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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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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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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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA 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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA 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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA 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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA 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
Strength:plain· not yet calibratedn = 312Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt 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
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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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
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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
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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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
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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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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.
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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
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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
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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
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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
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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
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- 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
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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
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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
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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
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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.
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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
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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.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably 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
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably 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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt 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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably 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.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt 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.
Post-incidence follow-up duration has conflicting values
MinorThe discussion calls post-incidence follow-up 1.8 years, while Table 1 reports a mean of 3.9 years from incidence to the last evaluation among patients with post-incidence follow-up. The table separately lists 1.8 as the mean number of post-incidence evaluations.
“the postincidence follow up was relatively limited (1.8 years)”
“| After incidence (n = 131) | | | | Years from incidence to | 3.9 (2.39) | 0.9-11.1 | | last evaluation | | |”
Visit counts do not match the reported total
MinorThe numbers of patients with two through nine evaluations imply 1,154 assessments, not the reported 1,159.
“Overall, the 312 included AD subjects had 1159 separate cognitive assessments.”
“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
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Items 201–300 of 354
Moon, H. E., Kaholokula, J. K., MacLehose, R. F., & Rote, S. M. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01338-y · Cited by 16
“AIANs were more likely to have lower formal educational attainment than NHWs, a potential risk factor for dementia [31, 32].”
BackgroundEducation Levels and Poststroke Cognitive Trajectories
Springer, M. V., Whitney, R. T., Ye, W., Briceño, E. M., Gross, A. L., Aparicio, H. J., Beiser, A., Burke, J. F., Elkind, M. S. V., Ferber, R. A., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.2002 · Cited by 16
O’Shea, D. M., Fieo, R. A., Woods, A. J., Williamson, J. B., Porges, E. C., & Cohen, R. A. (2018) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2018.1452195 · Cited by 17
Farina, N., Tabet, N., & Rusted, J. (2016) · Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition · doi:10.1080/13825585.2015.1080213 · Cited by 15
Joint Models for Estimating Determinants of Cognitive Decline in the Presence of Survival Bias
Davis-Plourde, K. L., Mayeda, E. R., Lodi, S., Filshtein, T., Beiser, A., Gross, A. L., Seshadri, S., Glymour, M. M., & Tripodis, Y. (2022) · Epidemiology · doi:10.1097/ede.0000000000001472 · Cited by 15
Merten, N., Pinto, A. A., Paulsen, A. J., Chen, Y., Engelman, C. D., Hancock, L. M., Johnson, S. C., & Schubert, C. R. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-221287 · Cited by 19
Liou, J., Lou, J. J., Aguilar, L. F., Nakagiri, J., Yong, W. H., Hom, C. L., Doran, E. W., Totoiu, M. O., Lott, I. T., Mapstone, M. E., et al. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.14479 · Cited by 16
“67,68 72 Our case exhibited a larger brain compared to typical individuals with DS in autopsy cases, suggesting a potential brain reserve effect.”
Devanand, D., Lee, J. H., Luchsinger, J. A., Manly, J. J., Marder, K. S., Mayeux, R. P., Scarmeas, N., Schupf, N., & Stern, Y. (2012) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-129041 · Cited by 15
“Among the 12 most cited articles that resulted from these studies, four reported on modifiable risk factors for AD [1–4], one reported on genetic risk factors for AD [10], two reported on predictors of conversion of MCI to AD [7, 9], four reported on progression of AD [5, 6, 11, 12], and one was a review article on an…”
BackgroundSelf-citationColombo, B., Balzarotti, S., & Greenwood, A. (2018) · Clinical Gerontologist · doi:10.1080/07317115.2018.1447526 · Cited by 15
MacDonald, S. W. S., Karlsson, S., Fratiglioni, L., & Bäckman, L. (2011) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000325666 · Cited by 15
The characteristics of brain atrophy prior to the onset of Alzheimer’s disease: a longitudinal study
Hu, Y., Zhu, T., & Zhang, W. (2024) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2024.1344920 · Cited by 16
Cognitive reserve can impact trajectories in ageing: a longitudinal study
Montemurro, S., Rumiati, R. I., Pucci, V., Nucci, M., & Mondini, S. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-025-03000-z · Cited by 18
“The former may compensate through a set of alternative strategies, which would be parallelled by the recruitment of alternative networks or structures in the brain [6, 7].”
Sun, S., Zhang, T., Yu, H., Xia, T., Yao, Y., Sun, M., Liang, H., Huang, Q., Wang, W., Yang, H., et al. (2024) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2024.1425577 · Cited by 14
“…of education are thought to be linked to a higher "cognitive reserve", meaning that the brains of individuals with more education may endure more damage (such as AD pathology or reduced blood flow) before reaching the point of clinically noticeable impairment (Scarmeas et al., 2006; Stern, 2006).”
BackgroundRelating Education, Brain Structure, and Cognition: The Role of Cardiovascular Disease Risk Factors
Mortby, M., Burns, R., Janke, A., Sachdev, P., Anstey, K., & Cherbuin, N. (2014) · BioMed Research International · doi:10.1155/2014/271487 · Cited by 15
de Matos, A. I. P., Mourão, I., & Coelho, E. (2016) · Motricidade · doi:10.6063/motricidade.6805 · Cited by 12
Tsang, S., Sperling, S. A., Park, M. H., Helenius, I. M., Williams, I. C., & Manning, C. A. (2017) · Journal of Applied Gerontology · doi:10.1177/0733464817711961 · Cited by 13
“With evidence suggesting people with higher education experience faster cognitive decline after the onset of AD (Roselli et al., 2009; Scarmeas, 2005; Stern, Albert, Tang, & Tsai, 1999), it is crucial for primary care physicians to be aware of signs of cognitive impairment among this group of older…”
Mauti, M., Monachesi, B., Taccari, G., & Rumiati, R. (2024) · Brain and Cognition · doi:10.1016/j.bandc.2024.106238 · Cited by 10
Zhu, Q., Bao, A., & Swaab, D. F. (2019) · Neuroscience Bulletin · doi:10.1007/s12264-019-00340-5 · Cited by 17
Ihle, A., Gouveia, É. R., de Gouveia, B. R. F. O., Orsholits, D., Oris, M., & Kliegel, M. (2020) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000511768 · Cited by 13
Demographic and clinical characteristics related to cognitive decline in Alzheimer disease in China
Peng, D., Shi, Z., Xu, J. L., Shen, L., Xiao, S., Zhang, N., Li, Y., Jiao, J., Wang, Y., Liu, S., et al. (2016) · Medicine · doi:10.1097/md.0000000000003727 · Cited by 13
MacPherson, S. E., Gillebert, C. R., Robinson, G. A., & Vallesi, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00432 · Cited by 13
A Longitudinal Normative Dataset and Protocol for Speech and Language Biomarker ResearchPreprint
Schwoebel, J. W., Schwartz, J., Warrenburg, L., Brown, R. Z., Awasthi, A., New, A., Butler, P. M., Moss, M. B., & Pissadaki, E. K. (2021) · medRxiv · doi:10.1101/2021.08.16.21262125 · Cited by 13
Pettemeridou, E., Kallousia, E., & Constantinidou, F. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.711301 · Cited by 14
“Most studies using the MMSE in healthy aging have focused on either global indices, such as the CSF, or specific regions (Breteler et al., 1994; Gunning-Dixon and Raz, 2003; Scarmeas et al., 2006; Janssen et al., 2007; Raz et al., 2007; Yavuz et al., 2007; Ferrarini et al., 2008; Chou et al., 2009; Kovacevic et al., 2…”
BackgroundJoo, Y. Y., Cha, J., Jeremy Freese, A., & Hayes, M. G. (2022) · Genes · doi:10.3390/genes13081320 · Cited by 13
“Secondly, given the role of hippocampal memory impairment in the pathophysiology of AD, our finding may lead to a potential link of the inherited genetic factor of cognitive resilience to the individual differences in hippocampal degeneration, as well as memory decline in AD [4,62].”
BackgroundKociolek, A. J., Fernández, K. K., Hernandez, M., Jin, Z., Cosentino, S., Zhu, C. W., Gu, Y., Devanand, D. P., & Stern, Y. (2023) · Current Alzheimer Research · doi:10.2174/1567205020666230908163414 · Cited by 13
Reproductive life events and Alzheimer’s disease in Italian women: a retrospective study
Zucchella, C., Siforiani, Citterio, A., Giarracca, V., Bono, G. G., & Mauri, M. F. (2012) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s36622 · Cited by 12
“This relationship, irrespective of gender, has been clearly demonstrated in the literature.(27,28) Education appears to have a protective effect on the development of AD; in addition to mentally and socially integrated lifestyles, education may postpone the onset of clinical dementia and therefore reduce its incidence.”
BackgroundCognitive Reserve and the Aging Brain
Tucker, A. M., & Stern, Y. (2014) · Wiley eBooks · doi:10.1002/9781118730676.ch5 · Cited by 12
Hausner, L., on behalf of the ICTUS-EADC study group, Frölich, L., Gardette, V., Reynish, E. L., Ousset, P., Andrieu, S., & Vellas, B. J. (2010) · Journal of Alzheimer s Disease · doi:10.3233/jad-2010-091489 · Cited by 11
“Thus, their lower cognitive performance might be influenced by their lower education level, which impacts MMSE score [35–38], partly via impaired cognitive reserve [39].”
Mez, J., Cosentino, S., Brickman, A. M., Huey, E. D., & Mayeux, R. P. (2013) · Journal of Alzheimer s Disease · doi:10.3233/jad-130320 · Cited by 10
“Age, APOEε4 status, race, and years of education have all been implicated in the rate of decline in AD [34–38].”
Veronelli, L., Tosi, G., & Romano, D. (2024) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2024.12.002 · Cited by 11
“These results support the literature demonstrating that higher CR may postpone clinical onset of AD but also accelerate cognitive decline after diagnosis (Andel et al., 2006; Scarmeas et al., 2006; Yoon et al., 2021).”
The relationship between cognition, education, and employment in multiple sclerosis patients
Conway, D. S., Bermel, R. A., & Planchon, S. M. (2022) · Multiple Sclerosis Journal - Experimental Translational and Clinical · doi:10.1177/20552173221118309 · Cited by 11
Sedghi, F., Foroughi, E., Sheikhzadeh, F., Youshanlui, M. A., Kohnehshahri, A. A., Karimzadeh, O., Sadatmadani, S.-F., Ghadri, H., Parhiz, P., Amirbeyk, A., et al. (2025) · IBRO Neuroscience Reports · doi:10.1016/j.ibneur.2025.05.010 · Cited by 11
Mourtzi, N., Charisis, S., Tsapanou, A., Ntanasi, E., Hatzimanolis, A., Ramı́rez, A., Heilmann‐Heimbach, S., Grenier‐Boley, B., Lambert, J., Yannakoulia, M., et al. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.12980 · Cited by 9
Self-citationParadela, E. M. P., & Lourenço, R. A. (2013) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12161 · Cited by 9
Yashkin, A. P., Akushevich, I. V., Ukraintseva, S. V., & Yashin, A. I. (2018) · Gerontology and Geriatric Medicine · doi:10.1177/2333721418811201 · Cited by 10
Reserve and Alzheimer's disease genetic risk: Effects on hospitalization and mortality
Filshtein, T. J., Brenowitz, W. D., Mayeda, E. R., Hohman, T. J., Walter, S., Jones, R. N., Elahi, F. M., & Glymour, M. M. (2019) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2019.04.005 · Cited by 9
Jester, D. J., Palmer, B. W., Thomas, M. L., Brown, L., Tibiriçá, L., Jeste, D. V., & Gilmer, T. (2023) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18340 · Cited by 11
Predictors of Cognitive Impairment Severity in Rural Patients at a Memory Clinic
Lacny, C., Kirk, A., Morgan, D., & Karunanayake, C. P. (2012) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100015602 · Cited by 9
Kim, H., Lee, S., Levine, A., Huber, B. D., Andrews, H., Kerner, N. A., Cohen, D., Carlson, S., Bell, S. A., Rivera, A. M., et al. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.13757 · Cited by 8
Ersoezlue, E., Perneczky, R., Tatò, M., Utecht, J., Kurz, C., Haeckert, J., Guersel, S., Burow, L., Koller, G., Stoecklein, S., et al. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-220464 · Cited by 8
Verdan, C., Casarsa, D., Perrout, M. R., Santos, M., de Souza, J. A., Nascimento, O. J. M., Coutinho, E. S. F., & Laks, J. (2014) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20140003 · Cited by 8
Conde‐Sala, J. L., Garre‐Olmo, J., Franch, J. V., Reglà, J. L., Garriga, O. T., Gallego, M. L., Hernández-Ferràndiz, M., Nierga, I. P., & Pousa, S. L. (2013) · Revista de Neurología · doi:10.33588/rn.5612.2013118 · Cited by 8
“Los pacientes con mayor nivel educativo [1-6] y con menor edad [7-9], tuvieron un declive cognitivo más rápido.”
BackgroundWezeman, S. L., Uleman, J. F., Scarmeas, N., Kosmidis, M. H., Dardiotis, E., Peeters, G. M. E. E., & Rikkert, M. G. M. O. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-215386 · Cited by 8
“Furthermore, according to the cognitive reserve theory, higher educated participants may also decline faster after a belated onset of cognitive impairment [26].”
BackgroundSelf-citationAraújo, N., Costa, A., Lopes-Conceição, L., Ferreira, A. C. G., Carneiro, F., Oliveira, J., Braga, I. C., Morais, S., Pacheco‐Figueiredo, L., Ruano, L., et al. (2022) · ESMO Open · doi:10.1016/j.esmoop.2022.100448 · Cited by 8
Cognitive reserve and emotion recognition in the context of normal aging
Guerrini, S., Hunter, E. M., Papagno, C., & MacPherson, S. E. (2022) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2022.2079603 · Cited by 9
“We also included the Stroop Test (Stroop, 1935) as a measure of executive functions since CR has been found to safeguard against the effects of normal aging in this cognitive domain (Roldán-Tapia et al., 2012; Scarmeas et al., 2006).”
Stern, Y. (2009) · doi:10.1093/acprof:oso/9780195328875.003.0006 · Cited by 7
Guo, L., Zhou, Y., Lu, H., & Fung, H. H.-L. (2025) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2025.07.016 · Cited by 7
Handing, E. P., Jiao, Y., & Aichele, S. (2023) · Journal of Intelligence · doi:10.3390/jintelligence11040065 · Cited by 6
Zhu, C. W., Gu, Y., Cosentino, S., Kociolek, A. J., Hernandez, M., & Stern, Y. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-230584 · Cited by 6
“Detailed descriptions of study methodology have been reported previously [41].”
Gottesman, R. T., Kociolek, A. J., Fernández, K. K., Cosentino, S., Devanand, D. P., Stern, Y., & Gu, Y. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-200729 · Cited by 6
“For example, it has been demonstrated that community-dwelling patients with AD in the Washington Heights and Inwood Aging Project (WHICAP) who have higher levels of education experience faster rates of cognitive decline [13].”
Consideration of Cognitive Reserve
Cosentino, S., & Stern, Y. (2019) · Clinical handbooks in neuropsychology · doi:10.1007/978-3-319-93497-6_2 · Cited by 7
NSAID exposure and risk of Alzheimer disease
Bennett, D. A., & Whitmer, R. A. (2009) · Neurology · doi:10.1212/wnl.0b013e3181a81664 · Cited by 6
Gross, A. L., Nichols, E. L., Rentería, M. A., Khobragade, P. Y., Meijer, E., Ganguli, M., Crimmins, E. M., Dey, S., Dey, A. B., Lee, J., et al. (2025) · medRxiv · doi:10.1101/2025.07.07.25331027 · Cited by 6
“(28) While LASI-DAD is not a study of patients with dementia, this may be a partial explanation.”
Serum brain-derived neurotrophic factor levels as a predictor for Alzheimer disease progression
Tsai, M.-J., Lin, Y., Chen, C., Lee, W., & Fuh, J. (2023) · Journal of the Chinese Medical Association · doi:10.1097/jcma.0000000000000991 · Cited by 5
“44 There is evidence that education strengthens the CR in AD patients, causing their cognitive function to deteriorate rapidly, 44 and analysis from the Amsterdam Dementia Cohort also supports this finding.”
ResultSuh, J., Park, Y. H., Kim, H., Jang, J., Kang, M. J., Yang, J., Baek, M. J., & Kim, S. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5072 · Cited by 5
Production of Inflected Novel Words in Older Adults With and Without Dementia
Nikolaev, A., Higby, E., Hyun, J., Lehtonen, M., Ashaie, S. A., Hallikainen, M., Hänninen, T., & Soininen, H. S. (2020) · Cognitive Science · doi:10.1111/cogs.12879 · Cited by 5
EFFECTS OF AGE, GENDER AND EDUCATION LEVEL ON COGNITION IN ELDERLY PEOPLE
Shuba, N., & Prakash, B. G. (2017) · Journal of Evolution of Medical and Dental Sciences · doi:10.14260/jemds/2017/1509 · Cited by 5
“(24,25) Contrast to our study, Scarmeas N et al(20) found faster rate of cognitive decline in incident AD patients with higher education attainment compared to those with lower education.”
Phase 3 randomized clinical trials of simufilam in mild-to-moderate Alzheimer’s disease
Kupiec, J. W., Porsteinsson, A. P., Turner, R. S., Hendrix, S. B., Mallinckrodt, C. H., Khan, A., Cohen, I., Liss, J., Clarnette, R., Park, K. H., et al. (2026) · The Journal of Prevention of Alzheimer s Disease · doi:10.1016/j.tjpad.2025.100469 · Cited by 4
“…participants had a 7 % higher level of university or higher education than RETHINK participants, which has been reported to correlate with more advanced disease or faster rate of decline[36,37] and may illustrate a potential difference in stage of disease between the two trials not evident in MMSE.”
Feldberg, C., Tartaglini, M. F., Hermida, P. D., García, L. M., Caruso, D., Stefani, D., Somale, V., & Allegri, R. (2020) · Neurología Argentina · doi:10.1016/j.neuarg.2020.10.001 · Cited by 7
“Diagnóstico (n, %) DCL amnésico único dominio 21 (23) DCL amnésico múltiple dominio 50 (58) DCL no amnésico único dominio 5 (7) DCL amnésico múltiple dominio 8(12)”
Dauphinot, V., Laurent, M., Prodel, M., Civet, A., Vainchtock, A., Moutet, C., Krolak‐Salmon, P., & Garnier‐Crussard, A. (2024) · Alzheimer s Research & Therapy · doi:10.1186/s13195-024-01533-5 · Cited by 5
“These results can be related to a later clinical revelation of the disease in these patients, followed by a more rapid decline once the cognitive reserve is exceeded as it was shown in previous studies [46–48].”
ResultElkana, O., Levy, M., Bicovsky, Y. T., Tal, N., Oren, N., & Ash, E. L. (2025) · Journal of dementia and Alzheimer's disease · doi:10.3390/jdad2020018 · Cited by 3
Popp, Z., Ang, T. F. A., Hwang, P. H., Au, R., & Chen, J. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251352216 · Cited by 3
Staniloiu, A., Woermann, F. G., & Markowitsch, H. J. (2014) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2014.00227 · Cited by 3
Cho, S., Scarmeas, N., Jang, T. W., Marder, K. S., Tang, M., & Honig, L. S. (2011) · Journal of Korean Medical Science · doi:10.3346/jkms.2011.26.3.412 · Cited by 3
“Details about the process have been published elsewhere (16, 17).”
MethodSelf-citationTang, J. Y. ‐., Wong, G. H. Y., Luo, H., Liu, T., & Lum, T. Y. S. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1636204 · Cited by 3
APOE gene region methylation is associated with cognitive performance in middle-aged urban adults
Shen, B., Hernandez, D. G., Chitrala, K. N., Kuczmarski, M. F., Hooten, N. N., Pacheco, N. L., Mode, N. A., Zonderman, A. B., Ezike, N., & Evans, M. K. (2022) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2022.03.010 · Cited by 3
Kato, T., Nishita, Y., Otsuka, R., Inui, Y., Nakamura, A., Kimura, Y., Ito, K., & SEAD-J Study Group (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.932906 · Cited by 4
“Compared with low CR, cognitive decline in high CR has been reported to be faster (Unverzagt et al., 1998; Andel et al., 2006; Scarmeas et al., 2006), slower (Fritsch et al.”
BackgroundUn voyage au travers des pensées les plus variées sur la démence
Cristini, C. (2007) · Gérontologie et société · doi:10.3917/gs.122.0193 · Cited by 3
Bilingualism (multilingualism) Helps Resist Alzheimer's Disease?
Cheng, K., Deng, Y., & Yao, D. (2014) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2014.01723 · Cited by 3
“…单领域 aMCI, 而正是这种子类型的认知疾病最 有可能发展为 AD (Ossher, Bialystok, Craik, Murphy, & Troyer, 2013)。该研究在时间进程上确 认了双语经验和老年痴呆症防御之间的相关, 证 明了这种抵御作用的延续性。 3 双语经验预防和抵抗老年痴呆症的 原因及神经机制 要探究双语经验抵抗老年痴呆症的原因, 我 们首先要知道大脑衰老的特点。一些 AD 研究发 现, 有至少 25%的老人虽然大脑病理现象已经达 到或超过 AD 的临床诊断标准, 但他们的各项认 知水平未受其影响(Esiri et al., 2001)。因此, 有学…”
Cerebral lactate metabolism and memory: Implications for Alzheimer's disease
Harris, R. A. (2017) · Scholarship@Western (Western University) · Cited by 3
Moderation-Mediation Effects in Bilingualism and Cognitive Reserve
Heredia, R. R., Blackburn, A. M., & Vega, L. A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.572555 · Cited by 4
Liu, N., Heng, C., Cui, Y., Li, L., Guo, Y., Liu, Q., Cao, B., Wu, D., & Zhang, Y. (2023) · Journal of Diabetes Research · doi:10.1155/2023/5224654 · Cited by 3
“Early education can stimulate and improve the functional efficiency of the cognitive system [50].”
BackgroundThe psychometric properties of the lifetime experience questionnaire (LEQ) in older American adults
Gonzales, C. (2012) · NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) · Cited by 3
Drachman, D. A. (2008) · Neurology · doi:10.1212/01.wnl.0000311452.58110.c7 · Cited by 3
Li, J., Han, Y., Lam, J. C. K., Li, V. O. K., Matthews, S., Cheung, L. Y. L., Yip, V., Downey, J., Chan, D. T.-M., & Gozes, I. (2021) · Preprints.org · doi:10.20944/preprints202102.0502.v1 · Cited by 3
Faul, J. D., Collins, S. D., Smith, T., Klopack, E. T., Mitchell, C. M., Crimmins, E. M., & Farina, M. P. (2026) · Clinical Epigenetics · doi:10.1186/s13148-026-02142-9 · Cited by 6
Cognitive Reserve: Cognitive Abilities that Shield Against Dementia Symptomatology
Rodriguez, F. S. (2018) · OBM Geriatrics · doi:10.21926/obm.geriatr.1804017 · Cited by 2
(2019) · Frontiers research topics · doi:10.3389/978-2-88945-837-0 · Cited by 2
The Development of Geriatric Everyday Life Health Index (GELHI)
Shin, E. Y., Cho, E. B., & Kim, J.-S. (2014) · Audiology and Speech Research · doi:10.21848/audiol.2014.10.2.125 · Cited by 2
“한 연구에 의하면 고등 교육을 받은 사람들은 인지능력이 더 좋으므로 치매 증상이 나타나는 시기가 늦어진다고 보고하였다 (Scarmeas et al., 2006).”
A Neuropathology Case Report of a Woman with Down Syndrome who Remained Cognitively StablePreprint
Liou, J., Lou, J. J., Nakagiri, J., Yong, W. H., Hom, C. L., Doran, E. W., Totoiu, M. O., Lott, I. T., Mapstone, M. E., Keator, D. B., et al. (2024) · medRxiv · doi:10.1101/2024.06.01.24308050 · Cited by 2
Mid‐life extrapyramidal symptoms predict cognitive impairment 23 years later
Holtback, C., Welin, C., Fu, M., Thunström, E. Ö., Rosengren, A., Lappas, G., & Hansson, P. (2021) · Acta Neurologica Scandinavica · doi:10.1111/ane.13557 · Cited by 1
“Clox & Cube Visuospatial 0– 12 <11 p 11 12 81 (25) Token test Language 0– 6 <5 p 5 5 71 (21) Stroop III Executive functions 0- no max >49 sec 34 31 26 (8) ROCF Copying Visuospatial 0– 36 <27 p 30 29 87 (26) FAS Language 0- no max <24 p 34 33 78 (23)”
Deng, T., Duan, J., Yu, W., Deng, Z., Tian, Q., Liu, X., Shou, J., Tang, T., Yu, W., & Lü, Y. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251379078 · Cited by 1
“Speci fi cally, consistent with previous study, our high-education group do not exhibit an attenuated negative association between cerebral structures and global cognition, 15 executive function, 15 visuospatial 25 or language 25 in early AD.”
InfluentialRoy, A. (2025) · Journal of Asian and African Studies · doi:10.1177/00219096251369524 · Cited by 1
“Research indicates that although higher education delays the onset of cognitive decline, once it does occur, the rate of decline is significantly faster for those with higher education (Scarmeas et al., 2006; Wilson et al., 2004).”
Marmor, A., Meiner, Z., Merhavi, S. K., & Vakil, E. (2025) · Journal of Alzheimer s Disease Reports · doi:10.1177/25424823251383903 · Cited by 1
“Although concurring with prior research, 53,55,56 it is important to note that fi ndings of accelerated decline among higher education have not been widely replicated across studies, thus underscoring its signi fi cance.”
Hanazawa, R., Sato, H., Suzuki, K., & Hirakawa, A. (2026) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2026.106337 · Cited by 1
Ušacka, A., Skrule, M., Šneidere, K., Freibergs, Z., Kaupužs, A., & Stepens, A. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1795165 · Cited by 1
Adams, N. A. (2010) · OpenCommons - UConn (University of Connecticut) · Cited by 1
La estimulación mental como factor potenciador de la reserva cognitiva y del envejecimiento activo
Redolat, R. (2013) · INFORMACIO PSICOLOGICA · Cited by 1
Alzheimer's Disease and the Disablement Process: Directions for Future Research
Dassel, K. B. (2009) · Physical & Occupational Therapy In Geriatrics · doi:10.1080/02703180902856240 · Cited by 1
Relationship of Leisure Activities and Alzheimer´s Disease
Sobral, M., & Paúl, C. (2013) · International journal of advances in psychology · doi:10.14355/ijap.2013.0204.01 · Cited by 1
Adrover‐Roig, D., & Ansaldo, A. I. (2009) · Cited by 1
Brain Ageing and Cognitive Impairment
Kaushik, R., & Kaushik, P. (2018) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/978-1-5225-3480-8.ch009 · Cited by 1
Stress-Related Socioeconomic Factors and Risk of Alzheimer's Disease: A Literature Review
Anant, S., Lum, N., & Wu, T. (2021) · Undergraduate Research in Natural and Clinical Science and Technology (URNCST) Journal · doi:10.26685/urncst.206 · Cited by 1
“8 years), so the full progression of cognitive decline may not have been captured [24].”
BackgroundResultInfluentialRobinson, K. M., & Grossman, M. (2006) · Cambridge University Press eBooks · doi:10.1017/cbo9780511545078.033 · Cited by 1
Shin, D.-S., Shin, H. S., Lee, S.-K., Lee, D. H., Park, J., Lee, T.-K., Sung, K. B., Yang, K. I., & Park, S. A. (2015) · Dementia and Neurocognitive Disorders · doi:10.12779/dnd.2015.14.4.158 · Cited by 1
Bonavita, V., Caltagirone, C., Mariani, C. B., Padovani, A., Scarpini, E. A., & Sorbi, S. (2011) · Journal of Alzheimer s Disease · doi:10.3233/jad-2010-1433 · Cited by 1
Una visione aperta: la psicologia transculturale
Inghilleri, P. (2021) · RICERCHE DI PSICOLOGIA · doi:10.3280/rip1-2021oa11631 · Cited by 1
Psicopatologia e invecchiamento nell'opera di Marcello Cesa-Bianchi
Cristini, C., & Sonzogni, A. B. (2021) · RICERCHE DI PSICOLOGIA · doi:10.3280/rip1-2021oa11626 · Cited by 1
Behavioral Neurology in the ICU
Stevens, R. D., Sharshar, T., & Ely, E. W. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139248822.009 · Cited by 1
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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