212002001 · Cited by 56
“However, when participants with higher levels of education progressed to the stage of late-stage aMCI, they experienced more rapid cognitive decline, similar to those with AD (Teri et al., 1995; Stern et al., 1999; Amieva et al., 2005; Scarmeas et al., 2006; Bruandet et al., 2008).”
BackgroundResultInfluentialNeuroimaging modalities in the detection of Alzheimer's disease-associated biomarkers
Dang, C., Wang, Y., Li, Q., & Lu, Y. (2023) · Psychoradiology · doi:10.1093/psyrad/kkad009 · Cited by 53
“Epidemiological studies have reported that higher education years are associated with a reduced risk of incident AD, suggesting that education may pr ovide pr otection a gainst the on-set of AD (Cho et al. , 2015 ; Scarmeas et al. , 2006 ).”
BackgroundOffspring Educational Attainment and Older Parents' Cognition in Mexico
Ma, M., Yahirun, J., Saenz, J. L., & Sheehan, C. (2021) · Demography · doi:10.1215/00703370-8931725 · Cited by 56
“Indeed, re sults of pre vi ous work sug gest that the var i ance explained by one’s own ed u ca tional at tain ment may dif fer across cog ni tive di men sions (Alley et al. 2000; GuerraCarrillo 2017; Leibovici 1996; Scarmeas 2006), in clud ing in Mexico (Ardila et al. 2000).”
BackgroundNon-fluent progressive aphasia: Cerebral metabolic patterns and brain reserve
Perneczky, R., Diehl‐Schmid, J., Pohl, C., Drzezga, A. E., & Kurz, A. (2006) · Brain Research · doi:10.1016/j.brainres.2006.11.054 · Cited by 53
Dynamic change of cognitive reserve: associations with changes in brain, cognition, and diagnosis
Bettcher, B. M., Gross, A. L., Gavett, B. E., Widaman, K. F., Fletcher, E., Dowling, N. M., Buckley, R. F., Arenaza‐Urquijo, E. M., Zahodne, L. B., Hohman, T. J., et al. (2019) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2019.08.016 · Cited by 54
Hu, Y., Zhang, Y., Zhang, H., Gao, S., Wang, L., Wang, T., Han, Z., Sun, B., & Liu, G. (2022) · Molecular Psychiatry · doi:10.1038/s41380-022-01695-4 · Cited by 48
“However, other observational studies show that higher education could not protect against advanced AD [7], and even was significantly associated with increased cognitive decline rates in AD [8, 9].”
BackgroundZolochevska, O., & Taglialatela, G. (2016) · Current Pharmaceutical Design · doi:10.2174/1381612822666160518142110 · Cited by 49
Metadata
- Authors
- Scarmeas, N.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Scarmeas, N
- ORCID
- Scarmeas, N
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2005-07-26
- Volume
- 77
- Issue
- 3
- Pages
- 308-316
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC2077720
- OpenAlex
- W2071700556
- Cited by
- 353
- References
- 68
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 9 · 2023: 15 · 2022: 18 · 2021: 26 · 2020: 16 · 2019: 23 · 2018: 21 · 2017: 12 · 2016: 11 · 2015: 15 · 2014: 20 · 2013: 22 · 2012: 19
- FWCI
- 8.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institute on Aging (P01AG007232, AG 07232)
- National Center for Research Resources (RR 00645, M01RR000645)
- 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, educational attainment, cognitive decline, disease progression, executive function, memory, older adults
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Cognition Disorders, Educational Status, Female, Follow-Up Studies, Humans, Male, Neuropsychological Tests, Prospective Studies, Psychometrics, Sick Role, Statistics as Topic, Cohort Studies, Disease Progression
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-29, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-29 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
