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Systematic review of the effect of education on survival in Alzheimer's disease

Published online by Cambridge University Press:  25 November 2008

Matt Paradise ,
Claudia Cooper  and
Gill Livingston
Matt Paradise*
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
Claudia Cooper
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
Gill Livingston
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
*
Correspondence should be addressed to: Matt Paradise, Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, U.K. Phone: +44 (0) 207 2885931 Email: mattparadise7@gmail.com.
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Abstract

Background: According to the cognitive reserve model, higher levels of education compensate for the neuropathology of Alzheimer's disease (AD), delaying its clinical manifestations. This model suggests that for any level of cognitive impairment, people with more education have worse neuropathology than those with less education and will therefore have shorter survival post-diagnosis. This is the first systematic review of the relationship between more education and decreased survival in people with AD.

Methods: We reviewed the literature systematically, searching electronic databases and reference lists of included studies. We used Centre for Evidence Based Medicine criteria for inclusion and rating of the validity of cohort studies that reported the relationship of education to survival in people with AD.

Results: 22 studies met inclusion criteria. We found Grade A evidence (highest evidence level) that more education was not associated with decreased survival post-diagnosis in AD. Only one of 11 studies rated 1b (highest level of quality) supported our hypothesis that more education predicted reduced survival after adjusting for age, gender and dementia severity; it comprised African-Caribbean participants, who had on average more severe cognitive impairment than other studies' participants.

Conclusions: Education delays the onset of the dementia syndrome in AD, but does not lead to earlier death after diagnosis.

Keywords

Alzheimer's diseasesurvivaleducationdeathsystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 25 - 32
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Agüero-Torres, H., Fratiglioni, L., Guo, Z., Viitanen, M. and Winblad, B. (1998). Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. Journal of the American Geriatrics Society, 46, 444–452.CrossRefGoogle ScholarPubMed
Bennett, D. A. et al. (2003). Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology, 60, 1909–1915.Google Scholar
Bowen, J. D. et al. (1996). Predictors of mortality in patients diagnosed with probable Alzheimer's disease. Neurology, 47, 433–439.CrossRefGoogle ScholarPubMed
Brehaut, J. C., Raina, P. and Lindsay, J. (2004). Does cognitive status modify the relationship between education and mortality? Evidence from the Canadian Study of Health and Aging. International Psychogeriatrics, 16, 75–91.Google Scholar
Bruandet, A. et al. (2008). Cognitive decline and survival in Alzheimer's disease according to education level. Dementia and Geriatric Cognitive Disorders, 25, 74–80.CrossRefGoogle ScholarPubMed
Burns, A., Lewis, G., Jacoby, R. and Levy, R. (1991). Factors affecting survival in Alzheimer's disease. Psychological Medicine, 21, 363–370.Google Scholar
Claus, J. J. et al. (1998). Predicting survival in patients with early Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 9, 284–293.CrossRefGoogle ScholarPubMed
Del Ser, T., Hachinski, V., Merskey, H. and Munoz, D. G. (1999). An autopsy-verified study of the effect of education on degenerative dementia. Brain, 2309–2319.Google Scholar
Dijkstra, A., Sipsma, D. H. and Dassen, T. W. N. (1998). Care dependency and survival among female patients with Alzheimer's disease: a two-year follow-up. Croatian Medical Journal, 39, 365–370.Google Scholar
Fratiglioni, L. et al. (1991). Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology, 41, 1886–1892.CrossRefGoogle Scholar
Freels, S., Nyenhuis, D. L. and Gorelick, P. B. (2002). Predictors of survival in African American patients with AD, VaD, or stroke without dementia. Neurology, 59, 1146–1153.CrossRefGoogle ScholarPubMed
Fritsch, T. et al. (2001). Effects of educational attainment on the clinical expression of Alzheimer's disease: results from a research registry. American Journal of Alzheimer's Disease and Other Dementias, 16, 369–376.CrossRefGoogle ScholarPubMed
Froehlich, T. E., Bogardus, S. T. Jr. and Inouye, S. K. (2001). Dementia and race: are there differences between African Americans and Caucasians? Journal of the American Geriatrics Society, 49, 477–484.Google Scholar
Ganguli, M., Dodge, H. H., Shen, C., Pandav, R. S. and DeKosky, S. T. (2005). Alzheimer disease and mortality: a 15-year epidemiological study. Archives of Neurology, 62, 779–784.Google Scholar
Geerlings, M. I., Deeg, D. J., Schmand, B., Lindeboom, J. and Jonker, C. (1997). Increased risk of mortality in Alzheimer's disease patients with higher education? A replication study. Neurology, 49, 798–802.CrossRefGoogle ScholarPubMed
Geerlings, M. I. et al. (1999). Cognitive reserve and mortality in dementia: the role of cognition, functional ability and depression. Psychological Medicine, 29, 1219–1226.CrossRefGoogle ScholarPubMed
Guralnik, J. M., Land, K. C., Blazer, D., Fillenbaum, G. G. and Branch, L. G. (1993) Educational status and active life expectancy among older blacks and whites. New England Journal of Medicine, 329, 110–116Google Scholar
Helmer, C., Joly, P., Letenneur, L., Commenges, D. and Dartigues, J. F. (2001). Mortality with dementia: results from a French prospective community-based cohort. American Journal of Epidemiology, 154, 642–648.Google Scholar
Heyman, A., Peterson, B., Fillenbaum, G. and Pieper, C. (1996). The consortium to establish a registry for Alzheimer's disease (CERAD). Part XIV: Demographic and clinical predictors of survival in patients with Alzheimer's disease. Neurology, 46, 656–660.Google Scholar
Hier, D. B., Warach, J. D., Gorelick, P. B. and Thomas, J. (1989). Predictors of survival in clinically diagnosed Alzheimer's disease and multi-infarct dementia. Archives of Neurology, 46, 1213–1216.CrossRefGoogle ScholarPubMed
Hui, J. S., Wilson, R. S., Bennett, D. A., Bienias, J. L., Gilley, D. W. and Evans, D. A. (2003). Rate of cognitive decline and mortality in Alzheimer's disease. Neurology, 61, 1356–1361.CrossRefGoogle ScholarPubMed
Hussain, S. K., Altieri, A., Sundquist, J. and Hemminki, K. (2008). Influence of education level on breast cancer risk and survival in Sweden between 1990 and 2004. International Journal of Cancer, 122, 165–169.CrossRefGoogle ScholarPubMed
Jagger, C., Clarke, M. and Stone, A. (1995). Predictors of survival with Alzheimer's disease: a community-based study. Psychological Medicine, 25, 171–175.CrossRefGoogle ScholarPubMed
Katzman, R. (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43, 13–20.Google Scholar
Larson, E. B. et al. (2004). Survival after initial diagnosis of Alzheimer disease. Annals of Internal Medicine, 140, 501–509.CrossRefGoogle ScholarPubMed
Livingston, G., Leavey, G., Kitchen, G., Manela, M., Sembhi, S. and Katona, C. (2001). Mental health of migrant elders: the Islington study. British Journal of Psychiatry, 179, 361–366.CrossRefGoogle ScholarPubMed
Lopez, O. L., Brenner, R. P., Becker, J. T., Ulrich, R. F., Boller, F. and DeKosky, S. T. (1997). EEG spectral abnormalities and psychosis as predictors of cognitive and functional decline in probable Alzheimer's disease. Neurology, 48, 1521–1525.Google Scholar
Moritz, D. J., Fox, P. J., Luscombe, F. A. and Kraemer, H. C. (1997). Neurological and psychiatric predictors of mortality in patients with Alzheimer disease in California. Archives of Neurology, 54, 878–885.CrossRefGoogle ScholarPubMed
O'Carroll, R., Whittick, J. and Baikie, E. (1991). Parietal signs and sinister prognosis in dementia: a four-year follow-up study. British Journal of Psychiatry, 358–361.Google Scholar
Pavlik, V. N., Doody, R. S., Massman, P. J. and Chan, W. (2006). Influence of premorbid IQ and education on progression of Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 22, 367–377.Google Scholar
Qiu, C., Backman, L., Winblad, B., Agüero-Torres, H. and Fratiglioni, L. (2001). The influence of education on clinically diagnosed dementia incidence and mortality data from the Kungsholmen Project. Archives of Neurology, 58, 2034–2039.Google Scholar
Regan, C., Katona, C., Walker, Z., Hooper, J., Donovan, J. and Livingston, G. (2006). Relationship of vascular risk to the progression of Alzheimer disease. Neurology, 67, 1357–1362.CrossRefGoogle Scholar
Roe, C. M., Xiong, C., Miller, J. P. and Morris, J. C. (2007). Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. Neurology, 68, 223–228.CrossRefGoogle ScholarPubMed
Satz, B. (1993). Brain reserve capacity on symptom onset after brain injury: a formulation and review of evidence for threshold theory. Neuropsychology, 7, 273–295.Google Scholar
Schoenberg, B. S., Kokmen, E. and Okazaki, H. (1987). Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features. Annals of Neurology, 22, 724–729.Google Scholar
Steenland, K., Henley, J and Thun, M. (2002). All-cause and cause-specific death rates by educational status for two million people in two American Cancer Society cohorts, 1959–1996. American Journal of Epidemiology, 156, 11–21.Google Scholar
Stern, Y., Alexander, G. E., Prohovnik, I. and Mayeux, R. (1992). Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease. Annals of Neurology, 32, 371–375.CrossRefGoogle ScholarPubMed
Stern, Y., Tang, M. X., Denaro, J. and Mayeux, R. (1995). Increased risk of mortality in Alzheimer's disease patients with more advanced educational and occupational attainment. Annals of Neurology, 37, 590–595.Google Scholar
Tang, X. et al. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 49–56.CrossRefGoogle ScholarPubMed
van Dijk, P. T., Dippel, D. W. and Habbema, J. D. (1991). Survival of patients with dementia. Journal of the American Geriatrics Society, 39, 603–610.Google Scholar
Walsh, J. S., Welch, H. G. and Larson, E. B. (1990). Survival of outpatients with Alzheimer-type dementia. Annals of Internal Medicine, 113, 429–434.Google Scholar
Wilson, R. S. et al. (2006). Cognitive decline and survival in Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 356–362.Google Scholar