Influence of education on the pattern of cognitive deterioration in AD patients: The cognitive reserve hypothesis

INSERM U.593, Université Victor Ségalen, Bordeaux, France.
Brain and Cognition (Impact Factor: 2.48). 04/2005; 57(2):120-6. DOI: 10.1016/j.bandc.2004.08.031
Source: PubMed


The cognitive reserve hypothesis proposes that a high educational level could delay the clinical expression of Alzheimer's disease (AD) although neuropathologic changes develop in the brain. Therefore, some studies have reported that when the clinical signs of the disease emerge, high-educated patients may decline more rapidly than low-educated patients because the neuropathology is more advanced. However, these studies have only investigated the decline of global cognition or an isolated cognitive process. To study the differential deterioration pattern of several cognitive processes according to education, the performance of 20 AD patients with a high educational level and a low educational level were compared with the performance of 20 control subjects on a neuropsychological battery. The results showed that cognitive deterioration of AD patients is different according to education, although the global performance was similar in AD patients. The high-educated patients exhibited greater impairment of abstract thinking whereas the low-educated patients showed greater impairment of memory and attentional function. This confirms that some cognitive processes, such as abstract thinking, decline more rapidly in high-educated patients whereas others seem to evolve more slowly if compared to low-educated patients. In this latter case, high-educated patients may still benefit from cognitive reserve after the diagnosis of the dementia.

15 Reads
  • Source
    • "Recently, it has been demonstrated that those individuals with more educational years show increased cerebral connectivity and more regional volume of the cerebral cortex (Arenaza-Urquijo et al., 2013;Liu et al., 2012). Among Alzheimer's disease patients, more education has been associated with a faster decline in certain cognitive domains, such as abstract reasoning, but at the same time it may help to conserve other cognitive performance (Le Carret et al., 2005). A low educational attainment may increase the risk of developing dementia (Caamaño-Isorna, Corral, MontesMartínez, & Takkouche, 2006; see meta-analysis byMeng & D'Arcy, 2012), whereas a high educational attainment may help to delay the clinical manifestation of brain damage (Carnero-Pardo & del Ser, 2007;Staff, Murray, Deary, & Whalley, 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The construct of cognitive reserve attempts to explain why some individuals with brain impairment, and some people during normal ageing, can solve cognitive tasks better than expected. This study aimed to estimate cognitive reserve in a healthy sample of people aged 65 years and over, with special attention to its influence on cognitive performance. For this purpose, it used the Cognitive Reserve Scale (CRS) and a neuropsychological battery that included tests of attention and memory. The results revealed that women obtained higher total CRS raw scores than men. Moreover, the CRS predicted the learning curve, short-term and long-term memory, but not attentional and working memory performance. Thus, the CRS offers a new proxy of cognitive reserve based on cognitively stimulating activities performed by healthy elderly people. Following an active lifestyle throughout life was associated with better intellectual performance and positive effects on relevant aspects of quality of life.
    Full-text · Article · Dec 2015 · Anales de Psicología
  • Source
    • "The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. may reduce the progression of memory decline and deterioration both in Alzheimer's disease (Koepsell et al., 2008; Le Carret et al., 2005; Stern, Albert, Tang, & Tsai, 1999) and in vascular dementia (Lane, Paul, Moser, Fletcher, & Cohen, 2011); may reduce the risk for dementia during aging (Stern et al., 1994; Valenzuela & Sachdev, 2006); and may explain cognitive performance variability in subjects with WMC (Schmidt et al., 2011) or with cognitive impairment and dementia (Vemuri et al., 2011). Those measures, such as reading ability, vocabulary, mental stimulation, and occupational attainment, which reflect lifetime experiences, have therefore been used as surrogate markers of the construct of cognitive reserve (Jones et al., 2011; Siedlecki et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study aims to investigate the protective effect of formal education on age-related changes in different cognitive domains with the hypothesis that it may attenuate the rate of decline. Individuals aged 50 years or older attending primary care physicians without known brain disease (431 participants, mostly [60.3%] female with 66.3 [±9.1] years of age and 7.7 [±4.1] years of education, on average), were evaluated with a neuropsychological battery including 28 cognitive measures. Cognitive domains identified by factor analysis were subject to repeated multiple regression analyses to determine the variance explained by age and education controlling for gender, depressive symptoms, and vascular risk factors. The slope of the regression equation was compared between two educational groups with an average of 4 years and 11 years of education, respectively. Factors identified corresponded to processing ability (Factor 1), memory (Factor 2), and acquired knowledge (Factor 3). Although education improved performance in Factors 1 and 3, it did not change the slope of age-related decline in any factor. This study suggests that in culturally heterogeneous groups, small increments in education enhance cognition but do not modify the rate of decline of executive functioning with age. These results contradict some clinical findings and need to be confirmed in longitudinal studies.
    Full-text · Article · Oct 2012 · Applied Neuropsychology
  • Source
    • "Roe et al. (2008) suggest that cognitive reserve, as reflected in education, may have a stronger or earlier effect on specific cognitive processes such as the abstract reasoning, compared with other cognitive processes. An inverse correlation was found in the study by Le Carret et al. (2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to longitudinally evaluate the potential association of educational level with performance on verbal and nonverbal tasks in individuals with mild cognitive impairment (MCI). We evaluated patients with MCI, age >50 years, no medication intake, absent vascular risk factors, and no lesions on brain magnetic resonance imaging (MRI). Each patient underwent a clinical assessment packet and a series of neuropsychological tests of the language and constructional praxis subtests of Cambridge Cognitive Examination (CAMGOG) and the Boston naming test (BNT), at baseline, 6 months, and 12 months. Educational levels were defined taking into account the total years of education, the school level, and diplomas. MCI patients with low education level showed a stepwise reduction in scores of naming objects (NO; P = 0.009), definition (DF; P = 0.012), language (LT; P = 0.021), constructional praxis (CD; P = 0.022), confrontation naming skills (BXB; P = 0.033), phonemic help (BFB; P = 0.041), and BNT (P = 0.002). Analysis of covariance, controlling for baseline scores, showed that education was associated with NO score (P = 0.002), DF score (P = 0.005), LT (P = 0.008), CD score (P = 0.008), BXB score (44.36 ± 1.84, P = 0.0001), BFB (P = 0.022), and BNT (P = 0.004). Our findings indicate that education appeared to affect verbal and nonverbal task performance in MCI patients. Despite the fact that higher educated patients are more acquainted with the tasks, slower deterioration in consecutive follow-up examinations could be explained by the cognitive reserve theory. The potential association of this protective effect with delayed onset of symptoms deserves further investigation.
    Full-text · Article · Sep 2012 · Brain and Behavior
Show more