Intellectual demand and formal education as: cognitive protection factors in Alzheimer's disease

Wajman, José Roberto; Bertolucci, Paulo Henrique Ferreira F.

doi:10.1590/S1980-57642010DN40400011

Abstract

To investigate the possible association between educational level and previous professional occupation, and objective cognitive and functional evaluation in a sample of elderly patients with Alzheimer's disease. Methods: Through retrospective analysis of medical files, 174 patients with probable Alzheimer disease were randomly selected, classified and submitted to analysis according to previous professional occupation and years of formal education. Results: Subjects with lower education and less intellectually-demanding occupations performed worse than higher educated subjects in all cognitive subtests and on the functional scale. Conclusions: Results indicate that not only the total years of education, but also professional occupation has an impact on cognition and functioning in accordance with the hypothesis of cognitive reserve. Our findings confirmed this hypothesis, where subjects with higher education/ higher intellectual demand manifested first symptoms later than low education/ low intellectual demand subjects, with the latter group also exhibiting faster disease progression.

Key words:
educational level; neuropsychological assessment; Alzheimer's disease

Resumo

Analisar as possíveis correlações entre nível educacional e atividade profissional prévia, com dados objetivos de avaliação cognitiva e funcional em uma amostra de idosos com doença de Alzheimer. Métodos: A partir de análise retrospectiva de prontuário médico foram selecionados aleatoriamente 174 pacientes com provável doença de Alzheimer que foram subdivididos e submetidos a análise conforme sua atividade profissional prévia e nível de escolaridade alcançado formalmente, calculado em anos. Resultados: Em praticamente todos os subtestes cognitivos, além de escala funcional, os participantes do grupo menos escolarizado e profissionais de áreas consideradas menos complexas em relação a demanda intelectual, saíram-se pior quando comparados com grupo mais escolarizados. Conclusões: Não apenas o total acumulado de anos formais concluídos, mas também a atividade profissional previamente exercida parece ter resultado sobre a cognição e funcionalidade à medida que evolui a doença crônico degenerativa, favorecendo assim o conceito de reserva intelectual. Por esta hipótese espera-se retardo no início dos sintomas da doença em pessoas com alta escolaridade/ alta demanda intelectual e, por outro lado, a baixa escolaridade/ baixa demanda intelectual profissional podem estar associadas a início precoce e progressão mais rápida, tanto do ponto de vista cognitivo como funcional.

Palavras-chave:
nível educacional; avaliação neuropsicológica; doença de Alzheimer

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

Instituto Brasileiro de Geografia e Estatística - IBGE. (http://www.ibge.gov.br).
» http://www.ibge.gov.br
Kirsch US, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America. The National Adult Literacy Survey. National Center for Education Statistics, US Department of Education. Washington DC: US Government Printing Office, 1993.
Kozol J. Illiterate America. Garden City, NY: Anchor Press/Doubleday, 1985.
Weiss BD, Red RL, Kligman EK. Literacy skills and comunication methods of low-income older persons. Patient Educ Counseling 1995;43:1523-1528.
Castell LS, MacLennan A. On defining Literacy. In. Literacy, Society and Schooling: A reader. Cambridge, Cambridge University Press; 1986.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington: American Psychiatric Association.
Hughes CP, Berg L, Danziger WL. A new clinical scale for the staging dementia. Br J Psychiatr 1982;140:566-572.
Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O Mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
Morris J, Edland S, Clark C, Galasko D, Koss E, Mohs R, van Belle G, Fillenbaum G, Heiman A. The consortium to establish a registry for Alzheimer's disease (CERAD). Part IV. Neurology 1993;43:2457-2465.
Rosner, B. Fundamentals of Biostatistics, Second edition. Boston, PWS Publishers; 1986.
Stern Y, Gurland B, Tatemich TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA 1994;271:1004-1010.
Cobb JL, Wolf PA, Au R, White R, D'Agostino RB. The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham Study. Neurology 1995;45:1707-1712.
Qiu C, Backman L, Winblad B, Aguero-Torres H, Fratiglione L. The influence of education on clinically diagnosed dementia incidence and mortality data from the Kungsholmen Project. Arch Neurol 2001;58:2034-2039.
Scarmeas N, Levy G, Tang M-x, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 2001;57:2236-2242.
Gatz M, Prescott CA, Pedersen NL. Lifestyle risk and delaying factors. Alzheimer Dis Assoc Disord 2006;20:S84-S88.
Hall CB, Derby C, LeValley A, Katz MJ, Verghese J, Lipton RB. Education delays accelerated decline on a memory test in persons who develop dementia. Neurology 2007;69: 1657-1664.
Paradise M, Cooper C, Livingston G. Systematic review of the effect of education on survival in Alzheimer's disease. Int Psychogeriatrics 2009;21:25-32.

Publication Dates

Publication in this collection
Oct-Dec 2010

History

Received
22 Aug 2010
Accepted
22 Oct 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Instituto Brasileiro de Geografia e Estatística - IBGE. (http://www.ibge.gov.br).
» http://www.ibge.gov.br

[2] Kirsch US, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America. The National Adult Literacy Survey. National Center for Education Statistics, US Department of Education. Washington DC: US Government Printing Office, 1993.

[3] Kozol J. Illiterate America. Garden City, NY: Anchor Press/Doubleday, 1985.

[4] Weiss BD, Red RL, Kligman EK. Literacy skills and comunication methods of low-income older persons. Patient Educ Counseling 1995;43:1523-1528.

[5] Castell LS, MacLennan A. On defining Literacy. In. Literacy, Society and Schooling: A reader. Cambridge, Cambridge University Press; 1986.

[6] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington: American Psychiatric Association.

[7] Hughes CP, Berg L, Danziger WL. A new clinical scale for the staging dementia. Br J Psychiatr 1982;140:566-572.

[8] Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O Mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

[9] Morris J, Edland S, Clark C, Galasko D, Koss E, Mohs R, van Belle G, Fillenbaum G, Heiman A. The consortium to establish a registry for Alzheimer's disease (CERAD). Part IV. Neurology 1993;43:2457-2465.

[10] Rosner, B. Fundamentals of Biostatistics, Second edition. Boston, PWS Publishers; 1986.

[11] Stern Y, Gurland B, Tatemich TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA 1994;271:1004-1010.

[12] Cobb JL, Wolf PA, Au R, White R, D'Agostino RB. The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham Study. Neurology 1995;45:1707-1712.

[13] Qiu C, Backman L, Winblad B, Aguero-Torres H, Fratiglione L. The influence of education on clinically diagnosed dementia incidence and mortality data from the Kungsholmen Project. Arch Neurol 2001;58:2034-2039.

[14] Scarmeas N, Levy G, Tang M-x, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 2001;57:2236-2242.

[15] Gatz M, Prescott CA, Pedersen NL. Lifestyle risk and delaying factors. Alzheimer Dis Assoc Disord 2006;20:S84-S88.

[16] Hall CB, Derby C, LeValley A, Katz MJ, Verghese J, Lipton RB. Education delays accelerated decline on a memory test in persons who develop dementia. Neurology 2007;69: 1657-1664.

[17] Paradise M, Cooper C, Livingston G. Systematic review of the effect of education on survival in Alzheimer's disease. Int Psychogeriatrics 2009;21:25-32.

Brasil