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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.
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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.
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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.
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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.
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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.
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- 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.
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- 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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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.
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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.
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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.
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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.
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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.
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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.
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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.”
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Cited by
Sorted by citations
Items 101–200 of 354
Geifman, N., Kennedy, R., Schneider, L. S. S., Buchan, I. E., & Brinton, R. D. (2018) · Alzheimer s Research & Therapy · doi:10.1186/s13195-017-0332-0 · Cited by 49
“Higher levels of education, as seen in Class 1, have also been found previously to be associated with risk for rapid cognitive decline [23].”
BackgroundLiu, Y., & Lachman, M. E. (2019) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbz034 · Cited by 57
Effects of cognitive reserve depend on executive and semantic demands of the task
Darby, R., Brickhouse, M., Wolk, D., & Dickerson, B. (2017) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-315719 · Cited by 42
Andin, J., Hallbeck, M., Mohammed, A. H. S., & Marcusson, J. O. (2007) · Brain Research · doi:10.1016/j.brainres.2007.06.101 · Cited by 48
Effects of Bilingualism on Verbal and Nonverbal Memory Measures in Mild Cognitive Impairment
Rosselli, M., Loewenstein, D., Curiel, R. E., Peñate, A., Torres, V. L., Lang, M. K., Greig, M. T., Barker, W. W., & Duara, R. (2018) · Journal of the International Neuropsychological Society · doi:10.1017/s135561771800070x · Cited by 51
van Loenhoud, A. C., Groot, C., Bocancea, D. I., Barkhof, F., Teunissen, C. E., Scheltens, P., van der Flier, W. M., & Ossenkoppele, R. (2022) · Neurology · doi:10.1212/wnl.0000000000200116 · Cited by 46
“Furthermore, in a sample of 312 individuals with incident dementia at follow-up, the accelerated decline in memory and executive function (but not in other domains) in more highly educated individuals was already present in the years prior to diagnosis.(35) However, the relationship between education and decline rates…”
BackgroundBeyond “Use It or Lose It”: The Impact of Engagement on Cognitive Aging
Stine‐Morrow, E. A. L., & Manavbasi, I. E. (2022) · Annual Review of Developmental Psychology · doi:10.1146/annurev-devpsych-121020-030017 · Cited by 52
Neuropsychological Predictors of Rapidly Progressing Patients with Alzheimer’s Disease
Musicco, M., Salamone, G., Caltagirone, C., Cravello, L., Fadda, L., Lupo, F., Mosti, S., Perri, R., & Palmer, K. (2010) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000319533 · Cited by 46
Alzheimer disease: are we intervening too late?
Emery, V. O. B. (2011) · Journal of Neural Transmission · doi:10.1007/s00702-011-0663-0 · Cited by 48
“Comparable results on delay of AD onset as a function of persistent cognitive activity were found by other researchers (e.g., Akbaraly et al. 2009; Helzner et al. 2007; Rebok et al. 2007; Rundek and Bennett 2006; Scarmeas et al. 2003, 2006; Verghese et al. 2006; Wilson and Bennett 2003).”
BackgroundResultDumurgier, J., Paquet, C., Benisty, S., Kiffel, C., Lidy, C., Mouton‐Liger, F., Chabriat, H., Laplanche, J., & Hugon, J. (2010) · Neurobiology of Disease · doi:10.1016/j.nbd.2010.07.007 · Cited by 44
Rapid cognitive decline in Alzheimer's disease: a literature review
Sona, A., Ellis, K. A., & Ames, D. J. (2013) · International Review of Psychiatry · doi:10.3109/09540261.2013.859128 · Cited by 46
Social Inequalities and the Road to Allostatic Load: From Vulnerability to Resilience
Juster, R., Seeman, T. E., McEwen, B. S., Picard, M. A., Mahar, I., Mechawar, N., Sindi, S., Smith, N. G., Souza‐Talarico, J. N., Sarnyai, Z., et al. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy408 · Cited by 46
Occupation and Health: A Review of Selected Literature
Creek, J., & Hughes, A. (2008) · British Journal of Occupational Therapy · doi:10.1177/030802260807101102 · Cited by 44
Formulaic Language in People with Probable Alzheimer’s Disease: A Frequency-Based Approach
Zimmerer, V. C., Wibrow, M., & Varley, R. A. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-160099 · Cited by 41
“…was also negatively correlated with education, which is consistent with findings that suggest earlier onset and faster decline in people of higher educational status [58, 59], but at odds with “cognitive reserve” hypotheses which predict later onset as the result of increased education [e.g., 60].”
Cognitive Reserve Relates to Functional Network Efficiency in Alzheimer’s Disease
Weiler, M., Casseb, R. F., de Campos, B. M., Teixeira, C. V. L., Carletti‐Cassani, A. F. M. K., Vicentini, J. E., Magalhães, T. N. C., de Almeira, D. Q., Talib, L. L., Forlenza, O. V., et al. (2018) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2018.00255 · Cited by 45
“, 2015), yet accelerate the cognitive decline after its onset (Scarmeas et al., 2006; Bruandet et al., 2008).”
BackgroundIhle, A., Ghisletta, P., Ballhausen, N., Fagot, D., Vallet, F., Baeriswyl, M., Sauter, J., Oris, M., Maurer, J., & Kliegel, M. (2018) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2018.10.013 · Cited by 43
O’Shea, D. M., Langer, K. G., Woods, A. J., Porges, E. C., Williamson, J. B., O’Shea, A. M., & Cohen, R. A. (2018) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2018.00361 · Cited by 46
Díaz-Venegas, C., Samper‐Ternent, R., Michaels-Obregón, A., & Wong, R. (2018) · Aging & Mental Health · doi:10.1080/13607863.2018.1501663 · Cited by 43
The Role of Ethnicity in Alzheimer’s Disease: Findings From The C-PATH Online Data Repository
Chen, H.-Y., & Panegyres, P. K. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-151089 · Cited by 42
“AfricanAmericanswithAD hadsignificantlylowervisual-spatialscoreatbase-linecomparedwithCaucasians;however,thedecline in cognition overtime was not significantly affected by ethnicity [40].”
Arenaza‐Urquijo, E. M., Bosch, B., Sala‐Llonch, R., Solé‐Padullés, C., Junqué, C., Fernández‐Espejo, D., Bargalló, N., Rami, L., Molinuevo, J. L., & Bartrés‐Faz, D. (2010) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181e448e1 · Cited by 43
Poorer clinical outcomes for older adult monolinguals when matched to bilinguals on brain health
Initiative, A. D. N., Berkes, M., Calvo, N., Anderson, J. A. E., & Bialystok, E. (2021) · Brain Structure and Function · doi:10.1007/s00429-020-02185-5 · Cited by 44
Association of Vascular Risk Factors With Cognition in a Multiethnic Sample
Schneider, B. C., Gross, A. L., Bangen, K. J., Skinner, J. C., Benitez, A. M., Glymour, M. M., Sachs, B. C., Shih, R. A., Sisco, S. M., Manly, J. J., et al. (2014) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbu040 · Cited by 37
Wang, T., Xiao, S., Chen, K., Yang, C., Dong, S., Cheng, Y., Li, X., Wang, J., Zhu, M., Yang, F., et al. (2017) · Current Alzheimer Research · doi:10.2174/1567205013666161122094208 · Cited by 41
“A higher level of brain activity also has been found to be associated with a decreased risk for incident AD [43].”
BackgroundCognitive reserve and cognitive performance of patients with focal frontal lesions
MacPherson, S. E., Healy, C., Allerhand, M., Spanò, B., Tudor-Sfetea, C., White, M. J., Smirni, D., Shallice, T., Chan, E., Bozzali, M., et al. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.12.028 · Cited by 43
“Education has been shown to predict performance on executive tasks and memory in AD (Scarmeas et al., 2006) but not in stroke (Ojala-Oksala et al.”
BackgroundMethodInfluentialWang, X., Wang, J., He, Y., Li, H., Yuan, H., Evans, A. C., Yu, X., Yong He, A., & Wang, H. (2015) · Journal of Alzheimer s Disease · doi:10.3233/jad-142556 · Cited by 38
“Notably, several previous studies supported that the premorbid IQ may be a better proxy of cognitive reserve [73, 76] but was not examined in the pilot work.”
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
Cieri, F., Zhuang, X., Cordes, D., Kaplan, N., Cummings, J. L., Caldwell, J., & Initiative, A. D. N. (2022) · Alzheimer s Research & Therapy · doi:10.1186/s13195-022-00973-1 · Cited by 41
Normative Data Estimation in Neuropsychological Tests: A Systematic Review
delCacho-Tena, A., Christ, B. R., Arango‐Lasprilla, J. C., Perrin, P. B., Rivera, D., & Olabarrieta‐Landa, L. (2023) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acad084 · Cited by 37
“…et al., 2014; Hall et al., 2018; Suarez et al., 2021), race/ethnicity (e.g., Casaletto et al., 2015; Kang et al., 2013; Lowery et al., 2004; Melikyan et al., 2021; Norman et al., 2000; Scarmeas et al., 2006), and disease status (e.g., Gifford et al., 2020; Iverson et al., 2009; Louey et al., 2014).”
Hayat, S. A., Luben, R., Moore, S., Dalzell, N., Bhaniani, A., Anuj, S., Matthews, F. E., Wareham, N. J., Khaw, K., & Brayne, C. (2014) · BMC Geriatrics · doi:10.1186/1471-2318-14-142 · Cited by 36
Education and Use of Dementia Drugs: A Register-Based Study of Over 600,000 Older People
Johnell, K., Weitoft, G. R., & Fastbom, J. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000111534 · Cited by 37
“High education has also been associated with faster cognitive decline after dementia diagnosis [”
BackgroundBracco, L., Piccini, C., Baccini, M., Bessi, V., Biancucci, F., Nacmias, B., Bagnoli, S., & Sorbi, S. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000111081 · Cited by 37
Effects of Sex, APOE4, and Lifestyle Activities on Cognitive Reserve in Older Adults
Pa, J., Aslanyan, V., Casaletto, K., Rentería, M., Harrati, A., Tom, S., Armstrong, N., Rajan, K., Avila-Rieger, J., Gu, Y., et al. (2022) · Neurology · doi:10.1212/wnl.0000000000200675 · Cited by 30
“Domain-Specific Cognitive Reserve Measures In previously published work, confirmatory factor analysis identified the Selective Reminding Test (total recall, immediate recall, and delayed recognition) and Color Trails Test A and B as domain-specific scores for memory and speed domains, respectively.(24) We used a resid…”
MethodFormal Education Level Versus Self-Rated Literacy as Predictors of Cognitive Aging
Kavé, G., Shrira, A., Palgi, Y., Spalter, T., Ben‐Ezra, M., & Shmotkin, D. (2012) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbs031 · Cited by 35
Rolstad, S., Nordlund, A., Eckerström, C., Gustavsson, M. H., Zetterberg, H., & Wallin, A. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000203130 · Cited by 37
Mild cognitive impairment: effect of education on the verbal and nonverbal tasks performance decline
Vadikolias, Κ., Tsiakiri, A., Trιpsianis, G., Tsivgoulis, G. K., Ioannidis, P., Serdari, A., Heliopoulos, J., Livaditis, M., & Piperidou, C. (2012) · Brain and Behavior · doi:10.1002/brb3.88 · Cited by 37
“In other words, a better task performance that is related with higher education seems to mask the clinical expression of a higher degree of neurodegeneration (Bennett et al. 2003; Perneczky et al. 2006; Scarmeas et al. 2006; Stern et al. 1992a).”
BackgroundPan, F., Huang, L., Chen, K., Zhao, Q., & Guo, Q. (2020) · BMC Neurology · doi:10.1186/s12883-020-01657-9 · Cited by 35
“Moreover, education related cognitive reserve plays an important role in cognitive decline before and after the clinical diagnosis of AD [6].”
BackgroundCognitive reserve and the severity of Alzheimer’s disease
Sobral, M., Pestana, M. H. D. A. P. E., & Paúl, C. (2015) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20150044 · Cited by 35
Course and Determinants of Anosognosia in Alzheimer’s Disease: A 12-Month Follow-up
Garriga, O. T., Garre‐Olmo, J., Calvó‐Perxas, L., Reñé‐Ramírez, R., Gascón‐Bayarri, J., & Conde‐Sala, J. L. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-150706 · Cited by 33
“This rapid evolution is characteristic of patients with higher cognitive reserve [36].”
BackgroundKnight, A., Bryan, J., & Murphy, K. J. (2016) · Nutritional Neuroscience · doi:10.1080/1028415x.2016.1183341 · Cited by 33
Feng, Z., Cramm, J. M., & Nieboer, A. P. (2019) · Journal of International Medical Research · doi:10.1177/0300060519882590 · Cited by 33
Graham, E. K., James, B. D., Jackson, K., Willroth, E. C., Luo, J., Beam, C. R., Pedersen, N. L., Reynolds, C. A., Katz, M. J., Lipton, R. B., et al. (2021) · Journal of Research in Personality · doi:10.1016/j.jrp.2021.104100 · Cited by 34
Alves, L., Simões, M. R., Martins, C., Freitas, S., & Santana, I. J. (2013) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988713484194 · Cited by 32
“However, more recent studies on both preclinical and incident AD cases show a positive association between higher education and faster global, memory, and executive decline.(16,17) The cognitive reserve model predicts a faster rate of cognitive decline when the reserve is overloaded, but slower progression is expected…”
BackgroundOccupational attainment influences survival in autopsy-confirmed frontotemporal degeneration
Massimo, L. M., Zee, J., Xie, S. X., McMillan, C. T., Rascovsky, K., Irwin, D. J., Kolanowski, A. M., & Grossman, M. (2015) · Neurology · doi:10.1212/wnl.0000000000001595 · Cited by 32
Myung, W., Lee, C., Park, J. H., Woo, S., Kim, S., Kim, S., Chung, J. W., Kang, H. S., Lim, S., Choi, J., et al. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-160257 · Cited by 31
“Scarmeas et al. reported similar results for the faster cognitive decline in AD patients with higher education [50].”
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., 2006; Boots et al., 2015), IQ (Pavlik et al., 2006; Bracco et al., 2007), and W-score method (van Loenhoud et al., 2019) have…”
The Progression of Alzheimer’s Disease: Are Fast Decliners Really Fast? A Four-Year Follow-Up
Barocco, F., Spallazzi, M., Concari, L., Gardini, S., Pelosi, A., & Caffarra, P. (2017) · Journal of Alzheimer s Disease · doi:10.3233/jad-161264 · Cited by 33
“…et al., 2009; Regan et al., 2006 = [50–52] High educational level Roselli et al., 2009; Musicco et al., 2009; Musicco et al., 2010; Teri et al., 1995; Scarmeas et al., 2006 > [5, 9, 10, 53, 54] Pavlik et al., 2006 < [55] Marra et al., 2000; Kinkingnéhun et al., 2008 = [11, 14] Low education…”
Dodich, A., Carli, G., Cerami, C., Iannaccone, S., Magnani, G., & Perani, D. (2018) · Cortex; a journal devoted to the study of the nervous system and behavior · doi:10.1016/j.cortex.2017.12.006 · Cited by 33
Sobral, M., & Paúl, C. (2013) · Dementia & Neuropsychologia · doi:10.1590/s1980-57642013dn70200008 · Cited by 30
Iwata, A., Iwatsubo, T., Ihara, R., Suzuki, K., Matsuyama, Y., Tomita, N., Arai, H., Ishii, K., Senda, M., Ito, K., et al. (2018) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1016/j.trci.2018.06.008 · Cited by 29
“Nonetheless, highly educated subjects are thought to decline more quickly after they are diagnosed [6].”
BackgroundDisease progression modeling of Alzheimer’s disease according to education level
Kim, K. W., Woo, S., Kim, S., Jang, H., Kim, Y., Cho, S. H., Kim, S. E., Kim, S. J., Shin, B., Kim, H. J., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-73911-6 · Cited by 28
Mungas, D., Fletcher, E., Gavett, B. E., Widaman, K. F., Zahodne, L. B., Hohman, T. J., Mayeda, E. R., Dowling, N. M., Johnson, D. K., & Farias, S. T. (2021) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617720001095 · Cited by 30
“cognitive decline after diagnosis (Amieva et al., 2014; Scarmeas et al., 2006; Stern, Albert, Tang, & Tsai, 1999; Ye et al., 2013).”
BackgroundGrønning, H., Rahmani, A., Gyllenborg, J., Dessau, R. B., & Høgh, P. (2012) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000337386 · Cited by 27
Dementia in Southeast Asia: influence of onset-type, education, and cerebrovascular disease
Vipin, A., Satish, V., Saffari, S. E., Koh, W. Z. H., Lim, L., da Silva, E. F., Mei, N. M., Choong, T. Y. O., Chua, E. V., Lim, L. L. H., et al. (2021) · Alzheimer s Research & Therapy · doi:10.1186/s13195-021-00936-y · Cited by 26
“a steeper decline in cognition among those with higher education [54, 55].”
BackgroundRelevance of outcome measures in different cultural groups - does one size fit all?
Chiu, H. F. K., & Lam, L. C. W. (2007) · International Psychogeriatrics · doi:10.1017/s1041610207004838 · Cited by 26
“However, there are also studies with different findings (Fritsch et al., 2002; Scarmeas et al., 2006).”
ResultNormative data on a battery of neuropsychological tests in the Han Chinese population
Wang, Q., Sun, J., Ma, X., Wang, Y., Yao, J., Deng, W., Liu, X., Collier, D. A., & Li, T. (2010) · Journal of Neuropsychology · doi:10.1348/174866410x516803 · Cited by 26
Laks, J., Coutinho, E. S. F., Junger, W. L., Silveira, H., Mouta, R., Batista, E. M. R., Contino, A. L. B., Barca, M. L., Selbæk, G., Engedal, K., et al. (2010) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462010005000009 · Cited by 26
“Years of education or educational milestones do not account for all of the cognitive reserve and abilities in elderly subjects, although it has been also demonstrated that cognitive reserve associated to educational attainment mediates the symptom presentation and the clinical picture of the stages of Alzheimer’s dise…”
Adam, S., Bonsang, É., Germain, S., Bay, C., & Sergio Perelman, A. (2006) · Open Repository and Bibliography (University of Liège) · Cited by 26
Bezerra, A. B. C., Coutinho, E. S. F., Barca, M. L., Engedal, K., Engelhardt, E., & Laks, J. (2011) · International Psychogeriatrics · doi:10.1017/s1041610211001554 · Cited by 25
“There are, however, some contradictory studies which show that there is a faster rate of cognitive decline in higher educated than in lower educated elderly people with incident Alzheimer’s disease (Scarmeas et al., 2006), although the same cognitive reserve hypothesis is also put forward to explain these findings.”
BackgroundMethodResultInfluentialKognitive Reservekapazität und ihre Bedeutung für Auftreten und Verlauf der Demenz
Perneczky, R., Alexopoulos, P., Schmid, G., Sorg, C., Förstl, H., Diehl‐Schmid, J., & Kurz, A. (2010) · Der Nervenarzt · doi:10.1007/s00115-010-3165-7 · Cited by 27
Salloway, S., Mintzer, J. E., Cummings, J. L., Geldmacher, D., Sun, Y., Yardley, J., & Mackell, J. A. (2012) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317512454708 · Cited by 25
“For example, higher education levels have been associated with a faster rate of cognitive decline in patients with AD.10,11 Thus, the higher level of education in the US subgroup may have contributed to the different pattern of SIB score change observed among patients who continued receiving their existing donepezil 1…”
InfluentialMez, J., Cosentino, S., Brickman, A. M., Huey, E. D., Manly, J. J., & Mayeux, R. P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065246 · Cited by 25
“APOEe4 status, ethnicity and years of education have all been implicated in the rate of cognitive decline in AD [23–26].”
BackgroundDemir, E. Y., & Özcan, T. A. (2015) · Psychogeriatrics · doi:10.1111/psyg.12093 · Cited by 26
Giovacchini, G., Giovannini, E., Borsò, E., Lazzeri, P., Riondato, M., Leoncini, R., Duce, V., Mansi, L., & Ciarmiello, A. (2019) · Journal of Cellular Physiology · doi:10.1002/jcp.28308 · Cited by 25
Dopamine Transporter Imaging as Objective Monitoring Biomarker in Parkinson's Disease
Dzialas, V., Bischof, G. N., Möllenhoff, K., Drzezga, A. E., & van Eimeren, T. (2025) · Annals of Neurology · doi:10.1002/ana.27223 · Cited by 24
“28,29 Similar mechanisms have been demonstrated in PD and may help explain the observed variability in the relationship between DaT signal decline and motor symptom progression in our study.”
Cognitive profiles in older males and females
Jockwitz, C., Wiersch, L., Stumme, J., & Caspers, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-84134-8 · Cited by 27
Cognitive changes in people with temporal lobe epilepsy over a 13-year period
Mameniškienė, R., Rimšienė, J., & Puronaitė, R. (2016) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2016.07.029 · Cited by 26
“Over a 20-year period, delayed recall declines by 25%; over 40 years, it declines by half [17].”
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.”
Rapp, S. R., Espeland, M. A., Manson, J. E., Resnick, S. M., Bryan, R. N., Smoller, S., Coker, L. H., Phillips, L. S., Stefanick, M. L., Sarto, G. E., et al. (2013) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.46.2.a · Cited by 23
“Support for the CR hypothesis [1, 3, 5] comes from studies reporting lower incident dementia and better functioning [10-13] in persons with higher education compared to those with less education and a more precipitous loss of function among persons with more education once diagnosed with Alzheimer’s dementia (AD) [14-…”
MethodBenvenutto, A., Giusiano, B., Koric, L., Guériot, C., Didic, M., Félician, O., Guye, M., Guedj, É., & Ceccaldi, M. P. (2018) · Journal of Alzheimer s Disease · doi:10.3233/jad-180292 · Cited by 24
“…disorder expression, as if these patients could better cope with pathological changes in the brain through compensatory mechanisms (more synapses that remain available or more efficient recruitment of alternative brain networks) [55–57], according to the active cognitive reserve hypothesis [56].”
Kil, T.-Y., Yoon, K., Ryu, H., & Kim, M. (2019) · Journal of Animal Science and Technology · doi:10.5187/jast.2019.61.6.379 · Cited by 25
Cognitive Reserve and Executive Functions in Adults with Type 2 Diabetes
Peña-González, P., Mondragón‐Maya, A., Silva‐Pereyra, J., & Roa‐Rojas, P. (2020) · Journal of Diabetes Research · doi:10.1155/2020/7941543 · Cited by 25
“Such functional changes may be perdurable through life, becoming evident at old age and in the presence of pathology [36].”
BackgroundGautherot, 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
“…2018; van Loenhoud et al., 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).”
BackgroundLü, H., Wang, X., Shi, Z., Yue, W., Zhang, Y., Liu, S., Liu, S., Zhao, L., Xiang, L., Zhang, Y., et al. (2019) · Scientific Reports · doi:10.1038/s41598-018-37286-z · Cited by 22
MacPherson, S. E., Allerhand, M., Gharooni, S., Smirni, D., Shallice, T., Chan, E., & Lisa Cipolotti, A. (2020) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617720000326 · Cited by 22
Effect of education on cognitive performance in patients with mild cognitive impairment
Godinho, F., Maruta, C., Borbinha, C., & Martins, I. P. (2021) · Applied Neuropsychology Adult · doi:10.1080/23279095.2021.1887191 · Cited by 23
Xie, H., Zhang, C., Wang, Y., Huang, S., Cui, W., Yang, W., Koski, L. M., Xu, X., Li, Y., Zheng, M., et al. (2015) · Journal of Alzheimer s Disease · doi:10.3233/jad-143066 · Cited by 21
“This result matches previous studies in which those with higher cognitive reserve experienced more rapid decline when reaching a threshold, such as the stage of clinical diagnosis of AD [34, 35], where the brain can no longer compensate for the neurodegenerative effects of AD pathology.”
ResultConsideration of Cognitive Reserve
Cosentino, S., & Stern, Y. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3106-0_2 · Cited by 21
Gamble, L. D., Clare, L., Opdebeeck, C., Martyr, A., Jones, R. W., Rusted, J. M., Pentecost, C., Thom, J. M., & Matthews, F. E. (2025) · Age and Ageing · doi:10.1093/ageing/afae284 · Cited by 28
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
“Therefore, the insufficient reserve in HE-AD contributes towards accelerated deterioration of AD (Stern et al., 1999; Wilson et al., 2000; Scarmeas et al., 2006).”
BackgroundResultInfluentialVonk, J. M. J., Rentería, M. A., Medina, V., Pericak‐Vance, M. A., Byrd, G. S., Haines, J. L., Brickman, A. M., & Manly, J. J. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-190415 · Cited by 21
“In minority populations, the strength of the effects of APOE (cid:2) 4 on dementia risk [5], as well as those of education on cognitive performance [7, 8], differ from non-Hispanic Whites.”
Ersoezlue, E., Rauchmann, B., Schneider-Axmann, T., Wagner, M., Ballarini, T., Tatò, M., Utecht, J., Kurz, C., Papazov, B., Guersel, S., et al. (2022) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2022.05.015 · Cited by 22
Multiple socioeconomic risks and cognitive impairment among older men and women in India
Muhammad, T., Pai, M., Kumar, M., & Sekher, T. V. (2023) · Dialogues in Health · doi:10.1016/j.dialog.2023.100119 · Cited by 22
“Indeed, studies document that while more education prolongs the onsetof cognitive decline, once it starts, the progression is much faster among those with more education [25,26].”
BackgroundSolé‐Padullés, C., Lladó, A., Bartrés‐Faz, D., Fortea, J., Sánchez‐Valle, R., Bosch, B., Antonell, A., Molinuevo, J. L., & Rami, L. (2011) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2010.12.001 · Cited by 19
“This finding corroborates previous reports in AD samples (Stern et al., 1999; Wilson et al., 2000; Scarmeas et al., 2006).”
ResultMeasures of cognitive reserve in Alzheimer's disease
Sobral, M., Pestana, M. H. D. A. P. E., & Paúl, C. (2014) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2014-0012 · Cited by 20
Rolstad, S., Nordlund, A., Eckerström, C., Gustavsson, M. H., Zetterberg, H., & Wallin, A. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000234912 · Cited by 18
“There is also some support for the claim that deterioration will be faster for patients with more CR [”
BackgroundLane, E., Paul, R. H., Moser, D. J., Fletcher, T. D., & Cohen, R. A. (2011) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617711000324 · Cited by 20
Iatraki, E., Simos, P. G., Bertsias, A., Duijker, G., Zaganas, I. V., Tziraki, C., Vgontzas, A. N., Lionis, C. D., & on behalf of the THALIS Primary Health Care Research Team/Network (2017) · European Journal of General Practice · doi:10.1080/13814788.2017.1324845 · Cited by 19
“Educational level and literacy are known determinants of performance on screening instruments and a well-documented risk factor for dementia [19,20], although causality has not been firmly established [21].”
BackgroundTrajectories of Cognitive Function Prior to Cancer Diagnosis: A Population-Based Study
van der Willik, K. D., Hauptmann, M., Jóźwiak, K., Vinke, E. J., Ruiter, R., Stricker, B. H. C., Compter, A., Ikram, M. A., & Schagen, S. B. (2019) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djz178 · Cited by 19
Assari, S., Cobb, S., Saqib, M., & Bazargan, M. (2020) · JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY · doi:10.29245/2578-2959/2020/2.1203 · Cited by 19
Sánchez, J. L., Torrellas, C., Martín‐Vallejo, J., & Barrera, I. (2011) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2011.567976 · Cited by 21
“It is also important to consider that some tests for neuropsychological evaluation very often create a ceiling/floor effect as a function of the educational level of the population being evaluated (Scarmeas et al., 2006), which could contaminate the results of the research and not adequately discriminate between the c…”
BackgroundCognitive reserve in stroke patients
Abdullah, A. H., Sharip, S., Rahman, A. H. A., & Bakar, L. (2021) · PsyCh Journal · doi:10.1002/pchj.423 · Cited by 17
Toward digitally screening and profiling AD: A GAMLSS approach of MemTrax in China
Liu, W., Yu, L., Deng, Q., Li, Y., Lu, P., Yang, J., Chen, F., Li, F., Zhou, X., Bergeron, M. F., et al. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13430 · Cited by 16
Picton, B., Wong, J. Y., Lopez, A. M., Solomon, S. S., Andalib, S., Brown, N. J., Dutta, R. R., Paff, M. R., Hsu, F. P. K., & Oh, M. Y. (2023) · World Neurosurgery · doi:10.1016/j.wneu.2023.12.083 · Cited by 18
Screening Pesticides for Neuropathogenicity
Doherty, J. D. (2006) · BioMed Research International · doi:10.1155/jbb/2006/70414 · Cited by 18
“Many factors may influence the progression of Alzheimer’s disease and a very recent report indicates that persons with higher levels of education have faster rates of cognitive decline [54].”
BackgroundMarsh, J. E., Hansson, P., Sörman, D. E., & Ljungberg, J. K. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01355 · Cited by 25
Cho, H., Kim, Y.-E., Chae, W., Kim, K. W., Kim, J., Kim, H. J., Na, D. L., Ki, C., & Seo, S. W. (2020) · Scientific Reports · doi:10.1038/s41598-020-69603-w · Cited by 19
[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
“Cette étude révèle que les sujets plus éduqués présentaient un déclin plus rapide que les moins éduqués dans les tâches exécutives (évaluées à l’aide de la fluence verbale et phonémique) et dans les tâches de mémoire visuelle (évaluée à l’aide du Selective Reminding Test et du Benton Visual Rentention Test) avant et a…”
Racial/Ethnic Differences in Cognitive Symptoms During the Menopausal Transition
Im, E., Hu, Y., Cheng, C., Ko, Y., Chee, E., & Chee, W. (2018) · Western Journal of Nursing Research · doi:10.1177/0193945918767660 · Cited by 19
Lau, H., Shahar, S., Hussin, N. M., Kamarudin, M. Z., Hamid, T. A., Mukari, S. Z. S., Rajab, N. F., Din, N. C., Omar, A., Singh, D. K. A., et al. (2019) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13598 · Cited by 17
Education level predicts retrospective metamemory accuracy in healthy aging and Alzheimer’s disease
Szajer, J., & Murphy, C. A. (2013) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2013.844771 · Cited by 17
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
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