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Education and Dementia in the Context of the Cognitive Reserve Hypothesis: A Systematic Review with Meta-Analyses and Qualitative Analyses

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  • Xiangfei Meng
  • Carl D’Arcy

Abstract

Background: Cognitive reserve (CR) or brain reserve capacity explains why individuals with higher IQ, education, or occupational attainment have lower risks of developing dementia, Alzheimer’s disease (AD) or vascular dementia (VaD). The CR hypothesis postulates that CR reduces the prevalence and incidence of AD or VaD. It also hypothesizes that among those who have greater initial cognitive reserve (in contrast to those with less reserve) greater brain pathology occurs before the clinical symptoms of disease becomes manifest. Thus clinical disease onset triggers a faster decline in cognition and function, and increased mortality among those with initial greater cognitive reserve. Disease progression follows distinctly separate pathological and clinical paths. With education as a proxy we use meta-analyses and qualitative analyses to review the evidence for the CR hypothesis. Methodology/Principal Findings: We searched PubMed, PsycoINFO, EMBASE, HealthStar, and Scopus databases from January 1980 to June 2011 for observational studies with clear criteria for dementia, AD or VaD and education. One hundred and thirty-three articles with a variety of study designs met the inclusion criteria. Prevalence and incidence studies with odds ratios (ORs), relative risks or original data were included in the meta-analyses. Other studies were reviewed qualitatively. The studies covered 437,477 subjects. Prevalence and incidence studies with pooled ORs of 2.61 (95%CI 2.21–3.07) and 1.88 (95%CI 1.51–2.34) respectively, showed low education increased the risk of dementia. Heterogeneity and sensitivity tests confirmed the evidence. Generally, study characteristics had no effect on conclusions. Qualitative analyses also showed the protective effects of higher education on developing dementia and with clinical disease onset hastening a decline in cognition and function, and greater brain pathology. Conclusion/Significance: This systematic review and meta-analyses covering a wide range of observational studies and diverse settings provides robust support for the CR hypothesis. The CR hypothesis suggests several avenues for dementia prevention.

Suggested Citation

  • Xiangfei Meng & Carl D’Arcy, 2012. "Education and Dementia in the Context of the Cognitive Reserve Hypothesis: A Systematic Review with Meta-Analyses and Qualitative Analyses," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-16, June.
    • Handle: RePEc:plo:pone00:0038268
    DOI: 10.1371/journal.pone.0038268
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    References listed on IDEAS

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    1. Harling, Guy & Kobayashi, Lindsay C. & Farrell, Meagan T. & Wagner, Ryan G. & Tollman, Stephen & Berkman, Lisa, 2020. "Social contact, social support, and cognitive health in a population-based study of middle-aged and older men and women in rural South Africa," Social Science & Medicine, Elsevier, vol. 260(C).
    2. Ewa Jarosz, 2023. "Does ageing make life simpler? The dynamics, covariates, and implications of complexity of time-use patterns in late adulthood," Quality & Quantity: International Journal of Methodology, Springer, vol. 57(5), pages 4153-4170, October.
    3. Amitabh Chandra & Courtney Coile & Corina Mommaerts, 2023. "What Can Economics Say about Alzheimer's Disease?," Journal of Economic Literature, American Economic Association, vol. 61(2), pages 428-470, June.
    4. Lior Rennert & Sharon X. Xie, 2022. "Cox regression model under dependent truncation," Biometrics, The International Biometric Society, vol. 78(2), pages 460-473, June.
    5. Stephanie Langella & N. Gil Barksdale & Daniel Vasquez & David Aguillon & Yinghua Chen & Yi Su & Natalia Acosta-Baena & Juliana Acosta-Uribe & Ana Y. Baena & Gloria Garcia-Ospina & Margarita Giraldo-C, 2023. "Effect of apolipoprotein genotype and educational attainment on cognitive function in autosomal dominant Alzheimer’s disease," Nature Communications, Nature, vol. 14(1), pages 1-8, December.

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