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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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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
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
“was present over and above age, gender, ethnicity, differential baseline cognitive performance, depression, and vascular comorbidity.”
- Also stated in: § Education and rates of cognitive decline · plain
“When we considered depression together with vascular risk factors, the results did not change either: time6education: b = 20.003;p = 0.017.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Abstract
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.
- 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
“Depression at first evaluation was present for 8% of the subjects and was not related to educational level (t = 1.57; p = 0.12).”
§ 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
“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
“Rates of decline before and after AD incidence were similar.”
- Also stated in: § Decline of cognition over time · plain
“Rates of cognitive decline before and after the AD incidence visit were similar (time6pre-post incidence interaction term b = 0.007; p = 0.57).”
§ 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: passes — 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 · 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 an association between education and z score decline for executive speed, memory, and abstract reasoning domains”
- Also stated in: § Education and rates of cognitive decline · plain
“significant time6education interaction for memory (b = 20.005;p = 0.002), abstract reasoning (b = 20.003;p = 0.026), and executive speed (b = 20.007;p,0.001)”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
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.
- 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 were no differential rates of decline for the other cognitive domains: abstract reasoning (b = 20.003;p = 0.31), visual-spatial (b = 0.002; p = 0.47), and language (b = 20.002;p = 0.49).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Post-incidence visits only
plainn = 131- 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 evidence of cognitive impairment at the baseline evaluation, with subjects who were to be diagnosed with AD ,3.8 years later, already performing 0.37 SD lower than the age, gender, and education matched controls without dementia.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Decline of cognition over time
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.
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
“As expected, mean cognitive z scores were even lower at the AD incidence visit, with cognitive performance 0.89 SD below that of the controls.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Decline of cognition over time
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
“As expected, AD patients with more education had better baseline composite cognitive performance (r = 0.14, p,0.001).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: 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 were no differential rates of decline for the other cognitive domains: abstract reasoning (b = 20.003;p = 0.31), visual-spatial (b = 0.002; p = 0.47), and language (b = 20.002;p = 0.49).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Post-incidence visits only
plainn = 131- 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
“This association was particularly noted in the specific domains of executive speed and memory.”
§ 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: 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 were no differential rates of decline for the other cognitive domains: abstract reasoning (b = 20.003;p = 0.31), visual-spatial (b = 0.002; p = 0.47), and language (b = 20.002;p = 0.49).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Post-incidence visits only
plainn = 131- 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
“As expected, AD patients with higher education had less hypertension (t = 2.30; p = 0.022) and diabetes (t = 2.36; p = 0.019).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plaincorrelational- 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 were significant education differences among ethnicities (omnibus ANOVA F = 29.1,p,0.001).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: 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
“Our incident AD patients' cognitive performance 3.9 years before incidence was already 0.37 SD lower than that of age, gender, and education matched controls.”
§ 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.
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 addition, rates of cognitive decline were almost identical before and after incidence.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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 supplementary analyses which included only the post-incidence evaluations, both the direction and the magnitude of the coefficients were very similar despite the smaller number of patients included in these analyses.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: 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
“The memory domain was borderline non-significant (b = 20.004;p = 0.067).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Post-incidence visits only
plaincorrelationaln = 131 ·- 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
“Similarly, there were significant cognitive performance differences among ethnicities (omnibus ANOVA F = 5.47, p = 0.001).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: 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
“The language domain score was skewed to the left because of a ceiling effect in the constituent neuropsychological measures.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Distribution of cognitive scores
plaindirect- 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
“In post-hoc Scheffe's tests, Hispanic subjects (mean 5.2 years of education) had significantly lower education as compared to both white subjects (mean 10.2 years of education) and black subjects (mean 8.9 years of education).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: 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
“As expected, AD patients with higher education had less hypertension (t = 2.30; p = 0.022) and diabetes (t = 2.36; p = 0.019).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plaincorrelational- 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
“We found a faster rate of cognitive decline in incident AD patients with higher educational attainment compared to those with lower education.”
§ 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.
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
“We detected no evidence of gradual acceleration or deceleration of rates of decline.”
- Also stated in: § Decline of cognition over time · plain
“This was the case both preincidence (time 2 b = 0.001; p = 0.66) and post-incidence (time 2 b = 0.001; p = 0.75).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Decline of cognition over time
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: § Decline of cognition over time · 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
“In a model with gender, age, ethnicity, time, education, and cognitive scores (at incidence), we detected faster decline for higher education patients in the executive speed domain (b = 20.007;p = 0.025).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Post-incidence visits only
plaincorrelationaln = 131 ·- 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
“Depression at any point during the follow up was present for 32% of the subjects and was not related to educational level (t = 1.25; p = 0.21).”
§ 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
“Higher education was associated with significantly higher baseline performance in all cognitive domains except language (p = 0.08).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plaincorrelational- 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 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
“Conclusions: We conclude that higher education AD patients experience faster cognitive decline.”
- Also stated in: § Education and rates of cognitive decline · plain
“When we simultaneously considered all the above variables in a single GEE model, the results were unchanged: higher education patients had faster cognitive decline: b = 20.003;p = 0.017.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Abstract
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.
- Also stated in: § Education and rates of cognitive decline · plain
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 large range and variety of education in our multiethnic population offers the advantage of higher power and generalisability.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plaindirect- 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 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
“The results of the present analyses are suggestive of model B-a in fig 2: the lower incidence of AD reported in previous studies may be the result of a later inflection point and not of a slower preincidence rate of decline for higher education AD patients.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“Second, because we used pre-incidence data and the postincidence follow up was relatively limited (1.8 years), it is possible that we have not fully captured the later stages of the disease.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
hedged- 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 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
“Our results do not support this since we know that the onset of clinical AD occurred during the evaluation period for these subjects and we included age as a covariate in the analyses.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“We therefore feel that data collected for a few years prior to AD clinical incidence reflect the effects of AD associated pathological changes.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plaindirect- 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.
In the paper
“In a Xenon study, AD patients with higher education 52 manifested more prominent cerebral blood flow deficits (and hence more AD pathology) when controlling for clinical severity.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites [52] 52. Stern Y, Alexander GE, Prohovnik I, et al. Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease. Ann Neurol 1992;32(3):371-5.
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.
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
“Selecting another sample of controls matched to the incident AD patients not only for age, gender, and education but also for ethnicity did not change the results.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Outcomes
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.
In the paper
“In an MRI study of AD patients, controlling for cognitive performance, higher levels of education were associated with more severe parietal atrophy (an indirect measure of brain AD pathology).56”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites [56] 56. Kidron D, Black SE, Stanchev P, et al. Quantitative MR volumetry in Alzheimer's disease. Topographic markers and the effects of sex and education. Neurology 1997;49(6):1504-12.
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.
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
“Based on the distributions within the subsamples, the proportion of individuals within each ethnic group and age stratum who participated in the study did not differ significantly from the source population.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Sample and procedure
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.
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
“In contrast to most previous studies which included AD patients who were self referred to clinics or university based AD research centres, the current investigation was performed in a representative sample of a multiethnic community, which provides increased generalisability of the findings.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plaindirect- 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. 15
- It may state two separate claims as one. 19
- The quote only partly states this claim. 1
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Men performed slightly better than women: mean baseline composite score was -0.35 for men and -0.50 for women (p = 0.03).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results were similar in supplementary analyses that used language domain as the outcome in the form of a recoded four level categorical variable.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Distribution of cognitive scores
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between age and education (r = 0.09, p = 0.14) or between age and baseline composite score (r = 0.10, p = 0.08).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between education and gender (mean years of education 7.2 for males and 7.1 for females; p = 0.86).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, we included baseline scores as covariates in the analyses and the results were unchanged.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In post-hoc Scheffe's tests, Hispanic subjects (mean baseline composite z score -0.57) had significantly lower baseline cognitive performance as compared to black subjects (mean baseline composite z score 20.32) but had similar baseline cognitive performance as compared to white subjects (mean baseline composite z score -0.38).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no differential rates of decline for abstract reasoning (b = 20.002;p = 0.33), visual-spatial (b = 20.001;p = 0.81), and language (b = 20.001;p = 0.78).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Pre-incidence visits only
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between age and education (r = 0.09, p = 0.14) or between age and baseline composite score (r = 0.10, p = 0.08).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education, baseline cognitive performance, and demographic characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The composite z score, and all cognitive domain scores with the exception of the language domain, were normally distributed.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Distribution of cognitive scores
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no significant association between education and LDL, history of heart disease, stroke, or current smoking.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Education and rates of cognitive decline
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was faster decline for higher education AD patients in the memory (b = 20.004;p = 0.037) and executive speed domains (b = 20.008;p = 0.006).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Pre-incidence visits only
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The association between education and cognitive decline was still noted after controlling for differential cognitive performance at the initial visit and was not accounted for by literacy, vascular comorbidity, or depression.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Results from the Religious Order Study, including clinical and neuropathological data from 130 older Catholic clergy, contested this.57 The association between cognitive function and AD pathology was modified by education: there was less effect of AD pathology on cognitive function for each additional year of education.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites [57] 57. Bennett DA, Wilson RS, Schneider JA, et al. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60(12):1909-15.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinical diagnosis was based on uniform application of widely accepted criteria via a consensus diagnostic conference procedure.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Third, although we examined rates of decline using both linear and non-linear (quadratic) terms, it is possible that other types of non-linear decline may be present.8 9 60 61”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites 8 9 60 61
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“More specifically, there were no differences between the 548 subjects and the 312 incident AD patients regarding gender (x 2 = 0.19; p = 0.67), age tertiles (x 2 = 4.16 = 0.13), or education tertiles (x 2 = 1.53; p = 0.47).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Outcomes
plainn = 548- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Previous reports studied more impaired AD patients (either prevalent cases or patients seeking medical attention) capturing the part of disease course corresponding to more advanced stages, while the design of the present study enables testing of the hypothesis during earlier stages of disease.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming that the progression of AD pathology does not differ as a function of education, this delay in clinical onset may result from differences in rate of cognitive decline, differences in the time when cognitive decline begins (''inflection point''), or a combination of both.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- The authors state this as an assumption: The progression of AD pathology does not differ as a function of education.
In the paper
“The CR hypothesis predicts that among AD patients with similar cognitive status, those with more CR would have (or be able to tolerate) more severe degrees of brain pathology.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites 1 2 43
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We used a comprehensive battery of cognitive assessment, permitting evaluation of a full range of cognitive domains.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data were examined to ensure that the variables included in the models met the model assumptions (that is, normality).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Statistical analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This is one of the largest studies examining this hypothesis and provided sufficient power for detection and more precise calculation of effects of interest as well as the ability to control for potential confounders.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“For the diagnosis of probable or possible AD, the criteria of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association 34 were used.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Sample and procedure
What the sources say
- Not checked yetcites [34] 34. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34(7):939-44.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Evaluations were performed approximately every 1.5 years for an average of 5.6 (and up to 13.3) years, which provides multiple assessments of cognitive performance and therefore permits more accurate slope calculations.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“the criteria used for the diagnosis of dementia as required by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R).33”
§ Education and rates of cognitive decline in incident Alzheimer's disease > Sample and procedure
What the sources say
- Not checked yetcites [33] 33. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Washington, DC: American Psychiatric Association, 1987.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifth, years of schooling cannot completely capture all aspects of educational experience (that is, different quality of education in different educational systems, etc).”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, because AD pathology progresses independently of educational attainment (or CR), when pathological burden becomes more severe and widespread, sufficient neural substrate is no londer available and a faster decline may ensue.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Many prospective studies have suggested that higher education is associated with reduced risk of incident AD. 11 20 45-51”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites 11 20 45-51
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The used standard diagnostic criteria have a sensitivity of ,81% with a specificity of ,70%.59”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
What the sources say
- Not checked yetcites [59] 59. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56(9):1143-53.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
Pathological changes of Alzheimer's disease are present in the brain many years before clinical symptoms of dementia appear.
“the pathological changes of AD are present in the brain many years before the onset of clinical symptoms of dementia”
The paper relies on this without support.
Previous studies of education and AD progression usually used clinic-referred patients, which limits generalizability to the general population.
“subjects studied in previous reports were usually clinic referred AD patients, which could limit generalisability to the population.”
The paper relies on this without support.
Previous studies of education and AD progression used prevalent AD patients recruited at various disease stages, so they could not accurately control for disease duration.
“previous studies were of prevalent AD patients who were recruited at various stages of their disease.Time of disease onset could only be estimated retrospectively or inferred by cognitive performance status.Therefore, previous studies could not accurately control for duration of disease.”
The paper relies on this without support.
Most previous investigations used limited neuropsychological measures that do not assess many cognitive domains and can suffer from floor and ceiling effects.
“most previous investigations have used limited neuropsychological measures that do not assess many cognitive domains and can suffer from floor and ceiling effects resulting in inadequately assessed cognitive performance.”
The paper relies on this without support.
Most previous reports did not adequately control for education-related differences in baseline cognitive performance.
“most previous reports did not adequately control for the potential effect on rates of cognitive decline of education related differences in baseline cognitive performance.”
The authors state this as an assumption.
The progression of AD pathology does not differ as a function of education.
“Assuming that the progression of AD pathology does not differ as a function of education”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“We replicated this observation in patients with incident AD28 and also found more rapid decline in cognitive function in AD patients who engaged in more leisure activities prior to dementia onset29.”
From Cognitive reserve in ageing and Alzheimer's disease (2012) · cites this paper as [28]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The rate of decline is more rapid in individuals with high reserve than those with low reserve, even when accounting for a multitude of other factors that may contribute to disease course27, 28, 46.”
From Cognitive reserve in ageing and Alzheimer's disease (2012) · cites this paper as [28]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
“the postincidence follow up was relatively limited (1.8 years)”
§ Education and rates of cognitive decline in incident Alzheimer's disease > DISCUSSION
“| After incidence (n = 131) | | | | Years from incidence to | 3.9 (2.39) | 0.9-11.1 | | last evaluation | | |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Education and rates of cognitive decline in incident Alzheimer's disease > RESULTS
“Overall, the 312 included AD subjects had 1159 separate cognitive assessments.”
§ Education and rates of cognitive decline in incident Alzheimer's disease > RESULTS
“More specifically, 110 (35%) had two evaluations, 47 (15%) had three, 60 (19%) had four, 40 (13%) had five, 37 (12%) had six, 14 (5%) had seven, three (1%) had eight, and one (0.3%) had nine.”
Citations
Cites
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Cited by
Sorted by citations
Cognitive reserve in ageing and Alzheimer's disease
Stern, Y. (2012) · The Lancet Neurology · doi:10.1016/s1474-4422(12)70191-6 · Cited by 3,557
Stern, Y. (2009) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2009.03.004 · Cited by 2,943
“Study 8 Scarmeas et al. (2003b) 17 youngf, 19 oldg Nonverbal serial recognition GLM Identify voxels where the change in PET”
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“, 2000) and education (Bruandet et al., 2008; Hall et al., 2007; Scarmeas et al., 2006; Teri, McCurry, Edland, Kulkull, & Larson, 1995; Wilson, Li, et al., 2004).”
Education and cognitive functioning across the life span
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Mediterranean diet and risk for Alzheimer's disease
Scarmeas, N., Stern, Y., Tang, M., Mayeux, R., & Luchsinger, J. A. (2006) · Annals of Neurology · doi:10.1002/ana.20854 · Cited by 1,103
“WHICAP 1999 cohort, N (%) 395 (55) 508 (55) 312 (54) 0.”
Self-citation
Metadata
- Authors
- Scarmeas, N.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Scarmeas, N
- ORCID
- Scarmeas, N
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2005-07-26
- Volume
- 77
- Issue
- 3
- Pages
- 308-316
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC2077720
- OpenAlex
- W2071700556
- Cited by
- 353
- References
- 68
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 9 · 2023: 15 · 2022: 18 · 2021: 26 · 2020: 16 · 2019: 23 · 2018: 21 · 2017: 12 · 2016: 11 · 2015: 15 · 2014: 20 · 2013: 22 · 2012: 19
- FWCI
- 8.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institute on Aging (P01AG007232, AG 07232)
- National Center for Research Resources (RR 00645, M01RR000645)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- Alzheimer's disease, educational attainment, cognitive decline, disease progression, executive function, memory, older adults
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Cognition Disorders, Educational Status, Female, Follow-Up Studies, Humans, Male, Neuropsychological Tests, Prospective Studies, Psychometrics, Sick Role, Statistics as Topic, Cohort Studies, Disease Progression
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-29, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-29 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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