Very low levels of education and cognitive reserve: A clinicopathologic study

• Published in: Neurology Vol. 81; no. 7; pp. 650 - 657
• Main Authors: Farfel, Jose Marcelo, Nitrini, Ricardo, Suemoto, Claudia Kimie, Grinberg, Lea Tenenholz, Ferretti, Renata Eloah Lucena, Leite, Renata Elaine Paraizo, Tampellini, Edilaine, Lima, Luzia, Farias, Daniela Souza, Neves, Ricardo Caires, Rodriguez, Roberta Diehl, Menezes, Paulo Rossi, Fregni, Felipe, Bennett, David A, Pasqualucci, Carlos Augusto, Jacob Filho, Wilson
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by AAN Enterprises, Inc 13-08-2013; Lippincott Williams & Wilkins
• Subjects: Aged; Biological and medical sciences; Brain - pathology; Cognitive Reserve - physiology; Cross-Sectional Studies; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Educational Status; Female; Humans; Immunohistochemistry; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; Education level; Nervous system diseases
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e3182a08f1b

OBJECTIVE:We conducted a clinicopathologic study in a large population with very low levels of education to determine whether very few years of education could contribute to cognitive reserve and modify the relation of neuropathologic indices to dementia.
METHODS:In this cross-sectional study, we included 675 individuals 50 years of age or older from the Brazilian Aging Brain Study Group. Cognitive abilities were evaluated through a structured interview with an informant at the time of autopsy, including the Clinical Dementia Rating (CDR) scale. Neuropathologic examinations were performed using immunohistochemistry and following internationally accepted criteria. Multivariate linear regression models were conducted to determine whether the association between cognitive abilities (measured by CDR sum of boxes) and years of education was independent of sociodemographic variables and neuropathologic indices, including neuritic plaques, neurofibrillary tangles, lacunar infarctions, small-vessel disease, and Lewy bodies. In addition, interaction models were used to examine whether education modified the relation between neuropathologic indices and cognition.
RESULTS:Mean education was 3.9 ± 3.5 years. Formal education was associated with a lower CDR sum of boxes (β = −0.197; 95% confidence interval −0.343, −0.052; p = 0.008), after adjustment for sociodemographic variables and neuropathologic indices. Furthermore, education modified the relationship of lacunar infarcts with cognitive abilities (p = 0.04).
CONCLUSIONS:Even a few years of formal education contributes to cognitive reserve.