Education and Dementia


Many studies have demonstrated that intellectual enrichment such as higher lifetime education, non-leisure learning, primary occupation, and mentally stimulating activities are protective against cognitive decline and Alzheimer’s dementia.[1] Education may provide a cognitive reserve that delays the onset of dementia by years.[2]


In a Mayo Clinic study on aging, 1995 non-demented subjects were followed over time. This study found that only three things were significantly associated with changes in cognitive performance from baseline:[3]

  • Baseline age

  • Mid-to-late life cognitive activity

  • The APOE4 genotype


Some forms of the APOE4 gene increase risk for Alzheimer’s. For APOE4 carriers with high lifetime intellectual enrichment, the onset of cognitive impairment was about 8.7 years later than in carriers with low lifetime intellectual enrichment. High intellectual enrichment is the 75th percentile of both education and occupation and significant mid-to-late life cognitive activity.


Higher levels of education, occupation, and cognitive activity are independently associated with a lower risk of dementia in other studies as well.[4] Education and occupation seems to matter more than mid-to-late life cognitive activity. In individuals with low education and occupation scores, high mid-to-late-life cognitive activity appears to have more impact. This suggests that late-life cognitive training programs to delay the onset of dementia may not work well for those with high education and occupation.


Cognitive activities such as reading, playing board games, playing musical instruments were associated with lower risk of dementia in several studies.[5] Significant protection from cognitive loss can be gained by engaging in cognitive activity throughout your life.


[1] Stern Y, Gurland B, Tatemichi TK et al., Influence of education and occupation on the incidence of Alzheimer’s disease. JAMA 1994; 271(13):1004-1010.

[2] Sattler C, Toro P, Schroder J. Cognitive activity, education and socioeconomic status as preventive factors for mild cognitive impairment and Alzheimer’s disease. Psychiatry Res. 2012; 196(1):90-95.

[3] Vemuri P, Lesnick TG, Przybelski SA, et al., Association of lifetime intellectual enrichment with cognitive decline in the older population, JAMA Neurol 2014; 71(8): 1017-1024.

[4] Ott A, Breteler MM, van Harskamp F, et al. Prevalence of Alzheimer’s disease and vascular dementia: Association with education. The Rotterdam Study. BMJ 1995; 310 (6985): 970-973.

[5] [5] Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003; 348(25): 2508-2516.