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Effects of education on the progression of early- versus late-stage mild cognitive impairment

  • Byoung Seok Ye (a1), Sang Won Seo (a1), Hanna Cho (a1), Seong Yoon Kim (a2), Jung-Sun Lee (a2), Eun-Joo Kim (a3), Yunhwan Lee (a4), Joung Hwan Back (a4), Chang Hyung Hong (a5), Seong Hye Choi (a6), Kyung Won Park (a7), Bon D. Ku (a8), So Young Moon (a9), SangYun Kim (a10), Seol-Heui Han (a11), Jae-Hong Lee (a12), Hae-Kwan Cheong (a13) and Duk L. Na (a1)...


Background: Highly educated participants with normal cognition show lower incidence of Alzheimer's disease (AD) than poorly educated participants, whereas longitudinal studies involving AD have reported that higher education is associated with more rapid cognitive decline. We aimed to evaluate whether highly educated amnestic mild cognitive impairment (aMCI) participants show more rapid cognitive decline than those with lower levels of education.

Methods: A total of 249 aMCI patients enrolled from 31 memory clinics using the standard assessment and diagnostic processes were followed with neuropsychological evaluation (duration 17.2 ± 8.8 months). According to baseline performances on memory tests, participants were divided into early-stage aMCI (−1.5 to −1.0 standard deviation (SD)) and late-stage aMCI (below −1.5 SD) groups. Risk of AD conversion and changes in neuropsychological performances according to the level of education were evaluated.

Results: Sixty-two patients converted to AD over a mean follow-up of 1.43 years. The risk of AD conversion was higher in late-stage aMCI than early-stage aMCI. Cox proportional hazard models showed that aMCI participants, and late-stage aMCI participants in particular, with higher levels of education had a higher risk of AD conversion than those with lower levels of education. Late-stage aMCI participants with higher education showed faster cognitive decline in language, memory, and Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores. On the contrary, early-stage aMCI participants with higher education showed slower cognitive decline in MMSE and CDR-SOB scores.

Conclusions: Our findings suggest that the protective effects of education against cognitive decline remain in early-stage aMCI and disappear in late-stage aMCI.


Corresponding author

Correspondence should be addressed to: Sang Won Seo, MD, PhD, Department of Neurology, Samsung Medical Center, Sunkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Republic of Korea. Phone: +82-2-3410-1233; Fax: +82-2-3410-0052. Email:


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Ahn, H. al. (2010). Seoul Neuropsychological Screening Battery-dementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. Journal of Korean Medical Science, 25, 10711076.
Ahn, H. al. (2011). The cortical neuroanatomy of neuropsychological deficits in mild cognitive impairment and Alzheimer's disease: a surface-based morphometric analysis. Neuropsychologia, 49, 39313945.
Aisen, P. al. (2010). Clinical Core of the Alzheimer's Disease Neuroimaging Initiative: progress and plans. Alzheimer's & Dementia, 6, 239246.
Amieva, al. (2005). The 9 year cognitive decline before dementia of the Alzheimer type: a prospective population-based study. Brain, 128, 10931101.
Ardila, A., Ostrosky-Solis, F., Rosselli, M. and Gomez, C. (2000). Age-related cognitive decline during normal aging: the complex effect of education. Archives of Clinical Neuropsychology, 15, 495513.
Barnes, D. E. and Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurology, 10, 819828.
Bruandet, al. (2008). Cognitive decline and survival in Alzheimer's disease according to education level. Dementia and Geriatric Cognitive Disorder, 25, 7480.
Burggren, A. al. (2008). Reduced cortical thickness in hippocampal subregions among cognitively normal apolipoprotein E e4 carriers. Neuroimage, 41, 11771183.
Christensen, K. J., Multhaup, K. S., Nordstrom, S. K., and Voss, K. A. (1991). A cognitive battery for dementia: development and measurement characteristics. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 168174.
Ellis, K. al. (2009). The Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging: methodology and baseline characteristics of 1112 individuals recruited for a longitudinal study of Alzheimer's disease. International Psychogeriatrics, 21, 672687.
Evans, D. al. (1993). Level of education and change in cognitive function in a community population of older persons. Annals of Epidemiology, 3, 7177.
Fratiglioni, L. and Wang, H. X. (2007). Brain reserve hypothesis in dementia. Journal of Alzheimer's Disease, 12, 1122.
Garibotto, al. (2008). Education and occupation as proxies for reserve in aMCI converters and AD: FDG-PET evidence. Neurology, 71, 13421349.
Gauthier, al. (2006). Mild cognitive impairment. Lancet, 367, 12621270.
Kang, Y. and Na, D. L. (2003). Seoul Neuropsychological Screening Battery (SNSB). Incheon, South Korea: Human Brain Research & Consulting Co.
Kang, Y., Chin, J., Na, D. L., Lee, J. and Park, J. (2000). Brief report: a normative study of the Korean version of Controlled Oral Word Association Test (COWAT) in the elderly. The Korean Journal of Clinical Psychology, 19, 385392.
Kang, Y., Chin, J. and Na, D. L. (2002). A normative study of the Digit Span Test for the elderly. The Korean Journal of Clinical Psychology, 21, 911922.
Kim, H. and Na, D. L. (1999). Normative data on the Korean version of the Boston Naming Test. Journal of Clinical and Experimental Neuropsychology, 21, 127133.
Lee, J., Kang, Y. and Na, D. L. (2000). Efficiencies of stroop interference indexes in healthy older adults and dementia patients. The Korean Journal of Clinical Psychology, 19, 807818.
Lyketsos, C. G., Chen, L. S. and Anthony, J. C. (1999). Cognitive decline in adulthood: an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area study. Americal Journal of Psychiatry, 156, 5865.
Manly, J. J., Schupf, N., Tang, M. X. and Stern, Y. (2005). Cognitive decline and literacy among ethnically diverse elders. Journal of Geriatric Psychiatry and Neurology, 18, 213217.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.
Park, H. al. (2011). Clinical characteristics of a nationwide hospital-based registry of mild-to-moderate Alzheimer's disease patients in Korea: a CREDOS (Clinical Research Center for Dementia of South Korea) study. Journal of Korean Medical Scince, 26, 12191226.
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303308.
Scarmeas, N., Albert, S. M., Manly, J. J. and Stern, Y. (2006). Education and rates of cognitive decline in incident Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 77, 308316.
Sole-Padulles, al. (2009). Brain structure and function related to cognitive reserve variables in normal aging, mild cognitive impairment and Alzheimer's disease. Neurobiological Aging, 30, 11141124.
Stern, Y. (2006). Cognitive reserve and Alzheimer disease. Alzheimer Disease and Associated Disorders, 20, S6974.
Stern, Y., Albert, S., Tang, M. X. and Tsai, W. Y. (1999). Rate of memory decline in AD is related to education and occupation: cognitive reserve? Neurology, 53, 19421947.
Stern, Y., Gurland, B., Tatemichi, T. K., Tang, M. X., Wilder, D. and Mayeux, R. (1994). Influence of education and occupation on the incidence of Alzheimer's disease. JAMA, 271, 10041010.
Teri, L., McCurry, S. M., Edland, S. D., Kukull, W. A. and Larson, E. B. (1995). Cognitive decline in Alzheimer's disease: a longitudinal investigation of risk factors for accelerated decline. The Journals of Gerontology, Series A, Biological Science and Medical Sciences, 50A, M4955.
Wilson, R. S., Hebert, L. E., Scherr, P. A., Barnes, L. L., Mendes de Leon, C. F. and Evans, D. A. (2009). Educational attainment and cognitive decline in old age. Neurology, 72, 460465.
Winblad, al. (2004). Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240246.


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Effects of education on the progression of early- versus late-stage mild cognitive impairment

  • Byoung Seok Ye (a1), Sang Won Seo (a1), Hanna Cho (a1), Seong Yoon Kim (a2), Jung-Sun Lee (a2), Eun-Joo Kim (a3), Yunhwan Lee (a4), Joung Hwan Back (a4), Chang Hyung Hong (a5), Seong Hye Choi (a6), Kyung Won Park (a7), Bon D. Ku (a8), So Young Moon (a9), SangYun Kim (a10), Seol-Heui Han (a11), Jae-Hong Lee (a12), Hae-Kwan Cheong (a13) and Duk L. Na (a1)...


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