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From the Rush Alzheimer’s Disease Center (Drs. Wilson, Aggarwal, and Barnes), Rush Institute for Healthy Aging (Drs. Li, McCann, Gilley, and Evans), Departments of Neurological Sciences (Drs. Wilson, Aggarwal, Barnes, and Evans), Internal Medicine (Drs. Li, Gilley, and Evans), and Psychology (Drs. Wilson and Barnes), and the College of Nursing (Dr. McCann), Rush University Medical Center, Chicago, IL.
Address correspondence and reprint requests to Dr. Robert S. Wilson, Rush Alzheimer’s Disease Center, Rush University Medical Center, Armour Academic Center, 600 South Paulina, Suite 1038, Chicago, IL 60612; e-mail: rwilson{at}rush.edu
Objective: To test the hypothesis that higher level of education is related to more rapid cognitive decline in Alzheimer disease (AD).
Methods: Participants are older persons with clinically diagnosed AD recruited from health care facilities in the Chicago area. At 6-month intervals for up to 4 years, they underwent uniform structured clinical evaluations that included administration of nine cognitive performance tests from which a composite measure of global cognition was derived. Analyses are based on 494 persons with follow-up data (89.3% of those eligible). In mixed models that allowed for linear and nonlinear decline, the authors first accounted for the effects of age on cognition and then tested the relation of education to rate of cognitive decline.
Results: Global cognitive decline had linear and nonlinear components, resulting in a gradually accelerating course of decline. Age was related to linear but not nonlinear decline, with more rapid decline observed in younger compared with older persons. Higher educational level was related to more rapid global cognitive decline, as hypothesized, with education related to the nonlinear but not the linear component of decline.
Conclusion: Higher educational attainment is associated with a slightly accelerated rate of cognitive decline in Alzheimer disease.
Received March 3, 2004. Accepted in final form June 4, 2004.
Related Article
Neurology 2004 63: 1146-1147.
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