Cognitive decline and survival in Alzheimer's disease according to education level

Objective: We tested the hypothesis that a higher education level is associated with faster cognitive decline and lower survival in a cohort of 670 Alzheimer's disease patients, followed for 3.5 years at the Lille-Bailleul memory centre. Methods: The patients were categorized in 3 groups according to educational levels: low (<= 8 years), intermediate (9-12 years) and high (> 12 years). Cognitive function was measured with the Mini Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (DRS). Survival was analyzed with a Cox model. Analyses were adjusted for age, sex, cholinesterase inhibitor treatment, diabetes, hypertension, visible vascular lesions on MRI, baseline DRS and MMSE. Results: The adjusted mixed random model showed that MMSE declined faster for patients with high and intermediate educational levels compared with those with a low educational level (p < 0.0001). The mean annually adjusted DRS decline was highest for the groups with the most education (p = 0.05). The mortality risk was not higher in the better- educated groups (high vs. low: RR = 0.84; 95% Cl = 0.35-1.99, intermediate vs. low: RR = 0.82; 95% Cl = 0.41-1.63). Conclusion: In our cohort, highly educated patients had a faster cognitive decline than less educated patients but similar mortality rates. Our findings support the cognitive reserve hypothesis. Copyright (c) 2007 S. Karger AG, Basel.