Forget Me Not

Investigators have long thought that highly educated people are less likely to develop symptoms of Alzheimer's disease. This has spawned the so-called "brain reserve" theory, the notion that the well educated are protected from cognitive decline, either because they have more neurons to lose or because they have a larger brain volume.

Neurologists now have to rethink this concept. New research indicates that current tests may only detect cognitive decline among people of average or little education, but are not designed to register cognitive changes in highly educated patients. If this is the case, then the "brain reserve" may be no more than a methodological shortcoming.

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In a study presented recently to the International Neuropsychological Society, Holly Tuokko, Ph.D., a professor of psychology at the University of Victoria in Canada, reviewed data from the 1991 Canadian Study of Health and Aging, an epidemiological survey of dementia in 1,879 subjects. In 1996, Tuokko retested 844 subjects who exhibited no dementia in 1991. She classified the subjects' level of education as low at 0 to 5 years, medium at 6 to 12 years, or high at more than 13 years.

In 1996, less than 10 percent of the highly educated group were considered cognitively impaired, compared with more than 20 percent of the least educated subjects. But when Tuokko reviewed the 1991 data on the highly educated subjects, she found that their cognitive performance had been in the low-average range. "According to their level of education, their scores should have been high-average," says Tuokko. "We were calling their cognitive abilities normal, even though they probably were not."

Tuokko says that future assessment of dementia in highly educated people may involve comparing subjects' scores over time to their own baselines.

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