title: Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis.
abstract: 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.
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave., Box 8067, St. Louis, MO 63110, USA. cathyr@wubios.wustl.edu
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Roe
authors.forename: Chengjie
authors.initials: C
authors.lastname: Xiong
authors.forename: J Phillip
authors.initials: JP
authors.lastname: Miller
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008954:Models, Biological; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology