Education, cognitive function, and severity of neuropathology in Alzheimer disease
Abstract
Background Education may modulate the degree to which the neuropathology of Alzheimer disease (AD) is expressed as impaired cognitive performance. Methods We studied 2,051 participants age 65+ years at 27 AD Centers who died and underwent autopsy. All took the Mini-Mental State Examination (MMSE) within 2 years before death. Braak & Braak stage, neuritic plaque density, and Consortium to Establish a Registry for Alzheimer's Disease and National Institute on Aging (NIA)/Reagan diagnostic classifications quantified AD neuropathologic severity. Multivariate analyses modeled MMSE in relation to education and neuropathologic severity, adjusting for age at death, Lewy body pathology, and vascular dementia. Results Higher education was associated with higher MMSE scores when AD neuropathology was absent or mild. But with more advanced neuropathology, differences in MMSE scores among education levels were attenuated. For example, among patients without AD by NIA/Reagan criteria, fitted MMSE scores ranged from 19.6 for patients with less than high school education to 25.9 with education beyond high school. But among patients with neuropathologically advanced AD, the range of scores by education was only 7.1 to 8.6. Conclusions We found no evidence of larger education-related differences in cognitive function when Alzheimer disease (AD) neuropathology was more advanced. Higher Mini-Mental State Examination scores among more educated persons with mild or no AD may reflect better test-ta…
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The finding that education was not associated with decline contrasts with studies reporting more rapid decline among those with more years of education.
“This finding contrasts with studies reporting more rapid decline among those with more years of education,(37) but is consistent with higher education conferring advantages early in the disease course.(38)”
Cites
Analysis of Incomplete Multivariate Data
Schafer, J. L. (1997) · doi:10.1201/9781439821862 · Cited by 6,012 · see citing works
Schafer, J. L. (1999) · Statistical Methods in Medical Research · doi:10.1177/096228029900800102 · Cited by 3,949 · see citing works
Dementia and Alzheimer Disease Incidence: A Prospective Cohort Study
Kukull, W. A., Higdon, R., Bowen, J. D., McCormick, W. C., Teri, L., Schellenberg, G. D., van Belle, G., Jolley, L., & Larson, E. B. (2002) · Archives of Neurology · doi:10.1001/archneur.59.11.1737 · Cited by 806 · see citing works
Self-citationEducation modifies the relation of AD pathology to level of cognitive function in older persons
Bennett, D. A., Wilson, R. S., Schneider, J. A., Evans, D. A., Mendes de Leon, C. F., Arnold, S. E., Barnes, L. L., & Bienias, J. L. (2003) · Neurology · doi:10.1212/01.wnl.0000069923.64550.9f · Cited by 549 · see citing works
Evans, D. A., Hebert, L. E., Beckett, L. A., Scherr, P. A., Albert, M. S., Chown, M. J., Pilgrim, D. M., & Taylor, J. O. (1997) · Archives of Neurology · doi:10.1001/archneur.1997.00550230066019 · Cited by 435 · see citing works
Education and rates of cognitive decline in incident Alzheimer's disease
Scarmeas, N. (2005) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2005.072306 · Cited by 353 · see citing works
Education and the incidence of dementia in a large population-based study: The Rotterdam Study
Ott, A., van Rossum, C. T. M., van Harskamp, F., van de Mheen, H., Hofman, A., & Breteler, M. M. B. (1999) · Neurology · doi:10.1212/wnl.52.3.663 · Cited by 103 · see citing works
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Nelson, P. T., Alafuzoff, I., Bigio, E. H., Bouras, C., Braak, H., Cairns, N. J., Castellani, R. J., Crain, B. J., Davies, P., Tredici, K. D., et al. (2012) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e31825018f7 · Cited by 2,050 · see citing works
Self-citationWebster, S. J., Bachstetter, A. D., Nelson, P. T., Schmitt, F. A., & Van Eldik, L. J. (2014) · Frontiers in Genetics · doi:10.3389/fgene.2014.00088 · Cited by 755 · see citing works
“…2002; Tiraboschi et al., 2002; Guillozet et al., 2003; Bennett et al., 2004; Kraybill et al., 2005; Holtzer et al., 2006; Markesbery et al., 2006; Koepsell et al., 2008; Whitwell et al., 2008; Beach et al., 2009; Brayne et al., 2009; Giannakopoulos et al., 2009; Sabbagh et al., 2010; Robinson…”
BackgroundNeuropathology and Cognitive Impairment in Alzheimer Disease: A Complex but Coherent Relationship
Nelson, P. T., Braak, H., & Markesbery, W. R. (2009) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181919a48 · Cited by 643 · see citing works
Microglia, neuroinflammation, and beta-amyloid protein in Alzheimer’s disease
Cai, Z., Hussain, M. D., & Yan, L.-J. (2014) · International Journal of Neuroscience · doi:10.3109/00207454.2013.833510 · Cited by 583 · see citing works
Tschanz, J. T., Corcoran, C. D., Schwartz, S., Treiber, K., Green, R. C., Norton, M. C., Mielke, M. M., Piercy, K., Steinberg, M., Rabins, P. V., et al. (2011) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181faec23 · Cited by 244 · see citing works
“This finding contrasts with studies reporting more rapid decline among those with more years of education,(37) but is consistent with higher education conferring advantages early in the disease course.(38) Differences in results may also reflect sample differences in years of education and the timing of observations a…”
ResultNelson, P. T., Abner, E. L., Schmitt, F. A., Kryscio, R. J., Jicha, G. A., Smith, C. D., Davis, D. G., Poduska, J. W., Patel, E., Mendiondo, M. S., et al. (2010) · Brain Pathology · doi:10.1111/j.1750-3639.2008.00244.x · Cited by 239 · see citing works
- Authors
- Koepsell, T. D., Kurland, B. F., Harel, O., Johnson, E. A., Zhou, X. H., & Kukull, W. A.
- Affiliations
- University of Connecticut (US)
- Venue
- Neurology
- Published
- 2008-05-06
- Volume
- 70
- Issue
- 19_part_2
- Pages
- 1732-1739
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2063509852
- Cited by
- 115
- References
- 7
- Citations by year
- 2026: 8 · 2025: 1 · 2023: 1 · 2022: 5 · 2021: 10 · 2020: 2 · 2019: 8 · 2018: 5 · 2017: 9 · 2016: 4 · 2015: 4 · 2014: 9 · 2013: 9 · 2012: 10
- FWCI
- 5.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (U01AG016976)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- Alzheimer's disease, educational attainment, cognitive reserve, cognitive function, Braak staging, neuritic plaques, Lewy body pathology, vascular dementia, Mini-Mental State Examination, older adults, autopsy
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Atrophy, Autopsy, Brain, Cognition Disorders, Educational Status, Environment, Female, Humans, Intelligence Tests, Male, Neuronal Plasticity, Neuropsychological Tests, Severity of Illness Index, Statistics as Topic, Disease Progression
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