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Educated People Develop Dementia Later in Life, but Decline Quicker: Study

Posted on: Monday, 22 October 2007, 18:00 CDT

By Sheryl Ubelacker, Health Reporter, THE CANADIAN PRESS

TORONTO - It's been known for some time that people with higher education levels tend to develop Alzheimer's disease later in life than those with less formal schooling. But a new study suggests that once the symptoms begin, people with more classroom time go cognitively downhill at a faster rate.

In fact, said lead researcher Charles Hall, the study showed that someone with 16 years of formal education would experience a rate of memory decline that is 50 per cent quicker than someone with just four years of schooling.

"People with more education experience a delay in the actual decline in memory that is characteristic of people who are developing dementia, in particular Alzheimer's disease," said Hall, a biostatistician at the Albert Einstein College of Medicine.

"However, once that decline begins, it proceeds more rapidly and by the time people are actually diagnosed, they're about at the same place" as less-educated people diagnosed earlier, Hall said Monday from New York.

"What we think this represents is that there's some amount of neuronal reserve or compensational ability . . . such that the pathology of Alzheimer's disease will develop at whatever rate it develops and people with more education have more neuronal capacity . . . and therefore aren't affected until much later in the natural history of the disease process."

"However, once that disease process gets to a certain level, the brain cannot handle it anymore and the decline begins and proceeds more rapidly because there's more pathology there," he said, referring to the death of cells and other abnormalities in the brain caused by the progressive disease.

The study, published in Tuesday's issue of the journal Neurology, involved 488 seniors who were followed over time, including 117 who developed dementia. All participants, who were born between 1894 and 1908, were physically and mentally healthy when enrolment for the study began in 1980.

Hall said researchers followed participants for an average of six years using annual cognitive tests. Levels of education ranged from less than three years of elementary school to postgraduate degree work.

The study found that for each additional year of formal education, memory decline associated with oncoming dementia was delayed by approximately 2 1/2 months. But once that accelerated decline began, more highly educated subjects experienced cognitive decline that occurred four per cent faster for each additional year of education.

For example, a university graduate with 16 years' education and diagnosed at age 85 would have begun to experience accelerated memory decline 3.8 years earlier, at age 81. But a person with just four years of schooling, diagnosed at the same age, would have begun to experience a less rapid rate of decline around age 79, 6.3 years before diagnosis, the study shows.

Hall said because the subjects were born at a time when educational opportunities differed markedly from more modern schooling, it's difficult to predict how the findings would apply to subsequent generations.

"Whether that (would) apply to people who were born in the 1920s or the 1950s who had different life experiences is not known," he said. "Although I don't know any reason why it would not hold, I haven't proven it."

Hall said people shouldn't misinterpret the results and believe that having more education has little benefit against the ravages of dementia in the long run.

"I would not say that it's bad to get more education," he said. "It certainly does not cause the disease process (itself) to speed up, and given the opportunity of an extra year or two of symptom-free life, I would definitively take it."

Neuropsychologist Dr. Mary Tierney, director of the Geriatric Research Unit at Sunnybrook Health Sciences Centre in Toronto, agrees that attaining a few years more of functional quality of life is a goal worth shooting for.

And it may not be just formal education in early life that promotes longer cognitive health: there is some suggestion that flexing mental muscles even later in life with puzzles, reading, socializing - and even video games - may help stave off the onset of dementia.

Tierney, who was not involved in the study, called the findings "quite important and valid, absolutely."

"People who are involved in intellectual activity, problem-solving, they're just generally intellectually stimulated," she said. "So those people, when they start developing the . . . neuronal loss that we find in Alzheimer's, they can compensate more . . . they look better and they perform better in the environment."

Source: Canadian Press

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