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Topic: Amyloid, tau and blood-test diagnosis

A higher prevalence of dementia in individuals with fewer years of education has suggested that education may protect against Alzheimer's disease (AD). We tested whether individuals with more years of education have a more advanced AD before it is clinically evident. As a measure of pathophysiological severity, we quantified regional cerebral blood flow (rCBF), by the 133Xenon inhalation technique; a specific pattern of flow reduction in the parietotemporal cortex corresponds to AD pathology. In 3 groups of patients with probable AD, matched for clinical measures of dementia severity but with varying levels of education, whole-cortex mean flows were comparable. However, the parietotemporal perfusion deficit was significantly greater in the group with the highest level of education, indicating that AD was more advanced in this group. We conclude that education or its covariates or both may provide a reserve that compensates for the neuropathological changes of AD and delays the onset of its clinical manifestations.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

Stern, Y., Alexander, G. E., Prohovnik, I., & Mayeux, R. (1992). Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease. Annals of neurology. https://doi.org/10.1002/ana.410320311

Vancouver

Stern Y, Alexander GE, Prohovnik I, Mayeux R. Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease. Annals of neurology. 1992. doi:10.1002/ana.410320311. PMID: 1416806.

BibTeX

@article{stern1992-1416806,
  author  = {Stern, Y. and Alexander, G. E. and Prohovnik, I. and Mayeux, R.},
  title   = {{Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease}},
  journal = {Annals of neurology},
  year    = {1992},
  doi     = {10.1002/ana.410320311},
  pmid    = {1416806},
  url     = {https://doi.org/10.1002/ana.410320311}
}

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Key findings

A higher prevalence of dementia in individuals with fewer years of education has suggested that education may protect against Alzheimer's disease (AD).
However, the parietotemporal perfusion deficit was significantly greater in the group with the highest level of education, indicating that AD was more advanced in this group.
We conclude that education or its covariates or both may provide a reserve that compensates for the neuropathological changes of AD and delays the onset of its clinical manifestations.

Why it matters

Patients with probable Alzheimer's who had similar symptom severity but more years of education showed a larger blood-flow deficit in the parietotemporal region (the brain area this pattern links to Alzheimer's), while overall brain blood flow was similar across groups. The authors read this as more advanced disease hidden behind the same symptoms, and propose that education "or its covariates or both" may provide a reserve that delays symptoms. This is a one-time comparison of patient groups using blood flow as a stand-in for pathology. It does not show that education prevents Alzheimer's or that any intervention helps.

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Study details

Evidence strengthLow

How this study scored 50/100

Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.

Component	Points	Why
Journal tier	9 / 10	Tier 2 — leading specialty journal (Annals of neurology)
Journal's citation record	3 / 4	Annals of Neurology: journal h-index 437 (OpenAlex, 2026-10-29)
Study design	0 / 12	No study design recorded — scores zero, not guessed (not stated in the record — scored 0)
Strength of evidence	1 / 5	Rated “low” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	1992 — older than 20 years, still counted
Sample size	0 / 4	Participant count not stated — scores zero (not stated in the record — scored 0)
Effect reported	0 / 3	No effect size reported — scores zero (not stated in the record — scored 0)
Studied in people	0 / 3	Not stated whether this was studied in people — scores zero (not stated in the record — scored 0)
Randomised / blinded	0 / 2	No randomisation or blinding stated — scores zero (not stated in the record — scored 0)
Times cited	6 / 7	Cited 474 times (OpenAlex, 2026-10-10)
Citations per year	3 / 5	13.2 citations a year over 36 year(s) since 1992
Impact for its field and year	3 / 6	Cited 4.8× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	3 / 6	Cited by 23 other studies in this library
Still being cited	2 / 4	Cited 28 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	4 / 4	Last-listed author Richard P Mayeux: h-index 158 (OpenAlex, whole career)
Institution's track record	2 / 3	Columbia University: institution h-index 1,824 (OpenAlex)
Multi-centre collaboration	1 / 3	OpenAlex lists 2 institution(s) in 1 country
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 1416806)
Free to read	0 / 2	Behind a paywall — scores zero
Total	50 / 100	—

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