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Education and the cognitive decline associated with MRI-defined brain infarct

From the University of California, San Francisco, CA (J.S.E., S.C.J.); University of Washington, Seattle, WA (W.T.L.); National Heart, Lung, and Blood Institute, Bethesda, MD (T.A.M.); University of Pittsburgh, Pittsburgh, PA (A.B.N.); and Tufts-New England Medical Center, Boston, MA (R.A.B.).

Address correspondence and reprint requests to Dr. Jacob S. Elkins, UCSF, Department of Neurology, 505 Parnassus Ave., Box 0114, San Francisco, CA 94143; e-mail: jacob.elkins{at}ucsfmedctr.org

Objective: To assess whether educational attainment, a correlate of cognitive reserve, predicts the amount of cognitive decline associated with a new brain infarct.

Methods: The Cardiovascular Health Study is a population-based, longitudinal study of people aged 65 years and older. Cognitive function was measured annually using the Modified Mini-Mental State Examination (3MS) and the Digit-Symbol Substitution Test (DSST). The authors tested whether education level modified 1) the cross-sectional association between cognitive performance and MRI-defined infarct and 2) the change in cognitive function associated with an incident infarct at a follow-up MRI.

Results: In cross-sectional analysis (n = 3,660), MRI-defined infarct was associated with a greater impact on 3MS performance in the lowest education quartile when compared with others (p for heterogeneity = 0.012). Among those with a follow-up MRI who had no infarct on initial MRI (n = 1,433), education level was not associated with the incidence, size, or location of new brain infarct. However, a new MRI-defined infarct predicted substantially greater decline in 3MS scores in the lowest education group compared with the others (6.3, 95% CI 4.4- to 8.2-point decline vs 1.7, 95% CI 0.7- to 2.7-point decline; p for heterogeneity < 0.001). Higher education was not associated with smaller declines in DSST performance in the setting of MRI-defined infarct.

Conclusions: Education seems to modify an individual's decline on a test of general cognitive function when there is incident brain infarct. These findings are consistent with the hypothesis that cognitive reserve influences the impact of vascular injury in the brain.

The research reported in this article was supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01 HC-15103 from the National Heart, Lung, and Blood Institute. Dr. Elkins is supported by an NINDS Career Development Award (K23 NS046302).

Disclosure: The authors report no conflicts of interest.

Received November 22, 2005. Accepted in final form April 4, 2006.

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