How education is linked to the development of dementia and Alzheimer’s disease:

Introduction:

When considering any major disease, it is almost always true that effective prevention is far more beneficial that treatment – why wait to treat a condition you can prevent from arising in the first place? This is very true for a disease involving cognitive decline often experienced by the elderly, known as dementia. Losing touch with your life’s memories and family members is a tragedy that dissociates you from the real world. It is essential that we identify risk factors and investigate how to prevent dementia.

One factor that may pose a significant impact on one’s dementia risk is one’s education, in both childhood and beyond¹. Emerging research suggests that keeping one’s mind active and forming neural synaptic connections can be a great way to prevent the development of dementia and retain strong cognitive capabilities decades into the future². This has led many researchers to pose the question: does learning prevent dementia later in life? In this article we will explore links between lifelong learning and dementia, how education prevents loss of cognitive function and where we currently stand in terms of research.

The impacts of education:

Many studies have identified links and associations between the education one receives and one’s chances at developing dementia. The University of Michigan conducted a study with 10,000 Americans, and found that the risk of dementia between 2000 and 2012 decreased by 24% for both men and women³. During this time the average years of education increased from 12 to 13. What’s more, this trend was observed over a time period when conditions that led to vascular dementia such as hypertension and diabetes increased in prevalence.

Researchers suggest that 5% of all dementia cases could be delayed or prevented entirely by a good education early in one’s life². The Alzheimer’s Disease International Federation also presented similar findings in their 2020 conference, noting that increased education was linked with a reduced risk of dementia⁴.

US researchers conducted a longitudinal study with 2400 people over 21 years, concluding that higher-quality education was linked to lower dementia risk in many of the participants.

Another study found that the prevalence of Alzheimer’s disease was 7.2% for those who cannot read, 2.8% for those with 5th grade education and only 0.5% for education beyond this point¹.

One study found that each extra year of education lowered dementia risk by 11%⁵. Studies measuring cognitive test scores amongst elderly participants observed different patterns between those who were educated and those who were not⁶. Those who were not educated experienced a slow, steady decline in scores and cognitive function from a much younger age, while those who were educated lasted much longer while sharply declining near the end of their life⁷. Education significantly helped to prolong the cognitive function of these participants.

Another similar study found that elderly participants who had attained higher levels of education showed better overall cognitive performance. This extended beyond just memory, improving vision and language abilities too⁶. Educated elderly participants were also more likely to engage in hobbies and activities that involved knowledge such as Tai Chi, arts, reading and working on computers. All these tasks were found to boost cognitive function and delay dementia symptoms.

The ApoE4 gene is one that is highly associated with dementia risk⁸. It was found that people without this high-risk gene and a high education had much lower risks of dementia than those with the ApoE4 gene and low education.

From studies conducted in Nigeria, to America, to Finland, research from a worldwide standpoint arrives at a similar endpoint – education seems to be a significant factor in determining dementia risk⁹.

How does education help?

The biological mechanisms underlying the links between learning and dementia are not fully understood, but there are several proposed mechanisms and theories.

Cognitive reserve theory:

One of the most popular theories about how education can help lower dementia risk is the theory of “Cognitive reserve”³. The idea is that cognitive reserve is our brain’s ability to cope with damage induced by various factors such as aging, which lead to cognitive decline and conditions such as dementia.

There are two proposed mechanisms of how this theoretical cognitive reserve works to lower dementia risk. The first is that learning promotes the formation of neural synaptic connections which accumulate to form a complete neural network². The more vast and populated this neural network is, the more cognitive reserve one has, making them more resilient to cognitive damage. Factors such as aging may inevitably damage some synaptic connections, but because they have a greater overall number of synaptic connections, they are able to maintain strong cognitive function using their other remaining ones. Their greater bank of neural connections means that even if a few are lost, they have enough remaining ones to compensate for this loss, creating cognitive resilience. Additionally, a more vast network of neural connections can help one to repair or build new neural connections. This can allow one to retain cognitive function and avoid conditions such as dementia even when their neural connections are damaged and lost as they age.

The second proposed mechanism of the cognitive reserve theory is that education actually has neuroprotective effects, changing the physiology of the brain and neural connections to make it more resilient to damage and pathology¹. Some studies have suggested that brains of those with less education experience more atrophy of the anterior and temporal regions⁶. The loss of the brain’s grey and white matter is a natural process associated with aging. However, it is suggested that education may allow the brain to develop stronger anterior regions, a thicker temporal pole, and prevent the loss of grey and white brain matter, slowing down atrophy and cognitive decline. However, some other studies have contradicted this proposed mechanism. Autopsies of the brain have shown that education in fact did not have an effect on neuropathological conditions occurring in the brain⁸. This finding was backed up by the work of Professor Carol Brayne of the University of Cambridge⁵. Factors such as amyloid plaques still occurred – it’s just that their effects of cognitive impairment and dementia were not exhibited as strongly.

This has led researchers to favour the first proposed mechanism more strongly – the idea that with more education and cognitive reserve, the aging-related damage physically affects the brain just the same but the effects of this on one’s cognitive power are less pronounced and more delayed due to a more vast, resilient neural network². Delaying dementia symptoms may mean that educated patients are more likely to naturally pass away from other aging-related causes before showing cognitive decline symptoms¹. However, even this mechanism is not confirmed. It is also possible that instead of education promoting cognitive reserve, one’s cognitive reserve is innate and drives one to seek education⁸. Studies investigating what specific qualities of education seem to be most important for dementia prevention have found that duration of education seems to be extremely pertinent – one found that having 10+ years of education was a threshold for significantly lower dementia risk¹⁰.

Other potential ways that education can lower dementia risk:

More education also has the potential to indirectly lower one’s dementia risk through other ways. For example, one who is more educated is more likely to be aware of other risk factors of health and dementia such as smoking and alcohol consumption, and consciously avoid them³. On the other hand, one who lacks education may lack the knowledge to make these healthy lifestyle choices, placing them at a greater risk of developing dementia. It was also found that those with a lower education were at a higher risk for stroke, myocardial infarction, diabetes and depression – all of these are precursors of various forms of dementia⁸.

In addition, education can open up more life opportunities, potentially giving one access to better socioeconomic conditions, safer neighborhoods to live in and increased access to healthcare¹¹. All of these may be protective factors against dementia development as well.

The importance of one’s childhood:

Early childhood is an extremely critical point of one’s life. At this time, not only education, but a stimulating and enriching environment is very important for development⁷. In early childhood children go through “critical” and “sensitive” periods, where experience and stimuli are needed for the formation of neural synaptic connections and healthy brain development.

This is because in this time period the brain is undergoing significant changes and maturation, with many neural connections being formed². An infant’s brain has high plasticity, meaning that synaptic connections can get molded and fine-tuned before getting locked into place as one ages⁷. Life experiences, stimuli and learning guide the formation of these neural connections, which can have an impact on one’s brain and cognitive capabilities for the remainder of their life. The development of the brain is guided by genetics but shaped and sculpted by learning from one’s environment. The formation of more neural networks can both increase cognitive function by helping with information processing, thinking and problem solving, and make one more resilient to aging-induced cognitive damage, able to withstand more before showing signs of cognitive decline².

This was observed not only with humans but with other mammals as well. Numerous studies on animals such as rats have shown that when raised in a more enriching environment, they formed more dendritic branches and a thicker cortex¹. This helped them to retain more cognitive function as they aged.

Factors such as the education-level of a child’s parents and socioeconomic status also matter⁹. Educated parents and a strong socioeconomic status may help infants have more access to books, enriching experiences, social interactions, nutritious food and healthy lifestyle habits. All of these factors can promote the formation of more neural connections formed during this critical time, increasing cognitive capability and preventing decline. It is important for parents to try their best to provide their young children with enriching environments, a good education and encourage social interaction.

The importance of learning later in life:

Childhood education in one’s sensitive and critical periods is imperative, while their brain is in a period of maturation⁷. However, mental activities and learning at later stages in one’s life, such as during adulthood or late adulthood, is also important . A researcher named Yesavage showed via his research that stimulation training programs for the elderly can help activate their innate cognitive reserve¹. This can help improve their memory and cognitive functioning, countering the effects of dementia. 2 studies demonstrated the positive effects of mental stimulation programs on cognitive test scores for the elderly. This highlights the importance of lifelong learning for dementia prevention and cognitive retention. Just as it is important for parents of young children to provide them with an environment as enriching as possible and help them receive a strong education, nursing and retirement homes should encourage residents and implement programs to help them stay mentally active and “wake up” their cognitive reserve, fighting against cognitive damage.

Is more research needed?

Although all the evidence presented in this article seems to indicate a clear link between education and the prevention of dementia, further research is needed to solidify these findings and deconstruct the underlying mechanisms of how education impacts long-term cognitive function. However, today we can safely rely on education throughout one’s life as an effective deterrent of cognitive decline.

Conclusion:

In conclusion, keeping one’s brain active and learning is important, not just in childhood, but even in adulthood. Doing so can have obvious benefits – fostering a better understanding of the world, and promoting more social and career opportunities. However, lifelong learning can also have benefits that are less obvious, such as building cognitive reserve and protecting one from dementia and cognitive decline years in the future. This should serve as a reminder to us all that education and learning are critical at any point in our lives. Parents should promote learning and enriching environments for their children. Adults should try to learn and keep their minds active despite having completed schooling. The elderly should try new things and find hobbies that keep their minds active. The simple task of keeping one’s brain working is one that can boost and prolong cognitive function for everyone, and one that should not be neglected. Taking these simple preventative measures may allow us to grow old while still retaining memories of all our greatest experiences, our loved ones and our dreams. Today this may be a privilege, but by continuing to research treatments for dementia and identifying new risk factors, we can one day make this the norm.

Sources for reference or further reading:

1. Orrell, M., and B. Sahakian. “Education and Dementia.” BMJ, vol. 310, no. 6985, 15 Apr. 1995, pp. 951–952, doi:10.1136/bmj.310.6985.951.
2. Alzheimer’s Research UK’s Information Services team. “Education and dementia risk.” Alzheimer’s Research UK, July 2024, https://www.alzheimersresearchuk.org/dementia-information/dementia-risk/education-and-dementia-risk/. Accessed 31 May 2025.
3. Johns Hopkins Medicine. “Does Higher Learning Combat Dementia?” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/wellness-and-prevention/does-higher-learning-combat-dementia. Accessed 31 May 2025.
4. Pinches, Ed. “Differences in early-life education linked to dementia risk.” Alzheimer’s Research UK, 30 July 2020, https://www.alzheimersresearchuk.org/news/differences-in-early-life-education-linked-to-dementia-risk/. Accessed 31 May 2025.
5. Department of Public Health and Primary Care. “Why more education lowers dementia risk.” University of Cambridge, 23 July 2010, https://www.cam.ac.uk/research/news/why-more-education-lowers-dementia-risk. Accessed 31 May 2025.
6. Chen, Yaojing, et al. “The Positive Impacts of Early-Life Education on Cognition, Leisure Activity, and Brain Structure in Healthy Aging.” Aging, vol. 11, no. 14, 17 July 2019, pp. 4923–4942, doi:10.18632/aging.102088.
7. Ian, McDowell. “Mapping the Connections between Education and the Risk of Dementia.” Annals of Alzheimer’s and Dementia Care, vol. 7, no. 1, 13 Oct. 2023, pp. 001–007, doi:10.17352/aadc.000026.
8. Ngandu, T., et al. “Education and Dementia.” Neurology, vol. 69, no. 14, 2 Oct. 2007, pp. 1442–1450, doi:10.1212/01.wnl.0000277456.29440.16.
9. Le, Tung, et al. “Cognitive Impairment and Dementia—Are They Linked to Childhood Health and Socioeconomic Status? A Systematic Review.” PLOS ONE, vol. 20, no. 3, 27 Mar. 2025, doi:10.1371/journal.pone.0311074.
10. Then, Francisca S., et al. “Education as Protector against Dementia, but What Exactly Do We Mean by Education?” Age and Ageing, vol. 45, no. 4, 7 Apr. 2016, pp. 523–528, doi:10.1093/ageing/afw049.
11. Sharp, Emily Schoenhofen, and Margaret Gatz. “Relationship between Education and Dementia.” Alzheimer Disease & Associated Disorders, vol. 25, no. 4, 25 Oct. 2011, pp. 289–304, doi:10.1097/wad.0b013e318211c83c.