Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity

Abstract

Background: Variability in cognitive functions in healthy and pathological aging is often explained by educational attainment. However, it remains unclear to which extent different disease states alter protective effects of education. We aimed to investigate whether protective effects of education on cognition depend on (1) clinical diagnosis severity, and (2) the neuropathological burden within a diagnosis in a memory clinic setting.Methods: In this cross-sectional study, we included 108 patients with subjective cognitive decline [SCD, median age 71, IQR (66–78), 43% men], 190 with mild cognitive impairment [MCI, median age 78, IQR (73–82), 44% men], and 245 with Alzheimer’s disease dementia (AD) [median age 80, IQR (76–84), 35% men]. We combined visual ratings of hippocampal atrophy, global atrophy, and white matter hyperintensities on MRI into a single neuropathology score. To investigate whether the contribution of education to cognitive performance differed across SCD, MCI, and AD, we employed several multiple linear regression models, stratified by diagnosis and adjusted for age, sex, and neurodegeneration. We re-ran each model with an additional interaction term to investigate whether these effects were influenced by neuropathological burden for each diagnostic group separately. False discovery rate (FDR) corrections for multiple comparisons were applied.Results: We observed significant positive associations between education and performance for global cognition and executive functions (all adjusted p-values < 0.05). As diagnosis became more severe, however, the strength of these associations decreased (all adjusted p-values < 0.05). Education related to episodic memory only at relatively lower levels of neuropathology in SCD (β = −0.23, uncorrected p = 0.02), whereas education related to episodic memory in those with higher levels of neuropathology in MCI (β = 0.15, uncorrected p = 0.04). However, these interaction effects did not survive FDR-corrections.Conclusions: Altogether, our results demonstrated that positive effects of education on cognitive functioning reduce with diagnosis severity, but the role of neuropathological burden within a particular diagnosis was small and warrants further investigation. Future studies may further unravel the extent to which different dimensions of an individual’s disease severity contribute to the waxing and waning of protective effects in cognitive aging.

Depressive Symptoms and Cognitive Decline Among Chinese Rural Elderly Individuals: A Longitudinal Study With 2-Year Follow-Up

“…Although some studies reported age-modified associations between depression and cognition ( 35 , 51 ), in the current study, increased depression symptoms were similarly associated with more cognitive decline among different age groups. Some previous studies reported education-modified associations between depression and cognition ( 36 , 52 ). Similarly, education level moderated associations between depression symptoms and cognition decline were also detected in the current study.…”

“…Since many studies have indicated that sex and age might be related to cognitive decline and depression (33)(34)(35), sexand age-stratified analyses were also performed. In addition, accumulating evidence suggested that having more years of education is a protective factor for cognitive impairment (36,37); thus, additional analyses stratified by education levels were also conducted to examine the associations in different subgroups. Stata version 15.1 software (Stata Corp, College Station, TX) was used for all analyses.…”

Effects of cognitive reserve proxies on cognitive function and frontoparietal control network in subjects with white matter hyperintensities: A cross‐sectional functional magnetic resonance imaging study

“…Recent studies on Alzheimer's disease (AD) have revealed stage‐dependent effects of CR on cognitive function across the AD spectrum. CR's positive effects on cognition are stronger in predementia stages than in dementia stages 15,16 . High CR attenuates the cognitive decline in predementia stages, but accelerates cognitive decline in dementia stages 17 .…”

“…CR's positive effects on cognition are stronger in predementia stages than in dementia stages. 15,16 High CR attenuates the cognitive decline in predementia stages, but accelerates cognitive decline in dementia stages. 17 For WMH subjects, Zahodne et al 18 showed that education mitigated the effect of WMH on cognitive function in subjects at lower risk for dementia, but exacerbated the effect in those at higher risk for dementia.…”

Diagnostic accuracy study of automated stratification of Alzheimer’s disease and mild cognitive impairment via deep learning based on MRI

“…It is reported to have exceptional performance relative to other traditional ML programs. MRI is a medical imaging diagnostic program that is safe, non-invasive, non-persistent, and pain-free (32,33). Unlike CT and other imaging, MRI is not associated with radiation (34); rather, it uses a uniform magnetic field and radio-frequency to display the internal system of the human body.…”