@article {911, title = {Education and the cognitive decline associated with MRI-defined brain infarct.}, journal = {Neurology}, volume = {67}, year = {2006}, month = {2006 Aug 08}, pages = {435-40}, abstract = {

OBJECTIVE: To assess whether educational attainment, a correlate of cognitive reserve, predicts the amount of cognitive decline associated with a new brain infarct.

METHODS: The Cardiovascular Health Study is a population-based, longitudinal study of people aged 65 years and older. Cognitive function was measured annually using the Modified Mini-Mental State Examination (3MS) and the Digit-Symbol Substitution Test (DSST). The authors tested whether education level modified 1) the cross-sectional association between cognitive performance and MRI-defined infarct and 2) the change in cognitive function associated with an incident infarct at a follow-up MRI.

RESULTS: In cross-sectional analysis (n = 3,660), MRI-defined infarct was associated with a greater impact on 3MS performance in the lowest education quartile when compared with others (p for heterogeneity = 0.012). Among those with a follow-up MRI who had no infarct on initial MRI (n = 1,433), education level was not associated with the incidence, size, or location of new brain infarct. However, a new MRI-defined infarct predicted substantially greater decline in 3MS scores in the lowest education group compared with the others (6.3, 95\% CI 4.4- to 8.2-point decline vs 1.7, 95\% CI 0.7- to 2.7-point decline; p for heterogeneity < 0.001). Higher education was not associated with smaller declines in DSST performance in the setting of MRI-defined infarct.

CONCLUSIONS: Education seems to modify an individual{\textquoteright}s decline on a test of general cognitive function when there is incident brain infarct. These findings are consistent with the hypothesis that cognitive reserve influences the impact of vascular injury in the brain.

}, keywords = {Cerebral Infarction, Cognition Disorders, Cross-Sectional Studies, Educational Status, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Neuropsychological Tests}, issn = {1526-632X}, doi = {10.1212/01.wnl.0000228246.89109.98}, author = {Elkins, J S and Longstreth, W T and Manolio, T A and Newman, A B and Bhadelia, R A and Johnston, S C} }