title: Influence of education on the relationship between white matter lesions and cognition.
abstract: OBJECTIVE
  To test the hypothesis that education level modulates the effects of cerebral white matter hyperintensities (WMH) on cognition in a large population-based study.
  
  
  METHODS
  A total of 845 elderly subjects aged 64 to 76 years who enrolled in a longitudinal study on cognitive decline and vascular aging had an MRI examination. Cognitive functions were assessed by Mini-Mental State Examination, Trail Making Test Part B, Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-Revised, Finger Tapping Test, Word Fluency Test, and Raven Progressive Matrix. MRI scans were interpreted visually using a standardized scale for rating WMH.
  
  
  RESULTS
  Severe WMH were present in 17% of the participants who had lower performances on tests involving attention tasks. In participants with a lower level of education, presence of severe WMH was significantly associated with lower cognitive performances. This was found for all cognitive tests. Conversely, in participants with a high level of education, there was no significant association between severity of WMH and level of cognitive functions.
  
  
  CONCLUSIONS
  Education modulates the consequences of WMH on cognition. Participants with a high level of education were protected against the cognitive deterioration related to vascular insults of the brain.
authors.affiliation: INSERM Unit 360, Epidemiological Research in Neurology and Psychopathology, Hôpital La Salpêtrière, Paris, France. carole.dufouil@chups.jussieu.fr
authors.forename: C
authors.initials: C
authors.lastname: Dufouil
authors.forename: A
authors.initials: A
authors.lastname: Alpérovitch
authors.forename: C
authors.initials: C
authors.lastname: Tzourio
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D014652:Vascular Diseases / Q000453:epidemiology