The effects of higher education on dementia symptoms

A lot of evidence suggests that higher education levels and regular mentally challenging activities can decrease the risk of dementia. However, a new study suggests that people with higher education levels who are diagnosed with dementia may experience a more rapid onset and progression of symptoms than those with lower education levels.

These results were published in the Journal International Psychogeriatrics by researchers based in Seoul, South Korea. They followed 36 participants with early Alzheimer’s disease and 14 healthy age matched participants for five years. At the initial visit, each participant underwent clinical interviews, a neurological examination, a battery of memory tests and a brain MRI scan. Potential secondary causes of cognitive deficit were also ruled out at this stage, and participant’s education levels were identified.

Each participant was re-assessed (using the same tests) at years one, three and five. The results showed that all of the participants with Alzheimer’s disease had an increased rate of brain atrophy (called cortical thinning) in parts of the brain responsible for memory and activities of daily living compared to healthy controls. However, there was also a discrepancy between those with high and low levels of formal education, with the rate of atrophy higher on average for participants who had had more than nine years of formal education than for those who had completed fewer than nine years


The researchers suggest that their finding could be explained by the cognitive reserve hypothesis. Essentially, the cognitive reserve hypothesis suggests that a lifetime of mentally stimulating activity (which is, on average, more likely among those who’ve had higher levels of formal education) may result in a greater capacity for the brain to cope with damage associated with Alzheimer’s disease or other forms of dementia. The theory would suggest, for example, that somebody who has developed and perfected a range of strategies for remembering lots of new information might be able to cope better with the impact of the disease attacking the brain’s memory centre, than somebody with fewer memory strategies to draw upon.

More generally, the hypothesis suggests that people with higher levels of cognitive reserve developed over a lifetime of deliberate or incidental ‘mental exercise’ might have the capacity to ‘hold out’ against the impact of the disease for longer and maintain relatively normal cognitive and other brain functions in the face of even moderate levels of brain atrophy. However, when a tipping point is reached and the reserve of coping strategies is exhausted, they might be expected to experience a much more rapid decline.

The below figure is taken from a paper published in the Journal Lancet Neurology which shows how memory function is predicted to change over time in individuals with dementia who have high and low cognitive reserves.

Of course, in the same way as people who never smoke can still develop lung cancer, and people who exercise and eat healthily their whole lives are not immune from heart disease, higher education and mentally challenging activity cannot eliminate the possibility of dementia altogether. However, the evidence is clear that there are things that everyone can do to pursue a mentally active, heart-healthy lifestyle with regular social and physical activity and a healthy diet to reduce their risk of dementia. See www.yourbrainmatters.org.au for more.



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