Background Education promotes cognitive reserve (CR), potentially buffering Alzheimer's disease pathology (ADP). However, the education-CR relationship may differ by population and genetic background. Objective To examine education, APOE ε4, and functional scores in a Puerto Rican (PR) cohort with varying plasma pTau181, an ADP biomarker. Methods A subset of 514 PR older adults with “high” (>mean+1SD) or “low” pTau181 (0) and (2) severity among impaired participants, adjusting for age and sex. Results High EA was associated with better CDR-FUNC than low EA within the high pTau181 group (n = 80; Median LowEA = 7, Median HighEA = 0; p = 0. 011). The hurdle model similarly showed that each additional year of education reduced the odds of any functional impairment in the high-pTau181 group (OR = 0. 89, 95% CI 0. 79–0. 99). No significant education × APOE ε4 interaction was observed, though a negative trend suggested that increasing education attenuated ε4-related impairment. Conclusions Greater education is linked to functional preservation in PR older adults, particularly in those with elevated ADP, suggesting potential CR-mediated resilience. APOE ε4 may worsen outcomes with decreasing education, suggesting both educational and genetic factors should inform strategies to mitigate cognitive decline globally.
Dorfsman et al. (Mon,) studied this question.