EDUCATION AND ALZHEIMERS-DISEASE - A REVIEW OF RECENT INTERNATIONAL EPIDEMIOLOGIC STUDIES

A review of epidemiological studies has been undertaken to examine the relationship between limited education and the risk of developing Alz heimer's disease in later life. On the basis of a large number of inte rnational studies of prevalence and incidence, as well as clinic-and c ommunity-based case-control studies, it seems that the relationship is strongest when the diagnostic criteria applied emphasize 'cognitive i mpairment'. It is least evident in longer-term prospective studies of incidence based upon clinically verified caseness. Education is consid ered as a socializing process promoting certain lifelong learning stra tegies, encouraging children to develop forms of decontextualized thin king. These learned habits of 'thinking on demand' enable educated peo ple to adapt to and perform more competently on the neuropsychological and mental state tests that make up screening batteries and case asce rtainment methodologies in epidemiological research on Alzheimer's dis ease. As a result, surveys of elderly poorly educated populations in b oth developed and developing countries may lead to significant over-di agnosis of clinical dementia - and by implication a possible under-dia gnosis of dementia in relatively well-educated populations.