Paradise Matt, Cooper Claudia, Livingston Gill
Department of Mental Health Sciences, University College London, UK.
Int Psychogeriatr. 2009 Feb;21(1):25-32. doi: 10.1017/S1041610208008053. Epub 2008 Nov 25.
According to the cognitive reserve model, higher levels of education compensate for the neuropathology of Alzheimer's disease (AD), delaying its clinical manifestations. This model suggests that for any level of cognitive impairment, people with more education have worse neuropathology than those with less education and will therefore have shorter survival post-diagnosis. This is the first systematic review of the relationship between more education and decreased survival in people with AD.
We reviewed the literature systematically, searching electronic databases and reference lists of included studies. We used Centre for Evidence Based Medicine criteria for inclusion and rating of the validity of cohort studies that reported the relationship of education to survival in people with AD.
22 studies met inclusion criteria. We found Grade A evidence (highest evidence level) that more education was not associated with decreased survival post-diagnosis in AD. Only one of 11 studies rated 1b (highest level of quality) supported our hypothesis that more education predicted reduced survival after adjusting for age, gender and dementia severity; it comprised African-Caribbean participants, who had on average more severe cognitive impairment than other studies' participants.
Education delays the onset of the dementia syndrome in AD, but does not lead to earlier death after diagnosis.
根据认知储备模型，较高的教育水平可补偿阿尔茨海默病（AD）的神经病理学改变，延缓其临床表现。该模型表明，对于任何程度的认知障碍，受教育程度较高者比受教育程度较低者具有更严重的神经病理学改变，因此确诊后的生存期更短。这是首次对AD患者中受教育程度较高与生存期缩短之间的关系进行的系统评价。
我们系统地回顾了文献，检索了电子数据库和纳入研究的参考文献列表。我们采用循证医学中心的标准来纳入和评估报告AD患者教育程度与生存期关系的队列研究的有效性。
22项研究符合纳入标准。我们发现A级证据（最高证据水平）表明，受教育程度较高与AD确诊后的生存期缩短无关。在11项质量等级为1b（最高质量水平）的研究中，只有一项支持我们的假设，即在调整年龄、性别和痴呆严重程度后，受教育程度较高预示生存期缩短；该研究纳入的是非洲加勒比裔参与者，他们的认知障碍平均比其他研究的参与者更严重。
教育可延缓AD痴呆综合征的发病，但不会导致确诊后过早死亡。
