Journal of the International Neuropsychological Society

Research Articles

Quality, and not Just Quantity, of Education Accounts for Differences in Psychometric Performance between African Americans and White Non-Hispanics with Alzheimer's Disease

Alexander L. China1, Selam Negasha2, Sharon Xiea3, Steven E. Arnolda2 and Roy Hamiltona2a4 c1

a1 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

a2 Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania

a3 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania

a4 Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania


The effect of race on cognitive test performance in the evaluation of Alzheimer's disease (AD) remains controversial. One factor that may contribute substantially to differences in cognitive test performance in diverse populations is education. The current study examined the extent to which quality of education, even after controlling for formal years of education, accounts for differences in cognitive performance between African Americans and White Non-Hispanics (WNHs). The retrospective cohort included 244 patients diagnosed with AD who self-identified as African Americans (n = 51) or WNHs (n = 193). The Wechsler Test of Adult Reading (WTAR) was used as an estimate of quality of education. In an analysis that controlled for traditional demographics, including age, sex, and years of formal education, African Americans scored significantly lower than WNHs on the Mini-Mental State Examination, as well as on neuropsychological tests of memory, attention, and language. However, after also adjusting for reading level, all previously observed differences were significantly attenuated. The attenuating effect remained even after controlling for disease severity, indicating that reading scores are not confounded by severity of dementia. These findings suggest that quality, and not just quantity, of education needs to be taken into account when assessing cognitive performance in African Americans with AD. (JINS, 2012, 18, 277–285)

(Received January 28 2011)

(Revised November 07 2011)

(Accepted November 07 2011)


c1 Correspondence and reprint requests to: Roy Hamilton, Penn Memory Center, 3615 Chestnut Street, Philadelphia, PA 19104. E-mail: