Higher education provides limited protection from Alzheimer’s disease

Cognitive reserve (CR) is the brain’s ability to maintain cognitive function despite age-related brain changes, damage or disease. It reflects an individual’s capacity to cope with these changes by utilizing pre-existing cognitive strategies or developing compensatory mechanisms.

The CR hypothesis presumes higher tolerance of Alzheimer’s disease (AD)-related pathology without functional decline for those with high education yet more rapid decline after AD onset. However, evidence supporting the second part of the hypothesis has been largely confined to U.S.-based studies.

A new study by researchers from Boston University Chobanian & Avedisian School of Medicine has found that people with more years of education lost their memory and thinking abilities faster after being diagnosed with AD, compared to those with less education.

These findings, published in the Journal of Alzheimer’s Disease, provide evidence for the CR theory using real-life data from older adults from England, Germany and France.

“Our study suggests that people with more education might be diagnosed with Alzheimer’s later—possibly because their brains hide the symptoms for longer—but then decline more quickly afterward. This means doctors and families need to be extra alert to early, subtle changes in memory, speech, thinking, judgment and mood in well-educated adults, so that treatment and support can start as early as possible,” explains corresponding author Jinying Chen, Ph.D., assistant professor of medicine.

The researchers analyzed data from more than 1,300 older adults diagnosed with AD in memory clinics across England, Germany and France, (as part of the GERAS European study).

Participants were followed for 18 months to three years, having their cognitive performance measured using the Mini-Mental State Examination (MMSE)—a brief test commonly used to screen for cognitive impairment and track decline over time.

They then used a statistical method to see how quickly people’s MMSE scores went down after being diagnosed with AD, comparing those with more education (12 years or more) to those with less.

They also took into account other things that could affect cognitive decline, such as age, sex, other health conditions, treatments for AD, the country they lived in and how long it had been since they were diagnosed.

Their findings suggest that common cognitive tests like the MMSE may miss early signs of Alzheimer’s in highly educated individuals. While more detailed neuropsychological tests are more sensitive, they can take hours to complete, are expensive, and require trained professionals to administer and interpret.

The researchers believe that in the future, self-administered digital tests—especially those using mobile devices or wearables with automated scoring—could offer a faster, more affordable, and scalable way to detect early changes in thinking and memory.

“We hope our findings will lead to better ways of detecting Alzheimer’s disease early—especially in people who may not show obvious symptoms at first. Earlier detection means families can plan sooner, and doctors can start treatments that may help slow the disease.”