Less education may delay recognition of Alzheimer disease

Epidemiological data suggest people with less education may be at risk for slightly delayed detection of Alzheimer disease

A review of epidemiological data has found evidence that people who spend fewer years in school may experience a slight but statistically significant delay in the realization that they're having cognitive problems that could be Alzheimer disease.

Scientists at the Alzheimer's Disease Research Center at Washington University School of Medicine in St. Louis reviewed data on 1449 Alzheimer's patients from their center and 21,880 patients from the National Alzheimer's Coordinating Center, a collaboration of approximately 30 Alzheimer disease research centers nationwide.

"We may have a group of people who are at risk for slightly delayed detection of Alzheimer's disease," says lead author Catherine Roe PhD, a neurology research instructor at the Alzheimer's Disease Research Center. "Early detection of Alzheimer's disease is important as we progress toward treatments and cures because those treatments will need to be applied as early as possible to have the maximum possible benefit."

The paper appears in this month's issue of Archives of Neurology.

In an earlier study of patients with a form of Alzheimer disease linked to a genetic mutation, Roe and other Washington University researchers found patients with more years of education were likely to be diagnosed with Alzheimer disease earlier. This surprised them because higher levels of education have typically been associated with decreased risk of Alzheimer disease.

The new study confirmed those surprising results, revealing that patients with 12 years or more of schooling were on average slightly younger when diagnosed with Alzheimer disease than patients with less than 8 years of schooling. Age of diagnosis for a group with 8 to 11 years of schooling fell in-between the other 2 groups.

Next, researchers analyzed the severity of patients' dementia when they went to the Alzheimer disease center for the first time. They found that patients with fewer years of education were likely to be more severely impaired on their first visit.

Alzheimer disease is cumulatively disabling. This suggested to the researchers that those with lower education levels may be slower to notice the early signs of disease, only going to see a specialist after their symptoms become impossible to ignore. Those with more education may be becoming aware of their symptoms while they are still relatively subtle, and seek a specialists' help early on in the disease process.

"People with higher education levels may be more likely to have a job or a hobby that highlights early cognitive impairment as well as better access to medical care," Roe says. "These could be factors that we need to incorporate into our procedures for screening patients for early signs of cognitive impairment."

Funding from the Alzheimer's Disease Research Center and the National Institute on Aging supported this research.

Source: News Release
Washington University in St. Louis 
January 23, 2008