Education and Dementia in the Context of the Cognitive Reserve Hypothesis: A Systematic Review with Meta-Analyses and Qualitative Analyses
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{"title"=>"Education and dementia in the context of the cognitive reserve hypothesis: A systematic review with meta-analyses and qualitative analyses", "type"=>"journal", "authors"=>[{"first_name"=>"Xiangfei", "last_name"=>"Meng", "scopus_author_id"=>"49863941800"}, {"first_name"=>"Carl", "last_name"=>"D'Arcy", "scopus_author_id"=>"7004553494"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"364955421", "sgr"=>"84861903121", "pmid"=>"22675535", "scopus"=>"2-s2.0-84861903121", "isbn"=>"1932-6203", "doi"=>"10.1371/journal.pone.0038268", "issn"=>"19326203"}, "id"=>"a5ea3102-88ab-317e-a7c0-4f00665ea5ed", "abstract"=>"BACKGROUND Cognitive reserve (CR) or brain reserve capacity explains why individuals with higher IQ, education, or occupational attainment have lower risks of developing dementia, Alzheimer's disease (AD) or vascular dementia (VaD). The CR hypothesis postulates that CR reduces the prevalence and incidence of AD or VaD. It also hypothesizes that among those who have greater initial cognitive reserve (in contrast to those with less reserve) greater brain pathology occurs before the clinical symptoms of disease becomes manifest. Thus clinical disease onset triggers a faster decline in cognition and function, and increased mortality among those with initial greater cognitive reserve. Disease progression follows distinctly separate pathological and clinical paths. With education as a proxy we use meta-analyses and qualitative analyses to review the evidence for the CR hypothesis. METHODOLOGY/PRINCIPAL FINDINGS We searched PubMed, PsycoINFO, EMBASE, HealthStar, and Scopus databases from January 1980 to June 2011 for observational studies with clear criteria for dementia, AD or VaD and education. One hundred and thirty-three articles with a variety of study designs met the inclusion criteria. Prevalence and incidence studies with odds ratios (ORs), relative risks or original data were included in the meta-analyses. Other studies were reviewed qualitatively. The studies covered 437,477 subjects. Prevalence and incidence studies with pooled ORs of 2.61 (95%CI 2.21-3.07) and 1.88 (95%CI 1.51-2.34) respectively, showed low education increased the risk of dementia. Heterogeneity and sensitivity tests confirmed the evidence. Generally, study characteristics had no effect on conclusions. Qualitative analyses also showed the protective effects of higher education on developing dementia and with clinical disease onset hastening a decline in cognition and function, and greater brain pathology. CONCLUSION/SIGNIFICANCE This systematic review and meta-analyses covering a wide range of observational studies and diverse settings provides robust support for the CR hypothesis. The CR hypothesis suggests several avenues for dementia prevention.", "link"=>"http://www.mendeley.com/research/education-dementia-context-cognitive-reserve-hypothesis-systematic-review-metaanalyses-qualitative-a", "reader_count"=>238, "reader_count_by_academic_status"=>{"Unspecified"=>6, "Professor > Associate Professor"=>10, "Librarian"=>1, "Researcher"=>33, "Student > Doctoral Student"=>23, "Student > Ph. D. Student"=>36, "Student > Postgraduate"=>15, "Other"=>10, "Student > Master"=>49, "Student > Bachelor"=>40, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>3, "Professor"=>10}, "reader_count_by_user_role"=>{"Unspecified"=>6, "Professor > Associate Professor"=>10, "Librarian"=>1, "Researcher"=>33, "Student > Doctoral Student"=>23, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/325695", "https://ndownloader.figshare.com/files/325759"], "description"=>"<div><h3>Background</h3><p>Cognitive reserve (CR) or brain reserve capacity explains why individuals with higher IQ, education, or occupational attainment have lower risks of developing dementia, Alzheimer’s disease (AD) or vascular dementia (VaD). The CR hypothesis postulates that CR reduces the prevalence and incidence of AD or VaD. It also hypothesizes that among those who have greater initial cognitive reserve (in contrast to those with less reserve) greater brain pathology occurs before the clinical symptoms of disease becomes manifest. Thus clinical disease onset triggers a faster decline in cognition and function, and increased mortality among those with initial greater cognitive reserve. Disease progression follows distinctly separate pathological and clinical paths. With education as a proxy we use meta-analyses and qualitative analyses to review the evidence for the CR hypothesis.</p> <h3>Methodology/Principal Findings</h3><p>We searched PubMed, PsycoINFO, EMBASE, HealthStar, and Scopus databases from January 1980 to June 2011 for observational studies with clear criteria for dementia, AD or VaD and education. One hundred and thirty-three articles with a variety of study designs met the inclusion criteria. Prevalence and incidence studies with odds ratios (ORs), relative risks or original data were included in the meta-analyses. Other studies were reviewed qualitatively. The studies covered 437,477 subjects. Prevalence and incidence studies with pooled ORs of 2.61 (95%CI 2.21–3.07) and 1.88 (95%CI 1.51–2.34) respectively, showed low education increased the risk of dementia. Heterogeneity and sensitivity tests confirmed the evidence. Generally, study characteristics had no effect on conclusions. Qualitative analyses also showed the protective effects of higher education on developing dementia and with clinical disease onset hastening a decline in cognition and function, and greater brain pathology.</p> <h3>Conclusion/Significance</h3><p>This systematic review and meta-analyses covering a wide range of observational studies and diverse settings provides robust support for the CR hypothesis. The CR hypothesis suggests several avenues for dementia prevention.</p> </div>", "links"=>[], "tags"=>["dementia", "systematic", "meta-analyses", "qualitative", "analyses"], "article_id"=>124288, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0038268.s001", "https://dx.doi.org/10.1371/journal.pone.0038268.s002"], "stats"=>{"downloads"=>2, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Education_and_Dementia_in_the_Context_of_the_Cognitive_Reserve_Hypothesis_A_Systematic_Review_with_Meta_Analyses_and_Qualitative_Analyses/124288", "title"=>"Education and Dementia in the Context of the Cognitive Reserve Hypothesis: A Systematic Review with Meta-Analyses and Qualitative Analyses", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-06-04 01:11:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/628356"], "description"=>"<p>Flow chart of review process.</p>", "links"=>[], "tags"=>["public health and epidemiology", "Mental health", "neurological disorders"], "article_id"=>298849, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.g001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_chart_of_review_process_/298849", "title"=>"Flow chart of review process.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-06-04 02:27:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/628903"], "description"=>"<p>Education and the risk of dementia: Characteristics of studies included in the meta-analysis.</p>", "links"=>[], "tags"=>["characteristics", "studies", "included"], "article_id"=>299394, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.t001", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Education_and_the_risk_of_dementia_Characteristics_of_studies_included_in_the_meta_analysis_/299394", "title"=>"Education and the risk of dementia: Characteristics of studies included in the meta-analysis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-06-04 02:36:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/628489"], "description"=>"<p>Summary of findings from observational studies of education and prevalence of dementia (* denotes studies with two or more empirical findings).</p>", "links"=>[], "tags"=>["findings", "observational", "studies", "prevalence", "dementia", "denotes", "empirical"], "article_id"=>298983, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.g002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_findings_from_observational_studies_of_education_and_prevalence_of_dementia_denotes_studies_with_two_or_more_empirical_findings_/298983", "title"=>"Summary of findings from observational studies of education and prevalence of dementia (* denotes studies with two or more empirical findings).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-06-04 02:29:43"}
  • {"files"=>["https://ndownloader.figshare.com/files/628940"], "description"=>"<p>Qualitative analysis: Studies linking education to various aspects of dementia (* denotes studies with findings related to two or more areas of inquiry).</p>", "links"=>[], "tags"=>["studies", "linking", "aspects", "dementia", "denotes", "findings", "areas"], "article_id"=>299434, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.t002", "stats"=>{"downloads"=>5, "page_views"=>24, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Qualitative_analysis_Studies_linking_education_to_various_aspects_of_dementia_denotes_studies_with_findings_related_to_two_or_more_areas_of_inquiry_/299434", "title"=>"Qualitative analysis: Studies linking education to various aspects of dementia (* denotes studies with findings related to two or more areas of inquiry).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-06-04 02:37:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/628834"], "description"=>"<p>Funnel plot of incidence studies of dementia and education.</p>", "links"=>[], "tags"=>["incidence", "studies", "dementia"], "article_id"=>299339, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.g005", "stats"=>{"downloads"=>2, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Funnel_plot_of_incidence_studies_of_dementia_and_education_/299339", "title"=>"Funnel plot of incidence studies of dementia and education.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-06-04 02:35:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/628764"], "description"=>"<p>Funnel plot prevalent studies of dementia and education with a variety of study designs.</p>", "links"=>[], "tags"=>["prevalent", "studies", "dementia"], "article_id"=>299254, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.g004", "stats"=>{"downloads"=>2, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Funnel_plot_prevalent_studies_of_dementia_and_education_with_a_variety_of_study_designs_/299254", "title"=>"Funnel plot prevalent studies of dementia and education with a variety of study designs.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-06-04 02:34:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/628634"], "description"=>"<p>Summary of findings from observational studies of education and the incidence of dementia (* denotes studies with two or more empirical findings).</p>", "links"=>[], "tags"=>["findings", "observational", "studies", "incidence", "dementia", "denotes", "empirical"], "article_id"=>299127, "categories"=>["Mental Health", "Biotechnology", "Neuroscience"], "users"=>["Xiangfei Meng", "Carl D’Arcy"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0038268.g003", "stats"=>{"downloads"=>3, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_findings_from_observational_studies_of_education_and_the_incidence_of_dementia_denotes_studies_with_two_or_more_empirical_findings_/299127", "title"=>"Summary of findings from observational studies of education and the incidence of dementia (* denotes studies with two or more empirical findings).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-06-04 02:32:07"}

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Relative Metric

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