Education and the course of cognitive decline in Alzheimer disease.
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.


CONCLUSIONS
Higher educational attainment is associated with a slightly accelerated rate of cognitive decline in Alzheimer disease.
Rush Alzheimer's Disease Center, Rush University Medical Center, 600 South Paulina, Suite 1038, Chicago, IL 60612, USA. rwilson@rush.edu
R S
RS
Wilson
Y
Y
Li
N T
NT
Aggarwal
L L
LL
Barnes
J J
JJ
McCann
D W
DW
Gilley
D A
DA
Evans
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D000544:Alzheimer Disease / Q000523:psychology*; D003071:Cognition; D004493:Education; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological