title: Very low levels of education and cognitive reserve: a clinicopathologic study.
abstract: OBJECTIVE
  We conducted a clinicopathologic study in a large population with very low levels of education to determine whether very few years of education could contribute to cognitive reserve and modify the relation of neuropathologic indices to dementia.
  
  
  METHODS
  In this cross-sectional study, we included 675 individuals 50 years of age or older from the Brazilian Aging Brain Study Group. Cognitive abilities were evaluated through a structured interview with an informant at the time of autopsy, including the Clinical Dementia Rating (CDR) scale. Neuropathologic examinations were performed using immunohistochemistry and following internationally accepted criteria. Multivariate linear regression models were conducted to determine whether the association between cognitive abilities (measured by CDR sum of boxes) and years of education was independent of sociodemographic variables and neuropathologic indices, including neuritic plaques, neurofibrillary tangles, lacunar infarctions, small-vessel disease, and Lewy bodies. In addition, interaction models were used to examine whether education modified the relation between neuropathologic indices and cognition.
  
  
  RESULTS
  Mean education was 3.9 ± 3.5 years. Formal education was associated with a lower CDR sum of boxes (β = -0.197; 95% confidence interval -0.343, -0.052; p = 0.008), after adjustment for sociodemographic variables and neuropathologic indices. Furthermore, education modified the relationship of lacunar infarcts with cognitive abilities (p = 0.04).
  
  
  CONCLUSIONS
  Even a few years of formal education contributes to cognitive reserve.
authors.affiliation: Department of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil. farfel@usp.br
authors.forename: Jose Marcelo
authors.initials: JM
authors.lastname: Farfel
authors.forename: Ricardo
authors.initials: R
authors.lastname: Nitrini
authors.forename: Claudia Kimie
authors.initials: CK
authors.lastname: Suemoto
authors.forename: Lea Tenenholz
authors.initials: LT
authors.lastname: Grinberg
authors.forename: Renata Eloah Lucena
authors.initials: RE
authors.lastname: Ferretti
authors.forename: Renata Elaine Paraizo
authors.initials: RE
authors.lastname: Leite
authors.forename: Edilaine
authors.initials: E
authors.lastname: Tampellini
authors.forename: Luzia
authors.initials: L
authors.lastname: Lima
authors.forename: Daniela Souza
authors.initials: DS
authors.lastname: Farias
authors.forename: Ricardo Caires
authors.initials: RC
authors.lastname: Neves
authors.forename: Roberta Diehl
authors.initials: RD
authors.lastname: Rodriguez
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Pasqualucci
authors.forename: Wilson
authors.initials: W
authors.lastname: Jacob Filho
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D058245:Cognitive Reserve / Q000502:physiology*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests