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From the Division of Biostatistics (C.M.R., C.X., J.P.M.), Alzheimer's Disease Research Center (C.M.R., C.X., J.P.M., J.C.M.), and Departments of Neurology, Pathology and Immunology, and Physical Therapy (J.C.M.), Washington University School of Medicine, St. Louis, MO.
Address correspondence and reprint requests to Dr Roe, Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave., Box 8067, St. Louis, MO 63110; e-mail: cathyr{at}wubios.wustl.edu
Background: Individuals with no cognitive impairment during life but with neuropathologic Alzheimer disease (AD) may represent cases of presymptomatic, or unrecognized early symptomatic, AD. The cognitive reserve hypothesis suggests that at a particular level of AD pathology, highly educated individuals are less likely to manifest clinical symptoms of dementia vs less-educated individuals.
Objective: To investigate whether education can help explain a clinical diagnosis of no dementia within 1 year of death among individuals with neuropathologic diagnoses of AD.
Methods: Samples of participants (age 65+ years at last clinical assessment) meeting each of three neuropathologic criteria for AD were constructed using data from the National Alzheimer's Coordinating Center Minimum and Neuropathology Data Sets. Generalized linear mixed models (using the logit link function) were used in each sample to examine whether years of education was associated with dementia within 1 year of death, adjusting for other relevant variables.
Results: Twelve percent of individuals meeting Khachaturian (122/1,009), 19% meeting low, intermediate, or high likelihood for National Institute on Aging/Reagan Institute (320/1,704), and 14% meeting possible, probable, or definite Consortium to Establish a Registry for Alzheimer's Disease (265/1,835) neuropathologic criteria for AD were nondemented at their final clinical assessment. Persons with more education were less likely to have a dementia diagnosis in each sample.
Conclusions: Regardless of the neuropathologic criteria used, education is predictive of dementia status among individuals with neuropathologic Alzheimer disease. These results support the theory that individuals with greater cognitive reserve, as reflected in years of education, are better able to cope with AD brain pathology without observable deficits in cognition.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 16 issue to find the title link for this article.
Supported by a National Alzheimer's Coordinating Center Junior Investigator Award (U01 AG 016976) and grants P50 AG05681 and P01 AG03991 from the National Institute on Aging, Bethesda, MD.
Disclosure: The authors report no conflicts of interest.
Presented in part at the 58th American Academy of Neurology Annual Meeting, San Diego, CA, April 5, 2006, and at the 10th International Conference on Alzheimer's Disease and Related Disorders, Madrid, Spain, July 16, 2006.
Received June 8, 2006. Accepted in final form October 6, 2006.
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